CORK Bibliography: Needs Assessment
48 citations. January 2009 to present
Prepared: March 2012
Agorastos A; Zurhold H; Verthein U; Petridou A; Haasen C. Addiction services in Cyprus: Results of an EU Twinning Project. Drugs: Education, Prevention and Policy 18(5): 340-352, 2011. (38 refs.)Introduction: This evaluation is part of a Twinning Project between Cyprus and Germany, aimed at evaluating the governmental drug services in Cyprus and promoting the improvement and introduction of new drug treatment services, in order to assist the new Member State in the implementation and harmonization with the European Community's legislation. Methods: A field investigation studied parameters as population in need, treatment demand and coverage, as well as high-risk patterns and their trend over the past years. Results: The main findings were a high level of problematic drug use, mainly high-risk intravenous heroin and cocaine use, and an increase treatment demand for women, adolescents and migrants. Expert interviews named gaps in treatment options, including a previous lack of maintenance treatment, insufficient harm reduction measures and inadequate treatment concepts to meet specific needs of problematic drug users. Discussion: Recommendations for improvement can be integrated into present services. Cypriot authorities have started implementing the suggestions, so that an overall improvement of services can be expected in the future. Copyright 2011, Taylor & Francis
Baldacchino A; Greacen T; Hodges CL; Charzynska K; Sorsa M; Saias T et al. Nature, level and type of networking for individuals with dual diagnosis: A European perspective. Drugs: Education, Prevention and Policy 18(5): 393-401, 2011. (18 refs.)Aim: To obtain more detailed information on service availability and appropriateness and interagency networking for individuals with dual diagnosis (DD) at seven European centres. Methods: Data was collected using two parts of the three-part Treatment of Dual Diagnosis tool in seven European centres as part of the Integrated Services Aimed at Dual Diagnosis and Optimal Recovery from Addiction (ISADORA) study between 2002 and 2005 focusing on the nature, level and type of networking for individuals with co-morbid mental health and substance misuse problems (DD). A multi-level process of qualifying networking was used. Findings: Findings show that 50-90% of the listed centres across the ISADORA sites reported some level of networking but only 30% had a joint care agreement in place or shared patient/client records with at least one other agency. Barriers and facilitators to interagency collaboration are described. Conclusion: This pan-European study highlighted the need for a more integrated and focused approach to DD service delivery. Copyright 2011, Taylor & Francis
Barrett B; Fogel SJ; Garrett J; Young MS. Assessing health care needs among street homeless and transitionally housed adults. Journal of Social Service Research 37(3): 338- 350, 2011. (56 refs.)This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions. Copyright 2011, Haworth Press
Casanueva C; Stambaugh L; Urato M; Fraser JG; Williams J. Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system. Children and Youth Services Review 33(10): 1939-1949, 2011. (36 refs.)This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11-15 years at baseline were followed for 5-7 years. over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5-7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood. African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS. Copyright 2011, Elsevier Science
Cristofalo M; Boutain D; Schraufnagel TJ; Bumgardner K; Zatzick D; Roy-Byrne PP. Unmet need for mental health and addictions care in urban community health clinics: Frontline provider accounts. Psychiatric Services 60(4): 505-511, 2009. (32 refs.)Objective: To facilitate planning to improve care delivery in community health clinics, this study provides an in-depth description of the social, cultural, and organizational factors that create the context for mental health and addictions treatment delivery in this setting. Methods: Seventeen community health clinic providers and personnel were interviewed for 45-90 minutes with open-ended questions to elicit the context of their frontline provider experiences. Major themes and sub-themes of responses were identified with content analysis. Results: Issues that create significant barriers to care included complex patient comorbidity and demographic characteristics; clinic organization, resources, and funding shortfalls; communication barriers with specialty mental health and addictions agencies; and stigmatizing aspects of mental health, addictions, and disadvantaged status. Conclusions: The unique barriers to care in the community health care setting, as well as the unique characteristics of patients served, are likely to require context-specific solutions. These solutions will determine the viability of existing chronic disease management models, such as collaborative care, when applied to this setting. Copyright 2009, American Psychiatric Association
Curran GM; Ounpraseuth ST; Allee E; Small J; Booth BM. Trajectories in use of substance abuse and mental health services among stimulant users in rural areas. Psychiatric Services 62(10): 1230-1232, 2011. (11 refs.)Objective: This study examined substance abuse and mental health service utilization during a three-year period among stimulant users living in rural areas. Methods: Participants (N=710) were interviewed at baseline and every six months for 36 months. One-step transition probabilities were constructed between the two types of service use for each consecutive pair of interviews to examine the resulting steady-state probabilities among multiple one-step transition matrices. Results: Most participants received no substance abuse or mental health services. On average, the probabilities of reporting use of the same types of services during the 36-month follow-up were 82% for receiving neither service, 9% for receiving only mental health treatment, 6% for receiving only substance abuse treatment, and 2% for receiving both services. Conclusions: Further study is needed to determine factors that affect the decision to seek mental health or substance abuse treatment among residents of rural communities. Copyright 2011, American Psychiatric Association
d'Abbs P; MacLean S. Volatile Substance Misuse: A Review of the Interventions. National Drug Strategy Monograph No. 65. Sydney: Department of Health and Ageing (Australia), 2009This monograph addresses volatile (inhalant) substance misuse in Australia. It is organized in two parts. Part I describes tha patterns of solatile substance misuse, in the world, within Australia, and among indigenous Australians. Attention then turns to question "Why do some people inhale volative substances?" This is approached from the perspective of correlates of use, causes and identified reasons, and understandings of this use in indigenous communities. Next there is a discussion of the problems associated with use: by the individual, in terms of immediate and longer-term effects, and a presentation of data on mortality and morbidity. The social effects are then considered, followed by discussion of the problems experienced by families, the local community, and the wider society. Part II examines the possible interventions, in the domains of supply reduction and demand reduction. In terms of supply reduction, the possibilities include the modification of products, the replacement of harmful or psychoactive compounds, addition of deterrant chemicals, package modifications, sales restrictions related to legislative actions and voluntary efforts. Demand reduction includes community approaches, with descriptions of existing programs; education, youth and recreational programs, which includes examples of universal and targeted initiaves, as well as use of the native culture, recreation, and employment initiatives. Treatment is also a means of demand reduction. This chapter considers different settings, both inpatient and outpatient settings, issues related to clinical management, the need for services to those with acquired brain injury, and services tailored to indigenous people. Harm reduction is addressed separately, with emphasis on harm reduction in drug use settings and harm reduction practices for individuals. The final chapter addresses law enforcement initiatives., including preconditions for effective law enforcement, statutory sanctions, legislation which governs police powers, and community-based sanctions. Copyright 2011, Project Cork
