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CORK Bibliography: Assessments

59 citations. October 2006 to present

Prepared: September 2007

Baez A. Development of an objective structured clinical examination (OSCE) for practicing substance abuse intervention competencies: An application in social work education. Journal of Social Work Practice in the Addictions 5(3): 3-20, 2005. (38 refs.)

The substance abuse skills OSCE (Objective Structured Clinical Examination) was developed by an interdisciplinary faculty team at New York University from 2001 to 2003. The aims of the project were to teach medical, nursing, and social work students screening and brief intervention skills, provide a practice opportunity and feedback to students on their ability to demonstrate substance abuse skills, and to expose students to interdisciplinary collaboration. After students were educated and participated in the OSCE, the mean score on their substance abuse knowledge questionnaires increased from 6.24 (SD = 1.522) at pretest to 8.06 (SD = 1.600) at post test (t(16) = -6.080, p < .002). According to the faculty observer performance checklists, students manifested the fifteen competencies on the checklist at an average rate of 79.0%. Students rated the overall experience of participating in the OSCE highly favorably, at 4.9 on a five-point scale. While the OSCE proved to be highly compatible with the teaching and practicing of substance abuse intervention skills, it is a tool that also has relevance and applicability for the practicing and assessing of many other social work skills, and can be a powerful addition to the ways in which the field approaches the challenge of assessing competence in more direct ways.

Baletka DM; Shearer RA. Assessing program needs of female offenders who abuse substances. IN: Sims, B. ed. Substance Abuse Treatment with Correctional Clients: Practical Implications for Institutional and Community Settings. Binghamton NY: Haworth Press, 2005. pp. 227-242. (52 refs.)

The number of female inmates has grown 336 percent since 1980. However, treatment in the criminal justice system is geared toward males. The authors review the primary forms of treatment -- vocational training, parenting skills, family therapy, mental health, high-risk behaviors, confrontation techniques, anger management, individual therapy, empowerment training, and group therapy, and their differential effectiveness with men and women. The authors describe the development of gender-specific programs, and then describes an assessment tool for use with women in correctional settings, the Female Offender Critical Intervention Inventory.

Best D; Day E; Campbell A. Developing a method for conducting needs assessments for drug treatment: A systems approach. Addiction Research & Theory 15(3): 263-275, 2007. (13 refs.)

The article reports on a method for analysing the extent of need for drug treatment in a local area, based on estimated prevalence of problem drug use and treatment uptake. The aim of the project was to develop a method that could be replicated in each commissioning area ( referred to as Drug Action Teams) in England to assess treatment need among groups both in contact with and out of treatment. The sources of data used were derived from national monitoring systems for drug treatment and for drug interventions in the criminal justice system. These were utilised in three Drug Action Team areas ( out of a total of 149), supplemented by group work with local service managers and staff from treatment providers, service commissioners and other key informants, supplemented by local data on prevalence or treatment patterns that were available. The resulting analysis led to two types of treatment maps: one an assessment of treatment uptake and the second, a visual representation of service configuration that assessed the flow of clients into and through the local drug treatment system. The method enables treatment need and availability to be systematically assessed in order to inform the treatment commissioning process.

Bize R; Burnand B; Mueller Y; Cornuz J. Effectiveness of biomedical risk assessment as an aid for smoking cessation: A systematic review. (review). Tobacco Control 16(3): 151-156, 2007. (47 refs.)

Objective: To determine the efficacy of biomedical risk assessment (eg, exhaled carbon monoxide (CO), or genetic susceptibility to lung cancer) as an aid for smoking cessation. Data sources: Cochrane Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials, Medline (1966-2004) and EMBASE (1980-2004). Study selection: Randomised controlled smoking cessation interventions using biomedical tests with at least 6 months follow-up. Data extraction: Two reviewers independently screened all search results (titles and abstracts) for possible inclusion. Each reviewer then extracted data from the selected studies, and assessed their methodological quality based on the CONSORT ( Consolidated Standards of Reporting Trials) statement criteria. Data synthesis: Of 4049 retrieved references, eight trials were retained for data extraction and analysis. Three trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following ORs and 95% CIs: 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41) and 1.18 (0.84 to 1.64). Measurement of exhaled CO and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.60 (0.25 to 1.46), 2.45 (0.73 to 8.25) and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR (95% CI) of 1.21 (0.60 to 2.42). Ultrasonography of carotid and femoral arteries performed on light smokers gave an OR (95% CI) of 3.15 (1.06 to 9.31). Conclusions: Scarcity and limited quality of the current evidence does not support the hypothesis that biomedical risk assessment increases smoking cessation as compared with the standard treatment.

Brodey BB; McMullin D; Winters KC; Rosen CS; Downing DR; Koble JM. Adolescent substance use assessment in a primary care setting. American Journal of Drug and Alcohol Abuse 33(3): 447-454, 2007. (17 refs.)

Health initiatives suggest that adolescent substance use assessment may be beneficial as part of primary care to screen for early problematic behaviors. To examine the accuracy of such reporting, we compared the anonymous and confidential self-reports of 180 adolescents in a primary care setting. Matching samples to control for demographic variables, we found that adolescents were more likely to report marijuana use and substance use behaviors, such as selling drugs, when reporting anonymously vs. reporting confidentially. These results challenge the accuracy of confidential self-reports within this setting, and suggest further research is needed.

Buckley PF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. Journal of Clinical Psychiatry 67(Supplement 7): 5-9, 2006. (37 refs.)

The co-occurrence of a severe mental illness and a substance use or abuse disorder is common in the United States as well as internationally and could be considered as more the expectation than the exception when assessing patients with serious mental illness. Substance use disorders can occur at any phase of the mental illness, perhaps even inducing psychosis. Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate. The consequences of dual diagnosis include poor medication compliance, physical comorbidities and poor health, poor self-care, increased suicide risk or aggression, increased sexual behavior, and possible incarceration. All of these factors contribute to a greater health burden, which reduces the health care system's capacity to adequately treat patients. Therefore, screening, assessment, and integrated treatment plans for dual diagnosis that can address both the addiction disorder and the mental illness are recommended in order to provide accurate treatment, aftercare, and other health care to accommodate patients' social and vocational needs.

Campbell CI; Alexander JA. Availability of services for women in outpatient substance abuse treatment: 1995-2000. Journal of Behavioral Health Services & Research 33(1): 1-19, 2006. (32 refs.)

Women entering substance abuse treatment have more severe substance abuse problems and more medical and psychiatric comorbidities than men. Research shows that specialized women's set-vices are associated with better retention and outcomes but relatively little is known about their availability nationwide. This study examined the adoption and implementation of reproductive and female-sensitive social services in a national sample of outpatient substance abuse treatment (OSAT) organizations in 1995 (N = 617) and 2000 (N = 571) by several organizational factors. Overall, reproductive and social services for women have not been widely adopted, although some services did increase over the study period, particularly social services. There was no evidence of large-scale decreases in service availability over the study period, although child care did decline. Nonprofit and public ownership (relative to for-profit) were associated with greater service provision. Managed care units had greater service adoption compared to nonmanaged care units, and this increased over time. Public units and hospital-affiliated units had greater set-vice implementation than other units. However, OSAT units did not always implement the services they adopted, suggesting access to some services may be restricted.

Cathcart S; Patton R; Hickman M; Hendry C; Ashworth M. Comparing population estimates for drug users, the prevalence of blood-borne viruses and the provision of services in one London borough: Evidence of a gap in provision? Drugs: Education, Prevention and Policy 14(3): 205-215, 2007. (32 refs.)

