powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Treatment Programs

94 citations. July 2002 to present

Prepared: June 2003

Alexandre PK; Salome HJ; French MT; Rivers JE; McCoy CB. Consequences and costs of closing a publicly funded methadone maintenance clinic. Social Science Quarterly 83(2): 519-536, 2002. (48 refs.)

Objective. Local government officials closed the Central Methadone Clinic (CMT) in Miami, Florida on May 31, 1997. This study examined the economic consequences and related costs of closing this long- established substance abuse treatment program. Methods. Economic consequences were determined through a comparative analysis of patient status at baseline and one year following treatment cessation for Miami clients, relative to a comparison group in Jacksonville, Florida that had continued access to a publicly funded methadone treatment clinic. Outcome measures included health-care utilization, addiction treatment, employment income, and crime. Bivariate and multivariate analyses were conducted to estimate differences in consequences and related costs. Results. Total cost as well as the cost for each Category (except for addiction treatment) were statistically similar for both groups. Conclusions. Clients at the CMT did not generate significant economic consequences/costs for taxpayers or society in general during the year following closure relative to clients at a comparison clinic.

Arminen I; Perala R. Multiprofessional team work in 12-step treatment: Constructing substance abusers to alcoholics. Nordic Studies on Alcohol and Drugs 19: 18-32, 2002. (33 refs.)

This article is concerned with the way that a 12-step treatment program construes an image of its clients and their substance abuse problems. The main focus is on how the basic assumptions of the treatment program are reproduced and maintained at the weekly meetings of the multiprofessional team running the program. The article offers a behind-the-scenes look at the 12-step treatment program: in particular the authors are interested in the ways that the staff process and use the background information available on the clients admitted. Based originally on the AA recovery program, the 12-step treatment program draws on the disease concept of alcoholism. One of the main observations is that this disease concept is conducive to selective and purposive working methods in the program. Information on the patients' background or their test results are systematically so interpreted that the outcome confirms the view that the clients are indeed alcoholics who can only be treated by methods that are consistent with the program ideology. Strict normative expectations are placed upon clients in the program, and any sign of deviation will be interpreted as resistance and reluctance on the part of substance abusers to deal with their own alcohol problems. In this way the program itself may produce resistance among clients and the staff may easily elicit the resistance and denial that they regard as symptoms of alcoholism. A key focus in the article is on the interactive techniques and tactics applied in the program.

Asche SE; Harrison PA. The relationship between problem severity and ancillary treatment services: Is substance abuse treatment responsive to client need? Journal of Behavioral Health Services & Research 29(3): 345-356, 2002. (19 refs.)

This study examined whether a greater self-reported problem severity at intake is associated with a greater likelihood of receiving related ancillary treatment services. The sample of 3,625 adult substance abuse treatment completers represents 162 outpatient and 41 short-term inpatient/residential programs located throughout Minnesota. Problem severity and receipt of ancillary services were assessed in medical, psychological, family/social, employment, financial, and legal domains. Across treatment setting and client gender, individuals with higher problem severity were significantly more likely to receive related ancillary services in the areas of medical services, psychotropic medication, family/relationship counseling, financial services, and legal services. For other services, the positive association between problem severity and receipt of related ancillary services held for some but not all groups defined by treatment setting or gender. Despite consistent relationships between service need and receipt, large gaps remain with respect to programs' responsiveness to client needs.

Babor TF. Scribbling in the margins: Comments on Humphreys & Tucker. (editorial). Addiction 97(2): 137-138, 2002. (1 refs.)

Beauvais F; Jumper-Thurman P; Plested B; Helm H. A survey of attitudes among drug user treatment providers toward the treatment of inhalant users. Substance Use & Misuse 37(11): 1391-1410, 2002. (18 refs.)

This study assessed the attitudes of drug user treatment program directors towards the problem of inhalant "abuse". In 2000, surveys were mailed to directors asking about treatment success and prognosis for inhalant users, level of neurological damage incurred by users, availability of treatment resources, their program's policies toward admission of users, and staff training needs for inhalant use. Two open-ended questions queried their assessment of barriers to treatment and subjective feelings about the topic of inhalant use. Five hundred and fifty responses were received. Findings show that program directors perceive a great deal of neurological damage incurred through inhalant use and have a general pessimism about treatment effectiveness and recovery. The respondents also felt that there were insufficient resources for inhalant user treatment and that special staff training in the area was needed. The majority of the directors indicated that they have or would treat inhalant users. Implications for future research and policy change are discussed.

Bowman JA; Walsh RA. Smoking intervention within alcohol and other drug treatment services: a selective review with suggestions for practical management. (review). Drug and Alcohol Review 22(1): 73-82, 2003. (59 refs.)

This selective review was undertaken in order to highlight the need for alcohol and other drug treatment services to provide intervention for tobacco smoking to their clients. The reasons for the failure of treatment services to date to deal with nicotine addiction within their programmes are discussed and positive suggestions for change are proffered. In addition to the transformation of institutional culture which will be required, managers and staff of alcohol and other drug agencies need to know how best to implement smoking intervention within the treatment setting. The paper concludes with some practical suggestions for the management of intervention for tobacco smoking within treatment settings. These suggestions include: making decisions and formulating policies and procedures with regard to how tobacco smoking will be addressed; considering the particular physical, psychological and social/environmental factors that apply to substance abuse clients; building intervention around a simple structure such as the '5 A's'; encouraging and facilitating the use of nicotine replacement therapies; and allowing flexibility to tailor intervention to the individual. A great deal of further research is required to inform us as to how to intervene most effectively for tobacco smoking among this population group.

Brems C; Johnson ME; Namyniuk LL. Clients with substance abuse and mental health concerns: A guide for conducting intake interviews. Journal of Behavioral Health Services & Research 29(3): 327-334, 2002. (32 refs.)

Although comorbidity (co-occurrence of a psychiatric and substance use disorder) is a common phenomenon at both mental health and substance abuse treatment agencies, rarely do such agencies thoroughly assess for both types of diagnoses during their standard intake interview. This article describes the development of an intake from designed to guide a comprehensive assessment of both mental health and substance abuse concerns. The form guides intake interviewers toward documenting administrative and demographic information, substance use and mental health concerns, and variables needed for compliance with grant funding sources. Use of the protocol can provide a clinical foundation for treatment planning and continuity of care for clients, while also providing error-free agency data that can be used for administrative, program planning, outcome assessment, and research purposes.

Brochu S; Bergeron J; Landry M; Germain M; Schneeberger P. Impact of treatment on criminalized substance addicts. Journal of Addictive Diseases 21(3): 23-41, 2002. (39 refs.)

The objective of this research is to evaluate the impact of a treatment program specialized with criminalized addicts. In all, 119 criminalized addicts were admitted to the experimental procedure (specialized treatment) while 30 were admitted to a comparison group (general treatment). Both groups were contacted at five, eight, and eleven month intervals following the onset of the treatment process. Results showed that both groups improved. Those admitted to the unspecialized treatment improved earlier (in the first five months) than clients referred to the specialized treatment facility, however, after eight months, the improvement was similar for both groups.

Broekaert E; Vandevelde S; Vanderplasschen W; Soyez V; Poppe A. Two decades of "research-practice'' encounters in the development of European therapeutic communities for substance abusers. Nordic Journal of Psychiatry 56(5): 371-377, 2002. (26 refs.)

In 1981, a "research-practice'' breakthrough was realized through the foundation of the European Federation of Therapeutic Communities (EFTC). Since its foundation EFTC regularly organized conferences and symposia. A few years later (in 1983), the European Workshop On Drug policy Oriented Research (EWODOR) was established at the Erasmus University in Rotterdam, including a special section devoted to the therapeutic community (TC). The authors examined the proceedings of all meetings organized by EFTC and EWODOR. The major topics presented throughout the last 20 years are highlighted in a chronological selection and these presentations largely focus on the challenges of the TC and the state of the art regarding scientific knowledge. In this overview only those authors who published articles in scientific journals indexed in the "Web of Science'' (Institute for Scientific Information-ISI) were retained. Although research has never been the primary consideration in TCs, it played a far from negligible role in its development. Research findings prompted innovations and thus often provoked resistance, but on the other hand they functioned as a catalyst between the necessity of a belief system and the reality of society. The role of "grey'' literature and the availability of information through the Internet will become more and more important in the communication between researchers and practitioners.

Brown ND. Value and usefulness of a collaborative information sharing forum: Findings from the "Common Ground" Conference evaluation activities. Journal of Drug Issues 32(3): 849-863, 2002. (4 refs.)

To determine the value, usefulness, and impact of the "Common Ground, Common Language, Common Goals (CCC): Bringing Substance Abuse Practice and Research Together" conference, which was held April 2001 in Los Angeles, participants were surveyed regarding the effectiveness of the conference overall, the impact of the conference on attendees' collaborative behaviors, and the quality of the roundtable discussion sessions and other activities. Attendees of the two-day conference included substance abuse treatment providers, researchers, policy makers, and community representatives/activists. Based on evaluation findings, participants felt the event provided an appropriate venue for taking the first steps in establishing multidirectional lines of communication and candid knowledge exchange between these diverse stakeholders.

Burdon WM; Farabee D; Prendergast ML; Messina NP; Cartier J. Prison-based therapeutic community substance abuse programs: Implementation and operational issues. Federal Probation 66(3): 3+, 2002. (45 refs.)

Since prison-based TCs first appeared in the 1980s, numerous evaluations have been conducted at both the state and federal levels that have provided empirical support for the effectiveness of these programs in reducing recidivism and relapse to drug use, especially when combined with continuity of care in the community following release to parole. Other studies have focused on the so-called "black box" of treatment (i.e., the treatment process) in an effort to identify relevant factors that predict success among participants in TC treatment programs (e.g., Simpson, 2001; Simpson Knight; 2001). However, few have focused on the system- and treatment-level process issues relating to the implementation and ongoing operations of TCs in correctional environments and how these issues impact the ability of treatment providers to effectively provide treatment services to inmate populations. It is also important to note that most (if not all) of the issues discussed in this paper have application beyond prison-based TCs and should be considered in any initiative that seeks to implement or expand substance abuse treatment in correctional settings. In addition, although these issues may appear to address different aspects of treatment program operations, they are not mutually exclusive. Indeed, to maximize the operational effectiveness of substance abuse treatment programs in correctional environments, they should be considered in their entirety.

Public Domain

Carise D; Cornely W; Gurel O. A successful researcher-practitioner collaboration in substance abuse treatment. Journal of Substance Abuse Treatment 23(2): 157-162, 2002. (16 refs.)

The best efforts to improve substance abuse treatment come from the integration of practice and research. The purpose of this article is to discuss factors that contribute to fruitful research-practice collaborations using the example of our recent successful partnership between a group of treatment researchers and a group of substance abuse recovery houses operated by Fresh Start. The research effort was the Drug Evaluation Network System, a computer assisted method of integrating clinical research and policy relevant information into a standard admission interview. The article discusses several factors that were important in integrating this research effort into the treatment system. These factors included adequate advance preparation of clinical and research staff to employ the new system, overcoming bilateral biases, and determining the degree to which the clinicians' and researchers' missions are matched. The paper also discusses a range of general factors to consider in implementing and maintaining successful research-to-practice integrations.

