RESUMO
Trauma literature has proposed multiple theories of trauma development, maintenance, and transmission, which has led to a lack of clarity surrounding trauma in individuals, families, and communities. We investigated the impact of community-level trauma experiences on individual posttraumatic stress disorder (PTSD) symptoms using a sociointerpersonal model of PTSD (Maerker & Horn, 2013). A nationally representative sample (N = 2, 690) of Cambodian households across all regions of the country was surveyed regarding individual trauma experiences during and after the Khmer Rouge regime, symptoms of PTSD, and current stressors. Individual experiences of war trauma and current stressors were aggregated based on the district in which each individual lived. District mean and individual war trauma and current stressors were included in a multilevel model as predictors of individual levels of PTSD. Findings indicated that mean trauma experiences, ß = .05, p < .001, and current stressors, ß = .10, p < .001, in the district in which individuals live were positively and significantly associated with their individual PTSD symptoms. Individual war trauma, ß = .02, p < .001, and current stressors, ß = .08, p < .001, were also positively and significantly associated with individual PTSD symptoms. District trauma experiences accounted for 7% of the variance in individual PTSD symptoms, R2 Level 1 = .21, R2 Level 2 = .80. Additionally, current stressors at both the individual and district levels had a greater impact on individual PTSD symptoms than war trauma at either level of the model. Implications for policy and intervention are presented.
Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Explorando el trauma contextual en Camboya: Una perspectiva socio-interpersonal del TEPT TRAUMA CONTEXTUAL EN CAMBOYA La literatura sobre el trauma ha propuesto teorías múltiples del desarrollo, la mantención, y la transmisión del trauma, lo cual ha llevado a una carencia de claridad en torno al trauma en los individuos, las familias, y las comunidades. Estudiamos el impacto de las experiencias del trauma a nivel comunitario en los síntomas del trastorno de estrés postraumático (TEPT) a nivel individual usando el modelo sociointerpersonal del TEPT (Maerker & Horn, 2013). Una muestra representativa a nivel nacional (N = 2.690) de los hogares de Camboya en todas las regiones del país fue encuestada con respecto a las experiencias individuales de trauma durante y luego del régimen de Khmer Rouge, síntomas del TEPT y estresores actuales. Las experiencias individuales de traumas por conflictos armados y los estresores actuales fueron agregados basados en el distrito en el cual cada individuo vivía. La media por distrito y trauma individual por conflictos armados y estresores actuales fueron incluidos en un modelo multinivel como predictores de los niveles individuales del TEPT. Los hallazgos indicaron que las experiencias de trauma media, ß = .05, p < .001, y los estresores actuales, ß = .10, p < .001, en el distrito en que los individuos vivían se asociaron positiva y significativamente con sus síntomas individuales del TEPT. El trauma por conflictos armados a nivel individual, ß = .02, p < .001, y los estresores actuales, ß = .08, p < .001, se encontraron también positiva y significativamente asociados con los síntomas individuales del TEPT. Las experiencias de trauma del distrito explicaron un 7% de la varianza de los síntomas individuales del TEPT, R2 Nivel 1 = .21, R2 Nivel 2 = .80. Adicionalmente, los estresores actuales tanto a nivel individual como a nivel del distrito tuvieron un impacto más alto en los síntomas individuales del TEPT que el trauma por los conflictos armados en cada nivel del modelo. Se presentan las implicaciones para las políticas y la intervención.
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Exposição à Violência/psicologia , Genocídio/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Camboja/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment. METHODS: This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay. RESULTS: Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change. CONCLUSIONS: The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment.