Dierker LC; Sledjeski EM; Marshall S; Johnson S. Substance parity laws and the detection and treatment of substance use disorders among adolescents in mental health care. Journal of Dual Diagnosis 5(1): 2-13, 2009 , 2009. (38 refs.)This study investigated the association between substance use parity laws and the detection/treatment of co-occurring psychiatric and substance use disorders among adolescents seeking treatment within a mental health setting. Data were drawn from the Substance Abuse and Mental Health Services Administration 1997 Client/Patient Sample Survey (CPSS). The CPSS is a nationally representative survey of mental health service use obtained from standardized chart reviews. While 5.8% of the sample received a substance use diagnosis, only 32% of those youth received substance treatment. Youth receiving services in a state with a substance parity law were more likely to receive a substance use diagnosis and substance treatment compared with youth residing in a state without a substance parity law. Findings suggest that while substance parity laws may influence the detection and treatment of substance use disorders, overall, youth with a dual diagnosis remain underserved. Copyright 2009, Taylor & Francis
dos Santos MML; Trautmann F; Kools JP. Rapid Assessment Response (RAR) study: Drug use and health risk - Pretoria, South Africa. Harm Reduction Journal 8: article 14, 2011. (27 refs.)Background: Within a ten year period South Africa has developed a substantial illicit drug market. Data on HIV risk among drug using populations clearly indicate high levels of HIV risk behaviour due to the sharing of injecting equipment and/or drug-related unprotected sex. While there is international evidence on and experience with adequate responses, limited responses addressing drug use and drug-use-related HIV and other health risks are witnessed in South Africa. This study aimed to explore the emerging problem of drug-related HIV transmission and to stimulate the development of adequate health services for the drug users, by linking international expertise and local research. Methods: A Rapid Assessment and Response (RAR) methodology was adopted for the study. For individual and focus group interviews a semi-structured questionnaire was utilised that addressed key issues. Interviews were conducted with a total of 84 key informant (KI) participants, 63 drug user KI participants (49 males, 14 females) and 21 KI service providers (8 male, 13 female). Results. and Discussion: Adverse living conditions and poor education levels were cited as making access to treatment harder, especially for those living in disadvantaged areas. Heroin was found to be the substance most available and used in a problematic way within the Pretoria area. Participants were not fully aware of the concrete health risks involved in drug use, and the vague ideas held appear not to allow for concrete measures to protect themselves. Knowledge with regards to substance related HIV/AIDS transmission is not yet widespread, with some information sources disseminating incorrect or unspecific information. Conclusions: The implementation of pragmatic harm-reduction and other evidence-based public health care policies that are designed to reduce the harmful consequences associated with substance use and HIV/AIDS should be considered. HIV testing and treatment services also need to be made available in places accessed by drug users. Copyright 2011, BioMed Central
Ducray K; Byrne P; Burke C; Smyth BP. A comparison of the drug use patterns, measures of needs and quality of life of methadone-maintained patients using and not using cocaine. Heroin Addiction and Related Clinical Problems 13(3): 27-37, 2011. (62 refs.)Cocaine use on methadone maintenance treatment (MMT) is believed to complicate clinical outcomes. This study aimed to determine whether cocaine users on MMT require distinct services by virtue of their differential drug use, needs and quality of life relative to non- cocaine users. A cross sectional survey of 108 adults attending a Dublin opioid treatment service was conducted. The urine toxicology screens, Camberwell Assessment of Need Short Appraisal Schedules and WHO Quality of Life- Bref responses of respondents defined as either cocaine users or non-cocaine users were compared. Whilst cocaine use on MMT was not significantly associated with adverse measures of need or quality of life, it was linked to significantly greater heroin use and to more frequent injecting. Copyright 2011, Pacini Editore
Farabee D; Zhang S; Yang J. A preliminary examination of offender needs assessment: Are all those questions really necessary? Journal of Psychoactive Drugs 2011(7): 51-57, 2011. (14 refs.)Criminologists generally agree that offender recidivism can be reduced by addressing the criminogenic needs of this population. Two prominent assessments of offender risks and needs are the Level of Service Inventory-Revised (LSI-R) and the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS). Both predict recidivism, but they are largely based on data from records. In contrast, the determination of inmates' service needs is based on lengthy (and costly) offender interviews. In light of evidence that many correctional systems have not adopted standardized assessments of service needs and that time burden and costs are typically cited as barriers, the present study examined whether interviews involving complex scales improve the accuracy of offender needs assessment relative to a few single-item measures. To test this, 75 California prison inmates were administered the LSI-R, COMPAS, and a set of four yes/no items asking if they needed help with substance abuse, vocational training, housing, and education. Approximately 70% to 90% of inmates identified as needing these services according to the LSI-R or COMPAS could have been identified using these four supplemental items, though specificity rates were low for the financial and housing domains. The results suggest that simpler, less costly approaches to offender needs assessment might be achievable. Copyright 2011, Haight-Asbury Publishing
Ilgen MA; Schulenberg J; Kloska DD; Czyz E; Johnston L; O'Malley P. Prevalence and characteristics of substance abuse treatment utilization by US adolescents: National data from 1987 to 2008. Addictive Behaviors 36(12): 1349-1352, 2011. (16 refs.)Objective: Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services. Method: Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N = 25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization. Results: The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services. Conclusion: Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment. Copyright 2011, Elsevier Science