Chow J. Asian American and Pacific Islander mental health and substance abuse agencies: Organizational characteristics and service gaps. Administration and Policy in Mental Health 30(1): 79-86, 2002. (20 refs.)

Asian Americans are often termed "the model minority" and have lower prevalences of both substance use disorders and psychiatric problems. However, when treated, their problems are identified as more severe. This raises questions about under-utilization and whether barriers exist that restrict access. To explore this, a survey was conducted of agencies that serve a significant Asian-American population. Agencies were from 12 states, and were all member of a professional association of service providers for Asian Americans. Among the significant findings were that most of these agencies were did not exclusively provide mental health and substance abuse services. Of services provided those that were most common were out-patient care. None of the agencies provided detoxification or day treatment programs. In respect to boards, all had board member of their community Asian-American generally in proportion of the size of the local Asian population. However, it was noted that Southeast Asian communities and Filipino communities were under-represented. In terms of funding, public funding was almost the exclusive source of funding for substance abuse programs although that was not the case for mental health services. In addition, while mental health service funding had been largely stable, this was not the case for substance use services, with ups and largely downs. In terms of unmet needs among the programs mentioned were aftercare, family and individual counseling, and after school programs. In respect to outreach and community education, these agencies rarely used English language newspapers nor used local radio stations, the most common methods was via other community groups, and neighborhood-directed publications.

Clapp JD; Hohman MM. A key informant survey to assess service adequacy in California's publicly funded alcohol and other drug treatment system. Journal of Teaching in the Addictions 1(1): 53-68, 2002. (24 refs.)

This paper presents descriptive key informant data collected from 51 county administrators of publicly funded alcohol and other drug treatment systems in California. The study examined administrators' perceptions of service adequacy, the provision of services, and evaluation of services. County AOD administrators reported that publicly funded treatment systems in California adequately serve most populations (both drug-specific and ethnic/racial). Several administrators, however, suggested that adolescents, the elderly, and the homeless were not as adequately served. Administrators also felt that most services for different drug user groups were somewhat adequate. Administrators indicated that there was little use of psychological testing, placement criteria, children's counseling and spirituality counseling in their treatment systems. They reported current treatment approaches included as mixture of more traditional methods (use of 12 step programs) with newer ones (e.g. cognitive-behavioral therapy, relapse prevention work, and use of non-confrontational methods.) Recommendations for student education, future research, and policy are discussed.

Clark HW. Bridging the gap between substance abuse practice and research: The National Treatment Plan Initiative. Journal of Drug Issues 32(3): 757-768, 2002. (9 refs.)

The abuse of alcohol and other drugs leads to serious health problems, criminal activity, automobile crashes, and lost productivity in the workplace. As we advocate treatment for those who suffer from alcohol or drug addiction, we must advocate treatment that is proven effective for the drug and populace involved. However, due to background, cultural, and language differences between substance abuse researchers, treatment providers, and policy makers, empirically tested treatments are not being put into widespread practice. To bridge this gap, the Center for Substance Abuse Treatment sponsored the National Treatment Plan Initiative, a two-year effort to listen to multiple segments of the treatment field. This led to the formation of the Practice Improvement Collaborative (PIC) Program, whose purpose is to foster community-based partnerships that are committed to the identification, adoption, and evaluation of evidence-based practices that address locally defined needs. The PIC and the overall goals of the National Treatment Plan are discussed.

Clark JJ; Leukefeld C; Godlaski T; Brown C; Garrity J; Hays L. Developing, implementing, and evaluating a treatment protocol for rural substance abusers. Journal of Rural Health 18(3): 396-406, 2002. (23 refs.)

Substance abuse is a significant social and public health problem facing rural Americans. However, most treatment protocols have been developed in urban areas. This article describes the development, implementation, and evaluation of an innovative substance abuse treatment designed with the collaboration of rural professionals and consumers specifically for rural clients and delivered by rural clinicians. Results of the process evaluation of Structured Behavioral Outpatient Rural Therapy (SBORT) produced findings about the experiences of participating clients, clinicians, and program directors. Most clients perceived SBORT as a helpful learning process that used multiple treatment strategies and presented an alternative to 12-step programs. Clients also reported that treatment was stressful even when beneficial, and that clinician support was critical for remaining in treatment. Most clinicians found that SBORT challenged their "old" treatment frameworks, was demanding to learn and adopt, and that the training and supervision involved in the project implementation helped remedy rural isolation from the treatment community, Interestingly, agency approach to program implementation strongly influenced clinician responses to the innovation. Agency program directors' appraisals of SBORT included observations that the therapy was viable because of its rural- specific design and that most staff were able to adapt to the changes demanded by the manualized protocol. All three groups reported that they saw the emphasis and acceptance of motivation as an emergent process as important to the treatment. This project highlighted the challenge and importance of testing rural substance abuse treatment protocols in naturalistic settings.

Crane J; Quirk K; van der Straten A. "Come back when you're dying": The commodification of AIDS among California's urban poor. Social Science & Medicine 55(7): 1115-1127, 2002. (19 refs.)

As with any other long-term illness, the decline in health that accompanies symptomatic HIV infection often has a profound negative impact on employment and personal finances. However, research to date on the financial consequences of AIDS has focused largely on middle- class working individuals, and cannot account for the experiences of those who are already poor and unemployed at the time of their infection. We conducted in-depth qualitative interviews with 33 Californian heterosexual couples in which one partner was infected with HIV and the other was HIV-negative. Most couples interviewed were low-income, marginally housed, and either former or active substance users. Unlike their middle-class counterparts, it became clear through the course of our study that many participating couples were living in a world in which a positive HIV antibody test or an AIDS diagnosis could result in an improved quality of life by allowing for increased access to Supplemental Security Income, subsidized housing, food and services. This situation is in part a consequence of recent policy decisions related to the "War on Drugs" and welfare reform. These policies have contributed to the creation of an economy of poverty in which the sick, needy, and addicted must compete against each other for scarce resources. Within such an economy, an HIV or AIDS diagnosis may actually operate as a commodity.

Crevecoeur D; Finnerty B; Rawson RA. Los Angeles County Evaluation System (LACES): Bringing accountability to alcohol and drug abuse treatment through a collaboration between providers, payers, and researchers. Journal of Drug Issues 32(3): 865-879, 2002. (18 refs.)

The design and early implementation stages of a large-scale, system- wide evaluation of Los Angeles County's substance abuse treatment system (Los Angeles County Evaluation System: An Outcomes Reporting Program, or LACES) will be examined. In the first stage of implementation, individuals entering treatment will provide a standardized data set using the Los Angeles County Participant Reporting System (LACPRS) admission forms and the Addiction Severity Index (ASI). At treatment program discharge, the LACPRS discharge form will be administered, and at one-year post admission the ASI will be re-administered to a stratified sample of 1, 500 individuals from 31 "sentinel programs." Additional information will be gathered on the services provided by Los Angeles County alcohol and other drug treatment/recovery programs. Data from LACES will provide the treatment providers feedback on the impact of treatment services and will create the foundation of an ongoing evaluation system for the County's substance abuse treatment clients and services.

Currie SR; Nesbitt K; Wood C; Lawson A. Survey of smoking cessation services in Canadian addiction programs. Journal of Substance Abuse Treatment 24(1): 59-65, 2003. (38 refs.)

Many alcohol and drug treatment programs now offer smoking cessation (SC) services to their clients. Little is known about the prevalence of such services in Canadian addiction programs. A telephone survey was conducted of all Canadian adult substance abuse programs with outpatient, day program, and residential treatment to determine: (a) whether the program offered help in quitting smoking; (b) the type of SC services; (c) the overall priority placed on quitting smoking; and (d) for residential programs, what type of smoking ban (indoors, outdoors, or both), if any, is imposed. Over half (54%) of the 223 programs that responded to the survey reported providing help in quitting smoking. Twenty-three programs had formal SC services, most often in the form of group treatment. The majority of programs surveyed stated their program placed `very little' emphasis on smoking. Smoking was relatively unrestricted in residential programs. The implications of these findings for substance abuse treatment are discussed.

Dansereau DF; Dees SM. Mapping training: The transfer of a cognitive technology for improving counseling. Journal of Substance Abuse Treatment 22(4): 219-230, 2002. (38 refs.)

To provide information that will reduce the gap between research and practice, the transfer of a complex drug abuse counseling technology is examined. This technology, cognitive mapping, is a graphic tool shown to effectively facilitate communication and problem solving in group and individual counseling sessions. Unlike some techniques, mapping requires substantial counselor time, effort, and expertise to learn and to use. This article briefly describes the development and evolution of mapping and supporting research. It then focuses on our efforts to develop mapping training that will facilitate use of this evidence-based technique in drug abuse treatment. Major training and transfer pitfalls are noted, and strategies for successful training are recommended.

D'Aunno T; Pollack HA. Changes in methadone treatment practices: Results from a national panel study, 1988-2000. Journal of the American Medical Association 288(7): 850-856, 2002. (34 refs.)

Context: Results from several studies conducted in the early 1990s showed that the majority of US methadone maintenance programs did not use treatment practices that met established standards for the care of heroin users. Effective treatment for heroin users is critical given the upsurge in heroin use and the continued role of injection drug use in the human immunodeficiency virus and hepatitis C epidemics. Objectives To examine the extent to which US methadone maintenance treatment programs have made changes in the past 12 years to provide adequate methadone doses and to identify factors associated with variation in program performance. Design, Setting, and Participants Program directors and clinical supervisors of nationally representative methadone treatment programs that varied by ownership (for-profit, public, or private not-for- profit) and setting (e.g., free-standing, hospital-based) were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), and 2000 (n=150). Main Outcome Measures Percentage of patients in each treatment program receiving methadone dosages of less than 40, 60, and 80 mg/d. Results The percentage of patients receiving methadone dosage levels less than the recommended 60 mg/d has decreased from 79.5% in 1988 to 35.5% in 2000. Results also show that programs with a greater percentage of African American patients are especially likely to dispense low dosages, while programs with Joint Commission on Accreditation of Healthcare Organizations accreditation are more likely to provide adequate methadone doses. Conclusions: Efforts to improve methadone treatment practices appear to be making progress, but many patients are still receiving substandard care.

Davis TM; Carpenter KM; Malte CA; Carney M; Chambers S; Saxon AJ. Women in addictions treatment: Comparing VA and community samples. Journal of Substance Abuse Treatment 23(1): 41-48, 2002. (40 refs.)

Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/ outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.

Davis WT; Campbell L; Tax J; Lieber CS. A trial of "standard" outpatient alcoholism treatment vs. a minimal treatment control. Journal of Substance Abuse Treatment 23(1): 9-19, 2002. (23 refs.)

