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Treatment Services (treatment + services)
Kinds of Treatment Services Selected AbstractsDoes the Impact of Managed Care on Substance Abuse Treatment Services Vary by Provider Profit Status?HEALTH SERVICES RESEARCH, Issue 6p1 2005Todd A. Olmstead Objective. To extend our previous research by determining whether, and how, the impact of managed care (MC) on substance abuse treatment (SAT) services differs by facility ownership. Data Sources. The 2000 National Survey of Substance Abuse Treatment Services, which is designed to collect data on service offerings and other characteristics of SAT facilities in the U.S. These data are merged with data from the 2002 Area Resource File, a county-specific database containing information on population and MC activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. Study Design. For each facility ownership type (for-profit [FP], not-for-profit [NFP], public), we estimate the impact of MC on the number and types of SAT services offered. We use instrumental variables techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. Principal Findings. We find that the impact of MC on SAT service offerings differs in magnitude and direction by facility ownership. On average, MC causes FPs to offer approximately four additional services, causes publics to offer approximately four fewer services, and has no impact on the number of services offered by NFPs. The differential impact of MC on FPs and publics appears to be concentrated in therapy/counseling, medical testing, and transitional services. Conclusion. Our findings raise policy concerns that MC may reduce the quality of care provided by public SAT facilities by limiting the range of services offered. On the other hand, we find that FP clinics increase their range of services. One explanation is that MC results in standardization of service offerings across facilities of different ownership type. Further research is needed to better understand both the specific mechanisms of MC on SAT and the net impact on society. [source] Patterns of Treatment Services and Costs for Young Offenders with Mental DisordersJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2005Deborah Shelton PhD PROBLEM:,This study describes mental health treatment service delivery patterns and costs for youth in a juvenile justice system. METHODS:,A secondary data analysis on a random sample of juvenile offenders (N = 312) was completed. Service patterns and costs were described. Selected variables were examined for their ability to predict who received treatment. FINDINGS:,Only 23% of youth diagnosed with a mental disorder received any treatment. Older youth and African American youth received fewer services, and race was the only significant predictor for receiving treatment (p = .001). CONCLUSIONS:,Mental health treatment services were scarce, and the data reflects a race bias in the provision of services. Although the law protects the right to treatment for these individuals, provision of services remains a challenge. [source] Treating Substance-Abusing Parents: A Study of the Pima County Family Drug Court ApproachJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2004JOSÉ B. ASHFORD ABSTRACT A geographical comparison-group design was used to examine the effectiveness of the Pima County (Arizona) Court Assisted Treatment Services (CATS) program and its drug court intervention. The study compared the summary statistics for the volunteers to the family drug court (n=33) with a treatment-refusal group (n=42) and a treatment-as-usual group (n=45) from a matched geographical area. The findings of this study indicate that the family drug court group had higher engagement and completion rates of residential treatment than was true of the other comparison groups. In addition, the volunteers to the family drug court group had fewer parental rights severed, a higher percentage of permanency decisions reached within one year, earlier permanency decisions, and a higher percentage of children placed with their parents. The implications of this study's findings for future evaluations of the components of a family drug court intervention are discussed. [source] Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern WyomingTHE JOURNAL OF RURAL HEALTH, Issue 3 2006Nicholas J. Okon DO ABSTRACT:,Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. Methods: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. Findings: Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. Conclusion: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties. [source] Young people who attend specialist alcohol treatment: who are they and do they need special treatment?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2008Devon Indig Abstract Objective: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). Methods: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. Results: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. Conclusions: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment. [source] Does PTSD occur in sentenced prison populations?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2007A systematic literature review Background,A systematic review of the literature on mental disorder in prisoners, published in 2002, made no mention of post-traumatic stress disorder (PTSD), but indicators from other studies suggest that a history of serious and chronic trauma is common among offenders. Aims,To conduct a systematic review of the literature with the specific questions: does any epidemiological study of sentenced prisoners include data on prevalence of PTSD while in prison? If so, what is the prevalence in this group? Method,Literature databases EMBASE, Medline, PsychInfo, PILOTS and SIGLE were searched. The Journal of Traumatic Stress was searched manually. Preliminary screening was conducted by reading abstracts of hundreds of papers. Ten exclusion criteria were then applied to the screened selection. Reference sections of all accessed papers were searched for any further studies. Results,One hundred and three potentially relevant papers were identified after preliminary screening. Four met all criteria for inclusion and suffered none of the exclusion criteria. PTSD rates ranged from 4% of the sample to 21%. Women were disproportionately affected. Conclusions and implications for practice,All four papers suggested that the prevalence of PTSD among sentenced prisoners is higher than that in the general population, as reported elsewhere. Overall the findings suggest a likely need for PTSD treatment services for sentenced prisoners. Copyright © 2007 John Wiley & Sons, Ltd. [source] Drug misuse and acquisitive crime among clients recruited to the National Treatment Outcome Research Study (NTORS)CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2000Duncan Stewart Background Criminal activity among drug-misusing populations can result in considerable costs. This paper examines the relationship between acquisitive criminal behaviour and drug use among a cohort of 1075 clients recruited to the National Treatment Outcome Research Study (NTORS). Method Clients were recruited from 54 drug misuse treatment programmes in England. A structured interview was administered by clinical staff. The majority of clients were opiate-dependent poly-drug users. Results 27 000 acquisitive criminal offences were reported by the cohort in the three months prior to starting treatment, of which shoplifting was the most common offence. There was marked variation in the amount of acquisitive crime reported; just 10% of the sample were responsible for three-quarters of the crimes