Showing papers in "Journal of Psychoactive Drugs in 2008"
TL;DR: The definition of and principles for gender-responsive services and the Women's Integrated Treatment (WlT) model are presented, which is based on three foundational theories: relational-cultural theory, addiction theory.
Abstract: Historically, substance abuse treatment has developed as a single-focused intervention based on the needs of addicted men. Counselors focused only on the addiction and assumed that other issues would either resolve themselves through recovery or would be dealt with by another helping professional at a later time. However, treatment for women's addictions is apt to be ineffective unless it acknowledges the realities of women's lives, which include the high prevalence of violence and other types of abuse. A history of being abused increases the likelihood that a woman will abuse alcohol and other drugs. This article presents the definition of and principles for gender-responsive services and the Women's Integrated Treatment (WIT) model. This model is based on three foundational theories: relational-cultural theory, addiction theory, and trauma theory. It also recommends gender-responsive, trauma-informed curricula to use for women's and girls' treatment services.
292 citations
TL;DR: This article reviews policy initiatives that led to the growth of “specialized” treatment programs and services for women and recent policy changes that influence the provision of substance abuse treatment to women, and examines the effectiveness of evidence-based treatment practices that have either been modified, or have the potential to be adapted, to address the treatment needs of women.
Abstract: In the past three decades, there has been increased recognition of the role of gender in influencing the course of substance use and treatment utilization. Concurrently, a substantial body of research on gender-related issues and substance abuse and its treatment has developed. This article reviews (1) policy initiatives that led to the growth of "specialized" treatment programs and services for women and recent policy changes that influence the provision of substance abuse treatment to women; (2) gender differences in the prevalence of substance use disorders and admissions to treatment; (3) gender differences in treatment needs,utilization, and outcomes, including long-term outcomes following treatment; (4) organizational characteristics of substance abuse treatment providers for women and the types of services provided in these programs; (5) treatment outcomes in gender-specific programs for women; and (6) the effectiveness of evidence-based treatment practices that have either been modified, or have the potential to be adapted, to address the treatment needs of women. This body of research is viewed within the context of a series of paradigm shifts from a generic treatment approach to a focus on gender differences and gender specificity and, most recently, to an emergent focus on gender responsiveness.
195 citations
TL;DR: A recent study examined the use of two gender-responsive, trauma-informed curricula presented in a residential facility for women, 55% of whom had criminal histories, and indicated less substance use, less depression, and fewer trauma symptoms after participation in the WIT curricula.
Abstract: There is growing recognition of the complex needs of women with dual diagnoses of substance abuse and mental health disorders. Recent research indicates that 55% to 99% of women with co-occurring disorders have experienced trauma from abuse and that abused women tend to engage in self-destructive behaviors. These women often are not well served by the services found in their communities, which separate substance abuse and mental health programs, despite the fact that research shows that integrated, trauma-informed treatment services will increase the success of their recovery. A recent study examined the use of two gender-responsive, trauma-informed curricula presented in a residential facility for women, 55% of whom had criminal histories. Helping Women Recover and Beyond Trauma are both manualized programs founded on research and clinical practice and are grounded in the theories of addiction, trauma, and women's psychological development. This treatment model is named "Women's Integrated Treatment" (WIT). Women who successfully completed the programs were assessed at several points in time on several scales, including trauma symptomology, depression, and substance use before and after the programs. The findings indicated less substance use, less depression, and fewer trauma symptoms (p < or = .05)--including anxiety, sleep disturbances, and dissociation--after participation in the WIT curricula.
132 citations
TL;DR: It was found that low doses of MDMA were both psychologically and physiologically safe for all the subjects and future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.
Abstract: The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.
131 citations
TL;DR: Barriers to obtaining drug abuse treatment in the rural South using qualitative interviews conducted with 86 illicit stimulant users recruited in rural Arkansas and Kentucky between 2003 and 2005 suggests five interrelated categories of barriers.
Abstract: This article describes barriers to obtaining drug abuse treatment in the rural South using qualitative interviews conducted with 86 illicit stimulant users recruited in rural Arkansas and Kentucky between 2003 and 2005. Fifty-nine (69.0%) of the interviewees had never entered drug abuse treatment. Sixteen (19.0%) participants reported current perceived need for treatment, while seven (8%) were ambivalent about seeking it. Interview data suggest five interrelated categories of barriers to accessing drug abuse treatment: (1) geographical, (2) organizational, (3) economic, (4) social, and (5) psychological. The study findings can inform further examination of rural treatment barriers and have important implications for developing strategies to overcome these obstacles.