This study sought to examine the effectiveness of a "standard" outpatient alcoholism treatment (ST) program. An outpatient alcoholism treatment as it is commonly practiced in the US (with group and individual therapy, and an emphasis on Alcoholics Anonymous [AA]), was compared with a minimal treatment (MT) approach (weekly alcohol education movies). At 6 months, ST patients surpassed those in MT in terms of complete abstinence, reduction in amount of alcohol consumed, length of sobriety at follow-up, improvement in employment status, number of AA meetings attended, and lower initial drop-out. It is concluded that a ST approach is more helpful than MT in treating severely alcohol-dependent individuals who have not been able to cut down drinking on their own. Those already drinking less appeared to be helped by MT.

Denny JT; Ginsberg S; Papp D; Browne G; Morgan S; Kushins L; Solina A. Hospital initiatives in promoting smoking cessation: A survey of internet and hospital-based programs targeted at consumers. Chest 122(2): 692-698, 2002. (27 refs.)

Study objectives: This study assesses how often local US hospitals provide smoking cessation information in the following two ways: via hospital Web sites; and via routing incoming phone calls to their hospital switchboards to an in-house smoking cessation clinic. Design: Random survey of US hospitals. Setting: US hospital Web pages and telephone switchboards. Patients or participants: One hundred two randomly selected US hospitals. Interventions: One hundred two hospital Web sites were randomly selected across the United. States. The site was searched for the topic of smoking cessation. In the second phase of the survey the main switchboard number of the same 102 hospitals was anonymously called and the "stop smoking clinic" was asked for. Measurements and results: The overall results indicate that among the hospital Web sites surveyed, only, 30% contained information relating to smoking cessation programs. The phone survey of hospital switchboards showed that 47% had a smoking cessation program available via phone inquiry, while 53% did not. Conclusions: Of the US hospital Web sites visited, only 30% contained information on smoking cessation. The yield of finding the desired information was increased by the presence of an intrasite search option, which is a low-cost enhancement to any complex Web site. The relatively low cost of promoting healthy behaviors such as smoking cessation on a hospital Web site should be used more widely. Surprisingly, the phone survey of hospitals showed that the lower technology, route of providing smoking cessation information to patients via a patient-initiated phone call is only available in 47% of hospitals. Both the Internet and phone-based switchboard referrals could be more widely and effectively used. Joint Commission on Accreditation of Healthcare Organizations guidelines would be on avenue of increasing the availability of smoking cessation information at hospital switchboards and Web sites.

DiNitto DM; Webb DK; Rubin A. The effectiveness of an integrated treatment approach for clients with dual diagnoses. Research on Social Work Practice 12(5): 621-641, 2002. (28 refs.)

Objective: A randomized experiment tested the effectiveness of adding a psychoeducationally oriented group therapy intervention, Good Chemistry Groups, to standard inpatient chemical dependency services for clients dually diagnosed with mental and substance dependence disorders. Method: Ninety-seven clients were randomly assigned to an experimental group (n = 48) and a control group (n = 49). Outcome variables included drug and alcohol use, participation in self-help support group meetings, incarceration days, psychiatric symptoms, psychiatric inpatient admissions, compliance with prescribed psychotropic medication plans, and composite scores on the Addiction Severity Index. Results: No significant treatment effects were found on any of the outcome variables. The findings were generally consistent with those of prior controlled studies. Conclusion: Good Chemistry Groups did not add to the effects of standard treatments for dually diagnosed clients. Practitioners should continue to develop and evaluate alternative integrated treatment approaches that might prove to be more effective than this one.

Dobmeyer TW; Woodward B; Olson L. Factors supporting the development and utilization of an outcome-based performance measurement system in a chemical health case management program. Administration in Social Work 26(4): 25-44, 2002. (29 refs.)

This paper describes the development and utilization of a performance measurement system installed in the case management program for chronic substance abusers who are committed for chemical dependency treatment in Hennepin County, Minnesota. The system (operational for over four years) produces quarterly management reports which display client characteristics at program entry as well as client outcomes achieved during and following the six-month commitment period. Institutionalization of the system within the program and the associated measurement of client characteristics and outcomes have helped to standardize case planning and to sensitize program staff to both client needs and the outcomes toward which staff and client efforts should be directed. Finally, the paper describes the special studies that have been generated from the performance measurement system's database. These include the development of caseload difficulty indices, and multivariate investigations of the relationship between client characteristics and outcomes. The paper seeks to add to the knowledge of the ways in which performance measurement systems might be designed, implemented, and used.

Durkin EM. An organizational analysis of psychosocial and medical services in outpatient drug abuse treatment programs. Social Service Review 76(3): 406-429, 2002. (97 refs.)

Substance abuse programs do not universally comply with standards encouraging the provision of supplemental social, mental health, and medical services. Using a nationally representative panel study of outpatient treatment organizations, I examine the relationships between provision of these services and internal and external elements of the organizational context. Actors in the organizational environment such as funders, regulators, and accrediting bodies were particularly important, but their exact relationships to service provision varied across services. Other relationships between organizational elements and service provision also varied across services. Policies regarding compliance with standards should account for the complex role that organizational context plays.

el-Guebaly N; Cathcart J; Currie S; Brown D; Gloster S. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatric Services 53(12): 1617-1622, 2002. (58 refs.)

Objective: Health care facilities are increasingly implementing policies that ban smoking. A concern has been raised that these policies may have a negative impact on smokers who are mentally ill or substance dependent. The authors conducted a literature review to analyze the relevant empirical evidence. Methods: Major health care databases were searched. Major search terms included smoking, smoking cessation, nicotine, health policy, hospital policy, smoke-free policy, psychiatric disorders, and substance use disorders. The search was limited to empirical studies, which were analyzed on the basis of design, the behavioral indicators monitored, and the results of questionnaires. Results and conclusions: A total of 22 investigations of the impact of total or partial smoking bans suggest that the policies have had no major long-standing untoward effect in terms of behavioral indicators of unrest or compliance. However, the policies appear to have had little or no effect on smoking cessation. Smoking cessation strategies should be an inherent component of policies that ban smoking.

French MT; McCollister KE; Cacciola J; Durrell J; Stephens RL. Benefit-cost analysis of addiction treatment in Arkansas: Specialty and standard residential programs for pregnant and parenting women. Substance Abuse 23(1): 31-51, 2002. (62 refs.)

A benefit-cost analysis of specialty residential treatment (Specialty) and standard residential treatment (Standard) was conducted in a sample of pregnant and parenting substance abusers from Arkansas. Economic benefits were derived from client self-reported information at treatment entry and at 6-month postdischarge with the use of an augmented version of the Addiction Severity Index (ASI). The average cost of treatment in Specialty programs was $8,035 verses $1,467 for standard residential treatment. Average net benefits (benefit-cost ratios) were estimated to be $17,144 for Specialty and $8,090 for Standard. The main policy implication of this research is that investment in Specialty residential treatment for pregnant and parenting substance-abusing women appears to be economically justified, but future evaluations should analyze larger and more comparable samples to improve power and precision in the benefit-cost statistics.

Gariti P; Alterman A; Mulvaney F; Mechanic K; Dhopesh V; Yu E et al. Nicotine intervention during detoxification and treatment for other substance use. American Journal of Drug and Alcohol Abuse 28(4): 673-681, 2002. (8 refs.)

This preliminary study evaluated the efficacy of a brief smoking cessation intervention (30 controls, 34 intervention groups) on a smoke-free inpatient unit for substance use detoxification. Controls received usual care, including the transdermal nicotine patch and referral to an outpatient smoking program. The intervention group additionally received a structured motivational enhancement program. Biochemically confirmed smoking cessation rate and abstinence/reduction of alcohol or other drug use were the main outcome measures taken 6 months after treatment initiation. The smoking cessation intervention did not result in greater participation in formal outpatient smoking cessation treatment and was not associated with either enhanced smoking cessation (6 vs. 0%) or greater smoking reduction at follow-up. Both groups significantly reduced the number of cigarettes smoked per day (cpd) from about 24 at baseline to 10 cpd. The groups did not differ on abstinence from nonnicotine addictive substances. Smoking cessation treatment in substance users undergoing detoxification resulted in little or no smoking cessation advantage.

Garner BR; Godley SH; Funk RR. Evaluating admission alternatives in an outpatient substance abuse treatment program for adolescents. Evaluation and Program Planning 25(3): 287-294, 2002. (16 refs.)

Streamlined admission procedures for adolescents entering outpatient substance abuse treatment were evaluated. A time cohort of 128 adolescents receiving existing admission procedures over a 12 month period were compared to a subsequent cohort of 149 who received same day assessments, same day treatment placement staffings, use of pre- set admission appointments, and admission tracking procedures. Measures included: (a) the length of time taken to complete assessments, (b) the length of time between the assessment and admission appointments, and (c) the percentage of clients admitted to treatment. Results revealed that each of the new admission procedures were implemented in at least 50% of the cases, adolescents who received them completed their assessments sooner, and time-to-event analysis demonstrated that this group was admitted to treatment sooner. However, the percentage of adolescents who entered treatment was not significantly different between cohorts.

Garrison AH. Drug treatment programs: Policy implications for the judiciary. Court Review 38(4): 24-34, 2002. (82 refs.)

The goal of this paper is to review the factors that lead to successful drug treatment and the limitations/barriers to treatment success that the judiciary should consider when sentencing drug addicts. The paper is drawn from an evaluation of a drug treatment program in Wilmington Delaware. The paper covers epidemiology, the number of persons with substance sue problems that are in the criminal justice system, and disparate patterns of drug use. Following this discussion, there is a brief review of the historical use of heroin as well as the emergence of drug therapies, particularly naltrexone. The paper then considers the Wilmington program, SNAP, its rationale, organization, and the results to date, in respect to treatment completion, employment status, drug use. Different types of drug use patterns are identified. Policy implications are drawn from this experience. Those identified include: (1) the need to assess the pattern and characteristics of addiction history, and select a program that is able to deal with the issues present, e.g., drug use history, prior treatment experiences, presence or absence of social resources; (2) the use of multiple measures in assessing treatment outcome; (3) measures to address treatment outcome; (4) the importance of addressing psychological problems within treatment; (5) recognize that addiction frequently occurs in along with other disorders; (6) incorporate pharmacological treatments.

Gfroerer J; Penne M; Pemberton M; Folsom R. Substance abuse treatment need among older adults in 2020: The impact of the aging baby-boom cohort. Drug and Alcohol Dependence 69(2): 127-135, 2003. (69 refs.)

Background: There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. Methods: Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. Results: The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. Conclusions: The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults.

Green CA; Polen MR; Dickinson DM; Lynch FL; Bennett MD. Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. Journal of Substance Abuse Treatment 23(4): 285-295, 2002. (57 refs.)

We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education. Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance. Clinical implications of results are discussed. reserved.

Greenberg GA; Rosenheck RA; Seibyl CL. Continuity of care and clinical effectiveness: Outcomes following residential treatment for severe substance abuse. Medical Care 40(3): 246-259, 2002. (35 refs.)