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Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Fatores Etários , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento Domiciliar/estatística & dados numéricos , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to determine the longitudinal effects of selective serotonin reuptake inhibitor (SSRI) therapy and cytokine-related depression on levels of hepatitis C virus (HCV) during treatment with combination therapy. BACKGROUND: Prior studies have investigated the association between cytokine-related depression and sustained virological response, but it is unknown whether anti-inflammatory properties of SSRIs used to treat cytokine-related depression inadvertently contravene proinflammatory properties of pegylated interferon (Peg-IFN), in effect reducing therapeutic efficacy. STUDY: In a retrospective cohort design, patients being treated with Peg-IFN or interferon in combination with ribavirin at a gastroenterology clinic were followed from initiation of therapy until 24 weeks after the completion of therapy. Sustained virological response and rate of decline of HCV RNA levels were compared among patients with SSRI therapy and cytokine-related depression. RESULTS: Selective serotonin reuptake inhibitor therapy and cytokine-related depression did not adversely impact the proportion of patients achieving sustained virological response. In a multivariate longitudinal analysis, the mean slope of HCV RNA levels declined faster over time in patients without cytokine-related depression in comparison to patients with cytokine-related depression (P = 0.05), and the mean slope of HCV RNA levels declined similarly over time in patients with and without SSRI therapy. CONCLUSIONS: In this retrospective cohort, SSRI therapy did not interfere with immune activation dynamics of Peg-IFN/ribavirin, and patients without cytokine-related depression developed quicker responses and suppressed HCV replication more favorably over time.
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Antivirais/uso terapêutico , Citocinas/sangue , Depressão/tratamento farmacológico , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Mediadores da Inflamação/sangue , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adulto , Idoso , Biomarcadores/sangue , Depressão/sangue , Depressão/diagnóstico , Depressão/imunologia , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Hepacivirus/genética , Hepatite C/sangue , Hepatite C/diagnóstico , Hepatite C/imunologia , Humanos , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , RNA Viral/sangue , Estudos Retrospectivos , Ribavirina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
Data from a national study of 345 privately funded, community-based substance use disorder (SUD) treatment centers were used to investigate social workers' knowledge, perceptions of effectiveness, and perceptions of the acceptability of medication assisted treatments (MATs) for SUDs. Results reveal the importance of exposure to MATs for social workers to develop a knowledge base regarding the effectiveness of various pharmacological agents. Results also underline the importance of social workers' perceptions of effectiveness in forming opinions regarding the acceptability of the use of MATs in SUD treatment. Lastly, a 12-Step orientation toward treatment has a negative influence on social workers' opinions regarding the acceptability of MATs.
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Conhecimentos, Atitudes e Prática em Saúde , Serviço Social , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adulto , Dissuasores de Álcool/uso terapêutico , Analgésicos Opioides/uso terapêutico , Serviços de Saúde Comunitária , Intervalos de Confiança , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Razão de Chances , Centros de Tratamento de Abuso de Substâncias , Inquéritos e Questionários , Resultado do TratamentoRESUMO
The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing for baby boomers born between 1945-1965 in the United States. This public health initiative is known as birth cohort (baby boomer) testing for HCV. The intent of birth cohort testing is to identify and mobilize undiagnosed HCV-infected persons into care and treatment. Subsequently, clinical social workers in health care settings can anticipate a substantial increase in the number of HCV-infected persons presenting for care and treatment. The purpose of this article is to inform clinical social workers in health care settings of HCV, the standard of care and treatment for HCV, and clinical dilemmas associated with HCV patient care. Epidemiology and natural history of HCV, the standard of care and treatment for HCV, and etiology and management of neuropsychiatric adverse effects associated with patient care are discussed.
