Showing papers in "Journal of Social Work Practice in The Addictions in 2015"

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk

Abstract: The Body Keeps the Score gives readers an insightful look at how trauma affects the brain, body, and mind. It deftly interweaves practice wisdom and research findings. For example, van der Kolk bea...

Reducing Stigma: Lessons from Opioid-Dependent Women

Abstract: Opioid use during pregnancy is increasing. Little is known from the maternal perspective about pregnancy and opioid dependence. This qualitative study was undertaken to examine the experiences of opioid-dependent women during their prenatal and early postpartum care. Within a stigma theoretical framework, a series of group interviews elicited the shared experiences of 20 self-identified postpartum women who used opioids during their pregnancy. Themes developed around internal stigma of shame and guilt, with the majority experiencing external stigma. Interventions should involve stigma reduction strategies and increased support for this vulnerable population.

Community-Level Barriers to Recovery for Substance-Dependent Rural Residents

Abstract: This article identifies potential barriers to substance use recovery associated with rural residence. The evidence is discussed and illustrated with examples. Fourteen specific barriers to substance abuse recovery are identified within 4 broad categories: access to treatment services, access to other professionals, access to peer support groups, and barriers to confidentiality. Although telehealth, expansion of mental health care, intensive referral, and other efforts might enhance access to care, the evidence suggests practitioners and researchers should remain aware of community-level barriers to recovery from substance use disorder and work with clients to overcome them.

Adverse Childhood Experiences and Gambling: Results From a National Survey

Abstract: Pathological gambling disorder and problem gambling are addictive disorders with severe consequences for individuals, families, and society. Knowledge about associations between childhood adverse experiences (i.e., physical, sexual, and emotional abuse) and gambling pathology in adulthood is limited. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), associations between adverse childhood experiences and lifetime gambling status were tested. Strong bivariate associations between adverse childhood experiences and gambling status were found, which were attenuated with the inclusion of clinical covariates. Adverse childhood experiences might be related to pathological gambling in adulthood, but this relationship might not be gambling-specific.

Factors Associated With Substance Use Disorders Among Traumatized Homeless Youth

Abstract: This study aimed to identify homeless youths’ lifestyle and trauma-related risk factors as well as protective factors associated with alcohol use disorder or no disorder and drug use disorder or no disorder. Youth receiving homeless services in Denver (n = 201), Austin (n = 200), and Los Angeles (n = 200; N = 601) completed quantitative interviews assessing demographic information, alcohol and drug use, homeless lifestyle risk factors, trauma-related risk factors, and protective factors. Findings showed differences in trauma-related risk factors between alcohol and drug use disorders, but not homeless lifestyle risks. Protective factors predicted substance use disorders beyond risk factors. Understanding trauma-related risk and protective factors associated with substance use disorders could improve interventions.

Harnessing Attachment in Addiction Treatment: Regulation Theory and the Self-Medication Hypothesis

Abstract: Addiction is a multifaceted problem with complex etiology, calling for a multidimensional treatment approach. This article explores the interface of regulation theory and the self-medication hypothesis (SMH) and applies clinical strategies based on regulation theory to the treatment of substance addiction. Specifically, this article argues that treatment informed by regulation theory supports the development of an individual’s capacity for self-regulation, thereby targeting the dysregulation identified by the SMH as an underlying cause of addictive behaviors. This approach offers a viable framework for addiction treatment. Implications for clinical practice and further research are also explored.

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Abstract: Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.

Intergenerational Trauma Among Substance-Using Native American, Latina, and White Mothers Living in the Southwestern United States

Abstract: The high rates of traumatic experiences reported by women who use alcohol and drugs have been documented in the literature. This study builds on the existing literature by examining the experiences of intergenerational family loss trauma among 226 mothering female substance users from 3 racial and ethnic groups: Native American (26.5%), Latina (24.8%), and White (48.7%). Demographic information, substance use, intergenerational exposure to mothering, and other family traumatic losses were compared across racial and ethnic groups. Data indicate both similarities and significant differences in demographic characteristics, type of drug use, and traumatic family loss experiences—with a higher percentage of Native American women reporting instances of intergenerational family loss. The extent of intergenerational family traumatic loss among women who use substances is discussed, along with social policies that perpetuate such loss. Recommendations for effectively intervening at the individual, family, and poli...