Ives R. Meeting professionals' needs in the United Kingdom for effective VSM intervention. Substance Use & Misuse 46(Supplement 1): 134-139, 2011. (17 refs.)An exploratory study examined what professionals needed to support their responses to volatile substance misuse (VSM). Many respondents saw VSM as a problem of unknown dimensions and were uncertain about how to tackle it. Resources for treatment and prevention were seen as outdated. Workers were concerned that VSM was becoming more common among adults, supporting an indication found in a study of VSM-related deaths. Evidence-informed treatment protocols, information on working with clients, assessments of local needs, and the evaluation of existing approaches to VSM would improve the response. A further phase of the research will be reported in 2012. Copyright 2011, Informa Healthcare
Keller TE; Blakeslee JE; Lemon SC; Courtney ME. Subpopulations of older foster youths with differential risk of diagnosis for alcohol abuse or dependence. Journal of Studies on Alcohol and Drugs 71(6): 819-830, 2010. (70 refs.)Objective: Distinctive combinations of factors are likely to be associated with serious alcohol problems among adolescents about to emancipate from the foster care system and face the difficult transition to independent adulthood. This study identifies particular subpopulations of older foster youths that differ markedly in the probability of a lifetime diagnosis for alcohol abuse or dependence. Method: Classification and regression tree (CART) analysis was applied to a large, representative sample (N = 732) of individuals, 17 years of age or older, placed in the child welfare system for more than I year. CART evaluated two exploratory sets of variables for optimal splits into groups distinguished from each other on the criterion of lifetime alcohol-use disorder diagnosis. Results: Each classification tree yielded four terminal groups with different rates of lifetime alcohol-use disorder diagnosis. Notable groups in the first tree included one characterized by high levels of both delinquency and violence exposure (53% diagnosed) and another that featured lower delinquency but an independent-living placement (21% diagnosed). Notable groups in the second tree included African American adolescents (only 8% diagnosed), White adolescents not close to caregivers (40% diagnosed), and White adolescents closer to caregivers but with a history of psychological abuse (36% diagnosed). Conclusions: Analyses incorporating variables that could be comorbid with or symptomatic of alcohol problems, such as delinquency, yielded classifications potentially useful for assessment and service planning. Analyses without such variables identified other factors, such as quality of caregiving relationships and maltreatment, associated with serious alcohol problems, suggesting opportunities for prevention or intervention. Copyright 2010, Alcohol Research Documentation Center
Lipsky S; Caetano R; Roy-Byrne P. Triple jeopardy: Impact of partner violence perpetration, mental health and substance use on perceived unmet need for mental health care among men. Social Psychiatry and Psychiatric Epidemiology 46(9): 843-852, 2011. (86 refs.)Objectives To examine the relationship between intimate partner violence (IPV) perpetration, serious mental illness, and substance use and perceived unmet need for mental health treatment in the past year among men in the general population using the behavioral model for health-care use (Aday and Anderson in Health Services Research 9: 208-220, 1974; Andersen in A behavioral model of families' use of health services, 1968; Andersen in Medical Care 46:647-653, 2008). Methods Non-Hispanic black, Hispanic, and non-Hispanic white males aged 18-49 years and cohabiting with a spouse/partner were included in this analysis of the 2002 National Survey on Drug Use and Health. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using logistic regression. Results: The proportion of men reporting unmet treatment need was greater among IPV perpetrators than nonperpetrators (12.1 vs. 3.4%, respectively). Hazardous drinking, illicit drug use, alcohol and drug abuse/dependence, and SMI were also more common among perpetrators. Perpetrators were twice as likely to report unmet need for treatment after taking predisposing, enabling, and need factors into account (AOR 2.00, CI 1.13-3.55). Alcohol abuse/dependence (AOR 2.96, CI 1.79-4.90), drug abuse/dependence (AOR, 1.79, CI 1.01-3.17), substance abuse treatment (AOR 3.09, CI 1.18-8.09), and SMI (AOR 8.46, CI 5.53-12.94) were independently associated with perceived unmet need for treatment. Conclusions: These findings suggest that men who perpetrate IPV are at increased risk of perceived unmet need for mental health care. This study also emphasizes the need to identify substance use disorders and mental health problems among IPV perpetrators identified in health, social service, or criminal justice settings. Further research should address barriers to care specific to men who perpetrate IPV beyond economic factors. Copyright 2011, Springer
Mills K; Knight T. Offering substance misuse services to Accession Eight migrants in London: Findings from a qualitative study. Drugs: Education, Prevention and Policy 17(6): 853-869, 2010. (41 refs.)This article reports findings from a study undertaken in two parts between November 2006 and May 2008, investigating the drug treatment needs of new migrants to the UK. The study explored the eligibility and treatment needs of new communities in London. This article reports findings in relation to EU Accession Eight (A8) nationals' entitlement and access to drug treatment. For this part of the study 20, in depth interviews were conducted with staff of Drug and Alcohol Action Teams and treatment services in seven London boroughs to identify levels of service provision, along with practitioners' interpretations of entitlement to services, perceptions of local need and gaps in treatment. Additionally, 19 interviews were conducted with related service providers. Six service users were interviewed. Findings show professionals are eager to address the needs of A8 migrants but services are providing limited treatment to A8 nationals. However, entitlements vary between boroughs and decisions are pragmatic, based upon assessments of clinical necessity but also financial constraints. Decisions made on this footing can lead to services being denied despite intense need and resulting in reduced opportunities for planning. The article concludes with observations as to how provision might develop to meet a changing context. Copyright 2010, Taylor & Francis
Minugh PA; Lomuto N; Janke S. Projecting adolescent prevention and treatment need: A novel application utilizing the Communities that Care data in the state of Kansas. Journal of Drug Issues 40(3): 627-651, 2010. (45 refs.)This study projects substance abuse and dependence prevalence rates based on the number of early problem behaviors (tobacco alcohol and marijuana use and arrests prior to age 15) reported by youth who have taken part in eleven administrations of the annual Kansas Communities That Care survey following a model developed by McGue and Iacono (2005) The probability of males and females developing a substance abuse or dependence disorder at age 17 and 20 was assigned to each respondent Projections were mapped to show county and statewide dispersions for planning purposes. Projected numbers were much higher than expected In addition to young adult treatment need, the implications for prevention service planning became readily apparent. The findings highlight missed opportunities for indicated prevention and early intervention services and are further discussed in the context of how early intervention might alleviate demand on the treatment system as adolescents progress into young adulthood Copyright 2010, Journal of Drug Issues, Inc.