Aims: To estimate the size of the drug-using population in Lambeth, an inner city London borough, and the prevalence of blood-borne virus (BBV) infections in the drug-using population. To identify possible shortfalls in service provision for drug users. Methods: Direct and indirect estimates of the drug-using population size using national and local data sources. Prevalence estimates for BBV infections were derived from local survey data. Routine data and a survey of borough services for drug users were compiled. Findings: Based on indirect methods we estimated there were 3117 drug users in Lambeth in 2001-2002 (20 per 1000, 15- to 44-year-olds), of whom 1641 were injecting users (11 per 1000); 1353 were reported as being in drug treatment programmes. BBV prevalence rates: hepatitis B, 37%; hepatitis C, 71%; HIV, 6%. Estimated demand for needle exchange services, in terms of one syringe per injection, and methadone maintenance may be up to double local provision. Conclusions: More accurate and feasible methods are needed for the routine estimation of the population of drug users. Accurate information is needed for service planning.

Centers for Disease Control and Prevention; Bertrand J; Floyd RL; Weber MK. Guidelines for Identifying and referring persons with Fetal Alcohol Syndrome. MMWR. Morbidity and Mortality Weekly Report 54(RR-11): 1-24, 2005. (117 refs.)

Summary: Fetal alcohol syndrome (FAS) results from maternal alcohol use during pregnancy and carries lifelong consequences. Early recognition of FAS can result in better outcomes for persons who receive a diagnosis. Although FAS was first identified in 1973, persons with this condition often do not receive a diagnosis. In 2002, Congress directed CDC to update and refine diagnostic and referral criteria for FAS, incorporating recent scientific and clinical evidence. In 2002, CDC convened a scientific working group (SWG) of persons with expertise in FAS research, diagnosis, and treatment to draft criteria for diagnosing FAS. This report presents these recommendations. Diagnosis of FAS: A diagnosis of FAS should be made if documentation exists of 1) all three dysmorphic facial features (i.e., smooth philtrum, thin vermillion border, and small palpebral fissures), 2) prenatal or postnatal growth deficit in height or weight, and 3) CNS abnormality. The diagnosis should be classified on the basis of available history as confirmed prenatal alcohol exposure or unknown prenatal alcohol exposure. CNS abnormality may be documented as structural, neurologic, or functional. Referral: If prenatal alcohol exposure is known, a child or person should be referred for full FAS evaluation when alcohol abuse (defined as seven or more alcohol drinks per week or three or more alcohol drinks on multiple occasions, or both) is confirmed. If prenatal alcohol exposure is unknown, a child or person should be referred for full FAS evaluation when: a parent or caregiver (foster or adoptive parent) reports that a child has or might have FAS; all three facial features (i.e., smooth philtrum, thin vermillion border, and small palpebral fissures) are present; one or more facial features are present in addition to growth deficits in height, weight, or both; one or more facial features are present and one or more CNS abnormalities; or --- one or more facial features are present, with growth deficits and one or more CNS abnormalities. In addition to specific features associated with the FAS diagnosis, the following social and family history factors associated with prenatal exposures to alcohol might indicate a need for referral: premature maternal death related to alcohol use (either disease or trauma), living with an alcoholic parent, current or previous abuse or neglect, current or previous involvement with child PSAs, a history of transient caregiving situations, or having been in foster or adoptive care (including kinship care). Services : The FAS diagnosis and the diagnostic process (especially the neuropsychologic assessment) should be considered as part of a continuum of care that identifies and facilitates appropriate health-care, education, and community services. General areas of service needs for persons with FAS and their families should include strategies that stabilize home placement, improve parent-child interaction through caregiver education, advocate for access to services, and educate service professionals involved with affected persons and their families regarding FAS and its consequences. Specific intervention services should be tailored to a person's individual needs and deficits. These might include communication and social skills; emotional development; verbal and comprehension abilities; language usage; and, if appropriate, referral for medication assessments. The needs of children in adoptive or foster placements should receive particular attention in the diagnostic and referral process. Prevention: Broad education of women of childbearing age and communities countrywide regarding the risks of drinking alcohol during pregnancy. Universal screening by health-care providers for alcohol use is recommended for all women of childbearing age. For women drinking at risk levels and not effectively using contraception, brief interventions have proven effective in reducing the risk for an alcohol-exposed pregnancy. Because no safe threshold of alcohol use during pregnancy has been established, women who are pregnant, planning a pregnancy, or at risk for pregnancy should be advised not to drink alcohol. Women who are not pregnant, not planning a pregnancy, or not at risk for unintended pregnancy should be advised to drink no more than seven drinks per week and no more than three drinks on any one occasion. Additional information regarding these guidelines has been published. An appendice addreses central nervous system abnormalities associated with Fetal Alcohol Syndrome (FAS)

Public Domain

Cunningham JA; Humphreys K; Kypri K; van Mierlo T. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. Journal of Medical Internet Research 8(2): article 5, 2006. (39 refs.)

Background: In recent years, online services for problem drinkers have been developed. This paper describes ongoing efforts to improve one of these services, the Alcohol Help Center. Objective: This report summarizes new modules added to the Check Your Drinking (CYD) screener, a component of the Alcohol Help Center, to make the CYD screener more useful to periodic heavy drinkers, as well as to regular alcohol consumers. Participants' initial reactions to the CYD screener and the changes in their drinking habits at a three-month follow-up are presented. Methods: The CYD screener provides a free personalized Final Report that compares the user's drinking to that of others in the general population of the same age, gender, and country of origin. Current alcohol consumption and demographic characteristics are collected as part of the CYD screening process. After users were presented with a customized Final Report, they were hot-linked to a volunteer feedback survey The voluntary feedback survey asked about impressions of the CYD Final Report. Respondents agreeing to participate were sent a follow-up survey after three months. Results: We recruited 388 volunteers (69% female) who were registered users of another free-to-consumer online cHealth service. Of the 343 respondents agreeing to participate in the three-month follow-up, 138 accessed the survey, and 97 provided complete data (participation rate = 40%; completion rate 70%). Compared to moderate drinkers, current problem drinkers judged the Final Report to be more useful (34% vs. 69%, chi(2) = 41.5, P <.001) and accurate (43% vs. 76%, chi(2) (1) =36.0,P <.001). Respondents who participated in the three-month follow-up displayed reductions in drinking compared to baseline (F-4,F-76 = 12.2, P=.001). Conclusions: Improvements can still be made to make the CYD screener more relevant to specific populations, particularly periodic heavy drinkers. There is a need to further tailor algorithms that can present questions only relevant to specific populations. There also appears to be a need to further customize the Final Report for respondents who identify themselves as infrequent heavy drinkers. These improvements will be made, and a randomized controlled trial is planned to conduct a rigorous evaluation of the CYD screener as an intervention to help problem drinkers.

Dennis ML; Kaminer Y. Introduction to special issue on advances in the assessment and treatment of adolescent substance use disorders (editorial). American Journal on Addictions 15(Supplement 1): 1-3, 2006. (5 refs.)

D'Onofrio G; Becker B; Woolard RH. The impact of alcohol, tobacco, and other drug use and abuse in the emergency department. (review). Emergency Medicine Clinics of North America 24(4): 925-967, 2006. (171 refs.)

Substance abuse is a major preventable public health problem affecting all racial, cultural, and socioeconomic groups with the total annual economic costs to the United States currently estimated at over $414 billion [1]. Over 500,000 deaths annually are attributable to alcohol, tobacco, or illicit drug use: 107,000 related to alcohol [2], 25,000 to illicit drugs [2], and 435,000 to tobacco [3]. Substance abuse is a risk factor for multiple diseases and a major risk factor for injury [4]. Tobacco use, especially cigarette smoking, is the leading cause of preventable disease and a major risk factor for heart disease, stroke, lung cancer, and chronic lung diseases [5]. It is responsible for more than 30% of all cancer deaths each year [6]. An estimated 18 million people have alcohol abuse problems, whereas an additional 5 million abuse other drugs [7]. Less than 3% of people with alcohol problems and fewer than 10% with drug problems receive treatment, despite the fact that substance abuse treatment has been demonstrated to be effective in reducing use and costs associated with substance abuse [8]. The consequences of substance abuse affect not only individuals, but also families, workplaces, and communities.

Donovan DM; Marlatt GA, eds. Assessment of Addictive Behaviors, 2nd edition. New York: Guilford Press, 2005. (Chapter refs.)