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Instalações de Saúde , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Serviço Social , Adulto , Fatores Etários , Protocolos Clínicos/normas , Estudos de Coortes , Citocinas/efeitos adversos , Citocinas/uso terapêutico , Depressão/induzido quimicamente , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C/psicologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Though research on secondary traumatic stress (STS) has greatly increased in the past decade, to date the field lacks a coherent set of guiding principles for practice that behavioral health providers and organizations can use to mitigate the occurrence and impact of STS. As such it is important to identify effective strategies, grounded in research and professional experience, to reduce the occurrence and impact of STS among behavioral health professionals and organizations. METHOD: We conducted a four-stage modified Delphi survey. Thirty-one international STS experts were invited to participate, with a minimum of 19 responding in each round. Thematic analysis was conducted on qualitative data, which was incorporated into revisions of the principles. RESULTS: Consensus was achieved on 14 principles, seven targeted at individual professionals, and seven targeted at organizations. CONCLUSIONS: This is the first effort to delineate principles for practice intended to reduce the occurrence and impact of STS in individual and organizational practice in behavioral health services. The principles are intended to inform best practices for individuals and organizations providing services to persons and communities who have experienced trauma and thereby improve the quality and effectiveness of services to traumatized populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
RESUMO
Little is known about patients' addiction severity, substance use, or mental health symptoms upon entering integrated treatment. This is the first study to compare baseline characteristics among cohorts of patients with co-occurring disorders entering a private integrated residential treatment program in 2013 and 2017; a period when severe and persistent mental illness diagnoses, mental health service use, and overdose deaths increased. Our sample includes 3400 patients entering private, integrated residential treatment during 2013 (n = 1535) and 2017 (n = 1865). Trained staff completed admission interviews of all participants that included the Addiction Severity Index (ASI), a semi-structured interview to evaluate the past 30-day functioning of the following domains: medical, employment, alcohol, drug, legal, family or social support systems, and psychiatric. We used a p-value of 0.05 to assess significance. With the exception of the drug composite score, the 2017 cohort scored higher than the 2013 cohort on all other composite scores. Compared to the 2013 cohort, the 2017 cohort reported more days using alcohol, cocaine, amphetamines, and engaging in polysubstance use. Conversely, the 2017 cohort reported fewer days using other prescription opioids and sedatives than the 2013 cohort. After controlling for age, the 2017 cohort reported more days of marijuana use than the 2013 cohort. The 2017 cohort reported higher rates of the following symptoms: depression, anxiety, hallucinations, and suicidal ideation. Findings underscore differences among integrated treatment patient cohorts for baseline addiction severity, substance use, or mental health symptoms.
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Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Adulto , Estudos de Coortes , Hospitalização , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
Privately funded addiction treatment programs were surveyed to increase understanding of assessment and current treatment options for patients with co-occurring substance use and eating disorders. Data were collected from face-to-face interviews with program administrators of a nationally representative sample of 345 private addiction treatment programs. Although the majority of programs reported screening for eating disorders, programs varied in screening instruments used. Sixty-seven percent reported admitting cases of low severity. Twenty-one percent of programs attempt to treat eating disorders. These results highlight the need for education of addiction treatment professionals in assessment, referral, and treatment of eating disorders.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Apoio Financeiro , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Administradores de Instituições de Saúde , Humanos , Entrevistas como Assunto , Masculino , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnósticoRESUMO
By 2020, an estimated 4.4 million older adults will require substance abuse treatment compared to 1.7 million in 2000-01. This study examined the availability of special services for older adults, adoption of recommended treatment approaches, and organizational characteristics of centers that offer special services. Data were collected via face-to-face interviews with administrators and/or clinical directors from a nationally representative sample of 346 private treatment centers participating in the 2006-07 National Treatment Center Study. Results indicated that only 18% provided special services for older adults; age-specific recommendations were generally adopted; more older adult-specialty centers offered prescription drug addiction treatment, primary medical care, and housing assistance. The proportion of patients with Medicare payment predicted availability of special services. As more older adults will seek help with a myriad of substance use disorders (SUDs) over the next decade, treatment centers need to get ready for a plethora of challenges as well as unique opportunities for growth.
Assuntos
Setor Privado/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Idoso , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Setor Privado/organização & administração , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados UnidosRESUMO
AIM: This study assessed the validity and reliability of the Secondary Traumatic Stress Scale-Japanese Version. METHODS: The original Secondary Traumatic Stress Scale was translated into Japanese, and Japanese items were back-translated to English to confirm the accuracy of the translation. A total of 870 public health nurses from the Tohoku region in Japan completed the Secondary Traumatic Stress Scale-Japanese Version. An exploratory factor analysis was conducted to identify the number of components. Moreover, 351 public health nurses from the Saitama prefecture in Japan also completed the scale. A confirmatory factor analysis was performed with the factor structure identified in the exploratory factor analysis. RESULTS: The exploratory factor analysis identified two components: one associated with client-related distress and the other with trauma-related distress. The confirmatory factor analysis confirmed the two-factor structure. The two-factor structure model was better than the three-factor model presented in the original validation study for the English version of the scale. The two-factor model had good internal consistency for the overall product and the subscales. Pearson correlations showed that this model had good convergent validity against the Maslach Burnout Inventory, a psychological measure similar to the Secondary Traumatic Stress Scale. Finally, the two-factor model had good discriminant validity against the Maslach Burnout Inventory. CONCLUSION: This study identified two components of the Secondary Traumatic Stress Scale-Japanese Version that differ from the three components found in the original English version. The differences in the factor structure might indicate that the factor structure was culturally influenced.