73 citations
TL;DR: Sober living houses are suggested to be a good example of services that have been neglected in the addiction literature that might help individuals who need an alcohol-and drug-free living environment to succeed in their recovery.
Abstract: The call for evidence-based practices (EBPs) in addiction treatment is nearly universal. It is a noteworthy movement in the field because treatment innovations have not always been implemented in community programs. However, other types of community-based services that may be essential to sustained recovery have received less attention. This article suggests that sober living houses (SLHs) are a good example of services that have been neglected in the addiction literature that might help individuals who need an alcohol-and drug-free living environment to succeed in their recovery. It begins with an overview of the history and philosophy of this modality and then describes our five-year longitudinal study titled, “An Analysis of Sober Living Houses.” Particular attention is paid to the structure and philosophy of SLHs and purported therapeutic factors. It ends with the presentation of baseline data describing the residents who enter SLHs and six-month outcomes on 130 residents.
71 citations
TL;DR: Evaluated factors associated with drug dealing among injection drug users in Vancouver, Canada, and self-reported drug-dealing roles and reasons for dealing suggested elements of “balanced” drug policies may undermine each other and indicate the need for alternative interventions.
Abstract: So-called “balanced” drug policy couples enforcement initiatives targeting drug dealers with health-focused interventions serving addicted individuals. There are few evaluations of this approach, and little is known about how these two populations may overlap. We evaluated factors associated with drug dealing among injection drug users (IDUs) in Vancouver, Canada, and examined self-reported drug-dealing roles and reasons for dealing. Among 412 IDUs seen from March through December 2005, 68 (17%) had dealt drugs during the previous six months. Variables independently associated with drug dealing included: recent incarceration (adjusted odds ratio [AOR] = 2.9; 95%CI: 1.4 – 6.0); frequent heroin injection (AOR = 2.5; 95%CI: 1.4 – 4.6); frequent cocaine injection (AOR = 2.0; 95%CI: 1.1 – 3.8); and recent overdose (AOR = 2.7; 95%CI:1.0 – 7.3). The most common drug-dealing roles were direct selling (82%), middling (35%), and steering (19%), while the most common reasons for dealing included obtaining d...
68 citations
TL;DR: Examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs revealed that the majority of the variance in adolescents' ratings of the therapeutic alliance was due to adolescent factors, while therapist ratings of alliance were nearly equally divided between adolescent and therapist factors.
Abstract: Given the importance of the therapeutic alliance in achieving positive treatment outcomes, research is needed to illuminate the factors that contribute to the development of this important relationship. The aim of the current study was to expand upon the existing literature by examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs. Use of multilevel modeling techniques revealed that the majority of the variance in adolescents' ratings of the therapeutic alliance was due to adolescent factors (91%), while the variance in therapist ratings of alliance were nearly equally divided between adolescent and therapist factors (52% vs. 48%). Participant age was found to be the only significant predictor of therapist-rated alliance, with therapists reporting higher alliances with older adolescents. Adolescents reporting higher levels of social support, greater problem recognition, and more reasons for quitting also reported higher therapeutic alliance ratings. Future research is needed to examine if early identification of adolescents with low social support and problem recognition combined with brief treatment readiness interventions can be a promising approach to help improve therapeutic engagement and post-treatment substance use outcomes.
47 citations
TL;DR: A brief description of the plant that has only recently crept into the popular American consciousness, and a review of the different legal mechanisms through which states have controlled the plant and the pending legislation proposing controls are discussed.
Abstract: The legal status of the hallucinogenic plant Salvia divinorum has been rapidly changing. Legal prohibitions on this plant native to Oaxaca, Mexico have emerged at the state level, a phenomenon that has not occurred since the passage of the Controlled Substances Act (CSA). Included will be a brief description of the plant that has only recently crept into the popular American consciousness, and a review of the different legal mechanisms through which states have controlled the plant and the pending legislation proposing controls. Lastly, the implications of various state laws are discussed.
47 citations
TL;DR: Specific groups were developed and implemented in an effort to better address the uniquereasons for relapse that the authors' clients most commonly reported, and it is hoped that the addition of these groups will help to improve overall treatment outcome of the clients who are served by the agency.
