Mary R. Haack

Bio: Mary R. Haack is an academic researcher from University of Maryland, Baltimore. The author has contributed to research in topics: Online counseling & Child abuse. The author has an hindex of 8, co-authored 16 publications receiving 240 citations. Previous affiliations of Mary R. Haack include Rutgers University & University of Maryland, College Park.

Medication adherence among homeless patients: A pilot study of cell phone effectiveness

Abstract: Purpose: We examined the feasibility of using cell phones to monitor medication adherence among homeless participants and collected data for research purposes. Data sources: Ten homeless individuals with a co-occurring substance use and psychiatric disorders who were receiving psychopharmacologic treatment participated in the study. All psychopharmacologic treatment was provided by a psychiatric mental health nurse practitioner. Cell phones were provided to participants with unlimited phone service for 45 days. An automated telephone system was programmed to call participants daily for 30 days. All participant responses were reported to a computer and reviewed by study staff on a daily basis. Conclusions: The automated calls reached study participants 93% of days and, when reached, participants reported 100% adherence with the prescribed medication regimen. Exit interviews indicated strong support for the usefulness of the phone and the value of the call and survey as reminders to take their medication. No patients dropped out of this study. Implications for practice: This pilot study establishes the feasibility of using cell phones to monitor and manage medication regimens for hard-to-reach populations, such as the homeless with co-occurring disorders. It also establishes that this technology would work for research data collection.

State Policies and Nurses with Substance Use Disorders

Abstract: Purpose: To investigate the effects of two state regulatory policies on nurses with substance use disorders (SUD) on relapse rates and retention in the nursing workforce. Design & Methods: This longitudinal comparative study consisted of six data-collection points in 6 months. One sample of 100 registered nurses (RNs) and licensed practical nurses or vocational nurses (LPN/VNs) had disciplinary actions taken against their licenses by four U.S. state regulatory boards using a traditional, disciplinary approach. The alternative sample consisted of 119 RNs and LPN/VNs from three U.S. states where the regulatory board diverted nurses to programs for treatment and for determining suitability to return to practice. Data were collected via mailed surveys. Findings: When compared to the sample, the alternative sample had more nurses with active licenses, fewer with criminal convictions, and more nurses employed in nursing. No difference in relapse rate was found. Fewer than 15% of nurses in either sample experienced one or more episodes of relapse during the 6-month study. Of those who did relapse, the majority used alcohol or street drugs. Conclusions: Alternative policies worked as well as disciplinary policies and were a more humane and rehabilitative approach. Alternative policy is consistent with the recommendation in Healthy People 2010 to eliminate financial barriers limiting access to treatment. Further investigation is needed to identify situations that trigger relapse.

Impact of online counseling on drug use: a pilot study.

Abstract: Purpose To examine the effect of online counseling abuse counseling on drug use among underserved patients. Methods Subjects were recruited from an Indian Reservation in Eagle Butte, South Dakota; a family court in Newark, New Jersey; a probation office in Alexandria, Virginia; and a co-occurring disorders treatment clinic in Washington, District of Columbia. Subjects were predominantly poor, undereducated, unemployed, court involved, or diagnosed with co-occurring psychiatric disorders. A total of 79 subjects volunteered to participate in the project. Subjects were randomly assigned to either a control group or an experimental group. The control and experimental groups were both issued an Internet-ready computer and 1 year of Internet service. Only the experimental group had access to online counseling intervention. Drug use was measured using a combination of self-usage reporting and supervised urine tests. Results Urine tests were available for 37% of subjects. Exit surveys containing self-reported usage were obtained from 54% of the subjects. Self-usage reports or urine test results were available from 70% of subjects. The difference of the rates of drug use in the control and experimental groups (as calculated from urine tests or through self-report) was not significantly different from zero, suggesting that online counseling had not led to a reduction in substance use. It is possible that the study lacked sufficient power to detect small differences in the rate of drug use in the experimental and control groups. Conclusions Additional research is needed to establish the efficacy of online counseling in hard-to-reach populations.

Promoting Early Intervention for Substance Use Disorders Through Interdisciplinary Education for Health Professionals

Abstract: Substance use disorders (SUDs) impose enormous costs on individuals, families and public resources. Illegal drugs and alcohol are responsible for thousands of deaths each year, and contribute to the spread of communicable diseases such HIV and Hepatitis C, as well as some of the worst social problems in the United States, including child abuse, domestic violence and sexual assault. It is evident that in all areas of health care, untreated SUDs elevate the risk of complications and poor outcomes, and drive up the cost of health care.Despite a general agreement that SUDs are a leading cause of death, disability and disease, front-line health professionals are not trained to identify individuals with SUDs, assess their condition, intervene on their behalf, or refer them to treatment. Numerous studies demonstrate the effectiveness and cost effectiveness of activities intended to detect and intervene early with individuals with SUDs in health care settings (; ; ). Several forces either facilitate or inhibit ef...

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Abstract: Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review

Abstract: Background: Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective: This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods: A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results: A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions: Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions. Trial Registration:

Online Counseling: A Narrative and Critical Review of the Literature

Abstract: Objective This article aimed to critically review the literature on online counseling. Method Database and hand-searches were made using search terms and eligibility criteria, yielding a total of 123 studies. Results The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability, and clients’ and therapists’ attitudes and experiences of online counseling are reviewed. Conclusion A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters. A need remains for stronger empirical evidence to establish efficacy and effectiveness and to understand better the unique mediating and facilitative variables.