Caring for Grandchildren in Kinship Care: What Difficulties Face Irish Grandparents with Drug-Dependent Children?

Abstract: This article presents the findings of a small qualitative study of the experience of Irish grandparents providing full-time care for grandchildren whose birth parents were drug-dependent. In addition to the stresses and strains directly associated with caregiving of this kind, grandparents also reported considerable dissatisfaction with the support they received from statutory health and social service systems. In particular, they were critical of the attitudes of child protection social workers who, it was suggested, believed that grandparent carers in these circumstances did not need or deserve formal support.

Tobacco Cessation Interventions for Underserved Women

Abstract: Despite high rates of smoking among some subgroups of women, there is a lack of tailored interventions to address smoking cessation among women We identify components of a women-centered approach to tobacco cessation by analyzing 3 bodies of literature: sex and gender influences in tobacco use and addiction; evidence-based tobacco cessation guidelines; and best practices in delivery of women-centered care Programming for underserved women should be tailored, build confidence and increase motivation, integrate social justice issues and address inequities, and be holistic and comprehensive Addressing the complexity of women’s smoking and tailoring appropriately could help address smoking among subpopulations of women

Tobacco Harm Reduction: An Emerging Health Issue for Social Work

Abstract: Cigarette smoking remains a leading preventable cause of disease and death in the United States, and the impairment of smokers and those in their social environments is a concern for social workers. Despite primary prevention and cessation-based policies and interventions, quit rates are low and nicotine replacement therapies are underused and of limited efficacy. Tobacco harm reduction has garnered attention due to tobacco policy shifts and the increasing use and marketing of such products as electronic cigarettes. Social work has been criticized as ignoring this topic, and existing literature is limited. This article considers questions and concerns surrounding tobacco harm reduction, and offers guidance in formulating a social work position regarding this important issue.

Traumatic Experiences and Drug Use by LGB Adolescents: A Critical Review of Minority Stress

Abstract: High rates of illicit drug use found among lesbian, gay, and bisexual (LGB) adolescents are often attributed to unique and chronic traumatic events tied to sexual minority identity. Although initiation of drug use is relatively common within adolescence, little research contributes to our understanding of the disparities found among LGB adolescents. This review synthesized existing literature to determine if the minority stress model is applicable to LGB drug use disparities and fits within a trauma framework. Findings indicate that minority stress experiences have been inconsistently related to drug use among LGB adolescents. Implications for future research and practice are described.

Readiness for Treatment: Does It Matter for Women with Substance Use Problems Who Are Parenting?

Abstract: This study examined changes in outcomes for women in an outpatient, integrated substance use and parenting program in Toronto, Canada, and tested whether their self-reported treatment readiness at intake predicted changes in substance use and parenting outcomes from intake to 12 months after intake. Although there were improvements in both substance use and parenting outcomes, self-reported treatment readiness only predicted changes in parenting attitudes. In response to the unexpected findings, treatment readiness with respect to substance use and parenting-related goals in the integrated programs was discussed. Rather than being a barrier to treatment, women’s role as caregivers might be an important factor to treatment participation and outcomes. The importance of having a comprehensive focus in treatment for women with substance use problems who are parenting was also highlighted for future research and treatment implications.

Out-of-Control Sexual Behavior as a Symptom of Insecure Attachment in Men

Abstract: Out-of-control sexual behavior (OCSB) is often misunderstood. To gain a better understanding of its underlying dynamics, this study explored the relationships between insecure attachment and OCSB in men. Online surveys measured OCSB (Hypersexual Behavior Inventory [HBI]) and attachment style (Experiences in Close Relationships Short Form [ECR–S]) in 45 men who presented with OCSB and 32 men who did not. Multivariate analysis indicated that high ECR–S scores predicted high HBI scores and clinical determination of OCSB, which in turn predicted attachment-avoidant behavior. Avoidant behavior was a better predictor of OCSB than attachment anxiety, suggesting that OCSB might be a manifestation of avoidant attachment. Implications for practice are offered.

Racial Disparities in Community Outcomes Among Individuals with Schizophrenia and Cooccurring Substance Use Disorders

Abstract: Few studies have examined the effects of race on community outcomes in cooccurring schizophrenia and substance use disorders. Such effects were examined among 1,370 Black and White persons classified as having schizophrenia; schizophrenia and alcohol use disorders; schizophrenia and drug use disorders; or schizophrenia, alcohol, and drug use disorders. Results revealed that Black individuals with schizophrenia, alcohol, and drug use disorders demonstrated the greatest psychosocial deficits compared to all other groups observed. These findings underscore the need for social workers to optimize community services for this population, paying particular attention to the effects of race and its impact on recovery.