Continuity of care (COC) has often been viewed as a crucial indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, the relationship between COC and clinical outcomes has received little empirical evaluation. This study used hierarchical liner modeling to examine the relationship between six indicators of COC and seven outcome measures addressing symptoms, substance abuse, and social functioning. Patient interviews were conducted with 1,576 veterans 3 months after their discharge from one of 22 residential work therapy programs for the treatment of severe substance abuse. Few significant relationships were found between COC and outcome measures in analyses conducted at both the client and program level and fewer than half of these show better outcomes with greater COC. When a Bonferroni corrected P level of P less than 0.0012 was used, none of the relationships were statistically significant. It is concluded that although there were significant relationships between outcomes and measures of services received during residential treatment, postdischarge COC does not seem to be related to improved outcomes, at least when examined following long term intensive residential treatment. Thus, the results are specific to the context of aftercare following long-term residential rehabilitation and indicate that the value of standard performance measures may vary by treatment context.

Grella CE; Gilmore J. Improving service delivery to the dually diagnosed in Los Angeles County. Journal of Substance Abuse Treatment 23(2): 115-122, 2002. (51 refs.)

Service delivery to dually diagnosed individuals remains problematic in many communities because of entrenched administrative structures that maintain the separation of mental health and substance abuse treatment systems. This article describes efforts to improve service delivery to dually diagnosed individuals in Los Angeles County by increasing communication, coordination, and collaboration across the two treatment systems. Findings are presented on the relationships among program models of service delivery, treatment orientations of programs, and interactions with other service providers to the dually diagnosed. Results showed that drug treatment programs that adhered more closely to an integrated model of service delivery received more patient referrals from case management outreach teams and that programs with a stronger counseling approach to treatment had more linkages with other service providers. Knowledge gained from research on these differing models of service delivery can be combined with new clinical advances to improve service delivery to the dually diagnosed.

Gschwend P; Rehm A; Lezzi S; Blattler R; Steffen T; Gutzwiller F et al. Development of a monitoring system for heroin-assisted substitution treatment in Switzerland. Sozial- und Praventivmedizin 47(1): 33-38, 2002. (24 refs.)

Objectives: Switzerland introduced heroin-assisted treatment as a routine treatment for drug addicts. As a result the evaluation instruments were changed from a detailed scientific project to a routine monitoring system. The process for developing this monitoring system is described. Methods: The questionnaires and assessment instruments were restyled with staff of the treatment agencies. Indicators measuring quality of treatment and measures from the future national statistic on the addiction support system were integrated into admission, course and discharge questionnaires. Currently a system for feedback to treatment agencies is being developed. Results: All 21 treatment agencies are participating in the monitoring. Assessment quality is high. Conclusions: The described monitoring should provide continuous delivery of basic relevant data on patients.

Guydish J; Claus RE. Improving publicly-funded drug abuse treatment systems: The Target Cities initiative. (editorial). Journal of Psychoactive Drugs 34(1): 1-6, 2002. (29 refs.)

Henderson SA; Huey M; Roman P. Substance Abuse Treatment Philosophy and the Adoption of Pharmaceutical innovations: An organizational approach. , 2003. (0 refs.)

With an increase in pharmacotherapies in substance abuse treatment, it is imperative to understand the adoption of these pharmaceutical innovations, as well as clinical outcomes. The purpose of this analysis is twofold, to assess the influence of treatment philosophy on the adoption of pharmaceutical innovations, & to evaluate the extent to which the predictive models of adoption, including organizational structure, caseload & staff characteristics, & philosophy vary depending on the type of pharmacotherapy. At the organizational level, this study has implications for understanding similarities & differences in the adoption of different innovations. For the substance abuse treatment field, it provides an assessment of center characteristics that are enhancing or impeding the diffusion & adoption of these pharmaceutical innovations, & the role of treatment philosophy in this process. The data used for this analysis is taken from nationally representative sample of 400 private substance abuse treatment centers. Onsite interviews were used to collect data on center characteristics including but not limited to organizational structure, caseload & staff characteristics, & new treatment techniques. Current use of the three general types of pharmacotherapies, antagonists, partial agonists, & agonists, by centers that reported some knowledge of them was found in varying degrees in this sample. Antagonists such as antabuse & naltrexone were used in 66% & 52% of centers respectively. The partial agonist buprenorphine was used in 28% & the agonists methadone & LAAM in 25% & 6% respectively. With such variance in adoption, it is essential to understand any organizational & philosophical differences that are influencing the adoption of these pharmaceutical innovations.

Humphreys K; Horst D. Moving from inpatient to residential substance abuse treatment in the VA. (editorial). Psychiatric Services 53(8): 927-927, 2002. (2 refs.)

Johnson JA; Roman PM. Predicting closure of private substance abuse treatment facilities. Journal of Behavioral Health Services & Research 29(2): 115-125, 2002. (13 refs.)

Researchers in organizational ecology have long been interested in identifying the factors associated with organizations closing their doors. Though the predictors of closure have been examined across many different types of organizations, private substance abuse treatment centers, often characterized as unstable and having high closure rates, have not been subject to empirical study. Data for this study were derived from a nationally representative longitudinal study of 450 private substance abuse treatment centers. Contrary to most previous research, center age was not a significant predictor of closure. Significant predictors included center capacity, being a freestanding facility, the percentage of clients covered by Medicaid, and the ratio of patients to full-time equivalents.

Kavanagh DJ; Spence SH; Wilson J; Crow N. Achieving effective supervision. Drug and Alcohol Review 21(3): 247-252, 2002. (46 refs.)

Supervision probably does have benefits both for the maintenance and improvement of clinical skills and for job satisfaction, but the data are very thin and almost non-existent in the area of alcohol and other drugs services. Because of the potential complexity of objectives and roles in super vision, a structured agreement appears to be an important part of the effective supervision relationship. Because sessions can degenerate easily into unstructured socialization, agendas and session objectives may also be important. While a working alliance based on mutual respect and trust is an essential base for the supervision relationship, procedures for direct observation of clinical skills, demonstration of new procedures and skills practice with detailed feedback appear critical to supervision's impact on practice. To ensure effective supervision, there needs not only to be a minimum of personnel and resources, but also a compatibility with the values and procedures of management and staff, access to supervision training and consultation and sufficient incentives to ensure it continues.

Langford PH; Phillips D. Antecedents of community stakeholder satisfaction towards an Australian drug clinic. Drugs: Education, Prevention and Policy 9(4): 345-353, 2002

The aim of the study was to investigate the antecedents of community satisfaction towards an Australian drug clinic, with the aim of developing a general model of community stakeholder satisfaction that may apply to other clinics. A structured survey was administered via the telephone and face to face with 490 community stakeholders including residents, businesses and other health and community service providers. Multilingual interviewers were used because a large percentage of participants were from a non-English-speaking background. Community stakeholder satisfaction was found to correlate positively with variables such as stakeholder's perception of the importance of services, understanding of community needs, contribution to community, usefulness of communication, and staff skill. The antecedents related to quality of service, rather than to knowledge of the clinic, showed consistently stronger correlations with overall satisfaction. Stakeholders were least aware of the clinic's services that were rated the most important and given the highest satisfaction scores. It is concluded that regular surveying of community attitudes helps a clinic to modify its services to meet the needs of its community more accurately. Surveying can also provide early warning of growing problems that may, if left unresolved, impede future survival or growth of the clinic.

Laws KE; Gabriel RM; McFarland BH. Integration and its discontents: Substance abuse treatment in the Oregon health plan. Health Affairs 21(4): 284-289, 2002. (13 refs.)

With the creation of the Oregon Health Plan (OHP) in 1994, Oregon placed its Medicaid program under a managed care system. This paper examines the managed care practices of seven health plans serving OHP enrollees between 1996 and 1998. Results indicated that the original vision of integrating substance abuse treatment services with physical care for OHP enrollees evolved into a multilayered, carved- out approach. Factors working against integration included changes in the administration and management of the chemical dependency benefit, financial losses by health plans, and lack of training and incentives for physicians to refer clients to substance abuse treatment.

Lehman WEK; Greener JM; Simpson DD. Assessing organizational readiness for change. Journal of Substance Abuse Treatment 22(4): 197-209, 2002. (39 refs.)

A comprehensive assessment of organizational functioning and readiness for change (ORC) was developed based on a conceptual model and previous findings on transferring research to practice. It focuses on motivation and personality attributes of program leaders and staff, institutional resources, and organizational climate as an important first step in understanding organizational factors related to implementing new technologies into a program. This article describes the rationale and structure of the ORC and shows it has acceptable psychometric properties. Results of surveys of over 500 treatment personnel front more than 100 treatment units support its construct validity on the basis of agreement between management and staff on several ORC dimensions, relationships between staff organizational climate dimensions and patient engagement in treatment, and associations of agency resources and climate with organizational stability. Overall, these results indicate the ORC can contribute to the study of organizational change and technology transfer by identifying functional barriers involved.

Lemke S; Moos RH. Prognosis of older patients in mixed-age alcoholism treatment programs. Journal of Substance Abuse Treatment 22(1): 33-43, 2002. (36 refs.)

The prognosis of older patients in mixed-age alcoholism treatment programs was compared to that of younger and middle-aged patients. The research sample included 432 patients in each group, who provided background information. They also responded to measures of drinking quantity and frequency and answered questions about symptoms and consequences of their substance use. The following results of the study were seen: (1) poorer physical health and lower cognitive status at treatment entry for the older patients; (2) report by older patients of less consumption and fewer drinking-related problems and psychological symptoms; (3) more social support, more adaptive coping, and fewer barriers to abstinence for the older patients; (4) positive views of the programs on the part of older patients; (5) comparable treatment for all patients; (6) at discharge, significant change in most treatment areas for older patients; (7) a finding that better initial status was the strongest predictor of better discharge functioning; (8) a finding that higher cognitive functioning, stronger treatment motivation, more interpersonal support, and receiving of specialized treatment services resulted than better-than-expected improvement. All age groups showed similar outcomes, prognostic factors, and response to treatment orientation.

Liddle HA; Rowe CL; Quille TJ; Dakof GA; Mills DS; Sakran E; Biaggi H. Transporting a research-based adolescent drug treatment into practice. Journal of Substance Abuse Treatment 22(4): 231-243, 2002. (26 refs.)

This article describes the key ingredients and processes in transporting an empirically supported, research-developed family therapy for adolescent drug abusers, Multidimensional Family Therapy (MDFT), into an intensive day treatment program. Using the same systems change principles that guide this treatment approach, the technology transfer process has been, from its inception, a collaborative, multidimensional, systemic intervention aimed at changing organizational structures, and attitudinal and behavioral patterns with multiple staff members at several levels of the program. This article describes: (1) the conceptual and empirical basis for these technology transfer efforts; (2) the technology being adapted and transferred; and (3) the critical events and processes that have shaped the transfer of MDFT into this program. We discuss this process and the outcomes thus far through the lens of Simpson's organizational change model and specify the implications of this experience for the expansion of current conceptualization of technology transfer.

Logan TK; Walker R; Cole J; Leukefeld C. Victimization and substance abuse among women: Contributing factors, interventions, and implications. (review). Review of General Psychology 6(4): 325-397, 2002. (869 refs.)