This edited volume, with 13 chapters and 33 contributors, examines the assessment issues related to addictive disorders and compulsive behaviors. Interestingly it begins with consideration of relapse prevention and assessment issues to accomplish this. The following chapter deals with assessive of addictive disorders in racial and ethnic groups. The next six chapters focus upon assessment for those involved with a specific drug -- alcohol, nicotine, cocaine, amphetamines, opiodis, marijuana -- followed by one dealing with hallucinogens, inhalants and steroid use. The concluding four chapters deal with assesment, not of psychoactive drugs, but with compulsive behaviors -- gambling, disordered eating and obesity, sexual offender relapse, and high risk sexual behavior. Incorporated within the discussion is consideration of screening and assessment tools, as well as assessment of comorbid psychiatric disorders and other related medical co-occurring conditions.

El-Sayegh S; Fattal O; Muzina DJ. Is social anxiety disorder unrecognized in patients with substance dependence? Addictive Disorders and their Treatment 5(3): 145-151, 2006. (19 refs.)

OBJECTIVE: To examine the missed diagnosis of social anxiety disorder (SAD) in patients presenting for substance dependence (SD) evaluation. METHODS: Subjects being seen for SD evaluation provided SD history and were screened for SAD by completing the Social Phobia and Anxiety Inventory (SPAI). SPAI scores were examined in relation to SD history. RESULTS: One hundred and twenty patients participated. Although only 3% received a diagnosis of anxiety disorder by the SD psychiatrist, 50% of the patients were likely to have SAD based on a positive screen using the SPAI. Patients with a family history of emotional problems, personal use of hallucinogens, narcotics, or benzodiazepines were more likely to have social phobia. There were no significant associations between alcohol, cocaine, or cannabis use and the likelihood of having SAD. CONCLUSION: SAD may be unrecognized in patients with SD problems. Early detection can improve the treatment outcome.

Gallagher SM; Penn PE; Brooks AJ; Feldman J. Comparing the CAAPE, a new assessment tool for co-occurring disorders, with the SCID. Psychiatric Rehabilitation Journal 30(1): 63-65, 2006. (8 refs.)

Co-occurring mental health and substance use disorders (COD) are common and frequently under-detected, which may lead to less than optimal treatment for persons in psychosocial rehabilitation settings. A new, relatively brief instrument, the Comprehensive Addictions and Psychological Evaluation (CAAPE) was compared with the Structured Clinical Interview for DSM-IV (SCID). The CAAPE required less time to administer than the SCID, efficiently explored DSM substance use disorder criteria and served as a screen for psychiatric disorders. The CAAPE promises to be a useful screening and diagnostic instrument for persons with co-occurring disorders, especially suited for use in psychosocial rehabilitation.

Goldstein RZ; Woicik PA; Lukasik T; Maloney T; Volkow ND. Drug fluency: A potential marker for cocaine use disorders. Drug and Alcohol Dependence 89(1): 97-101, 2007. (21 refs.)

The goal of the current study was to tailor semantic fluency to increase its sensitivity and ecological validity in the study of drug use disorders. On a newly modified "drug" fluency task, individuals with cocaine use disorders who tested positive for cocaine at study day named more drug-related words than control subjects. The number of words provided on the classical semantic fluency task (animals and fruits/vegetables) did not differ between the groups. While the individuals with cocaine use disorders who tested negative for cocaine at study day did not differ from the control subjects in total words named on this task, a qualitative analysis indicated that both cocaine subgroups provided significantly more words pertaining to the experience of using drugs (paraphernalia, administration) than the matched control subjects. These results demonstrate that compared to classical neurocognitive assessment tools, newly tailored measures may be more sensitive to cocaine use disorders, psychopathologies that are often characterized by mild neuropsychological deficits but a well-circumscribed attentional bias to drug-related cues. Future studies are needed to probe the exact cognitive processes and neural circuitry underlying performance on this cue-sensitive 1-min measure.

Grunfeld A. Addressing the need for international forums in mental health and addictions research. (editorial). International Journal of Mental Health and Addiction 4(1): 1-2, 2006. (9 refs.)

Harris F; Hek G; Condon L. Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity. Health & Social Care in the Community 15(1): 56-66, 2007. (47 refs.)

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.

Hu HM; Kline A; Huang FY; Ziedonis DM. Detection of co-occurring mental illness among adult patients in the New Jersey substance abuse treatment system. American Journal of Public Health 96(10): 1785-1793, 2006. (44 refs.)

Objectives. We assessed the detection of mental illness in an adult population of substance abuse patients and the rate of referral for mental health treatment. Methods. We obtained combined administrative records from 1994 to 1997 provided by the New Jersey substance abuse and mental health systems and estimated detection and referral rates of patients with co-occurring disorders (n=47379). Mental illness was considered detected if a diagnosis was in the record and considered undetected if a diagnosis was not in the record but the patient was seen in both treatment systems within the same 12-month period. Predictors of detection and referral were identified. Results. The detection rate of co-occurring mental illness was 21.9% (n = 10364); 57.9% (n=6001) of these individuals were referred for mental health treatment. Methadone maintenance clinics had the lowest detection rate but the highest referral rate. Male, Hispanic, and African American patients, as well as those who used heroin or were in the criminal justice system, had a higher risk of mental illness not being detected. Once detected, African American patients, heroin users, and patients in the criminal justice system were less likely to be referred for treatment. Conclusions. There is a need to improve the detection of mental illness among substance abuse patients and to provide integrated treatment.

Kahan M; Srivastava A; Wilson L; Gourlay D; Midmer D. Misuse of and dependence on opioids: Study of chronic pain patients. Canadian Family Physician 52: 1081-1087, 2006. (50 refs.)

OBJECTIVE: To review the evidence on identifying and managing misuse of and dependence on opioids among primary care patients with chronic pain. QUALITY OF EVIDENCE MEDLINE was searched using such terms as "opioid misuse" and "addiction." The few studies on the prevalence of opioid dependence in primary care populations were based on retrospective chart reviews (level 11 evidence). Most recommendations regarding identification and management of opioid misuse in primary care are based on expert opinion (level III evidence). MAIN MESSAGE Physicians should ask all patients receiving opioid therapy about current, past, and family history of addiction. Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse. Patients suspected of opioid misuse can be treated with a time-limited trial of structured opioid therapy if they are not acquiring opioids from other sources. The trial should, consist of daily to weekly dispensing, regular urine testing, and tapering of doses of opioids. if the trial fails or is not indicated, patients should be referred for methadone or buprenorphine treatment. CONCLUSION Misuse of and dependence on opioids can be identified and managed successfully in primary care.

Kolind T. Form or content: The application of user perspectives in treatment research. Drugs: Education, Prevention and Policy 14(3): 261-275, 2007. (33 refs.)

As part of a general trend in modem society, the voice of the 'consumers' of the services of the welfare state has gained increased legitimacy. However, this is not the case when it comes to drug-treatment users. The continuing neglect of this group's experiences is also reflected in methadone maintenance treatment research. This article seeks to counter this imbalance by exploring users' experiences with enhanced psychosocial methadone maintenance treatment. The findings rest on an evaluation of the Danish Methadone Project. As part of the evaluation 37 semi-structured qualitative interviews with users were made, and two months of participant observation were conducted in the clinics. An important finding is that the users highlighted the form of the treatment as much as the actual content. It was not primarily the content of the services, but how the services were carried out that mattered. Most crucially, the users highlighted the attitude of the counsellor, the accessibility of spontaneous counselling, and spaces that facilitated non-stigmatizing social encounters. While drug users do not provide the definitive statement about the value of drug service provision, listening to their voices is a necessary step in building an ethically sound approach to drug treatment, with a high degree of client support where the treatment provided meets the consumers needs.

Korper SP; Raskin IE. Conclusions and policy implications. IN: Office of Applied Studies; Korper SP; Council CL, eds. Substance Use by Older Adults: Estimates of Future Impact on the Treatment System. Analytic Series: A-21. Rockville MD: Substance Abuse and Mental Health Services Administration, 2003. pp. unpaginated. (Chapter refs.)