Abstract: Asurvey to assess the most common reasons for relapse was developed and administered to 335 individuals who were current clients in various levels of care in a large substance abuse treatment program in order to better understand what factors were most relevant for relapse among these clients. Several reasons for relapse were chosen significantly more often than others. Common reasons for relapse for both men and women were the following: feeling bored, feeling anxious or stressed, wanting to use and get high, believing that use could occur without getting readdicted, and relationship problems and break up. In addition, men also commonly reported anger, having too much money, and no longer attending meetings as significant reasons for relapse. Among female clients, depression, loneliness, and the pain of withdrawal were among their top reasons for relapse. As a result of this survey, specific groups were developed and implemented in an effort to better address the uniquereasons for relapse that o...
44 citations
TL;DR: The nature, extent and predictors of the arrest histories of a sample of gay and bisexual substance users at very high risk for HIV infection and/or transmission are described.
Abstract: Gay and bisexual men continue to suffer the highest burden of HIV/AIDS in the U.S. Since the beginning of the epidemic, substance abuse has been shown to be one of the strongest predictors of sexual risk behaviors and seroconversion among this population. Recent research has focused on additional aspects of health risk disparities among gay and bisexual men, including depression and other mental health problems, childhood sexual abuse, and adult victimization, suggesting that these men are impacted by a syndemic of health risks. The involvement of gay and bisexual men with the criminal justice system is largely absent from the literature. This article describes the nature, extent and predictors of the arrest histories of a sample of gay and bisexual substance users at very high risk for HIV infection and/or transmission. These histories are surprisingly extensive, and are strongly associated with poverty, severe mental distress, substance abuse and dependence, and victimization. The involvement of gay and bisexual men in the criminal justice system deserves a stronger research focus because of the unique challenges facing such men and also because arrests are yet another marker for a host of health risks among them.
TL;DR: The collective impact of CAEs was related to both age of onset and severity, demonstrating the intergenerational cycle of addiction, and indicates the need for early intervention, which could prevent the onset of MA use and reduce the course of addiction.
Abstract: Women report extensive histories of childhood abuse, often leading to addiction. Studies assessing the same effects for men are lacking. This study describes childhood adverse events (CAEs) among methamphetamine (MA)-dependent men and women and assesses the relationship of CAEs to the onset and severity of dependence. Baseline and three-year interview data were collected for 236 men and 351 women. Dependent variables included onset of MA and severity of dependence. Women reported greater occurrence of all types of CAEs than men (28% vs. 13%,p < .01). Familial substance abuse was most predictive of onset for men and of dependence severity for women. The collective impact of CAEs was related to both age of onset and severity. This demonstrates the intergenerational cycle of addiction, and indicates the need for early intervention, which could prevent the onset of MA use and reduce the course of addiction.
TL;DR: Examination of women's perceptions of their relationships using the Sexual Relationship Power Scale and NIDA's HIV Risk Behavior Assessment revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors.
Abstract: The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationships and HIV risk behaviors.
TL;DR: Results reported here for 343 subjects who have completed the 90-day follow up indicate significant reductions in reported sexual risk behaviors for those participating the DVD intervention, compared to the other two brief interventions.
Abstract: Brief interventions to reduce harmful or problem behaviors have become increasingly popular in a variety of health fields, including HIV and hepatitis risk reduction. A central issue in intervention research involves the evaluation of what constitutes an effective "dose" of an intervention. This research examines the relative effectiveness of three alternative brief interventions of varying intensity designed to change the risk behaviors of inmates who are reentering society: a DVD-based, peer delivered intervention; the NIDA Standard HIV Intervention; and a standard practice condition (HIV educational video). All participants randomly received one of the interventions and were tested for HIV and HCV prior to release from custody. Thirty and ninety-day follow-ups examined changes in high-risk behaviors. Results reported here for 343 subjects who have completed the 90-day follow up indicate significant reductions in reported sexual risk behaviors for those participating the DVD intervention, compared to the other two brief interventions. This study is among the first to report any positive impacts on sexual behaviors among a population of inmates returning to the community.
TL;DR: Women from the bar patron sample exceeded the problem rates of men in the general population, and two of the bar motive variables, sensation seeking and mood change motives, were particularly predictive of heavier drinking and alcohol-related problems.