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Magura S; Schildhaus S; Rosenblum A; Gastfriend D. Substance user treatment program quality: Selected topics. Substance Use & Misuse 37(8/10): 1185-1214, 2002. (72 refs.)

This panel explores the "state of the art" in conceptualization and research pertinent to program quality in substance user treatment. First, seven critical questions for program quality are identified and discussed. Second, a recent national evaluation of treatment examines the implications of long-term patient outcomes for treatment quality. Third, a large number of clinical trials of behavioral and pharmacological treatments for cocaine dependence were conducted during the 1990s; this research is synthesized and interpreted. Fourth, progress is reported in improving the quality of treatment through standardized criteria for patient placement matching.

Marinelli-Casey P; Domier CP; Rawson RA. The gap between research and practice in substance abuse treatment. Psychiatric Services 53(8): 984-987, 2002. (26 refs.)

Integrating science-based practices into clinical care has become an increasingly important theme in the substance abuse field. The authors describe various factors that have traditionally kept researchers and practitioners from collaborating with one another and outline steps being taken to encourage a partnership between these two groups. Strategies for continuing to close the gap between research and practice are provided, including the incorporation of policy makers and consumers and their families into the process. The implementation of science-based treatment strategies into mainstream substance abuse care will depend partly on the new relationships that are built on the communication and cooperation between researchers and practitioners.

Martin TC; Klinedinst M; Josiah-Martin JA; Burke-Forde A. A comparison of Caribbean and non-Caribbean clients in a residential addiction treatment facility in Antigua, West Indies. Journal of Addictive Diseases 22(1): 57-65, 2003. (32 refs.)

The first 50 Caribbean clients admitted to a private, multicultural, not for profit addiction treatment center in Antigua, West Indies, were compared with the first 100 non-Caribbean clients admitted. There was no significant difference in age, 38 years (18-61 years) versus 40 years (22-63 years), or gender, 74% versus 67% male. Caribbean clients were more likely to be Black, 68% versus 2%, P < .001. Caribbean clients were less likely to have a prior psychiatric diagnosis, 18% versus 43%, P < .01, or to have been in prior treatment program, 22% versus 64%, P < .001. Caribbean and non-Caribbean clients were equally likely to be polydrug users, 48% versus 50%, and to use alcohol as a primary drug, 52% versus 51%. Caribbean clients were more likely to use cocaine, 30% versus 11%, P < .01, and marijuana, 12% versus 0%, P < .001, but less likely to use heroin, 6% versus 30%, P < .001 or pills, 0% versus 8%, P < .05. Caribbean clients were less likely to have elevated MCV, 24% versus 57%, P < .001 or serum transaminases, 23% versus 46%, P < .01. Differences between groups in this multicultural setting warrant further investigation.

McAuliffe WE; LaBrie R; Woodworth R; Zhang C; Dunn RP. State substance abuse treatment gaps. American Journal on Addictions 12(2): 101-121, 2003. (64 refs.)

This study estimated the adequacy of state substance abuse treatment rates relative to treatment needs. The investigators created composite drug and alcohol treatment need indexes from explicit-mention mortality and substance-defined arrest rates. The indexes were reliable and had evidence of construct validity, but alternative population-at-risk and survey-based need measures did not fare as well. States varied substantially in per capita alcohol and drug treatment needs, although the two did not correlate with each other. While the need indexes correlated significantly with state treatment rates, the adequacy of state treatment rates varied greatly. States with the largest treatment gaps were in the South, Southwest, and northern plains and mountain regions. The failure of the Block Grant formula to reflect the needs of rural states with high-risk minority populations may contribute to disparities in access to services.

McAuliffe WE; Woodworth R; Zhang C; Dunn RP. Identifying substance abuse treatment gaps in substate areas. Journal of Substance Abuse Treatment 23(3): 199-208, 2002. (55 refs.)

Investigating concerns about uneven utilization of health services, especially affecting disadvantaged high-risk populations, the authors constructed composite indexes for identifying substance abuse treatment gaps in Rhode Island towns and multi-town planning areas. The Drug, Alcohol, and Substance Abuse Need Indexes combined multiple- year rates of substance-related deaths, hospital discharges, and arrests. These indicators were reliable and possessed convergent validity; the composite indexes were also reliable and had construct validity. Regression of treatment admissions rates on town Substance Abuse Need Index scores revealed that some areas had relative gaps in treatment services. Having an objective and validated method for identifying treatment gaps could help treatment planners ensure equal access to services throughout the state. Reducing travel to treatment facilities can increase treatment utilization and treatment retention.

McNeece CA; Arnold EM. Program closure: The impact on participants in a program for female prostitutes. Research on Social Work Practice 12(1): 159-175, 2002. (28 refs.)

Objective: This study examines the impact of program closure on participants in a case management program for female prostitutes. Methods: Former program participants were surveyed about their experiences since participating in the program. Particular emphasis was paid to criminal behavior, substance abuse, and mental health problems. Results: Of those participants located (N = 52), the majority were incarcerated, but a smaller number were no longer abusing substances and were employed. An analysis of the relationship between incarceration status and recidivism revealed statistically significant differences on variables related to treatment completion. Conclusions: Overall, the program appeared to have an impact on participants' lives and behaviors, regardless of their prior life experiences. After the program closed, the great majority, of former clients were either prostituting and using drugs or incarcerated.

Milbrodt T. Breaking the cycle of alcohol problems among Native Americans: Culturally-sensitive treatment in the Lakota community. Alcoholism Treatment Quarterly 20(1): 19-44, 2002. (21 refs.)

This study explores methods of improving the treatment of alcoholism among Native American people by integrating culturally relevant practices into treatment methodology. Primary to the findings of this study are the opinions and experiences of four Lakota people living on the Rosebud Reservation in South Dakota, individuals who have worked with alcoholism in their community for a number of years. Also important is an understanding of the history of alcoholism among native American people, including forms of cultural breakdown that lead to increased levels of alcohol problems. Findings suggest that alcoholism treatment programs that integrate Native American culture and traditions into the recovery process will be more likely to be accepted by Native American alcoholics than mainstream rehabilitation programs that ignore cultural factors. Many of the problems involved with treating Native American alcoholics exist because of the discrepancy between how Native American alcoholics interpret the world and how rehabilitation programs try to combat their alcoholism. While there have been many good quantitative studies performed on Native American alcoholism, treatment professionals still lack information about the Native worldview that would allow them to more efficiently treat the disease.

Minto SD; Bennett RE II; Keltner BR; Porterfield DR. A new approach to student alcohol abuse at Georgetown University. Journal of American College Health 51(2): 81-87, 2002. (9 refs.)

This column on "Clinical and Program Notes" outlines the approach adopted by Georgetown University, a residential campus in Washington DC, to address alcohol use. There are five intra-related aims. (1) define the national problem in terms of its own community; (2) find an inclusive structure with purposeful operations to address its own community problems; (3) Establish a methodology for innovation and action; (4) mobilize the infrastructure to define and realize short-term goals and pursue medium- and long-term goals; and (5) Create mechanisms for evaluation, adjustments, and sustainability. This article provides a case study of the actions taken. Ten guiding principles provided a framework for the effort that was a joint action of faculty, students, and administrators, a group known as "Friends." These principles touched on Friends organization, plans for working together. Ultimately four working groups were established that addressed the following areas: Renewing and reimagining the Georgetown experience; Harm Reduction; (3) Strengthening the First-year Experience; and Alcohol Policy.

Montini T. Barriers to integrating nicotine dependence and substance abuse treatments. (meeting abstract). Journal of Addictive Diseases 21(2): 130, 2002. (0 refs.)

Findings are presented from 220 in-depth interviews of a national sample of substance abuse treatment (SAT) program clinical directors who were asked about their knowledge, attitudes, and beliefs about smoking cessation within substance abuse treatment. Key factors identified by directors as barriers to incorporating smoking cessation in treatment programs focused on clinical staff: (1) SAT staff smoke at a disproportionately high rate compared to the general population; clinicians estimated that approximately 40 percent smoke. (2) Clinicians conceptualized smoking cessation as a stressor that has the potential to jeopardize recovery from the "primary" problem of drug/alcohol abuse. They relayed beliefs that: smoking cessation will not be utilized by clients; smoking cessation has a longer trajectory than drug abuse treatment, so clients will not be able to finish while in treatment; their treatment programs are already crowded with too many components to add smoking cessation; and the effects of nicotine withdrawal will weaken client commitment to the drug abuse treatment program and make client management more difficult. (3) Clinicians were concerned that their staff were not trained to provide smoking cessation treatment, were dissatisfied with the availability of smoking cessation training, and interested in learning how to treat nicotine dependent clients. Clinicians also said it is difficult to secure adequate funding for substance abuse treatment, and funding for smoking cessation treatment is even scarcer.

Mulia N. Ironies in the pursuit of well-being: The perspectives of low-income, substance-using women on service institutions. Contemporary Drug Problems 29(4): 711-748, 2002. (62 refs.)

Interest in improving low-income, drug-abusing women's access to and utilization of care services tends to focus on remedies to personal, structural and gendered barriers to care. In contrast, this exploratory, qualitative study of women's perspectives illustrates how institutional rules, both within and across agencies, and informal provider practices can constrain women's use of health and social services. This paper draws attention to the ways in which low-income, drug-using women respond to obstacles and interpersonal tensions they experience in service settings. As a means of pursuing their material and social well-being, the women employ forms of resistance that are both protective and potentially harmful. This paper underscores the need to recognize how service institutions are implicated in drug users' everyday struggles for well-being.

Mulvey KP; Hubbard S; Hayashi S. A national study of the substance abuse treatment workforce. Journal of Substance Abuse Treatment 24(1): 51-57, 2003. (15 refs.)

This study's purpose is to gain a current perspective on the substance abuse treatment field's workforce. The data are from the Retrospective Study of treatment professionals designed to document how the Treatment Improvement Protocols published by the Center for Substance Abuse Treatment have influenced the implementation of best practices. The Retrospective Study consisted of a two-wave cross-sectional survey with telephone follow-up. Data for this study were from demographic information on Wave 1 study participants, which had a response rate of 80.1% (N = 3,267). The results of the study showed that most treatment professionals are White (84.5%) and middle-aged (i.e., between 40 and 55 years old) and slightly more are female (50.5.0%) than male (49.5%). Treatment professionals tend to enter the field and stay in it, and almost 80.0% of respondents possess a bachelor's degree or higher. In addition, most treatment professionals are licensed or certified and treat clients from different racial and ethnic backgrounds than themselves. Implications for the provision of treatment services are discussed.

Najavits LM. Seeking safety: A new psychotherapy for posttraumatic stress disorder and substance use disorder. IN: Ouimette P; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 147-169

This chapter reviews Seeking Safety, a cognitive-behavioral based therapy for the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder. The author provides (a) a description of Seeking Safety and how it was developed, (b) a comparison with existing treatments, (c) a review of outcome research on it, and (d) ideas for future directions.

Nebelkopf E; King J. A holistic system of care for Native Americans in an urban environment. Journal of Psychoactive Drugs 35(1): 43-52, 2003. (49 refs.)