Information contained in this concluding chapter documents the reasons for concern about the projected demand for substance abuse services over the next 20 to 30 years. There are relatively higher illicit substance abuse and dependence among those born between 1946 to 1964 (baby boomers) and it is not expected that this pattern of use will moderate as has been the case in previous generations. There may be a doubling in the number of citizens with substance abuse problems in the next 20 years. A brief summary of evidence provided by the analyses in this report includes the following: (1) Demographic projections suggest that the proportion of the population aged 65 years or older in the United States will rise from the current 12 percent to 20 percent by 2030. Moreover, the population will become more ethnically and racially diverse, live longer, and face higher health care service and prescription drug costs than ever before. (2) Few longitudinal studies provide direct measures of age-specific recovery, relapse, and mortality. However, examination of data available suggests the relationship between age and the progression of drug use or the recovery process appears to differ depending on the type of drug used. It appears that the abuse of tranquilizers and sedatives, although relatively low, increases with age. This is consistent with reports in the clinical literature of problem prescription drug use among older adults. Beginning at age 55, an increasing proportion of persons entering treatment were doing so for the first time, largely for abuse of alcohol alone. (3) National surveys should be modified to provide better data on the elderly, particularly those in different segments of the elderly population.

Public Domain

Kypri K; Langley JD; Saunders JB; Cashell-Smith ML. Assessment may conceal therapeutic benefit: Findings from a randomized controlled trial for hazardous drinking. Addiction 102(1): 62-70, 2007. (30 refs.)

The concept that assessment of a person's health status without subsequent intervention has beneficial effects in itself has stimulated much interest in underlying psychological mechanisms, methodological implications and its public health potential. There have, however, been few experimental studies of assessment effects. To test the hypothesis that assessment in itself produces a reduction in hazardous drinking. Two conditions (group A, leaflet only and group B, leaflet and assessment but no intervention) of a four-arm randomized controlled trial with enrolment in March-April 2003. A total of 975 students (17-29 years) attending a primary health-care clinic completed a web-based Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Of 599 who scored >= 8 or more, 576 consented to follow-up and were included in the full four-arm trial, of whom 293 (153 women) were assigned to groups A and B. Group A received an information leaflet at baseline. Group B received the information leaflet and 10 minutes of web-based assessment 4 weeks later. Drinking frequency, typical quantity, heavy episode frequency, personal problems and academic problems. Baseline mean AUDIT scores were 15.0 (SD = 5.4) and 14.9 (SD = 5.0) in groups A and B, respectively. Twelve months after baseline, relative to group A, group B reported lower overall consumption (geometric means ratio 0.82, 95% CI: 0.68-0.98), fewer heavy drinking episodes (0.66, 0.47-0.91), fewer problems (0.81, 0.67-0.99) and lower AUDIT scores (beta = -1.63, -0.62 to -2.65). Brief assessment appeared to reduce hazardous drinking. Controlled trials that rely on assessment may therefore underestimate treatment effects. Limitations include the possibility of measurement artefact due to social desirability bias.

La Rosa MR; Holleran LK; Rugh D; MacMaster SA. Substance abuse among U.S. Latinos: A review of the literature. Journal of Social Work Practice in the Addictions 5(1/2): 1-20, 2005. (74 refs.)

Latinos have recently become the largest minority in the United States. High fertility and high immigration rates suggest continued high rate of growth. Alcohol and illicit drug use within this population give reason for concern. Beginning in early adolescence, Latinos and Native Americans lead the nation in alcohol and illicit drug use. They also have a high need for alcohol and illicit drug treatment compared to Whites and African-Americans. Research concerning ethnic differences is reviewed in order to gain an understanding of the patterns and trajectories of substance use within the Latino community. Prevention and treatment interventions specific to Latinos are described, and gaps in the literature are noted. Finally, implications of the current research findings for social workers and recommendations for future research are discussed.

Lacy BW; Ditzler TF. Inhalant abuse in the military: An unrecognized threat. Military Medicine 172(4): 388-392, 2007. (42 refs.)

Although inhalant abuse represents the third most commonly abused class of drugs in the military, it is a frequently overlooked form of substance abuse in the active duty population. Inhalants' lack of visibility is also evident in the civilian community. In both the civilian and military communities, the factors leading to underrecognition of inhalant abuse include high availability, low cost, lack of drug screening and drug treatment programs, and frequent misdiagnosis by clinicians. This review seeks to inform care providers about the prevalence, health risks, diagnosis, and treatment of inhalant abuse in the active duty population, and encourages clinicians to be more aggressive in the identification of this serious but underrecognized problem.

Manning V; Wanigaratne S; Best D; Strathdee G; Schrover I; Gossop M. Screening for cognitive functioning in psychiatric outpatients with schizophrenia, alcohol dependence, and dual diagnosis. Schizophrenia Research 91(1-3): 151-158, 2007. (52 refs.)

Cognitive impairment is common to both schizophrenia and alcoholism. Despite increasing recognition that people with both disorders represent a problematic client group, little is known about the possible additive effect of a dual diagnosis upon impaired cognitive function. This study investigates impairment of cognitive functioning in patients with schizophrenia, alcohol dependence, or a dual diagnosis of schizophrenia and alcohol use disorder. It was hypothesised that patients with dual diagnosis would show greater cognitive impairment than those with a single diagnosis. The Mini-Mental State Examination (MMSE) and standardised measures of psychiatric health and substance use were administered to 120 community psychiatric patients with a diagnosis of schizophrenia, alcohol dependence and both conditions (dual diagnosis). Higher rates of cognitive impairment were found among dual diagnosis patients compared to the schizophrenia or alcohol patients. This was shown in age-adjusted measures of global functioning, and on the tests of language, reading and writing, and visuospatial construction. Despite its common usage, global MMSE scores were insensitive to the cognitive impairments typically found in these clinical groups. Where the MMSE is used as a screening tool, it is recommended that scores are adjusted for the effects of age.

Matheson C; Van Teijlingen E; Bond CM; Cameron IM; Cronkshaw G. Specialist substance misuse nurses' assessment and decision making in the management of drug misusers. Drugs: Education, Prevention and Policy 13(6): 551-562, 2006. (23 refs.)

Aims: To explore, in-depth, substance misuse nurses' roles in assessment and decision making, the relative role of the client, the nurse and others in this process and to consider policy implications. Methods: Semi-structured, face- to-face interviews were conducted with a sample of substance misuse nurses managing individuals with drug problems across Scotland (n = 29). The sample was identified from respondents to a questionnaire distributed to all substance misuse nurses in a linked study. Interviewees were purposively sampled to cover a range of gender, years' experience, attitudes and NHS area. Twenty-nine interviews were conducted across six areas. Interviews focused on assessment and treatment decision making. Thematic Analysis was undertaken. Findings: Nurses' descriptions of assessment and decision making reflected a client-centred approach with clients being the main influence in decision making. Protocols and guidelines provided an evidence-based background and nurses occasionally have to manage conflict between the client's objectives of treatment and the evidence. Other professionals were consulted for complicated cases. Additional policy issues included the time between assessment and implementing treatment. Conclusions. Nurses demonstrated professional autonomy in treatment decision making. A model of consultation described in general medical literature as an 'evidence-based, patient-choice consultation' (Ford, Schofield, & Hope, 2003) was practised. Ongoing legislative changes to extend nurse prescribing to substance misuse would legitimize current practice.

McCamant LE; Zani BG; McFarland BH; Gabriel RM. Prospective validation of substance abuse severity measures from administrative data. Drug and Alcohol Dependence 86(1): 37-45, 2007. (41 refs.)