Mosedale B; Kouimtsidis C; Reynolds M. Sex work, substance misuse and service provision: The experiences of female sex workers in south London. Drugs: Education, Prevention and Policy 16(4): 355-363, 2009. (14 refs.)Background: Observations suggest that patterns of drug use may be changing among sex workers and that service provision may be failing this group. The aim of this study was to investigate life, substance-related, and service-provision experiences of women who are both substance users and involved in sex work. Methods: The study was carried out using unstructured recorded confidential interviews and analysis of the themes arising from them. Results: Twelve women were interviewed. Most of them came from an abusive background. There is a vicious circle between sex working and taking drugs-sex work generates funds and drugs facilitate continuation of work. The emergence of crack cocaine was consistently significant. Conclusion: Experiences of the women discussed here are not new and confirm existing knowledge. Important issues related to service provision were discussed. Flexible services are necessary to attract, engage and support this vulnerable group. Copyright 2009, Taylor & Francis
Nejtek VA; Kaiser K; Vo H; Hilburn C; Lea J; Vishwanatha J. Are there racial/ethnic differences in indigent inner-city clients with dual diagnoses? Journal of Dual Diagnosis 7(1-2): 26- 38, 2011. (12 refs.)Objective: This is an exploratory, cross-sectional study that examined personal, clinical, and treatment characteristics among non-Hispanic Caucasian, non-Hispanic African American, and Hispanic indigent inner-city clients with co-occurring disorders. Methods: Men and women aged 20 to 50 years who met DSM-IV criteria for concurrent mood and substance use disorders were eligible. Inpatients, persons in detoxification programs, and incarcerated inmates were excluded. Assessments covered sociodemographic characteristics, clinical diagnoses, substance use, psychosocial variables, health care utilization and treatment history. Results: Two hundred volunteers were screened, and 145 were eligible to enroll. Racial/ethnic group differences in the distribution of mood and substance use disorders and medical diseases were evident. Receiving psychiatric treatment and psychiatric medications significantly differed among racial/ethnic groups, with Caucasians more likely to receive these services than African Americans or Hispanics. African Americans and Hispanics were also more likely than Caucasians to have positive screening results for their drug of choice and for other drugs as well. Serious medical illnesses were evident in about half of the sample, and the distributions of these illnesses significantly differed among racial/ethnic groups. There were no significant differences in hospitalization or emergency department visits among racial/ethnic groups. Conclusions: Indigent inner-city clients have multiple psychiatric and medical problems that warrant continuity of care. However, few doctor's visits for medical illnesses, lack of psychotropic medications, staggering unemployment, and homelessness were common in our sample. These results present health care and social service professionals with potentially serious treatment challenges. Better recognition and understanding of racial/ethnic needs in those with co-occurring disorders are needed. Copyright 2011, Routledge
Niv N; Pham R; Hser YI. Racial and ethnic differences in substance abuse service needs, utilization, and outcomes in California. Psychiatric Services 60(10): 1350-1356, 2009. (33 refs.)Objective: This study examined differences in service needs and treatment utilization, retention, and outcomes between African-American, Hispanic, and white substance abusers in community-based treatment programs. Methods: Data were collected from 2,401 African Americans, 3,222 Hispanics, and 7,980 whites who were admitted to 43 drug treatment programs across California from 2000 to 2001. The Addiction Severity Index (ASI) was administered at intake to assess clients' problem severity in a number of domains (alcohol use, drug use, employment, family and social relationships, legal, medical, and psychological), and treatment retention and arrest data were obtained from administrative records. A subsample was followed up at three months to assess service utilization (N=2,145) and again at nine months to readminister the ASI (N=2,566). Results: All three groups had similar severity levels of drug and legal problems upon treatment entry. Upon entry to treatment, white clients had the highest severity levels of alcohol, family, and psychiatric problems and African Americans had the highest severity levels of employment problems compared with the other two groups. Treatment retention did not differ between the three groups, but whites received a greater number of alcohol treatment services than did African Americans or Hispanics, and African Americans received a greater number of employment services than did Hispanic and white clients. All three groups showed significant improvement in all outcome domains except for medical outcomes. At the nine-month follow-up, whites had worse outcomes in the alcohol domain compared with the other two groups, and whites had worse outcomes in the legal domain compared with Hispanics. Compared with whites, African Americans were significantly less likely to be charged with driving under the influence in the year after treatment admission. Conclusions: All three groups improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of the psychosocial problems of each racial and ethnic group. Copyright 2009, American Psychiatric Association
North CS. A tale of two studies of two disasters: Comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees. Rehabilitation Psychology 55(3): 241-246, 2010. (34 refs.)An accumulation of disaster mental health research literature in the last few decades has contributed knowledge to direct disaster mental health interventions. However, no single set of principles can necessarily outline all anticipated mental health needs to be encountered in a particular disaster. Methods: To illustrate how different disaster scenarios may yield a divergence of mental health needs, this article compares mental health findings from two distinctly different studies of two very different populations affected by two very different disasters: directly exposed survivors the Oklahoma City bombing and sheltered evacuees from Hurricane Katrina. Results: Research on the two disasters reviewed illustrates many facets and complexities of postdisaster mental health needs in different populations in different settings after different types of disasters. The major findings of the Oklahoma City bombing study related to posttraumatic stress disorder and the main findings of the Hurricane Katrina study involved need for treatment of preexisting chronic mental health and substance abuse problems. Conclusion: The disaster studies in this review diverged in type of disaster, affected populations, setting, and timing of the study, and these studies yielded a divergence of findings. One disaster mental health model clearly cannot adequately describe all postdisaster scenarios. Copyright 2010, Educational Publishing Foundation
Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use Disorders in Substate Regions. (August 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (9 refs.)Substance use disorders (substance dependence or abuse) have a tremendous impact on the lives of our citizens, imposing burdens on individuals, families, communities, and governments. Nevertheless, substance use disorders are not distributed equally across all States,1 and within each State there are different patterns of substance use problems in different regions. Data on small geographic areas provide insight into the nature and scope of substance use problems and help State and local public health authorities to better understand and effectively address the needs in their communities. The National Survey on Drug Use and Health (NSDUH) can help address the need for more localized information. This issue of The NSDUH Report highlights substate estimates of alcohol and illicit drug use disorders and presents information on 21 key measures of substance abuse and mental health. Data were extracted from a larger report titled Substate Estimates from the 2006-2008 National Surveys on Drug Use and Health. In brief, data collected from more than 200,000 people between 2006 and 2008 show that substance use disorders vary extensively among regions within each State and throughout the country. Past year alcohol use disorders ranged from 4.8% in a substate region in southern Pennsylvania to 14.6% in a region in the District of Columbia. Past year illicit drug use disorders ranged from 1.5 percent in 2 substate regions in southern Pennsylvania to 6.7 percent in a region in the District of Columbia. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use and Treatment Need among Women Employed Full Time. (July 22, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (8 refs.)The recent economic downturn has focused attention on the increasing importance of women as wage earners. With men losing 7 of every 10 jobs lost, more families are relying on the jobs of women for economic support. Women currently make up nearly half of the U.S. labor force, and many represent the primary or sole breadwinner in their families. This issue of The NSDUH Report examines substance use and treatment need among women employed full time in the week prior to the interview. Women who indicated that they usually worked 35 hours or more per week are categorized as full-time employees. All findings are annual averages from combined 2004 to 2008 NSDUH data. In brief, combined data from 2004 to 2008 indicate that 19.8% of women aged 18 to 64 who were employed full time engaged in binge alcohol use and 6.4% used illicit drugs in the past month; this translates into 9.9 million binging on alcohol and 3.2 million using illicit drugs. Among women employed full time, the rates of past month binge alcohol use and illicit drug use decreased with age; for example, 37.3% of women aged 18 to 25 reported past month binge alcohol use compared with 25.9% of those aged 26 to 34, 18.1% of those aged 35 to 49, and 9.3 percent of those aged 50 to 64. About 3.6 million women employed full time (7.2 percent) were classified as being in need of treatment for an alcohol or drug use problem in the past year; of those, only 5.8% received treatment at a specialty facility. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among American Indian or Alaska Native Adults. (June 24, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (9 refs.)Over the past several decades, the population of the United States has become increasingly diverse. Gaining a better understanding of the behavioral health needs of particular racial/ethnic groups can help inform public health policy, build prevention and treatment programs that target the different needs of these populations, and expand access to services for individuals who need them. This report uses data from the National Survey on Drug Use and Health (NSDUH) to examine substance use and treatment need among single-race American Indian or Alaska Native adults aged 18 or older. [Other reports in this series will examine similar issues among other racial/ethnic groups.] According to the U.S. Census Bureau, 2 million people�1.0 percent of the total population in 2008�identify themselves as non-Hispanic American Indian or Alaska Native adults of one race. This report is based on NSDUH data from 2004 to 2008. In brief, the rate of past month alcohol use was lower among American Indian or Alaska Native adults than the national average for adults (43.9 vs. 55.2%); the rates of past month binge alcohol use and illicit drug use, however, were higher among American Indian or Alaska Native adults than the national averages (30.6 vs. 24.5% and 11.2 vs. 7.9%, respectively). The percentage of American Indian or Alaska Native adults who needed treatment for an alcohol or illicit drug use problem in the past year was higher than the national average for adults (18.0 vs. 9.6%). One in eight (12.6%) American Indian or Alaska Native adults in need of alcohol or illicit drug use treatment in the past year received treatment at a specialty facility; this rate did not differ significantly from the national average of 10.4 percent Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Young Adults' Need for and Receipt of Alcohol and Illicit Drug Use Treatment: 2007. (June 25, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (5 refs.)Young adults compose the majority of the college and university populations and are the backbone of the entry-level workforce. Also, young adults traditionally have had higher rates of alcohol and illicit drug use compared with other age groups. This issue of "The NSDUH Report" focuses on the alcohol and illicit drug use treatment needs of young adults (i.e., persons aged 18 to 25) and on the difference between the number who need treatment and those who actually receive it. About one fifth of young adults aged 18 to 25 (21.1%) were classified as needing treatment for alcohol or illicit drug use; 17.2% were in need of alcohol use treatment, 8.4% were in need of illicit drug use treatment, and 4.4 percent were in need of both alcohol and illicit drug use treatment. Less than one tenth (7.0%) of the young adults who were in need of alcohol or illicit drug use treatment in the past year received it at a specialty facility in the past year. Of the young adults who needed but did not receive alcohol or illicit drug use treatment in a specialty facility in the past year, 96.0% did not perceive the need. Less than one third of the young adults who did not receive treatment in a specialty facility but thought they needed it made an attempt to obtain it Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Substance Use Treatment Need and Receipt among Hispanics. (July 16, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (4 refs.)Hispanics comprise the largest minority group in the United States. They represent an estimated 13% of the U.S. population. Combing date from 2002 to 2007 indicates that on average 8.3% (2.6 million) of Hispanics aged 12 or older were in need of alcohol use treatment in the past year, and 3.4 percent (1.1 million) were in need of illicit drug use treatment. Among Hispanics, the prevalence of need for alcohol use treatment was highest among Mexicans (9.2%), and the prevalence of need for illicit drug use treatment was highest among Puerto Ricans (6.1%). Among Hispanics in need of alcohol use treatment in the past year, 7.7% received alcohol treatment in a specialty facility, and 15.1% of those in need of illicit drug use treatment received illicit drug treatment in a specialty facility. The need for alcohol use treatment and illicit drug use treatment, as well as the receipt of illicit drug use treatment among those needing it, were more likely among Hispanics born in the United States than among those not born in the United States. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. Results from the 2008 National Survey on Drug Use and Health: National Findings. NSDUH Series H-36. Rockville MD: Substance Abuse and Mental Health Administration, 2009. (104 refs.)Highlights: This report presents the first information from the 2008 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco for those aged 12 years and older. Information is provided on different classes of substances, the inititiation of use, prevention efforts, and involvement or need for treatment. In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users, a rate of 8.0% of the population. Marijuana was the most commonly used illicit drug (15.2 million past month users), a rate of 6.1%, similar to 2007. Of note, for those using pain relievers nonmedically, the majority (55.9%) got the drug they most recently used from a friend or relative for free, who had gotten it from a single doctor. Another 18.0% got the drug from one doctor. Only 4.3% got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.7% reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor. In terms of alcohol use, slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6%), similar to the prior year. More than one fifth (23.3%) reported binge drinking, for those aged 18 to 25 in 2008, the rate of binge drinking was 41.0%. In 2008, 28.4% used tobacco, with a decline in the proportion of users in the 12-17 age group. Data is presented in 76 tables and 70 figures. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. The TEDS Report: Differences in Substance Abuse Treatment Admissions between Mexican-American Males and Females. (May 5, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (5 refs.)As the proportion of racial/ethnic minority groups within the United States continues to increase, it is important that public health professionals understand the specific characteristics and substance abuse behaviors of these populations. Hispanics not only account for almost 15% of the nation's population, but also comprise 15% of all substance abuse treatment admissions. Of particular interest are Hispanics of Mexican origin, who represent the majority (64.0%) of the nation's Hispanic population. Using data from TEDS for 2007, this report focuses on Hispanic substance abuse treatment admissions of Mexican origin (hereafter referred to as "Mexican") and highlights gender differences within this population. Among Mexican admissions, males reported alcohol as their primary substance of abuse more often than other substances, and females most commonly reported methamphetamine. The majority of Mexican admissions reported that they first used their primary substance of abuse before the age of 18 (60.7% for males and 56.1% for females); overall, 7.4% reported using their first substance before the age of 12. About three quarters of Mexican admissions had no health insurance (78.8% for males and 71.5% for females), a substantially higher proportion than non-Mexican admissions (62.6% for males and 50.9% for females). Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. The TEDS Report: Gender Differences among Older Black Admissions to Treatment. (August 12, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (7 refs.)Because the U.S. population aged 50 or older continues to increase, and the proportion of racial/ethnic minority groups is also increasing. Non-Hispanic Blacks aged 50 or older are of particular interest. Blacks are the second largest racial/ethnic minority group in the United States. Although they comprise approximately 12.2 percent of the total population, this group represented more than one fifth (20.7%) of substance abuse treatment admissions with known race/ethnicity in publicly funded treatment programs in 2007. Older Blacks accounted for 15.7% of all Black admissions to treatment in 2007. It is estimated that Blacks aged 50 or older will account for more than one quarter of the total Black population by 2020. This report focuses on non-Hispanic Black substance abuse treatment admissions that were aged 50 or older termed "older Black admissions") and highlights gender differences within this population. Of the approximately 58,800 older Black admissions in 2007, about 45,500 were male and 13,300 were female. Among older Black substance abuse treatment admissions, males were more likely than females to have reported any abuse of alcohol (64.3 vs. 52.2%); however, females were more likely than males to have reported any abuse of smoked cocaine (50.5 vs. 42.4%) or heroin (34.7 vs. 29.6%). Nearly three fifths (59.6%) of older Black male admissions and close to half (48.3%) of older Black female admissions did not have health insurance. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Services Administration. May 27, 2010
Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Substance Use among American Indian or Alaska Native Adults. (June 24, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (9 refs.)The rate of past month alcohol use was lower among American Indian or Alaska Native adults than the national average for adults (43.9 vs. 55.2 percent); the rates of past month binge alcohol use and illicit drug use, however, were higher among American Indian or Alaska Native adults than the national averages (30.6 vs. 24.5 percent and 11.2 vs. 7.9 percent, respectively). The percentage of American Indian or Alaska Native adults who needed treatment for an alcohol or illicit drug use problem in the past year was higher than the national average for adults (18.0 vs. 9.6 percent). One in eight (12.6 percent) American Indian or Alaska Native adults in need of alcohol or illicit drug use treatment in the past year received treatment at a specialty facility; this rate did not differ significantly from the national average of 10.4 percent. Public Domain
Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Substance Use among Asian Adults. (May 20, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (10 refs.)Rates of past month alcohol use, binge alcohol use, and illicit drug use were lower among Asian adults than the national averages (39.8 vs. 55.2 percent, 13.2 vs. 24.5 percent, and 3.4 vs. 7.9 percent, respectively). Among Asian adults, substance use varied greatly among Asian subgroups; past month binge alcohol use, for example, ranged from a high of 25.9 percent among Korean adults to a low of 8.4 percent among Chinese adults. Among Asian adults, those who were born in the United States generally had higher rates of past month substance use than those who were not born in the United States, regardless of age. The percentage who needed treatment for a substance use problem in the past year was lower among Asian adults than for the national average of adults (4.8 vs. 9.6 percent) Public Domain
Ozechowski TJ; Waldron HB. Assertive outreach strategies for narrowing the adolescent substance abuse treatment gap: Implications for research, practice, and policy. (review). Journal of Behavioral Health Services & Research 37(1): 40-63, 2010. (206 refs.)In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse will have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered. Copyright 2010, Springer
Pecora PJ. Why current and former recipients of foster care need high quality mental health services. Administration and Policy in Mental Health and Mental Health Services Research 37(1-2, special issue): 185-190, 2010. (36 refs.)This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care ("alumni") in the United States to underscore the reasons why high quality mental health services are essential. Copyright 2010, Springer
Pinxten WJL; De Jong C; Hidayat T; Istiqomah AN; Achmad YM; Raya RP et al. Developing a competence-based addiction medicine curriculum in Indonesia: The training needs assessment. Substance Abuse 32(2, special issue): 101- 107, 2011. (23 refs.)Indonesia has one of the fastest growing, injecting drugs user-driven, human immunodeficiency virus (HIV) epidemics in Asia. Coverage of needle and syringe programs (NSPs), opioid substitution therapy (OST), and antiretroviral treatment (ART) is increasing, but is still low, whereas professional training in addiction medicine is not yet established. Urgent development and scaling-up of professional capacity in comprehensive, evidence-based addiction medicine is needed. In this article the results of the first step is presented, being the training needs assessment (TNA) and the process of further developing a national evidence- and competence-based addiction medicine curriculum in Indonesia. Copyright 2011, Taylor & Francis
Room R; Rehm J; Parry C. Alcohol and non-communicable diseases (NCDs): Time for a serious international public health effort. (commentary). Addiction 106(9): 1547-1548, 2011. (16 refs.)
Rothrauff TC; Abraham AJ; Bride BE; Roman PM. Substance abuse treatment for older adults in private centers. Substance Abuse 32(1): 7-15, 2011. (20 refs.)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. Copyright 2011, Taylor & Francis
Santos GM; Das M; Colfax GN. Interventions for non-injection substance use among US men who have sex with men: What is needed? AIDS and Behavior 15(supplement 1): s51-s56, 2011. (94 refs.)Men who have sex with men (MSM) remain disproportionately infected with HIV. MSM accounted for 53% of the 56,300 new HIV infections in the US in 2006, despite representing only 4% of the national male population. The recently released United States National HIV/AIDS strategy highlights the need to address substance use among MSM as a critical component of reducing HIV incidence in the United States. Non-injection substance use may increase susceptibility to HIV infection in multiple ways. Many epidemiological studies document the association between these substances and sexual risk behaviors. These sexual risks are paralleled by high rates of incident and prevalent HIV cases and sexually transmitted infections among SUMSM. Most notably, methamphetamine, cocaine, poppers, and alcohol use have each been associated with an increased risk for HIV and other STD infections. The contribution of polysubstance use may also be considerable. This article addresses patterns of substance use among MSM. Current interventions are described, including those delivered in and outside of drug treatment settings, other health needs, as well as factors which impede the creation and delivery of essential services. Copyright 2011, Springer/Plenum Publishers