The Native American Health Center has implemented a holistic system of care in the San Francisco Bay Area as a result of a multiyear strategic planning process that included a needs assessment based on the community-readiness model. The strategic plan links substance abuse, mental health, HIV/AIDS, and social services in a holistic approach congruent with Native American values and traditions. The plan also links prevention with treatment in a continuum of care. Based on a collaboration of Native American nonprofit community-based organizations and public agencies, the plan has resulted in bringing significant resources to the community.

Obert JL; London ED; Rawson RA. Incorporating brain research findings into standard treatment: An example using the Matrix Model. Journal of Substance Abuse Treatment 23(2): 107-113, 2002. (21 refs.)

One way to promote the goal of broadening the application of research to applied treatment is through the development and dissemination of empirically supported clinical treatment manuals. NIDA and NIAAA have published a series of manuals that delineate specific psychotherapies and/or behavioral approaches designed for the treatment of drug and alcohol abuse. This article describes a manualized treatment approach, the Matrix Model, which incorporates several of these psychosocial interventions with some basic explanations of recent brain research to form a comprehensive, multi-component model of outpatient stimulant abuse treatment. A large multi-site trial sponsored by CSAT compares the Matrix Model of outpatient treatment with treatment as usual in 7 sites where methamphetamine is a significant problem. The translation and adaptation of the Matrix manual for cocaine users in Mexico and methamphetamine users in Thailand will offer opportunities to evaluate this approach with very diverse populations of stimulant users.

O'Leary TA; Brown SA; Colby SM; Cronce JM; D'Amico EJ; Fader JS et al. Treating adolescents together or individually? Issues in adolescent substance abuse interventions. Alcoholism: Clinical and Experimental Research 26(6): 890-899, 2002. (65 refs.)

This article summarizes the proceedings of a symposium, chaired by Peter Monti and cochaired by Tracy O'Leary, that was presented at the 2001 RSA Meeting in Montreal, Quebec. The aim of this symposium was to present data on group- and individual-based interventions for adolescent alcohol and substance abuse, with a discussion of the implications of research findings hearing on developmental considerations when working with adolescents and young adults. Elizabeth J. D'Amico, PhD, reviewed recent findings on adolescents' choice of type of substance abuse treatment, Jennifer L. Maggs, PhD, presented a developmental perspective on this issue. Tracy O'Leary, PhD, presented data on enhancing motivational interviewing with the presence of a supportive peer for college students cited for alcohol infractions. Mary E. Larimer, PhD, presented 1-year follow-up results of the Greeks 2000 Project, a 5-year longitudinal study designed to evaluate the efficacy of an alcohol abuse prevention program provided to college students who were entering a pledge class (first year) of Greek houses. Barbara McCrady, PhD, a noted expert on the treatment of couples for substance abuse problems, served as discussant.

Oslin DW; Pettinati H; Volpicelli JR. Alcoholism treatment adherence: Older age predicts better adherence and drinking outcomes. American Journal of Geriatric Psychiatry 10(6): 740-747, 2002. (34 refs.)

Objective: Adherence to treatment has been demonstrated to be an important factor for remission from alcohol dependence. The authors compared therapy and medication adherence for treatment of alcohol dependence in older adults with adherence in younger adults. Methods: All subjects were participants in a randomized, double-blind, placebo- controlled efficacy trial of naltrexone for the treatment of alcohol dependence. All subjects received a medically-based psychosocial intervention focused on motivating patients to change and on adherence to treatment The therapy is non-confrontational and is delivered by a nurse-practitioner Results: Compared with younger adults, older adults bad greater attendance at therapy sessions and greater adherence to the medication. Age-group was the only pretreatment factor associated with adherence. The greater adherence in older adults translated to less relapse than in younger adults. Conclusion: Treatment for alcohol dependence can be effective for older adults. Older adults appear to respond well to a medically- oriented program that is supportive and individualized. In fact, findings from this study suggest that older adults can be treated in mixed-age treatment settings when psychotherapeutic strategies are used that are age-appropriate and delivered on an individual basis.

Osman MM. Drug and alcohol addiction in Singapore: Issues and challenges in control and treatment strategies. Journal of Social Work Practice in the Addictions 2(3/4): 97-117, 2002. (25 refs.)

The problem of drug addiction in Singapore has been relatively under control over the past few years. This is a result of the strategy of controlling supply to reduce demand for drugs. Alcohol consumption in Singapore is relatively low compared to Western countries. This paper provides an overview of the drug and alcohol control and treatment strategies adopted in Singapore. While new strategies have been formulated, some issues and challenges still remain. These issues and challenges are discussed and findings of a recent study conducted by the author are described. They include the need to focus on gateway drugs like alcohol, intervention involving family members, opportunities for regular employment for drug addicts, and the role of religion in aftercare treatment.

Osorio R; McCusker M; Salazar C. Evaluation of a women-only service for substance misusers. Journal of Substance Use 7(1): 41-49, 2002. (17 refs.)

This study evaluated the procedures and effectiveness of a women-only service (WS) within a substance misuse service in the United Kingdom. Questionnaire data were gathered from 208 attendees divided into two groups: those who had attended more than three sessions and those who had attended two or fewer sessions. Questions were designed to assess whether service aims had been achieved and satisfaction of the attendees with the program. A special assessment instrument was used to evaluate objective changes in health and social status. Most of the women were referred to the WS internally from the substance misuse service rather than from the community. More alcohol users were represented than drug users. The WS did not affect the male-female ratio within the substance misuse service. Results indicate that participants attained improved health and social status, and were satisfied with the program. Regular users of the service also attained both perceived and objective improvements in addition to user satisfaction. It is concluded that a gender-specific treatment program undertaken as an integral part of a substance misuse service can be effective.

Perl HI; Hilton ME. Ask the right questions and make good use of the answers: A response to Humphreys & Tucker. (editorial). Addiction 97(2): 134-136, 2002. (13 refs.)

Polcin DL; Prindle SD; Bostrom A. Integrating social model principles into broad-based treatment: Results of a program evaluation. American Journal of Drug and Alcohol Abuse 28(4): 587-601, 2002. (11 refs.)

Although traditional social model recovery programs appear to be decreasing, some aspects of social model recovery continue to exert a strong influence in broad-based, integrated programs. This article describes a four-week program that integrates licensed therapists, certified counselors, psychiatric consultation, and social model recovery principles into a broad-based treatment approach. The Social Model Philosophy Scale revealed a low overall rating on social model philosophy. However, social model principles that were heavily stressed included practicing 12-step recovery, the importance of getting a 12-step sponsor, staff-client interactions outside a formal office, employing staff who are in recovery, and emphasizing a goal of abstinence. Three- and six-month follow-up revealed significant improvement in alcohol and drug use, heavy alcohol use, satisfaction with family relationships, 12-step involvement, illegal behaviors, arrests, unsafe sex, self-esteem, use of medical resources, and health status. Findings provide a rationale for larger, multi-site studies that assess the effectiveness of social model characteristics using multivariate techniques.

Rawson RA; Branch C. Connecting substance abuse treatment and research: "Let's make a deal". Journal of Drug Issues 32(3): 769-782, 2002. (13 refs.)

Partnerships between substance abuse researchers and practitioners are being encouraged by numerous initiatives developed in response to a 1998 Institute of Medicine Report (IOM, 1998). The need for the initiatives is clear; however, the structure of the partnerships and how each partner can benefit from them is less clear. There is evidence that each group appreciates the principle of moving research and practice closer together. It is less clear what each group wants from the partnership and what each group can contribute to it. Researchers want to conduct well-controlled studies, with access to clinical populations and adequate control over the study environment to ensure rigorous protocol compliance. Practitioners should be compensated for the time they spend on these projects, and they want to address questions that are of importance to their clinical populations and stay current with new knowledge and technology. No matter how interesting and important these efforts are, unless each group derives adequate and fairly shared benefits, the partnerships will flounder.

Rawson RA; Gonzales R; Brethen P. Treatment of methamphetamine use disorders: An update. Journal of Substance Abuse Treatment 23(2): 145-150, 2002. (36 refs.)

Methamphetamine (MA) is a major public health and criminal justice problem in much of the Western and Midwestern US, and its use seems to be increasing east of the Mississippi River, MA use can produce significant psychiatric and medical consequences, including psychosis, dependence. overdose. and death. Cognitive behavioral therapy and contingency management are among the most promising approaches for treatment of MA abuse and dependence. A multisite study evaluating the Matrix Model of outpatient treatment will soon be completed to provide data on this manualized approach. An ambitious program of pharmacotherapy development research is currently being sponsored by the National Institute on Drug Abuse (NIDA) in geographic areas significantly affected by MA use. The development of treatments for MA-related problems is particularly critical for a number of user groups including MA users who experience persistent psychosis, pregnant women and women with children, gay and bisexual men, and MA users involved in the criminal justice system.

Rawson RA; Marinelli-Casey P; Ling W. Dancing with strangers: Will US substance abuse practice and research organizations build mutually productive relationships? Addictive Behaviors 27(6): 941-949, 2002. (18 refs.)

The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "blending" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.

Richter KP; Ahluwalia HK; Mosier MC; Nazir N; Ahluwalia JS. A population-based study of cigarette smoking among illicit drug users in the United States. Addiction 97(7): 861-869, 2002. (34 refs.)

Aims: People who use illicit drugs are thought to have high rates of cigarette smoking; however, few population-based studies have been reported. We describe smoking patterns among illicit drug users. assess whether cigarette smoking is more prevalent among illicit drug users than it is among non-users and explore how smoking relates to level and type of drug use. Design, setting, participants: We used adult responses to the 1997 National Household Survey on Drug Abuse (n = 16 661). Multivariate analyses used SUDAAN to adjust standard errors for the sampling design and controlled for age, race, sex, education, depression, treatment history and alcohol. Measurements: Smoking rates, cessation rates and smoking levels. Findings: Seventy-one per cent of recent illicit drug users smoked cigarettes at least once in the past month. Their adjusted odds of being a smoker were much greater than for the general population (OR = 3.07, P < 0.0001). Their quit rate, although substantial, was half that of non-users (23%, versus 56%, P = 0.0001). Odds of being a smoker were higher for poly- versus monodrug users (OR = 2.35. P = 0.0020) and rose with increased drug use (OR = 1.36, P = 0.0374). Illicit drug users who perceived smoking to be risky were four times less likely to smoke (OR = 0.23. P = 0.0008). Conclusions: Although most recent illicit drug users smoke, some are able to quit. Better understanding of concurrent cigarette and illicit drug use may provide impetus for policy change and shed light on underlying mechanisms of addiction. Clinicians, policy makers and user advocates should address tobacco use in drug treatment and in harm reduction interventions.

Riggs PD; Davies RD. A clinical approach to integrating treatment for adolescent depression and substance abuse. Journal of the American Academy of Child and Adolescent Psychiatry 41(10): 1253-1255, 2002. (16 refs.)