Assuntos
Fadiga de Compaixão , Análise Fatorial , Humanos , Japão/epidemiologia , Reprodutibilidade dos Testes , TraduçõesRESUMO
Substance abuse counselors are critical as the key arbiters of clients' acceptance and use of innovative treatment techniques, with their potential support embedded in their knowledge of and attitudes towards particular innovations. In this analysis the authors examine the role of substance abuse counselors in the adoption of a psychosocial treatment innovation, contingency management (CM). Using data collected from 1140 counselors employed in a national sample of 318 public treatment centers, the authors examine theoretical predictors of counselors' knowledge of CM, and their attitudes regarding CM's effectiveness and acceptability. Findings suggest that lack of exposure to CM through program use and innovation-specific training is the most salient barrier to CM adoption and diffusion. The study also highlights the importance of social networks in the diffusion and acceptance of treatment innovations.
Assuntos
Atitude do Pessoal de Saúde , Terapia Comportamental/métodos , Aconselhamento/educação , Disseminação de Informação/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Tratamento de Abuso de SubstânciasRESUMO
BACKGROUND: Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative effect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers' distress and impairment due to their work. OBJECTIVE: The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539). METHOD AND RESULTS: A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (ß = .08, p < .01; 95 % CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (ß = .05, p < .05; 95 % CI = .02, .09). Results indicated that the model accounted for 25 % of the variance in significant distress and impairment (R2 = .25, p < .001) and 5% of the variance in STS (R2 = .05, p < .05). CONCLUSIONS: Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.
Assuntos
Serviços de Proteção Infantil , Fadiga de Compaixão/psicologia , Assistentes Sociais/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Análise de Mediação , Pessoa de Meia-IdadeRESUMO
The opioid epidemic is a public health crisis that has captured the attention of the media and political leaders, but how much do we know about its implications for substance use disorder treatment providers? This study is the first to investigate the differing baseline characteristics among patients with co-occurring disorders who used opioids and entered residential treatment in 2013 and 2017. Our sample consisted of 1413 unique adults who reported using opioids upon admission to integrated residential treatment for co-occurring substance use and mental health disorders during 2013 (nâ¯=â¯718) and 2017 (nâ¯=â¯695). Opioid use was defined as self-reported use of heroin or illicit use of prescription opioids, including methadone, during the month prior to admission into the treatment program. All study participants completed an admission interview that included the Addiction Severity Index (ASI). The 2017 cohort demonstrated higher severity than the 2013 cohort on the employment, psychiatric, and alcohol and drug ASI composite scores. A comparison of days per month that the cohorts used various substances also reveals this trend, with the following comparisons listing the 2017 cohort data first, and the 2013 cohort data second: (1) alcohol (8.6â¯days vs. 7.0â¯days); (2) cocaine (4.1â¯days vs. 2.2â¯days); (3) amphetamines (6.2â¯days vs. 3.6â¯days); and (4) polysubstance use in one day (16.6â¯days vs. 11.6â¯days). The 2017 cohort was also intoxicated from alcohol more days per month (7.2â¯days vs. 5.1â¯days). However, the 2017 cohort reported fewer days using prescription opioids (9.9â¯days vs. 12.4â¯days). A higher proportion of the 2017 cohort reported (1) depression (74% vs. 68%); (2) anxiety (88% vs. 84%); (3) hallucinations (14% vs 8%); and (4) and suicidal ideation (22% vs. 17%).
Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Tratamento Domiciliar , Adulto , Estudos de Coortes , Comorbidade , Feminino , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Inquéritos e QuestionáriosRESUMO
Self-care is regarded as essential for effective social work practice, offsetting occupational stress and promoting well-being and resiliency among practitioners. However, the literature reveals a notable absence of psychometrically sound instruments to measure self-care. The purpose of the present study was to describe the development, refinement, and construct validity of the Self-Care Practices Scale (SCPS). The piloted version of the SCPS is a 38-item instrument designed to measure frequency of engagement in personal and professional self-care practices. Data were collected through mailed surveys from a random sample of master's-level clinical social workers and members of the National Association of Social Workers (N = 492). Analysis supports the construct validity of an 18-item SCPS with two subscales that demonstrate strong internal validity. The SCPS is useful for social work educators, practitioners, and administrators to ascertain frequency of self-care practice and build a stronger culture of self-care. The role of SCPS in future research is discussed.
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Escalas de Graduação Psiquiátrica/normas , Autocuidado/psicologia , Serviço Social/estatística & dados numéricos , Assistentes Sociais/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Psicometria , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Opioid use results in higher healthcare utilization and costs, particularly among those with co-occurring mental health disorders. Presumably, effective treatment would result in a reduction in healthcare utilization and costs. To date, research has not examined this question. As such, the purpose of this study was to estimate and compare pre- and post-treatment healthcare utilization and costs for individuals receiving residential integrated treatment for co-occurring mental health and opioid use disorders. METHODS: A single-group, repeated measures design was used to examine changes in pre- and post-treatment healthcare utilization and costs among a sample of individuals with co-occurring mental health and opioid use disorders who received residential, integrated treatment. RESULTS: Significant reductions in emergency rooms visits, inpatient admissions, and resulting costs were observed in the six months following treatment. CONCLUSIONS: Residential, integrated treatment of co-occurring mental health and opioid use disorders can significantly decrease both utilization and cost of healthcare among opioid users with co-occurring mental health disorders.
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INTRODUCTION: Despite considerable empirical evidence that psychosocial interventions improve addiction treatment outcomes across populations, implementation remains problematic. A small body of research points to the importance of research network participation as a facilitator of implementation; however, studies examined limited numbers of evidence-based practices. To address this gap, the present study examined factors impacting implementation of motivational interviewing (MI). METHODS: This study used data from a national sample of privately funded treatment programs (nâ=â345) and programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) (nâ=â156). Data were collected via face-to-face interviews with program administrators and clinical directors (2007-2009). Analysis included bivariate t tests and chi-square tests to compare private and CTN programs, and multivariable logistic regression of MI implementation. FINDINGS: A majority (68.0%) of treatment programs reported use of MI. Treatment programs participating in the CTN (88.9%) were significantly more likely to report use of MI compared with non-CTN programs (58.5%; Pâ<â0.01). CTN programs (82.1%) also were more likely to use trainers from the Motivational Interviewing Network of Trainers as compared with private programs (56.1%; Pâ<â0.05). Multivariable logistic regression models reveal that CTN-affiliated programs and programs with a psychiatrist on staff were more likely to use MI. Programs that used the Stages of Change Readiness and Treatment Eagerness Scale assessment tool were more likely to use MI, whereas programs placing greater emphasis on confrontational group therapy were less likely to use MI. DISCUSSION: Findings suggest the critical role of research network participation, access to psychiatrists, and organizational compatibility in adoption and sustained use of MI.
Assuntos
Pesquisa Biomédica/organização & administração , Ensaios Clínicos como Assunto/organização & administração , Entrevista Motivacional/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , HumanosRESUMO
The past decade has seen a marked increase in the illicit use of opioids, as well as a doubling of the percentage of individuals seeking treatment for opioid use disorders. However, little is known about the differences between opioid users and nonopioid users in residential treatment. Further, no studies have been published that compare opioid users and nonopioid users in treatment for co-occurring substance use and mental disorders. To address this gap, this study examined differences between opioid and nonopioid substance users in residential treatment for co-occurring disorders. Data was drawn from 1,972 individuals treated between 2009 and 2011 at one of three private residential treatment centers that provide integrated treatment for co-occurring substance use and mental disorders. Data was collected at program intake, and 1- and 6-month postdischarge using the Addiction Severity Index and the University of Rhode Island Change Assessment. To examine within-group changes in substance use, addiction severity, and mental health across time, linear mixed-model analyses were conducted with facility, year, age, gender, and race included as covariates. The authors found more similarities than differences between the two groups on baseline characteristics, treatment motivation, length of stay, and outcomes on measures of substance use, addiction severity, and mental health. The results demonstrate that though opioid users entered treatment with higher levels of substance use-related impairment, they were just as successful in treatment outcomes as their non-opioid-using peers.