Background: Severity measures for clients in substance abuse treatment programs are becoming increasingly important as funders adopt payment systems linked to agency performance. Recently, two severity measures based on administrative data have been developed. This study validated these measures using prospective data. Methods: Subjects were participants in the Drug Abuse Treatment Outcomes Study (adult or adolescent components) or the Substance Abuse and Mental Health Services Administration Medicaid Managed Behavioral Healthcare and Vulnerable Populations project (adult or adolescent chemical dependency components). Severity measures were calculated based on data obtained at entry into substance abuse treatment. The baseline severity measures were included along with age, gender, and race/ethnicity in logistic regression models predicting abstinence at follow-up for alcohol use. marijuana use, cocaine use, or heroin use. Results: For adults, the severity measures were highly statistically significant (p < 0.001) for all models in both data sets, indicating that adults with higher severity were more likely (and much more likely in many cases) to use alcohol, marijuana, cocaine, or heroin at the follow-up interview than were those with lower severity. For adolescents, the severity measure was highly statistically significant (p < 0.001) for marijuana in both data sets and for alcohol in the Medicaid data set. Conclusions: Baseline severity measures were powerful predictors of abstinence at follow-up. These measures, derived from routinely available electronic records, appear to have noteworthy predictive validity. The severity indicators can be used for administrative purposes such as risk-adjustment when examining treatment agency performance.

Miller NS. Prescription opiate medications: Clinical assessment and treatment of addiction, tolerance, and dependence. Psychiatric Annals 36(6): 390-396, 2006. (19 refs.)

This article describes the risks and benefits of chronic administration of prescription opiate medications. It discusses how chronic administration of prescription opiate medication leads to tolerance, dependence, and addiction. The signs and symptoms of dependence are discussed. The symptoms and treatment of withdrawal are outline. It also considers the fact that chronic administration of prescription opiate medication leads to increased pain or hypersensitivity to pain as a pharmacologic consequence.

Miller NS; Kipnis SS. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) 45. Rockville MD: Center for Substance Abuse Treatment, 2005. (828 refs.)

This Treatment Improvement Protocol (TIP) dealing with detoxification and its place in substance abuse treatment is a revision of TIP 19. Detoxification is considered as one component in the continuum of healt care services of substance-related disorder. Detoxification is seen as having three major govjectives: evaluation, medical stabilization, and fostering readiness for and entry into substance abuse treatment. The report is organized into six chapters. Chapter 1: Provides an overview, essential concepts, and guiding prinicples for detoxification services. There is also a brief description of the history of detoxfication services. Chapter 2: This addresses settings, levels of care and patient placement criteria. The ASAM (Amerian Society of Addiction Medicine) criteria for patient placement are used. Chapter 3: This chapter discusses the psychosocial and biomedical issues arising during detoxification. Special attention is paid to assessment and strategies for engaging and retaining patients in treatment. Chapter 4: This deals with physical/medical detoxification services with separate sections for specific drugs.Substances included are alcohol, opioids, benzodiazepines, stimulants, inhalants, nicotine, mairjuana,nabolic steroids, club drugs, and considerations related to polydrug use. Chapter 5: In this chapter there is consideration of special issues and concerns that accompany detoxification for those with co-occurring medical or psychiatric disorders. Chapter 6: Organizational issues and funding of detoxification services are considered. Appendices include signs and symptoms of withdrawal for different drug classes, as well as screening/assessment tools. There are 29 illustrative figures.

National Institute on Alcohol Abuse and Alcoholism. Helping the Patient Who Drinks Too Much. A Clinician's Guide. 2005 edition. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2005. (38 refs.)

About one-third of adults drink at levels that elevate risk for physical, mental health social problems. However, studies indicate that too often primary care providers and mental health clinicians fail to recognize alcohol problems. This guide is directed to primary care providers and mental health clinicians with suggestions as to how to incorporate alcohol screening into clinical care. Procedures are described for assessments, brief interventions and referral for treatment. It identifies clinical indications for screening, provides guidelines for discussing alcohol use, sets forth an assessment procedure that allows easily distinguishing at-risk drinking, alcohol abuse, and alcohol dependence from one another, and provides provides suggestions for intervention. A series of appendices includes the suggested screening instrument (AUDIT), referral resources, an overview of US drinking patterns, definitions of a standard drink, and information on medications used in alcohol treatment.

Nouroozifar M; Zangeneh M. Mental health and addiction state of ethnocultural/racial communities. International Journal of Mental Health and Addiction 4(4): 288-293, 2006. (45 refs.)

Migration has become a common trend and an expected fact of life among the majority of underdeveloped and developing nations. Immigration exposes newcomers to a new experience, an acculturation. Acculturation is not always a successful process and may become stressful. Acculturative stress can manifest itself in different ways. Many researchers have suggested a connection between immigration and increased risk of developing mental health/addiction problems. Studies have shown that ethnocultural/racial groups have experienced difficulties in gaining access to mental health and addiction care services. This background paper is prepared to 1) discuss the mental health & addiction state of ethnocultural/racial communities, and 2) offer working recommendations.

Office of Applied Studies. The NSDUH Report: Substance Use Treatment Need among Adolescents, 2003-2004. Issue 24. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (5 refs.)

This report, an issue in an occasional series of reports based upon data collected by the National Survey on Drug Use and Health, focuses upon treatment need among adolescents in 2003-2006. Among the significant findings are that in those years, 6.1 percent of youths aged 12 to 17 were classified as needing treatment for alcohol use and 5.4 percent as needing treatment for illicit drug use. This classification was made based on responses to questions related to symptoms consistent with DSM-IV criteria for dependence or abuse. For example, questions were related to the presence of symptoms of withdrawal, tolerance, use in dangerous situation, trouble with law, interference with major obligations, etc. Differences in estimated need for treatment are presented by a number of demographic characteristics: gender, age, race/ethnicity, family income. Of those classified as needing treatment for alcohol use, 7.2 percent received specialty alcohol use treatment; 9.1 percent of the youths who were classified as needing treatment for illicit drug use received specialty illicit drug use treatment. Thus there were over 90% untreated. Among the youths who were classified as needing treatment, very few of the youths who had not received treatment perceived themselves as having a need for treatment (2.2 percent for alcohol use treatment and 3.5 percent for illicit drug use treatment)

Office of Applied Studies; Wright D; Sathe N; Spagnola K. State Estimates of Substance Use from the 2004-2005 National Surveys on Drug Use and Health. NSSDUH Series H-31. Rockville MD: Office of Applied Studies, Substance Abuse Mental Health Administration, 2007. (27 refs.)

This report provides state estimates for 23 measures of substance use and mental health problems. there are drawn form the National Surveys on Drug Use and Health (NSDUH) for 2005 and 2004. There are 82 tables and figures. Information, by state and by state rankings for rates of illicit drug use, alcohol and tobacco use. There is also data on the need for treatment for substance use problems, (dependence and abuse), as well as mental health problems.

Polednak AP. Documentation of alcohol use in hospital records of newly diagnosed cancer patients: A population-based study. American Journal of Drug and Alcohol Abuse 33(3): 403-409, 2007. (19 refs.)

Alcohol use has been associated with increased risk and poorer prognosis of various types of cancer, but the extent of actual screening for alcohol use in hospitalized cancer patients has received limited attention. In a random sample of 618 Connecticut patients diagnosed in 2002 with invasive cancer at age 20+ years, ascertained from a population-based registry, some information on usual frequency of drinking was found in hospital records for 478 (77.3%), but 143 (57.2%) of the 250 current drinkers were poorly described (e.g., "social," "occasional"). Alcohol use disorders were rarely mentioned. Gamma glutamyl transpeptidase was found for only 21 (3.4%). Mean corpuscular volume (MCV) was found for 434 (70.2%) and was associated with heavier drinking, independent of other predictors of MCV. Better screening is needed for all hospitalized cancer patients, to plan for interventions and conduct follow-up studies of prognosis.

Ralston S; Kellett N; Williams RL; Schmitt C; North CQ. Practice-based assessment of tobacco usage in southwestern primary care patients: A Research Involving Outpatient Settings Network (RIOS Net) study. Journal of the American Board of Family Medicine 20(2): 174-180, 2007. (22 refs.)