Introduction to the Special Issue: Examining the Relationship Between Trauma and Addiction

Abstract: Trauma and trauma-related disorders as well as substance misuse and substance use disorders are often integral to the problems and issues that social workers contend with in their practice. Further...

Traditional, Alternative, and Harm Reduction Approaches: What Do Social Work Students Think?

Abstract: How social workers conceptualize substance use disorder (SUD) treatment will affect the types of interventions that they select, including the use of harm reduction strategies An amended version of the Treatment Attitudes Scale–Revised was given to 280 social work students (graduate and undergraduate) along with 30 SUD counselors The results indicated that all 3 groups in the sample scored similarly, with endorsing traditional methods as beneficial, blood-borne disease prevention and alternative methods as somewhat beneficial, and overdose fatality prevention methods as somewhat harmful Implications for curriculum development and in-service training are discussed

Knowledge Translation for Service Providers with Addiction or Recovery Experience: A Delphi Method

Abstract: Factors related to implementation of evidence-based practices in the treatment of addiction include the personal history of addiction and recovery of service providers working in those treatment services. The purpose of this Delphi study was to outline knowledge translation (KT) activities that are specific to the needs of service providers who are themselves in recovery from addiction. Twelve administrators of addiction agencies serving women in Canada proposed that service providers who are aligned predominantly with their recovery experiences when making clinical decisions would benefit from tailored KT. In addition, knowledge brokering, professional training, and inclusion of this subpopulation of service providers in research activities is the most promising KT for enhancing the implementation of evidence-based practices.

Screening, Brief Intervention, and Referral to Treatment (SBIRT): An Interview with Scott Caldwell, MA, and Darla Spence Coffey, PhD2

Abstract: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an integrated, public health approach to the identification, early intervention, and as needed, facilitation of treatment service...

Factors Related to the Delivery of Trauma Services in Outpatient Treatment Programs

Abstract: In recent years there has been growing recognition of the role of trauma in substance abuse treatment; however, only 20% of outpatient treatment programs report offering trauma services. We conducted a secondary analysis of the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) and explore how demographic, population served, and organization variables distinguish those programs that offer trauma services from those that do not. In this article, we present the findings, which revealed that organizational structure, process, and population served variables were the most important predictors of trauma services. Implications for social work practice in the addictions are discussed.

Biobehavioral Response Redirection: Innovations to Activate Personalized Recovery Cues and Decrease Relapse Risk

Abstract: The neuroscience of addiction suggests that drug cue exposure activates reward center regions, such as the ventral tegmental area (VTA), thalamus, insula, and amygdala, which predicts drug use (Filbey, Schacht, Myers, Chavez, & Hutchison, 2009) and affects learning and memory (Koob & Volkow, 2010; Wiers & Stacy, 2006). Behavioral decision making is impaired in persons with substance use disorders due to dysregulation in the sensory-emotional system, specifically as a result of enhanced reactivity in the amygdala and reductions in activity of the cognitive control systems (Verdejo-García & Bechara, 2009). Drug cues automatically activate implicit memory associations and motivate behavioral action (drug use) without the reflective (cognitive conscious control) system to govern behavioral inhibition (Strack & Deutsch, 2004). Therefore, verbal-based behavioral health treatment interventions that singularly rely on cognitively conscious processing systems might hold limited efficacy for those early in recovery or with a history of chronic relapse, where implicit drug cue triggers have a strong neurobiological effect. Treatment approaches that target implicit as well as explicit processes are necessary to enhance regulatory capacity and decrease relapse risk, by employing strategies that reduce emotional reactivity to drug stressor stimuli and disrupt the implicit cue–craving–behavior sequence. For example, researchers who have used cue-reactivity paradigms to examine emotional regulation capacity pre–post treatment with drug cue-exposure treatment

Comparing Two Types of Social Support: Changes in Alcohol Use Among Drug Court Enrollees

Abstract: This study explored the influence of 2 different types of social support on alcohol use in the context of drug court. Data from a drug court enrollee pilot study were analyzed using a series of simultaneous regression analyses. Results demonstrated that having a greater number of unconditional support providers was associated with a decrease in alcohol use from prearrest to postarrest. Having a greater number of directive support providers was associated with an increase in alcohol use from prearrest to postarrest. These findings indicated that different types of social support might mitigate or promote problematic alcohol use after arrest.