Abstract: Prior research has found heavier drinking and alcohol-related problems to be more prevalent in sexual minority populations, particularly among women. It has been suggested that differences may be explained in part by socializing in bars and other public drinking venues. This study explores gender, sexual orientation and bar patronage in two different samples: respondents from a random digit dial (RDD) probability study of 1,043 households in Northern California and 569 individuals who were surveyed exiting from 25 different bars in the same three counties that constituted the RDD sample. Bar patrons, in most instances, were at much higher risk of excessive consumption and related problems and consequences. On several key variables, women from the bar patron sample exceeded the problem rates of men in the general population. Bisexual women and bisexual men exhibited riskier behavior on many alcohol measures relative to heterosexuals. Measures of heavier drinking and alcohol-related problems were also elevated among lesbians compared to heterosexual women. Two of the bar motive variables, sensation seeking and mood change motives, were particularly predictive of heavier drinking and alcohol-related problems. Social motives did not predict problems.
TL;DR: A representative sample of betel products and additives was purchased in the Richmond, Virginia area to accurately estimate product emergence into the U.S. and other world markets, and the consequent impact on public health.
Abstract: Betel use involves oral placement of shards of areca nut (Areca catechu palm seed containing the cholinergic agonist arecoline) wrapped with slaked lime in a betel leaf (Piper betle plant) or various chopped or powdered products containing areca nut and/or parts of the betel plant. Additives to this mixture include catechu (areca palm extract), spices/sweeteners (e.g., saccharin, cloves), and/or tobacco. Betel use is most common in Asia and East India; however, little is known about the availability and characteristics of these products outside of this region. Thus, a representative sample of betel products and additives was purchased in the Richmond, Virginia area. Five venues were visited between March and May, 2006. Products successfully purchased were those containing betel alone (seven), betel/tobacco (three), tobacco alone (four), and additives (four). Most betel products listed ingredients on the packaging, though some did not explicitly distinguish between those with versus without tobacc...
TL;DR: There is a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.
Abstract: This study describes the extent and severity of multiple comorbidities in a juvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment, individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p < .05), emotional problems (r = .237, p < .05), behavior complexity (r = .318, p < .05), internal mental distress (r = .263, p < .05), environmental risk (r = .205, p < .0...
TL;DR: Process, baseline assessment and case study data are used to describe the needs and issues specific to Hartford's substance-abusing Latino and African-American youth.
Abstract: While outreach and case management services have been shown to improve retention of at-risk youth in behavioral health treatment, these important support services are challenging to implement. The Hartford Youth Project (HYP), established by the Connecticut Department of Children and Families as a pilot for the state adolescent substance abuse treatment system, made outreach and engagement integral to its system of care. HYPbrought together a network of stakeholders: referral sources (juvenile justice, schools, community agencies, child welfare, and families); community-based outreach agencies; treatment providers; and an administrative service organization responsible for project coordination. Culturally competent Engagement Specialists located in community agencies were responsible for: cultivation of referral sources; community outreach; screening and assessment; engagement of youth and families in treatment; case management; service planning; recovery support; and advocacy. This article describes HYP's approach to identifying and engaging youth in treatment, as well as its challenges. Use of family-based treatment models, expectations of referral sources, limited service capacity, youth and family problems, and staff turnover were all factors that affected the outreach and engagement process. Process, baseline assessment and case study data are used to describe the needs and issues specific to Hartford's substance-abusing Latino and African-American youth.
TL;DR: In this paper, a semistructured interview was administered to 17 subjects to investigate GHB use, including: manner of use; setting; positive and negative consequences; other drug history; and sexual practices.
Abstract: Gamma hydroxybutyrate (GHB) is a psychoactive substance with complex neurophysiological activity and significant potential for abuse, addiction, and dangerous toxicity. In this study, a semistructured interview was administered to 17 subjects to investigate GHB use, including: manner of use; setting; positive and negative consequences; other drug history; and sexual practices. Respondents were overwhelmingly male, but otherwise had a broad demographic background. Settings varied from nightclubs to private use at home. There was significant variability in the drug obtained, which subjects found problematic because of the narrow therapeutic window and ease of accidental overdose. Common positive experiences included increased sexual desire, decreased sexual inhibitions, and decreased anxiety. Common negative consequences included oversedation, loss of consciousness, motor incoordination, and mental confusion. Nine subjects reported that they would use GHB again, some despite severe negative consequ...
TL;DR: It is concluded that SPECT renderings of rCBF, particularly in the prefrontal cortex, are a potentially powerful clinical tool for anticipating response to stimulant medications, both positive and adverse.