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Comorbidade , Transtornos Mentais , Transtornos Relacionados ao Uso de Opioides , Tratamento Domiciliar , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: The 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) aims to secure parity in private insurance coverage between behavioral and other medical disorders in the United States (U.S.). This legislation represents an important change in the operating field of substance use disorder treatment, but to date, its impact on treatment centers has not been widely examined. The current study measured the extent of center leaders' familiarity with the MHPAEA and their perceptions of its overall impact on their centers. METHODS: Using a nationally representative sample of treatment centers in the U.S., we examined the extent of MHPAEA familiarity and its perceived impact as reported by treatment center leaders. We further employed logistic and ordered logistic regressions to determine personal and organizational characteristics associated with their reported familiarity and experienced impacts, including changes in the number of privately-insured clients seeking treatment and in the treatment coverage of those clients. RESULTS: We found that dissemination of parity information was low. Only 36% of administrators reported high levels of familiarity and 16% used professional sources of information. The majority of administrators (71%) reported no impact of the legislation on their organization, but those that reported any impact were more likely to state positive impact. Greater parity knowledge and perceived positive impacts were associated with administrator and organizational characteristics indicative of greater access to industry-specific knowledge, a medical model orientation, and reliance on private insurance revenue. CONCLUSION: This study demonstrates that dissemination of parity information is lacking and that the majority of leaders have yet to experience an impact of the MHPAEA. Leaders of centers with more sophisticated structures are most likely to be familiar with the legislation and perceive a positive impact. Research concerning the effective management of treatment centers, including environmental scanning techniques, continues to be needed.
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Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Centros de Tratamento de Abuso de Substâncias/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , Disseminação de Informação , Benefícios do Seguro/economia , Benefícios do Seguro/legislação & jurisprudência , Cobertura do Seguro/economia , Modelos Logísticos , Centros de Tratamento de Abuso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Estados UnidosRESUMO
Workplace violence disproportionately impacts healthcare and social service providers. Given that substance use and abuse are documented risk factors for the perpetration of violence, SUD treatment personnel are at risk for patient-initiated violence. However, little research has addressed SUD treatment settings. Using data nationally representative of the U. S., the present study explores SUD counselors' experiences of violent behaviors perpetrated by patients. More than half (53%) of counselors personally experienced violence, 44% witnessed violence, and 61% had knowledge of violence directed at a colleague. Counselors reported that exposure to violence led to an increased concern for personal safety (29%), impacted their treatment of patients (15%), and impaired job performance (12%). In terms of organizational responses to patient violence, 70% of organizations increased training on de-escalation of violent situations, and 58% increased security measures. Exposure to verbal assault was associated with age, minority, tenure, recovery status, 12-step philosophy, training in MI/MET, and higher caseloads of patients with co-occurring disorders. Exposure to physical threats was associated with age gender, minority, tenure, recovery status, and higher caseloads of patients with co-occurring disorders. Exposure to physical assault was associated with age, gender, and sample. Implications of these findings for organizations and individuals are discussed.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Relações Profissional-Paciente , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Violência no Trabalho/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
A structured diagnostic interview (Practical Adolescent Diagnostic Interview) designed to gather basic information about substance use disorders, other mental health conditions, and related experiences was used in a variety of clinical settings. Anonymous data from 279 adolescents interviewed as part of routine clinical assessments in a variety of clinical programs were analyzed to assess the ability of the questions to identify potential problem areas and to provide a preliminary exploration of interrelationships between those problems. Results demonstrated that the vast majority of individuals manifested indications of multiple problems. For a given diagnostic condition, the trend is for those meeting at least the minimal DSM-IV criteria to exhibit substantially more than the minimum number of symptoms. Internal consistencies for item groups defining the various conditions range from more than .700 to over .900 indicating adequate to excellent internal consistency and reliability. Utility of the instrument for routine clinical use is also discussed.