Treating Addictions With EMDR Therapy and the Stages of Change, by Nancy J. Abel and John M. O’Brien

Abstract: Developing effective intervention approaches for resolving substance-related addiction problems requires adoption of a biopsychosocial approach. This is an important facet and contribution of profe...

Increasing Follow-Up Rates in Longitudinal Studies of Women with Alcohol Use Disorders

Abstract: Follow-up rates of longitudinal studies are of particular concern for persons with alcohol use disorders (AUDs) as many have transient lifestyles. This article summarizes barriers to follow-up, as well as strategies to increase follow-up rates in a pilot randomized clinical trial for reducing HIV/STD risks in women with AUDs. Participants were 32 women enrolled in residential substance abuse treatment with an AUD diagnosis with follow-up interviews conducted at 2 and 6 months postresidential care discharge. The initial 2-month follow-up rate was lower than expected at 65%, so researchers implemented 6 strategies to improve future follow-up rates. Two-month follow-up rates improved from 65% to 86.6%. Only 1 participant was lost between 2-month and 6-month follow-up (95.8% completion rate), with 71.8% for the entire sample. Findings support the usefulness of these procedures to improve follow-up.

Shifts in Marijuana Policies and the Impact on Adolescents

Abstract: Marijuana policy is rapidly evolving in the United States. Between 1996 and March 2015, 23 states and the District of Columbia enacted laws making medical marijuana legal for adults 21 years and ol...

The Treatment of Substance-Abusing Women Recently Released from Jails: An Interview with Audrey Begun, PhD

Abstract: Although often interchanged in everyday parlance, jails and prisons are, in fact, distinct correctional institutions that present unique challenges to the social work community. Prisons are state and federally operated facilities that hold sentenced inmates usually with terms longer than 1 year. In contrast, jails are locally operated and are functionally diverse: Jails hold individuals still awaiting trial, those awaiting sentencing and transfer, and those serving sentences of 2 years or less. As such, jail populations are somewhat more transient: On average, jails turn over 60% of their population per week. For comparison, prisons have less than 50% turnover every year (Carson & Golinelli, 2014; Glaze & Herberman, 2013; Minton, 2013). As a result of this chaos and local variability, comparatively little is known about jail populations and even less about the growing minority of women inmates. The proportion of women in jails grew about 1% each year between 2005 and 2013, and women now represent 10.9% of the 731,000 people in jails in the United States (Minton & Golinelli, 2014). One third of the incarcerated women are there due to drug offenses (Carson & Golinelli, 2014). Many of these women might seek or need treatment from social work professionals to stay out of jail or prison: 33% of women drug

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

Abstract: This article asserts that case management, particularly in the area of substance use, be promoted as an integral tool to complement the integrated care models put forth under the Patient Protection and Affordable Care Act (ACA). The potential expansion of addictions services under the ACA reaffirms and elevates the importance of case management in contemporary systems of care. The article briefly reintroduces the rationale for the continuation and expansion of case management in substance use intervention programs and discusses the efficacy of this service based on available research. Given the expertise social workers have in case management, social work leaders will be critical participants in health care system and policy discussions to ensure the enactment of best practices in case management in substance use services.

Interview on Treatment for Women with Substance Use Disorder, Mental Health Disorders, and Histories of Trauma: An Interview with Francine Feinberg, PsyD, LCSW

Abstract: During the past several decades, the substance abuse treatment field has recognized that women often develop and experience substance use disorders differently than men. In addition, trauma, often ...

Trauma-Informed Care and Addiction Recovery: An Interview With Nancy J. Smyth, PhD, LCSW

Abstract: Holleran Steiker: It is a privilege to interview the Dean of the School of Social Work at the State University of New York at Buffalo. You wear a number of hats: dean, professor, researcher, and cl...

Social Workers and Brief Interventions: A Research-Informed Response to Changing Views on Marijuana

Abstract: Over the past 40 years, views on marijuana legalization have changed significantly, with surveys indicating that about 28% of U.S. residents were supportive of such legalization in the 1970s, where...