Abstract: The goal of this study was to test whether clinician-rated regional cerebral blood flow (rCBF) as rendered by SPECT imaging is a meaningful predictor of patient response to CNS stimulants. Chart reviews were used to identify patients who reported prior significant positive and negative responses to CNS stimulants. Each patient in the study had received resting and concentration SPECT scans using Tc99m exametazime. Differences in cerebral blood flow for frontal regions of interest were assessed in three conditions (resting, concentration, and their difference, or "delta") using ANCOVAs and age-matched ANOVAs. Prefrontal pole deltas were found to be highly sensitive and specific predictors of response to CNS stimulants, with pole activation predicting adverse responses and pole deactivation predicting good responses. Positive and negative predictive values were greater than .75 for both poles. We conclude that SPECT renderings of rCBF, particularly in the prefrontal cortex, are a potentially powerful clinical tool for anticipating response to stimulant medications, both positive and adverse.
TL;DR: While injecting use still appears to be fairly limited, this has the potential to change and further debate is required regarding the introduction of harm reduction approaches that have been found to be effective elsewhere.
Abstract: UN reports point to a steady increase in heroin use in a number of African countries, including South Africa. South Africa also has one of the highest HIV infection prevalence rates in the world. Given the link between intravenous heroin use and HIV transmission, this study aimed to investigate HIV-related risk behaviors among heroin users in the city. A snowballing or chain referral sampling technique was used to find 239 heroin users in Cape Town who were interviewed using a structured questionnaire. Overall, 24% of all the participants reported that they had injected heroin in the past 30 days and 89% of these had shared a needle at least once during that period. Condom use was irregular among the survey participants. Three percent stated that they were HIV positive. Heroin use has become a major concern in Cape Town and may still be increasing. While injecting use still appears to be fairly limited, this has the potential to change. Further debate is required regarding the introduction of harm reduction approaches that have been found to be effective elsewhere.
TL;DR: The present case shows for the first time that craving for propofol can be quite intense and able to induce addictive behaviour.
Abstract: Propofol is a widely used general anaesthetic with multisite mechanisms and especially ultrashort activation of certain central GABA-A receptors. Since its introduction into the market in the mid 1980s this is the seventh report on propofol dependence in the literature. The present case shows for the first time that craving for propofol can be quite intense and able to induce addictive behaviour.
TL;DR: A pilot test of an intervention designed to assist parents and siblings affected by youth substance use and related problems suggests the BEST Plus program offers a promising means of assisting families to respond to substance use problems in young people.
Abstract: Substance use is common among young people and can escalate into significant problems for affected individuals and their families. Family responses can influence the course of youth substance use and its consequences for family members, including parents and siblings. Family-level interventions developed to date have neglected the important role that siblings can play. This article describes a pilot test of an intervention designed to assist parents and siblings affected by youth substance use and related problems. The BEST Plus intervention consisting of professionally-led, multifamily groups sequenced over eight sessions is described with reference to the intended therapeutic processes. Professionally observed and self-reported changes for family participants including siblings suggested that the program had a beneficial therapeutic impact. This evaluation of early impacts suggests the BEST Plus program offers a promising means of assisting families to respond to substance use problems in young people.
TL;DR: The results show that delinquency is a consistent predictor of both HIV/ STD risk level and substance use disorders, and also that substance use directly predicts HIV/STD risk level among incarcerated adolescents.
Abstract: Incarcerated adolescents are among the most vulnerable groups for STD infection, and substance abuse is prevalent in over half of this population. Substance abuse and HIV/STD-associated risk behaviors are closely linked among juvenile justice-involved youth, but it is unclear whethercommon antecedents explain these different problems. The current study examined predictors of HIV/STD risk level and substance use disorders, and investigated whether family variables added unique predictive variance for these problems among incarcerated youth. The sample included 154 substance-involved youth ages 13 to 17 recruited in detention facilities in Miami and Tampa, FL and was primarily male (82%) and African-American (58%). Using a comprehensive assessment strategy with data obtained from youth report, parent report, and laboratory confirmed STD testing, the results show that delinquency is a consistent predictor of both HIV/STD risk level and substance use disorders, and also that substance use directly pr...
TL;DR: The arguments used both by the church and by the government are outlined, the facts of the cases are listed, and the likelihood of expansions of religion-based exceptions for entheogen use in light of the Supreme Court decision is evaluated.