Purpose: Primary care clinicians rely, perhaps erroneously, on general population-based data about risk factors to help form their strategies for allocating time in the brief primary care encounter. We conducted a case study using rates of tobacco usage among people presenting for primary care to explore comparability to general population-based rates. Methods: Clinicians in RIOS Net, a practice-based research network, gathered data on tobacco use for all patients presenting during a 2-week period. We compared those data to population-based data by gender and ethnicity. Results: Ninety-one primary care clinicians reported data on 2442 patients. Primary care smoking rates differed in important ways from general population-based rates. Hispanic women smoked at more than twice the national population-based rate (25% vs 12%). Youth smoked at higher rates as well, particularly young Native American men. Conclusions: Patients seen in primary care differ in important ways in rates and patterns of tobacco usage when compared with rates reported in population-based surveys. These differences could have important implications for preventive care within the context of multiple competing demands in the primary care encounter.

Rastegar DA; Fingerhood MI. Addiction Medicine: An Evidence-Based Handbook. Baltimore: Lippincott Williams & Wilkins, 2005. (Chapter refs.)

This handbook, intended for those in clinical medicine, provides practical and evidence-based guidelines for evaluating, treating, and managing patients with substance abuse problems. It is organized into 17 chapters. The initial four chapters provide an overview of basic constructs, responding to addictions in the primary care setting, the medical interview and an overview of treatment. This discussion includes consideration of different models for understanding addiction problems, the natural history of addiction and the recovery process, the basic clinical skills around screening, the use of drug testing, motivational interviewing, and responding to denial, and a introduction to the basic elements of treatment and the settings in which it is provided. The bulk of the book (10 chapters) are directed to the examination of a specific drug, its epidemiology, acute effects, diagnostic considerations, associated medical complications, and drug-specific treatment elements. Individuals chapters are devoted to alcohol, sedative-hypnotics, opioids, tobacco, cocaine and other stimulants, hallucinogens, marijuana, inhalants, and steroids. The final four chapters consider medical care for the addicted patient, including issues such as problems associated with the route of administration, issues around pain management, and "the difficult" patient. Another chapter is devoted to prescription drug abuse -- markers of abuse, strategies to avoid prescription drug abuse, the products most commonly abuse, as well as discussion too of over-the-counter products. The concluding chapters consider special populations -- women, the elderly, adolescents, prisoners -- as well as issues related to co-occurring mental illness.

Rissmiller DJ; Biever M; Mishra D; Steer RA. Screening detoxifying inpatients with substance-related disorders for a major depressive disorder. Journal of Clinical Psychology in Medical Settings 13(3): 315-321, 2006. (34 refs.)

The Beck Depression Inventory-Fast Screen for Medical Settings (BDI-FS; [Beck, Steer, & Brown, 2000]) and the Mood Module (MM) from the Primary Care Evaluation of Mental Disorders [Spitzer, Williams, Kroenke, Linzer, deGruy, III, Hahn, & Brody, 1995] were used to screen 100 inpatients detoxifying from alcohol, illicit substances, or both for a major depressive disorder (MDD). Receiver operating characteristic (ROC) analyses indicated that both tests were highly and comparably effective in differentiating patients who were and not diagnosed with a MDD; the ROC areas-under-curves for the BDI-FS and MM were, respectively, .87 and .84. A BDI-FS cut-off score of 10 and above had 90% sensitivity and 78% specificity rates, and a MM cut-off score of 7 and above had 90% sensitivity and 72% specificity rates for discriminating patients with and without a MDD. The clinical advantages and disadvantages of both instruments for rapidly screening detoxifying inpatients for clinical depression were discussed.

Schanzer BM; First MB; Dominguez B; Hasin DS; Caton CLM. Diagnosing psychotic disorders in the emergency department in the context of substance use. Psychiatric Services 57(10): 1468-1473, 2006. (28 refs.)

Objective: For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode. Methods: Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months). Results: Of the 223 patients whose symptoms were diagnosed in the emergency department as a primary psychotic disorder, one-quarter were determined by the BELD to have substance-induced psychosis or no psychosis. Overall, the diagnostic agreement was only fair (K=.32). Patients with an emergency department diagnosis of primary psychosis were significantly more likely than those with an emergency department diagnosis of substance-induced psychosis to be hospitalized, started on antipsychotic medication, and referred to mental health services instead of treatment for substance use (p <.001). Patients given an emergency department diagnosis of primary psychosis who were found by the BELD to have substance-induced psychosis or no psychosis were significantly more likely to be treated for a psychotic disorder rather than for substance-induced psychosis (p <.001) Conclusions: Clinicians in psychiatric emergency departments appear to have a tendency to attribute psychotic symptoms to a primary psychotic disorder rather than to concurrent substance use. Given that the diagnosis has significant implications for future management, it is important to improve diagnostic approaches in the emergency department.

Schmidt LA; Ye Y; Greenfield TK; Bond J. Ethnic disparities in clinical severity and services for alcohol problems: Results from the National Alcohol Survey. Alcoholism: Clinical and Experimental Research 31(1): 48-56, 2007. (62 refs.)

Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over- represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

Sinclair H. Drug Treatment Demand Data: Influence on Policy and Practice. Strasbourg: Council of Europe, 2006

The Pompidou Group has advocated the systematic and routine collection of information on patients entering treatment for problem drug use (treatment demand data) since the mid-1980s. Two decades later, the question now being asked is whether or not this data has been used as evidence in the development of policies and practices. In this publication, authors Hamish Sinclair, Carlo Bertorello, Michela Rial and Dusan Nolimal, all members of the Pompidou Group research platform, attempt to answer this question. Three case studies describe how treatment demand data has been used in the development of drug policies and services in Ireland, Italy and Slovenia. One strong message coming out of this report is the need for more information on the outcome of treatment. Policy makers clearly need more information on patients at the end of their treatment, including information on further treatment and its effectiveness.

Public Domain

Solorio MR; Milburn NG; Andersen RM; Trifskin S; Rodriguez MA. Emotional distress and mental health service use among urban homeless adolescents. Journal of Behavioral Health Services & Research 33(4): 381-393, 2006. (22 refs.)

The Expanded Behavioral Model for Vulnerable Populations was used to examine the predisposing, enabling, and need factors associated with mental health service use in a homeless adolescent sample (N=688). Among all youth, 32% perceived a need for help with mental health problems and 15% met Brief-Symptom Inventory (BSI) criteria for emotional distress. The rate of mental health service use in our sample was 32%. One enabling factor, having a case manager/discussed mental health concerns, and one need factor, which met criteria for BSI, were found to be associated with mental health service use in the past 3 months. The majority of youth who used mental health services had obtained services from crisis centers. Among those who perceived a need for help with mental health problems but who did not use services, the most common barrier was not knowing where to go or what service to use (57%). These findings suggest that due to the high prevalence of mental health problems among homeless youth, it would be helpful for service providers coming into contact with youth to make them aware of existing community resources for mental health services; making youth aware of these resources may in turn decrease the rate of crisis center use and instead allow youth to receive mental health services in outpatient settings that provide continuity of care.

Stephens RS; Roffman RA. The marijuana check-up. IN: Roffman RA; Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. London: Cambridge University Press, 2006. pp. 180-203

This chapter introduces the approach known as "the marijuana check-up." Beyond characterizing the essential elements, key elements in its implementation are set forth. The assessment process and personal feedback report are described, along with the the related skills involved with motivational interviewing. Clinical as well as ethical issues are discussed. The chapter concludes with a presentation of a controlled trial of the marijuana check-up.

Storvik M; Tiihonen J; Haukijarvi T; Tupala E. Amygdala serotonin transporters in alcoholics measured by whole hemisphere autoradiography. Synapse 61(8): 629-636, 2007. (38 refs.)