Despite both clinical and empirical support for integrating treatment for depression (and other comorbid disorders) and SUD, several barriers impede progress toward implementing truly integrated treatment models into clinical practice. These barriers include the following: (1) the historical separation of substance and mental health treatment programs, coupled with the paucity of integrated clinical and research training programs, has resulted in an extremely limited workforce of highly trained researchers and clinicians who are experienced in integrated treatment models for adolescent SUD and comorbid psychiatric disorders; (2) the exclusion of substance-involved adolescents from controlled pharmacotherapy and psychotherapy trials for psychiatric disorders has led to a serious gap in our knowledge of treatment safety and efficacy for adolescents with SUD and comorbid psychiatric disorders; and (3) similarly, controlled clinical trials demonstrating the efficacy of several treatment modalities for adolescent SUD have not given attention to comorbid psychiatric disorders such as depression, resulting in a lack of knowledge about which substance treatment approaches might be most effective in adolescents with dual diagnoses. To date, only two adequately powered placebo-controlled pharmacotherapy trials have targeted the treatment of any comorbid disorder in nonabstinent adolescents with SUD, but neither of these targeted MDD. Despite the paucity of pharmacotherapy trials in adolescents with SUD, several controlled clinical trials have demonstrated the efficacy of psychosocial treatment interventions for adolescent SUD, including family-based, behavioral, and cognitive-behavioral therapies. Therefore, it is important that we at least begin to derive a more standardized clinical treatment algorithm to guide our approach to integrated treatment from the current empirical base. A six step algorithm is then set forth. (1) establish a strong treatment alliance and patient-generated goals regarding his/her substance use. With comorbid depression, clinicians will want to emphasize the importance of rapidly reducing or discontinuing substance use (2) Once the adolescent is engaged in substance treatment, and if both self-report and urine toxicology results indicate abstinence or significant reduction in substance use, then carefully monitored pharmacotherapy for depression may be initiated-even within the first 2 weeks of treatment; current research would support the use of serotonin reuptake inhibitors (3) If pharmacotherapy is initiated, clinicians must closely monitor substance use, urine toxicology results, side effects, medication compliance, motivation, and target symptom response as well as behavior change and psychosocial functioning (4) If pharmacotherapy is clinically contraindicated, for example by ongoing heavy substance use, then psychotherapy for depression such as cognitive-behavioral therapy or interpersonal psychotherapy may be initiated without pharmacotherapy. Use of 12-step programs; (5) If depression and substance use do not significantly improve within the first 2 months after initiating treatment (or if functioning deteriorates), this may be an indication that a more intensive level (6) The potential for relapse after achieving abstinence should be openly discussed and anticipated, both during and after successful treatment. A detailed plan should be developed to intensify treatment and family involvement

Robbins MS; Bachrach K; Szapocznik J. Bridging the research-practice gap in adolescent substance abuse treatment: The case of brief strategic family therapy. Journal of Substance Abuse Treatment 23(2): 123-132, 2002. (22 refs.)

This article presents an empirically validated intervention, Brief Strategic Family Therapy (BSFT), for the treatment of adolescent drug abusers. The BSFT intervention steps and program format are presented. Challenges to implementation in community treatment settings are discussed to identify factors that may facilitate or block the integration of BSFT into community practice settings. In particular, this discussion explores how 3 critical aspects of community treatment programs-program philosophy, program structure, and cost/funding influence the blending of BSFT into community treatment practice.

Roman PM; Johnson JA. Adoption and implementation of new technologies in substance abuse treatment. Journal of Substance Abuse Treatment 22(4): 211-218, 2002. (16 refs.)

in addition to clinical outcomes, understanding the adoption and implementation of new treatment interventions is essential. This analysis was designed to assess the predictive utility of organization-level features in understanding the adoption and implementation of new technologies in substance abuse treatment. Naltrexone, which was found to be in current use in 44.1% of a national sample of 400 private substance abuse treatment centers, was selected as an appropriate sample technology for study. Adoption of naltrexone is significantly related to both the treatment center's age and its administrative leadership. Naltrexone adoption is also significantly associated with the percentage of the center's caseload covered by managed care programs and by the percentage of relapsers represented in the caseload. The analysis was less successful in predicting naltrexone implementation for either primary alcohol dependence or primary opiate addiction.

Saulnier CF; Clay C. Population-specific women's alcohol services. Substance Abuse 23(2): 138-139, 2002

Theoretical work and empirical evidence suggest that providers who have responded to the identified need for women-specific drug and alcohol treatment have varying conceptualizations of women's services. Theoretical formulations as well as real world women's services appear to have at least four dimensions by which they can be analyzed: (1) level of orthodoxy -- how much the program adheres to a traditional approach to services; (2) women-specificity -- how much the program's variation from traditional services has to do with women's needs; (3) contextualization -- whether the program is designed to analyze and alter the individual service user only, the service user's family, the community, social/political systems, or some combination; (4) population-specificity -- how carefully the program addresses the needs of a specified group of women, for example, Latinas or women of African descent. Using the first of these three criteria, a preliminary typology of women-specific programs was recently proposed. The study was based on a small number of programs in Western New York. Programs that provide services to specified populations of women, (e.g., lesbians, Latinas, Native American women, African-American women) were not examined. This study explored women-specific services and population-specific women's services in Massachusetts.

Schippers GM; Schramade M; Walburg JA. Reforming Dutch substance abuse treatment services. Addictive Behaviors 27(6): 995-1007, 2002. (30 refs.)

The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior- oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

Shand FL; Mattick RP. Clients of Treatment Service Agencies: May 2001 Census Findings. Sydney, Australia: National Drug and Alcohol Research Centre, 2002. (7 refs.)

A fourth national census of Australian clients of treatment service agencies (COTSA) is described. The census was conducted to identify the characteristics of clients attending drug and alcohol treatment services and to compare the problems being treated since the first census. The census was conducted on two days in May of 2001 in all states and territories. All services identified as providing face-to-face specialist treatment were surveyed. The following results were seen: (1) response by 458 of the 507 agencies surveyed; (2) report of a total of 5,304 clients treated on census day; (3) a majority in treatment for their own substance use; (4) mean age of 32.8 years for substance users; (4) a majority of clients of male gender; (5) in a relative/friend group, a majority of female gender; (6) most clients born in Australia, speaking English at home, and in unpaid employment or unemployed; (7) most common presenting problems being alcohol and opiates, followed by cannabis and amphetamines; (8) report of polydrug use by 12.6 percent; and (9) report that just under half of substance users had injected illicit drugs in the 12 months preceding the census. The results indicate that the gap between the proportion of clients presenting to specialist treatment agencies with alcohol problems and opiate problems has narrowed since the first census in 1990. While alcohol-related problems have decreased, other drug problems have increased. There has also been an increase in the proportion of substance users under the age of 25.

Shavelson L. Hooked: Five Addicts Challenge Our Misguided Drug Rehab System. New York: The New Press, 2002

The author, a physician and photo-journalist, chronicles the events in the lives of five addicted prisons -- addicted to alcohol, methamphetamine and heroin -- over a two year period. He follows them through different California drug rehabilitation programs, some voluntary and others court-mandated. He follows these people through weeks-long waiting periods prior to entering treatment, stays in rehabilitation centers, doctors' offices, the judges' chambers of drug courts, and, often, back to the street. It highlights the problems that are often overlooked by the substance abuse treatment system-- mental illness, and trauma, including child abuse. The author argues for an integrated approach to drug treatment that addresses the root causes of drug abuse, not just its outward behaviors.

Shen WW; Chang C; Hsieh WC; Yeh CJ; Chiu FY; Chuang YC. The flunitrazepam abuse prevention program at a general hospital in Taiwan: A descriptive study. Psychiatry and Clinical Neurosciences 56(4): 425-430, 2002. (15 refs.)

The Bureau of Controlled Drugs at Ministry of Health, Executive Yuan in Taiwan announced, on 1 April 2000, the schedules of controlled drugs with abuse potential and implemented a policy on 1 October 2000 to control them. Flunitrazepam (FM2), along with other two benzodiazepines (triazolam and brotizolam), is placed on Schedule III. The aim of the present study was to analyze the pattern of flunitrazepam prescriptions across all medical subspecialty departments at Taipei Medical University-Wan Fang Hospital (TMU-WFH), Taiwan. We analyzed 1170 prescriptions over 12 month period from 1 July 2000 to 31 May 2001. All prescription data were divided into three 4 month periods: period I was when the flunitrazepam prescription was not controlled, period II represented the time when flunitrazepam was placed on Schedule III and when physicians were required to use a special duplicated prescription form and period III was when the TMU-WFH started to set a stricter control for the prescription of flunitrazepam. The results indicated that the number of flunitrazepam prescriptions during period III had decreased significantly compared with period I (P less than or equal to 0.05). Eventually, 45.7% of flunitrazepam-medicated patients were followed up monthly with a restriction of their flunitrazepam supply to no more than 14 days, 22.9% of patients were followed up fortnightly at clinics with a 14 day supply of flunitrazepam, 15.7% were followed up fortnightly with a 14 day restriction of flunitrazepam plus a non- flunitrazepan benzodiazepine supplement, 10.7% were referred to clinics within the Department of Psychiatry and 5% were switched from flunitrazepam to other drugs.

Simpson DD. A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment 22(4): 171-182, 2002. (69 refs.)

Systematic evaluations of efforts to transfer research-based interventions and procedures into general practice at community drug treatment programs have been limited. However, practical experiences as well as results from studies of technology transfer and organizational behavior in related fields provide a basis for proposing a heuristic model of key factors that influence this process. The successful completion of four stages of activity typically involved in program change (exposure, adoption, implementation, and practice of new interventions) appears to be influenced by several organizational considerations (e.g., institutional readiness for change, resources, and climate) as well as staff attributes. Assessment instruments for measuring organizational functioning (based on ratings aggregated for staff and patients in a program) are introduced, along with preliminary evidence for their validity. A better conceptual understanding of the process of program change and common barriers that may be encountered is needed for effectively transferring research to practice.

Smith GL; Kelly KJ. Utilizing technology: The challenges and opportunities facing "substance abuse" professionals in rural communities. Substance Use & Misuse 37(5-7): 805-814, 2002. (12 refs.)

Many rural communities are actively pursuing technology as a resource for solving education, health care, and economic development issues. These communities are establishing a technology and telecommunication infrastructure that makes them appealing to individuals and companies from urban communities. But this has created a challenge and an opportunity for the mental health industry in general, and more specifically, "substance abuse" professionals. The opportunity for the "substance abuse" profession is to design and use new services using the exact same technologies that may precipitate the need for the services.

Solomon J; Floritti A. Motivational intervention as applied to systems change: The case of dual diagnosis. Substance Use & Misuse 37(14): 1833-1851, 2002. (30 refs.)