Abstract: In 2006, the Supreme Court paved the way for the sacramental use of a hallucinogen, hoasca, to be imported, distributed and ingested by a religious group. This case has broad implications for religious freedom for using sacramental psychotropics and how such cases might be decided in the future. This article outlines the arguments used both by the church and by the government. It lists the facts of the cases, explains and analyzes the decision, evaluates the likelihood of expansions of religion-based exceptions for entheogen use in light of the Supreme Court's decision and offers a profile for those groups most likely to receive such an exemption.
TL;DR: Analysis of characteristics of prisoners who engaged in high-risk behaviors prior to incarceration found those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity.
Abstract: Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sex-related risk), low education, low income, type of offense, history of abuse, mental health disorders, vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.
TL;DR: Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas, and the exception was for cluster 1, for whom emotional problems actually increased.
Abstract: This article describes the Strengthening Communities for Youth (SCY) initiative using data from 1,297 adolescents in eight US cities (Oakland, CA; Tucson, AZ; Iowa City, IA; Bloomington, IL; St Louis, MO; Cleveland, OH; Louisville, KY, New York, NY) to better understand the pattern of services they received, how these services varied by need, and how services were associated with initial treatment outcomes Data include adolescent reports collected with the Global Assessment of Individual Needs (GAIN) at treatment intake and 90 days post-intake, information on early therapeutic alliance using a modified Working Alliance Inventory (WAI), and staff reports from service logs Cluster analysis identified four patterns of treatment received: (1) substance abuse and mental health treatment, (2) primarily residential treatment, (3) interrupted treatment, and (4) primarily outpatient treatment Outcomes examined included changes in substance use, substance abuse/dependence problems, recovery environment risk, as well as risk from social peers, illegal activity and emotional problems Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas The exception was for cluster 1, for whom emotional problems actually increased Implications for placement, treatment planning and future research are discussed
TL;DR: Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers, resulting in a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.
Abstract: Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.
TL;DR: The psychopharmacological literature on B. caapi is reviewed in light of recent ethnographic work conducted among the Piaroa of southern Venezuela, which indicates the plant's importance for heightening empathy and its potential as a stimulant and antidepressant-like substance.
Abstract: Recent attention to the monoamine oxidase inhibiting properties of Banisteriopsis caapi's harmala alkaloids has precluded a balanced assessment of B. caapi's overall significance to indigenous South American societies. Relatively little attention has been paid to the cultural contexts, local meanings and patterns of use of B. caapi among snuff-using societies, such as the Piaroa, who do not prepare decoctions containing N,N-dimethyltryptamine (DMT) admixtures. This article reviews the psychopharmacological literature on B. caapi in light of recent ethnographic work conducted among the Piaroa of southern Venezuela. Piaroa shamans use only B. caapi's cambium, identify at least five distinct varieties of B. caapi, and emphasise the plant's importance for heightening empathy. Some Piaroa people also attribute a range of extra-shamanic uses to B. caapi, including as a stimulant and hunting aid. In light of the psychopharmacological complexity of harmala alkaloids, and ethnographic evidence for a wide range of B. caapi uses, future research should reconsider B. caapi's cultural heritage and psychopharmacological potential as a stimulant and antidepressant-like substance.
TL;DR: Based on the results of this study, the development and integration of trauma-informed practice within substance abuse treatment for adolescents to help them recover from trauma and substance abuse issues is advocated.
Abstract: The purpose of this study was to evaluate the effectiveness of outpatient substance abuse treatment for youth with high traumatic stress compared to youth without high traumatic stress in substance abuse treatment centers across the United States. The data for this study were gathered using a longitudinal survey design with purposive sampling from nine drug treatment delivery systems across the United States participating in the cooperative grant Strengthening Communities for Youth (SCY) awarded by SAMHSA's Center for Substance Abuse Treatment (CSAT) between September 2002 and June 2006. Follow-up assessments were conducted with the youth at three, six, and 12 months following intake. Traumatized youth responded to outpatient treatment in a similar pattern when compared to nontraumatized youth, although the traumatized youth had consistently higher scores on substance use frequency and substance problems scales than nontraumatized youth throughout the study. Current empirically validated treatments for adolescent substance abuse do not prepare the practitioner for trauma-informed practice or specifically address trauma-informed recovery. Based on our results, we advocate for the development and integration of trauma-informed practice within substance abuse treatment for adolescents to help them recover from trauma and substance abuse issues.