Background: A dysfunction in brain serotonin turnover is a well-established factor associated with the impulsive and sociopathic behavior in alcoholics. The conjuncted alterations in functioning of serotonin transporter (SERT) may play a role in the regulation of emotional balance, judgement, and the adverse behavioral effects of ethanol misuse. These traits may be related to serotonergic regulation in the amygdala and prefrontal cortex. Methods: The binding of [H-3]citalopram to SERT was evaluated in the amygdala of Cloninger type 1 and 2 alcoholics (n = 17), and nonalcoholic control subjects (n = 10) by postmortem whole-hemisphere autoradiography. Results: The SERT binding was substantially lower in the dorsal amygdala in alcoholic subjects when compared with the controls (-28%, effect size 1.26, P = 0.016). In secondary analysis, this reduction was observed in both alcoholic subgroups (-26% in type 1 alcoholics, and -33% in type 2 alcoholics). In ventral amygdala, no alteration was observed. There were significant correlations between the SERT binding in dorsal amygdala and in previous results from frontal cortical areas in alcoholics, depending on the type of alcoholic. Conclusions: These results suggest that SERT binding in the amygdala, as well as the differential regulation of the SERT in amygdala and frontal cortex in alcoholics may help to explain the dysfunctional regulation of emotions in alcoholics.

Taxman FS; Perdoni ML; Harrison LD. Drug treatment services for adult offenders: The state of the state. Journal of Substance Abuse Treatment 32(3): 239-254, 2007. (67 refs.)

We conducted a national survey of prisons, jails, and community correctional agencies to estimate the prevalence of entry into and accessibility of correctional programs and drug treatment services for adult offenders. Substance abuse education and awareness is the most prevalent form of service provided, being offered in 74% of prisons, 61% of jails, and 53% of community correctional agencies; at the same time, remedial education is the most frequently available correctional program in prisons (89%) and jails (59.5%), whereas sex offender therapy (57.2%) and intensive supervision (41.9%) dominate in community correctional programs. Most substance abuse services provided to offenders are offered through correctional programs such as intensive supervision, day reporting, vocational education, and work release, among others. Although agencies report a high frequency of providing substance abuse services, the prevalence rates are misleading because less than a quarter of the offenders in prisons and jails and less than 10% of those in community correctional agencies have daily access to these services through correctional agencies; in addition, these are predominantly drug treatment services that offer few clinical services. Given that drug-involved offenders are likely to have dependence rates that are four times greater than those among the general public, the drug treatment services and correctional programs available to offenders do not appear to be appropriate for the needs of this population. The National Criminal Justice Treatment Practices survey provides a better understanding of the distribution of services and programs across prisons, jails, and community correctional agencies and allows researchers and policy makers to understand some of the gaps in services and programs that may negatively affect recidivism reduction efforts.

Tracy SW; Trafton JA; Weingardt KR; Aton EG; Humphreys K. How are substance use disorders addressed in VA psychiatric and primary care settings? Results of a national survey. Psychiatric Services 58(2): 266-269, 2007. (13 refs.)

Objective: This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings. Methods: National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders. Results: Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs. Conclusions: Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

van de Mheen H; Cruts AAN; Lempens ALF; Ketelaars APM; van Laar MW. Monitoring of alcohol and drugs under scrutiny: Output and shortcomings. European Addiction Research 12(4): 222-229, 2006. (21 refs.)

A major focus of Dutch addiction policy is to improve the monitoring of substance use and addiction -- and determining which surveys and registrations are important for the monitoring of alcohol and drugs problems, and what information is generated or needs to be generated by these monitors? Three methods were used: an inventorisation of existing monitoring projects, a survey among experts in the field of alcohol and drugs to study the information needs, and a study on the output and shortcomings of the existing monitors. Sixty monitors and 13 'umbrella' monitors were found. Experts formulated the needs of 11 topics which were matched with the output of the monitors. Coverage of the nature and extent of use in general is good. Shortcomings apply to the use and accessibility of the monitors, as well as to their completeness, standardisation and content. Especially questions with respect to problem use, treatment demand/need of help and user careers cannot be answered sufficiently with the existing information.

Van Hook S; Harris SK; Brooks T; Carey P; Kossack R; Kulig J; NEPSAR. The "Six T's": Barriers to screening teens for substance abuse in primary care. Journal of Adolescent Health 40(5): 456-461, 2007. (40 refs.)

Purpose: To identify barriers to adolescent substance abuse screening in primary care. Methods: Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each. Results: The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group. Conclusions: Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.

Vornik LA; Brown ES. Management of comorbid bipolar disorder and substance abuse. Journal of Clinical Psychiatry 67(Supplement 7): 24-30, 2006. (64 refs.)

Bipolar disorder is a severe and often chronic disorder with lifetime prevalence rates of bipolar spectrum disorders of up to 6.5% in the general population. Patients with bipolar disorder frequently report co-occurring substance use disorders, and the rates of alcohol and other substance use disorders are significantly higher in persons with bipolar disorder than in the general population. The present review discusses why people with bipolar disorder use substances, provides an overview of the impact of alcohol and other substance use on the course of bipolar disorder, and outlines the treatment options currently available to patients with co-occurring bipolar disorder and substance abuse. Our aim is to summarize the existing data on the pharmacologic treatment options and to include the most recent published data whenever possible. Three randomized, placebo-controlled studies of dual-diagnosis patients treated with carbamazepine, lithium, and valproate are discussed. The results are generally positive and support the use of these agents in dual-diagnosis patients. Open-label studies are also presented, and the need for controlled data is outlined. The review also briefly discusses the psychotherapeutic approaches to patients with comorbid bipolar and substance use disorders.

Weaver T; Charles V; Madden P; Renton A; COSMIC Study Group. Co-morbidity of Substance Misuse and Mentall Illness Collaborative Study (COSMIC): A study of prevalence and management of co-morbidity among adult substance misuse and mental health treatment populations. Drugs: Education, Prevention, and Policy 12(Supplement 1): 124-133, 2005. (0 refs.)

The main aim of the study has been to estimate the prevalence of co-morbid substance misuse and mental health problems among current patients of substance misuse and mental health services, to describe the range of co-morbid presentations and assess treatment needs, and assess whether there were differences between populations from London and provincial urban areas. The prevalence were as follows: psychotic disorder, 7.9%; personality disorder, 37%, severe depression, 26.9%, mild depression 40.3%, severe anxiety 19%, mixed depression and anxiety disorder, 18.5%, and depression or anxiety disorder, 67.7%. The diagnosis recorded by the drug services had limited utility. Of those patients with a psychiatric disorder, 38.5% had not contact with a health service specifically for their mental health problem. Detailed information is provided for the alcohol service treatment population and the adult mental health service treatment population. Data is also provided on the relationship of drug use history to the onset of mental health problems. All subjects were using drugs when they started to experience mental health problems. Factors influencing the pattern of subsequent drug use are examined. There is also discussion and implications for service development.

Weigel DJ; Donovan KA; Krug KS; Dixon WA. Prescription opioid abuse and dependence: Assessment strategies for counselors. Journal of Counseling and Development 85(2): 211-215, 2007. (21 refs.)

The authors review the article "Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies" (J.H.Isaacson, J. A. Hopper, D. R Alford, & T Parran, 2005), which provides an overview of the recent increase in prescription opioid abuse and dependence from the physician's perspective. In the present article, the authors discuss the counselor's role in identifying issues related to client misuse and abuse of prescription opioids. Associated terminology, common drug acquisition strategies, and signs of problematic use are provided and discussed.

Weitzel JA; Nochajski TH; Coffey SF; Farrell MG. Mental health among suburban drug court participants. American Journal of Drug and Alcohol Abuse 33(3): 475-481, 2007. (18 refs.)

The issue of co-occurring disorders is of concern to the Criminal Justice field, including drug courts. To assess the potential co-occurrence of substance use- and mental health-related diagnoses, the Psychiatric Diagnostic Screening Questionnaire and similar instruments was administered to suburban drug court clients. Based on the screening, one quarter to one half of the 108 participants would be referred for follow-up for a mental health issue; women would be referred at a greater rate than men. There is a need to develop appropriate, brief mental health screening instruments for use in drug court settings so that clients can receive necessary services.