Shamblen SR; Dwivedi P. Is some data better than no data at all? Evaluating the utility of secondary needs assessment data. Drugs: Education, Prevention and Policy 17(6): 835-852, 2010. (26 refs.)Needs assessments in substance abuse prevention often rely on secondary data measures of consumption and consequences to determine what population subgroup and geographic areas should receive a portion of limited resources. Although these secondary data measures have some benefits (e.g. large sample sizes, lack of survey response biases and cost), statistical tests on these data may not actually answer our underlying research questions. The present study sought to examine the reliability and validity of a set of alcohol consumption and consequence proxy measures as predictors of actual criterion data on youth alcohol use collected using a sampling design. The results of this study suggest that measures of more excessive alcohol use or problem behaviour occurrence are more likely to be related to criterion measures of youth alcohol use, as these secondary data tend to be more time invariant. Furthermore, the measures of less-excessive alcohol use or problem behaviour occurrence, while more normally distributed, tend to be more time variant and will typically lead policy makers to incorrect needs assessment allocation decisions. These findings suggest that policy makers should focus on secondary data measures that reflect extreme alcohol use problems, such that geographic areas that are most in need of help receive limited resources. Copyright 2010, Taylor & Francis
Stillman FA. Capacity building and human resource development for tobacco control in Latin America. Salud Publica de Mexico 52(Supplement 2): S340-S346, 2010. (13 refs.)Objective. To assess capacity and human resources in Latin America countries and compare with other countries. Material and Methods. Data were gathered through needs assessments that were conducted at the 2009 World Conference on Tobacco or Health, and the 2(nd) Society for Research on Nicotine and Tobacco-International American Heart Foundation, Latin America Tobacco Control Conference held in Mexico City in 2009. Results. In comparing Latin America respondents to respondents from other countries, we found that the average number of years in tobacco control was higher and the majority of respondents reported higher levels of educational attainment. Respondents reported lack of funding and other resources as their number one challenge, as well as, tobacco industry interference and lack of political will to implement tobacco control policies. Conclusions. In Latin America there are some countries that have made significant progress in building their capacity and human resources to address their tobacco epidemics, but much still needs to be done. Copyright 2010, Institut Nacional Salud Publica
Terplan M; Smith EJ; Kozloski MJ; Pollack HA. Methamphetamine use among pregnant women. Obstetrics and Gynecology 113(6): 1285-1291, 2009. (35 refs.)OBJECTIVE: To estimate trends in the prevalence of methamphetamine treatment during pregnancy in the United States. METHODS: Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among women admitted for methamphetamine use and stratified by year of admission to assess trends over time. RESULTS: From 1994 to 2006 there were 245,970 pregnant women admitted. In 1994, methamphetamine accounted for 8% of admitted pregnant women, rising to 24% by 2006. This proportion was higher than methamphetamine admissions among both nonpregnant women (12%) and men (7%). The majority of methamphetamine admissions occurred in the West (73%) among white (64%) unemployed (88%) women. Over the time of analysis, women admitted for methamphetamine treatment became sicker (measured by increasing co-occurring psychiatric disorders) and more marginalized (measured by increasing dependent-living situations and criminal justice involvement). CONCLUSION: Methamphetamine has become the primary substance compelling treatment during pregnancy. Our findings suggest a need for more effective drug and alcohol screening by clinicians who are positioned to identify and address such concerns outside the criminal justice system. Copyright 2009, Lippincott, Williams & Wilkins
Todd CS; Stibich MA; Stanekzai MR; Rasuli MZ; Bayan S; Wardak SR et al. A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006-2007. International Journal of Drug Policy 20(2): 111-120, 2009. (21 refs.)Background: The purpose of this paper was to examine the context of injection drug use in Kabul, Afghanistan among injection drug users (IDUs) utilising and not utilising needle and syringe programmes (NSPs). Methods: Following identification of themes from eight focus group discussions, free-lists were used for further exploration with both NSP using (n = 30) and non-NSP using (n = 31) IDUs. Results All participants were male, had been injecting for 5 years (mean), and most (95%) had been refugees in the past decade. Main reasons for sharing syringes were convenience and lack of availability and did not vary based on NSP use, Drug users perceived alienation from the community, evidenced by names used for drug users by the community which convey social stigma and moral judgment. Health risks were the principal stated risk associated with drug use, which was mentioned more frequently by NSP users. Harm reduction services available in Kabul are perceived to be insufficient for those in need of services, resulting in under utilisation. The limited scope and distribution of services was frequently cited both as an area for improvement among NSP using IDU or as a reason not to use existing programmes. Conclusions: While some positive differences emerged among NSP-using IDU, the current context indicates that both rapid scale-up and increased variety of services, particularly in the realm of addiction treatment, are urgently needed in this setting. Copyright 2009, Elsevier Science
Tucker JS; Wenzel SL; Golinelli D; Zhou A; Green HD. Predictors of substance abuse treatment need and receipt among homeless women. Journal of Substance Abuse Treatment 40(3): 287-294, 2011. (50 refs.)Many homeless women do not receive needed treatment for substance abuse. This study identified social network and other predisposing factors associated with perceived need for and receipt of substance abuse treatment among 273 homeless women who screened positive for past-year substance abuse. Perceived treatment need was more likely among women with drug-using sex partners, a denser network, and an arrest history but less likely for those with a minor child and a longer history of homelessness. Receiving treatment was more likely among women who received informational support from their sex partners and who had an arrest history but less likely among those who had a more street-based social network, had a minor child, considered themselves homeless, and recently needed mental health treatment. Treatment services researchers should attend more closely to social contextual factors, as well as the more traditional individual factors, to understand access and barriers to treatment. Copyright 2011, Elsevier Science
VanDerNagel J; Kiewik M; Buitelaar J; DeJong C. Staff perspectives of substance use and misuse among adults with intellectual disabilities enrolled in Dutch disability services. Journal of Policy and Practice in Intellectual Disabilities 8(3): 143-149, 2011. (15 refs.)Although the use of psychoactive substances seems to be a growing problem among clients of intellectual disability services (IDS) in the Netherlands, rates of such substance use are unknown, and it is unclear how the services deal with substance-related problems. This study explored the perspectives of staff with respect to the occurrence of substance use and abuse, as well as users' profiles, and service organization policies regarding substance use. A semi-structured questionnaire asked staff to comment on lifetime, current, and problematic substance use among their clients, provide illustrative case reports, and describe policies within their service regarding substance-related problems. Data from 39 IDS were included. Estimations of occurrence of substance use varied greatly across services. Alcohol was reported to be used most often but at lower rates than reported in the general population. Cannabis and other drugs were reported to be used relatively often when compared with the rates noted in the general population. Case reports on 86 substance users were analyzed, and subgroups of users were identified, including younger clients who used both cannabis and alcohol, and older clients with mild ID who used only alcohol. Psychiatric comorbidity and lack of daytime activities were highly prevalent among users. Of the interventions the services reported using to address abuse, psychosocial and restrictive measures were rated as most effective and collaboration with addiction facilities and rewarding abstinence as least effective. Most services reported to have inadequate expertise with substance use. According to respondents, users with both borderline and mild ID used substances, but there were different patterns of use across age groups and level of ID. Respondents noted that substance users face a number of psychosocial problems but that they were poorly equipped to meet the users' needs and to affect functional policies. The authors concluded that the low effectiveness of mainstream addiction treatment or consultation suggests that there is a need for more cross-system collaboration to address this problem. Copyright 2011, Wiley-Blackwell