The concept of motivational interviewing is based on helping individual clients build and sustain a commitment to reach and carry out a decision to change. In this paper, the motivational interviewing model is applied to systems change. Different stages of involvement and readiness to change are identified within systems which closely resemble those found in individuals. When applied to a system, we call this process "Motivational Intervention." In this paper, the motivational intervention model is applied to a psychiatric system of health care delivery where large numbers of psychiatric patients are found to also have substance use-related problems. Several Italian health districts invited the authors to present a series of lectures and workshops in order to facilitate the incorporation of substance user treatment into existing psychiatric services. Using the motivational intervention model to determine where the system was in the process of change, we then identified the tasks necessary to facilitate further change.

Sowers KM; Ellis RA; Washington TA; Currant M. Optimizing treatment effects for substance-abusing women with children: An evaluation of the Susan B. Anthony Center. Research on Social Work Practice 12(1): 143-158, 2002. (16 refs.)

Substance abuse among women is a significant national problem. Historically, the treatment of this condition has been difficult, but it has been even more challenging when the woman in treatment has had children. This article reports the results of an evaluation of the Susan B. Anthony Center (SBAC), a residential treatment facility for recovering women and their children. Researchers studied outcomes for 41 women who were first treated in a detoxification program, then referred to either SBAC or a day treatment program. Although random assignment to groups was not possible, the groups were comparable on four major demographic variables. The SBAC groups reported better outcomes on three psychosocial variables: abstinence, arrest, and employment. They improved their total score on the Functional Assessment Rating Scale substantially more than did the comparison group. Consumer satisfaction was also high.

Spear S; Rawson RA. Preface: Perspectives from the conference, "Common Ground, Common Goals, Common Language: Bringing Substance Abuse Practice and Research Together. Journal of Drug Issues 32(3): 751-755, 2002. (4 refs.)

Spear S; Rawson RA. Linking researchers and practitioners in the substance abuse field: Perspectives of two "bridgers". Journal of Drug Issues 32(3): 881-892, 2002. (16 refs.)

This article presents a conceptual framework for substance abuse research and practice collaboration based on John-Steiner's (2000) seminal work on characterizing creative collaborative processes in fields such as science, art, music, and literature. Using John-Steiner's core concept of "co-construction of knowledge," the authors provide examples of informal and formal collaborative methods for "bridging the gap" between substance abuse research and practice. An ongoing collaborative effort in Los Angeles County, California, called "L.A. County Partnerships Network," is described and important strategies for developing collaborative relationships between substance abuse researchers and practitioners are highlighted. Informal patterns of collaboration, such as those used by the L.A. Partnerships Network, can lead to significant developments among substance abuse researchers and practitioners.

Stancliff S; Myers JE; Steiner S; Drucker E. Beliefs about methadone in an inner-city methadone clinic. Journal of Urban Health 79(4): 571-578, 2002. (24 refs.)

Despite being considered both the most effective treatment for heroin addiction and an essential tool in the prevention of human immunodeficiency virus (HIV), methadone maintenance (MM) is often held in low esteem by heroin addicts-even those in MM treatment. This survey examined current beliefs and attitudes about MM of patients at an inner-city clinic, and the personal experience and attitudes of these patients with this treatment. Consenting patients in a methadone clinic serving a poor population with high rates of human immunodeficiency virus infection were queried about their attitudes toward and beliefs about methadone using a 16-item questionnaire. Over 2 days, 315 questionnaires were completed (acceptance rate 40%), totaling 32% of the 1000 clinic patients. Nearly 80% believed that methadone had a positive effect on his or her life, but 80% were certain or unsure as to whether methadone is bad for one's health, and a similar percentage (80%) believed that discontinuing methadone was an important goal. Patients continue to have strongly negative attitudes toward and beliefs about methadone despite their acknowledgement that methadone has been very positive for them as individuals. As a result, many patients leave MM treatment prematurely, and there are usually unfilled slots in MM programs in New York City, even while continued need exists (e.g., less than 25% of the heroin addicts in the city are in treatment). The restrictive nature of many MM programs may account for these attitudes and beliefs.

Steele LD; Rechberger E. Meeting the treatment needs of multiply diagnosed consumers. Journal of Drug Issues 32(3): 811-823, 2002. (16 refs.)

Recent research demonstrates that approximately 10 million people in the United States have been diagnosed with at least one co-occurring mental health disorder and substance abuse disorder in any given year (Substance Abuse & Mental Health Services Administration National Advisory Council, 1997). Emerging awareness by clinicians, substance abuse counselors, and researchers has subsequently awakened the treatment community to the needs of consumers who are afflicted with co-occurring problems. One panel of the Los Angeles County-wide conference "Common Ground, Common Language, Common Goals: Bringing Substance Abuse Research and Practice Together" (held in April 200 1) focused on the prevalence and treatment of co-occurring disorders. This article outlines the discussion and findings of this panel on the numerous treatment needs of consumers with multiple diagnoses and the converging and conflicting treatment models that have been developed for them.

Stone E; Fletcher K. User views on supervised methadone consumption. Addiction Biology 8(1): 45-48, 2003. (4 refs.)

To assess the views of opiate-dependent individuals about supervised methadone consumption. Three groups of opinions were sought: (i) new patients referred for assessment and treatment, using rating scales; (ii) the consensus view of the Methadone Alliance (a national users' forum); and (iii) the consensus view of a local service users' forum. All three groups expressed the view that supervised consumption has an important place in methadone treatments. Users understand the need for daily supervision of methadone and are generally willing to accept it. Users' views provide support for the introduction of flexible methadone prescribing regimes incorporating supervised consumption. Privacy in pharmacies and the possibility of moving away from supervision are important elements in an acceptable programme. Supervised consumption is an important component of safe, effective and responsible methadone prescribing.

Taxman FS; Simpson SS; Piquero NL. Calibrating and measuring theoretical integration in drug treatment programs. Journal of Criminal Justice 30(3): 159-173, 2002. (36 refs.)

A major criticism of correctional programs is that they lack a clear theoretical foundation for the services delivered; yet, there had been little empirical exploration of this issue. Using a survey of 149 staff working in correctional programs that employed a cognitive behavioral approach, it was examined (1) whether theoretical frameworks informed staff beliefs about the causes of drug use and criminal behavior; (2) if intervention strategies were guided by theory; and (3) the degree of theoretical consistency between beliefs about causation and intervention. Consistency was hypothesized to occur when the underlying theories of etiology for criminal behavior/substance abuse corresponded to the recommended intervention strategies. Results suggested that staff adhered to theoretical rationales for both drug abuse causation and intervention more so than would have been predicted based on the literature in this area. There was a fair amount of inconsistency between the theories that informed causation and those that underlied interventions. As expected, staff adhered to principles derived from social learning theories but they also subscribed to principles from social control, labeling, and strain. This study discussed the implications of these findings for program design, implementation, and outcomes.

Topp L; Day C; Degenhardt L. Changes in patterns of drug injection concurrent with a sustained reduction in the availability of heroin in Australia. Drug and Alcohol Dependence 70(3): 275-286, 2003. (88 refs.)

Between 1996 and 2000, heroin was the drug most frequently injected in Australia, and viable heroin markets existed in six of Australia's eight jurisdictions. In 2001, there was a dramatic and sustained reduction in the availability of heroin that was accompanied by a substantial increase in its price, and a 14% decline in the average purity of seizures analysed by forensic laboratories. The shortage of heroin constitutes a unique natural experiment within which to examine the impact of supply reduction. This paper reviews one important correlate of the shortage, namely changes in patterns of illicit drug injection. A number of studies have consistently suggested that between 2000 and 2001, there was a sizeable decrease in both prevalence and frequency of heroin injection among injecting drug users. These changes were accompanied by increased prevalence and frequency of stimulant injection. Cocaine was favoured in NSW, the sole jurisdiction in which a cocaine market was established prior to the heroin shortage; whereas methamphetamine predominated in other jurisdictions. Some data suggest that, at least in the short-term, some drug injectors left the market altogether subsequent to the reduced heroin availability. However, the findings that (1) some former heroin users switched their drug preference to a stimulant; and (2) subsequently attributed this change to the reduced availability of heroin, suggests that reducing the supply of one drug may serve to increase the use of others. Given the differential harms associated with the use of stimulants and opiates, this possibility has grave implications for Australia, where the intervention and treatment system is designed primarily to accommodate opiate use and dependence.

Torrey WC; Drake RE; Cohen M; Fox LB; Lynde D; Gorman P; Wyzik P. The challenge of implementing and sustaining integrated dual disorders treatment programs. Community Mental Health Journal 38(6): 507-521, 2002. (53 refs.)

Integrated dual disorders treatment programs for people with severe mental illness and co-occurring substance use disorder have been implemented in a variety of community mental health center sites across the U.S. and in several other countries over the past 15 years. Consumers who receive services from programs that offer integrated dual diagnosis treatments that are faithful to evidence- based principles achieve significant improvements in their outcomes. Unfortunately, not all programs that attempt implementation are successful, and the quality of high-fidelity programs sometimes erodes over time. This article outlines implementation strategies that have been used by successful programs. As a general rule, success is achieved by involving all major participants (consumers, family members, clinicians, program leaders, and state or county mental health authorities) in the process and attending to the three phases of change: motivating, enacting, and sustaining implementation.

Weiss S; Gefen L. The Israel Society for the Prevention of Alcoholism. Addiction 98(3): 255-259, 2003. (98 refs.)

This paper describes the profile of the Israel Society for the Prevention of Alcoholism is a nation-wide, public, non-profit association. It portrays various aspects of ISPA treatment and rehabilitation facilities -- the residential treatment center, the rehabilitative hostel and the 'warm home' for homeless alcoholics. It depicts ISPA prevention activities, prevention materials and its usage of the media, and deals with ISPA involvement in policy issues. The paper also addresses the research reality of ISPA and its scientific journal, and refers to the society's structure and its future.

Zanis DA; Mulvaney F; Coviello D; Alterman AI; Savitz B; Thompson W. The effectiveness of early parole to substance abuse treatment facilities on 24-month criminal recidivism. Journal of Drug Issues 33(1): 223-235, 2003. (17 refs.)

This naturalistic study involved 569 offenders who had a history of substance abuse or dependence prior to incarceration, and were subsequently approved for early parole to a community-based substance abuse treatment facility (SATF). Overall 495 offenders were paroled directly to a SATF while 74 were paroled to the community without transfer to a SATF due to prison overcrowding. Criminal history records for all 569 offenders were obtained approximately 24 months following parole. Any new conviction as a result of a new crime committed during the 24-month window following parole to the community was considered a negative outcome. Results found that 22% of offenders paroled to a substance abuse treatment facility (SATE) were convicted of a new crime compared to 34% of offenders paroled directly to the community (chi-square = 4.57, df=1, p=.03). A stepwise logistic regression analysis was conducted to determine how different factors contributed to a new conviction. Overall more prior convictions (p<.001) and lower age (p=.001) were strong significant predictors and cocaine dependence (p=.06) and parole without treatment (p=.08) were predictive of a new conviction. Additionally, offenders who completed treatment were significantly less likely to be convicted of a new crime (11.8% vs. 29%) than those who dropped out of treatment-(chi-square = 11.50, df = 1, p<.01). These data suggest that early parole to a SATF could be considered as a viable means to reduce prison sentences for addicted offenders.

Last Updated on June 11, 2003