Wetterling T; Weber B; Depfenhart M; Schneider B; Junghanns K. Development of a rating scale to predict the severity of alcohol withdrawal syndrome. Alcohol and Alcoholism 41(6): 611-615, 2006. (30 refs.)

Aim: Various factors that may influence the severity of the alcohol withdrawal syndrome (AWS) have been identified. We tested the predictive value of these factors compiled in a newly developed scale, LARS (Luebeck alcohol withdrawal risk scale). Method: A total of 100 individuals (81 males, 19 females, mean age: 47.6 +/- 9.9 years) consecutively transferred to inpatient detoxification were included in this prospective study. All fulfilled the ICD-10 criteria for alcohol dependence. The LARS was applied at the time of admission. The course of the AWS was assessed by AWS-scale at least every 4 h. The maximum AWS-score was taken as indicator of the severity of AWS. Results: The mean AWS-score(max) was 6.5 +/- 3.3. In all 20% of the patients developed a severe AWS (AWS-score(max) >= 10). The maximum score usually occurred within 36 h after the last drink. A short version, the LARS11, was developed by statistically grounded item reduction. The optimal cut-off of the LARS11 was calculated as 10. The positive predictive value for severe AWS was 76%, while the negative predictive value was 98.7%. The sensitivity and specificity were high (95 or 92.5%, respectively). Conclusion: LARS11 assessed immediately before detoxification appears to provide a useful estimate of mild/moderate versus severe AWS, and is now ready to be validated in an independent sample.

Williams N. 10-minute consultation: Problem drug use. British Medical Journal (Clinical Research Edition) 3333(7569): 639, 2006. (3 refs.)

This is part of a series of occasional articles on problems common in primary care. It focuses upon a 24 year old man seeking assistance for his heroin problem. The author considers two areas: what issues should be covered and what should be done. In respect to assessment, areas noted as important for consideration are the following; current drug use; past drug history and treatment experiences; Injecting history; medical history; psychiatric history; forensic history; social situation; welfare of children in individual's care. In terms of clinical care, the following tasks are outlined: the priority for the first consultation entails harm reduction and efforts to ensure further contact; physical examination; harm reduction; urine drug screening; home work (Drug diary, of all drugs taken over the next 7-14 days); vaccination (all drug users should be vaccinated against hepatitis B on an accelerated schedule and discussion of benefits of screening for other infections, such as HIV and hepatitis C); notification (note: Britian requires notification to a regional drug misuse database); and plans for follow up, to review test results and discuss treatment plan.

Winters KC. Introduction: Progress in the assessment of adolescent drug abuse. (editorial). Journal of Child & Adolescent Substance Abuse 16(1): 1-4, 2006. (9 refs.)

Winters KC; DeWolfe J; Graharn D; Cyr WS. Screening American Indian youth for referral to drug abuse prevention and intervention services. Journal of Child & Adolescent Substance Abuse 16(1): 39-52, 2006. (20 refs.)

The development and psychometric properties of a brief screening tool for use with American Indian Youth suspected of abusing substances is described. The Indian Health Service-Personal Experience Screening Questionnaire (IHS-PESQ) is a brief questionnaire that screens for drug abuse problem severity, response distortion tendencies, and psychosocial risk factors. The psychometric properties of the problem severity scale are favorable when tested in reservation-based American Indian students (grades 6-12). The paper also describes the role of the IHS-PESQ within a prevention, intervention and treatment referral system designed for American Indian youth.

Wood E; Mattick RP; Burns L; Shakeshaft A. The costs and utility of parental drug-testing in child protection: A review of the available literature and commentary. NDARC Technical Report No. 242. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (88 refs.)

AIMS: The aim of this project was to undertake a comprehensive review of the research evidence related to the utility and cost of parental drug-testing in child protection cases. [NB. Assessment of alcohol misuse has not been included in this report]. FINDINGS: The potential effects of parental substance abuse range widely and, while the causal relationship between parental substance abuse and child abuse or neglect could be considered at length, suffice to state that there is an increased risk of potential negative effects on the family. Drug use in the context of true drug dependence is of greater concern than lower levels of consumption. The literature on the value of parental drug-testing in the context of child protection is small, but suggests its appropriate use is feasible and that it can promote better outcomes in child-at-risk cases. Overall, it seems practical to recommend the use of parental drug-testing, assuming there is reasonable suspicion of substance abuse, multiple tests are undertaken over periods ranging between two to six months or more (depending on level of use), confirmation testing is undertaken on all positive results, and parents who are seeking treatment or found to be drug abusing/dependent are immediately referred to treatment in a supportive fashion. BEST PRACTICE IN DRUG-TESTING: Drug-testing is limited in its ability to determine dependence and/or impairment in relation to parenting ability; however, drug-testing may have some utility in leading to treatment and/or confirmation of self-reports of use. Urine or hair testing are the recommended methods of drug-testing in the context of child protection. The use of frequent (weekly or more often), regular, monitored urine testing is one best practice model with good reliability and validity. Hair testing has significant benefits that should be weighed up in terms of convenience and the desired window of observation. Both are reliable methods for assessing the extent of ongoing illicit drug use. DRUG USE AND PARENTING CAPACITY: There is no level of illicit drug use that can be claimed to be reasonable, if it inhibits parents' ability to effectively and safely parent their children, although regular daily use and preoccupation with use is the most debilitating. Binge use for consecutive days will cause dysfunction for the period of the binge use and for the subsequent days of recovery. If use is to occur, then infrequent use (weekly to monthly or less often) is the pattern least likely to compromise parenting skills. Children of different ages will be affected differently by substance using parents. Infants and young children will be more prone to suffer the effects of neglect, such as malnourishment and poor parental bonding. In addition to experiencing these effects, older children may also take on the role and responsibilities of the parent, or imitate the parent's behaviour. It is important to note that not all substance using parents experience impaired parenting capacity; however, it seems reasonable to assume that longer term dependent parents may be diminished in their capacity to parent effectively, due to the significant amount of time given to drug seeking and taking. There is a high level of mental health disorders among drug dependent people. In particular, there are high levels of post-traumatic stress disorder, borderline and antisocial personality disorder and anxiety and depression. It is likely these will also impact on ability to parent. TREATMENT ISSUES: There are a variety of treatment modalities available, although overall evidence suggests the longer a person remains in treatment the better the outcome, with respect to diminished drug use. There are no gender differences in treatment compliance; however, there is some evidence to suggest women may benefit more from treatment catering for women only, and family-focused treatment may be beneficial to parents with children.

Wryobeck JM; Chermack ST; Closser MH; Blow FC. Using the Addiction Severity Index to predict mental and medical health service utilization. Journal of Addictive Diseases 25(4): 1-14, 2006. (45 refs.)

This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g., substance use disorder services, other mental health services, outpatient medical visits, urgent care visits, inpatient psychiatric and medical). Multivariate analysis using Tobit regression models showed six out of seven ASI scales were significant predictors, and that combining ASI data with demographics and clinical data significantly improved prediction of health care services. It also was found that certain psychiatric and medical diagnoses were related to service use measures, and that a diagnosis of depression was related to overall healthcare utilization.

Yu J; Evans PC; Clark LP. Alcohol addiction and perceived sanction risks: Deterring drinking drivers. Journal of Criminal Justice 34(2): 165-174, 2006

This study argued that while sanctions deter offenders from being involved in future drinking-driving offenses, alcohol addiction prevents individuals from making rational choices, &, thus, increases offenders' chances of being involved in drinking driving regardless of the certain, severe, & swift punishments they had experienced. Results indicated that, individuals with more severe alcohol addiction problems had increased chances of committing multiple offenses regardless of the sanctions that they had experienced relative to those with less severe alcohol-related problems. Findings seemed to suggest that criminal justice sanctions alone might not obtain expected deterrent impacts on individuals with alcohol & other addiction problems. Drinking drivers & other drug & alcohol offenders should be screened for substance abuse problems, &, if necessary, provided with treatment.