Wechsberg WM; Wu LT; Zule WA; Parry CD; Browne FA; Luseno WK et al. Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa. Substance Abuse Treatment, Prevention and Policy 4: e-article 11, 2009. (29 refs.)Background: This study examined cross-sectional data collected from substance-using female sex workers (FSW) and non-sex workers (non-SW) in Pretoria, South Africa, who entered a randomized controlled trial. Methods: Women who reported alcohol use and recently engaging in sex work or unprotected sex were recruited for a randomized study. The study sample (N = 506) comprised 335 FSW and 171 female non-SW from Pretoria and surrounding areas. Self-reported data about alcohol and other drug use as well as treatment needs and access were collected from participants before they entered a brief intervention. Results: As compared with female non-SW, FSW were found to have a greater likelihood of having a past year diagnosis of alcohol or other drug abuse or dependence, having a family member with a history of alcohol or other drug abuse, having been physically abused, having used alcohol before age 18, and having a history of marijuana use. In addition, the FSW were more likely to perceive that they had alcohol or other drug problems, and that they had a need for treatment and a desire to go for treatment. Less than 20% of participants in either group had any awareness of alcohol and drug treatment programs, with only 3% of the FSW and 2% of the non-SW reporting that they tried but were unable to enter treatment in the past year. Conclusion: FSW need and want substance abuse treatment services but they often have difficulty accessing services. The study findings suggest that barriers within the South African treatment system need to be addressed to facilitate access for substance-using FSW. Ongoing research is needed to inform policy change that fosters widespread educational efforts and sustainable, accessible, woman-sensitive services to ultimately break the cycle for current and future generations of at-risk South African women. Copyright 2009, BioMed Central
Wittchen HU; Behrendt S; Hoefler M; Perkonigg A; Rehm J; Lieb R et al. A typology of cannabis-related problems among individuals with repeated illegal drug use in the first three decades of life: Evidence for heterogeneity and different treatment needs. Drug and Alcohol Dependence 102(1/3): 151-157, 2009. (63 refs.)Background: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and Young adults. We aim to identify clinically meaningful latent classes of Users of cannabis and other illegal substances with distinct problem profiles. Methods: N=3021 community subjects aged 14-24 at baseline were followed-up over a period ranging Lip to 10 years. Substance Use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N = 1089 Subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders. Results: Four latent classes were identified: "Unproblematic CU" (class 1: 59.2%), "Primary alcohol use disorders" (class 2: 14.4%), "Delinquent cannabis/alcohol DSM-IV-abuse" (class 3: 17.9%), "CUD with multiple problems" (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2-4. Conclusion: While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders. Copyright 2009, Elsevier Science
Xiang YT; Ma X; Lu JY; Cai ZJ; Li SR; Xiang Y et al. Alcohol-related disorders in Beijing, China: Prevalence, socio-demographic correlates, and unmet need for treatment. Alcoholism: Clinical and Experimental Research 33(6): 1111-1118, 2009. (37 refs.)The study aimed to determine the prevalence of alcohol use, episodic heavy drinking, and alcohol dependence and their socio-demographic correlates in Beijing, China. A total of 5,926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview (CIDI 1.0). Data on basic socio-demographic and current major medical conditions were also collected. The 12-month prevalence of alcohol use and episodic heavy drinking were 32.5 and 13.8%, respectively. The 12-month and lifetime prevalence of alcohol dependence were 1.7 and 4.3%, respectively. Age above 24 years, male sex, being married and employed, low education level (junior high school, primary school or illiterate), rural residence, and having comorbid psychiatric disorders were all significantly associated with a higher likelihood of alcohol-related disorders. Only 2.4% of the subjects with alcohol dependence were receiving treatment, and a mere 1.4% had sought treatment from mental health professionals. Nationwide surveys are urgently needed to further explore the prevalence of alcohol-related disorders in China. Copyright 2009, Research Society on Alcoholism
Young DW; Farrell JL; Henderson CE; Taxman FS. Filling service gaps: Providing intensive treatment services for offenders. Drug and Alcohol Dependence 103(Supplement 1): S33-S42, 2009. (61 refs.)Consistent with the few studies that have previously examined treatment prevalence and access in the adult and juvenile justice systems, the recent National Criminal Justice Treatment Practices (NCJTP) survey indicated that there is a particular need to expand intensive treatment modalities for offenders in both institutional and community corrections settings. Applying multilevel modeling techniques to NCJTP Survey data, this study explores conditions and factors that may underlie the wide variation among states in the provision of intensive treatment for offenders. Results indicate that states' overall rates of substance abuse and dependence, funding resources, and the state governor's political party affiliation were significantly associated with intensive treatment provision. Numerous factors that have been implicated in recent Studies of evidence-based practice adoption, including state agency executives' views regarding rehabilitation, agency Culture and climate, and other state-level measures (e.g., household income, crime rates, expenditures on treatment for the general population) were not associated with treatment provision. Future research should examine further variations in offenders' service needs, the role of legislators' political affiliations, and how other factors may interact with administrator characteristics in the adoption and expansion of intensive treatment services for offenders. Copyright 2009, Elsevier Science
The NSDUH Report: Substance Use among Hispanic Adults. (May 27, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (10 refs.)Over the past several decades, the population of the United States has become increasingly diverse. About one third of the population belongs to a racial/ethnic minority group; this percentage is projected to increase to 54 percent by 2050. As the country becomes more diverse, it becomes increasingly important to address health and health care disparities related to race/ethnicity, as well as age and gender, socioeconomic status, geography, and disability. One area of concern is assessing substance use and abuse and ensuring access to substance abuse treatment and how this impacts people in all racial/ethnic groups. This report uses data from the National Survey on Drug Use and Health (NSDUH) to examine substance use and treatment need among Hispanic adults aged 18 or older. Other reports in this series will examine similar issues among Hispanic adolescents and among adults and adolescents in other racial/ethnic groups. According to the U.S. Census Bureau, 47 million people-15.4% of the total U.S. resident population in 2008-identify themselves as Hispanic. This report is based on NSDUH data from 2004 to 2008. Among the findings are that rates of past month alcohol use and illicit drug use were lower among Hispanic adults than the national averages for adults (46.1 vs. 55.2% and 6.6 vs. 7.9%. However, past month binge alcohol use was higher among Hispanics than the national average (26.3 vs. 24.5%). Among Hispanic adults, substance use varied greatly by subgroup; past month illicit drug use, for example, ranged from a high of 13.1% among adults of Spanish origin to a low of 3.9% among those of Dominican origin. Hispanic adults born in the United States had higher rates of past month substance use than Hispanic adults not born in the United States, regardless of age Among Hispanics who needed treatment for an alcohol or illicit drug problem, the percentage who received such treatment did not differ significantly from the national average. Public Domain
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