committed. Two other groups were identified: low-rate offenders, and those who did not commit an acquisitive crime. Multivariate analyses revealed that frequency of illicit drug use was associated with increased levels of criminal behaviour. Compared with the no-crime group, the high-rate offenders were 11 times more likely to be regular users of heroin, and three times more likely to have used cocaine regularly. Discussion These findings suggest that the most dependent and problematic drug misusers present treatment services with the greatest challenge in terms of reducing levels of criminality. Copyright © 2000 Whurr Publishers Ltd. [source] Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory UniversityDEPRESSION AND ANXIETY, Issue 6 2008Ph.D., Steven J. Garlow M.D. Abstract The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002,2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = ,9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (,2 = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5,4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults. Depression and Anxiety 0:1,7, 2007. © 2007 Wiley-Liss, Inc. [source] Youth retention: Factors associated with treatment drop-out from youth alcohol and other drug treatmentDRUG AND ALCOHOL REVIEW, Issue 6 2009RIA SCHRODER Abstract Introduction and Aims. This study examined factors associated with treatment drop-out among young people aged 13,19 years attending alcohol and other drug (AOD) treatment. Design and Methods. Data were gathered from structured interviews (n = 79) and a clinical file search of 184 randomly selected young people who had attended youth specific AOD treatment services in Aotearoa, New Zealand during 2003 or 2004. Results. The median length of stay was 2.7 months for those attending day/residential services (n = 42) and 4.0 sessions for those attending outpatient services (n = 37) 16.7% of participants from day/residential services dropped out of treatment early (within the first month) and 32.4% of participants from outpatient treatment services dropped out of treatment early (before the third session). Fixed client characteristics, such as age, sex, ethnicity, substance use and mental health diagnoses were not found to be associated with treatment retention. Dynamic client characteristics, such as motivation to attend treatment and expectations about treatment outcomes and program characteristics, such as positive experiences with treatment staff and feeling involved in the treatment process were found to be associated with treatment retention. Discussion and Conclusions. The findings of this study support previous research indicating that fixed client characteristics are not sufficient to explain youth retention in AOD treatment. Of more use are dynamic client characteristics and program variables. These findings stress the potential for improving treatment retention by creating more youth appropriate services.[Schroder R, Sellman D, Frampton C, Deering D. Youth retention: Factors associated with treatment drop-out from youth alcohol and other drug treatment. Drug Alcohol Rev 2009] [source] Are we becoming more alike?DRUG AND ALCOHOL REVIEW, Issue 5 20082004 national household surveys, Comparison of substance use in Australia, the United States as seen in the 199 Abstract Introduction. This paper reports the results of the 1995, 1998, 2001 and 2004 Australian and US household surveys, with emphasis on changes since 2001. Design and Methods. The US survey data were recalculated to match age groups in the Australian data. Statistically significant changes are reported. Differences in prevalence of use by gender within age group were tested for significance. Results. The past-year use of ,any illicit drug', cannabis, cocaine, tranquillisers and injecting drugs decreased between 2001 and 2004 in Australia, but remained stable for all these drugs except ecstasy between 2002 and 2004 in the United States. The use of hallucinogens decreased in both countries. Alcohol and use of many illicit drugs by teenage girls in both countries increased to rates similar to or higher than boys, and teens in both countries reported binge and heavy drinking in the past month. Australians in their 20s had the highest rates of use, but in the United States, past-year use of many drugs was highest among teenagers. Discussion. More treatment services are needed, particularly for people dependent upon non-opiate drugs. The changes in acceptability of use of different drugs and their perceived availability are related to changes in prevalence rates. Even with the similarities in levels of use, there are differences in patterns of use and preferences for certain drugs in each country, and geographic proximity to drug sources is a factor. [source] Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdoseDRUG AND ALCOHOL REVIEW, Issue 3 2002DAVID BEST Abstract One hundred and thirty-five drug users in contact with treatment services in Scotland and England were interviewed about their experiences of witnessing overdoses both overdoses resolved successfully and those leading to death and actions taken to effect resuscitation. One hundred and four (77%) had witnessed a mean of 11.5 overdoses, of whom 41 (30.4% of the study sample) had witnessed an average of 4.2 fatal overdoses. A wide range of actions was reported at the most recent witnessed overdose, the most common being slapping or shaking the victim (an average of 2.5 minutes after overdose was first recognised) or walking the person around the room (3.2 minutes after recognizing overdose). There was no consistent relationship between the time taken to acting and the number of actions taken. Successful resolution of last witnessed overdose was associated more strongly with immediate onset of overdose, while those that led to death were more often those that involved slow onset of overdose. There is clear evidence of the opportunity and willingness of witnesses to intervene, particularly when overdose onset is immediate, with a wide range of strategies adopted to encourage recovery, although these may often be inappropriate and wrongly prioritized. [source] Case studies of tobacco dependence treatment in Brazil, England, India, South Africa and UruguayADDICTION, Issue 10 2010Martin Raw ABSTRACT Aims The aims of this study are to describe the tobacco dependence treatment systems in five countries at different stages of development of their systems, and from different income levels and regions of the world, and to draw some lessons from their experiences that might be useful to other countries. Methods and data sourses Data were drawn from an earlier survey of treatment services led by M.R. and A.M., from Party reports to the Secretariat of the Framework Convention on Tobacco Control, and from correspondents in the five countries. These data were entered onto a standard template by the authors, discussed with the correspondents to ensure they were accurate and to help us interpret them, and then the templates were used as a basis to write prose descriptions of the countries' treatment systems, with additional summary data presented in tables. Results Two of the middle-income countries have based their treatment on specialist support and both consequently have very low population coverage for treatment. Two countries have integrated broad-reach approaches, such as brief advice with intensive specialist support; these countries are focusing currently upon monitoring performance and guaranteeing quality. Cost is a significant barrier to improving treatment coverage and highlights the importance of using existing infrastucture as much as possible. Conclusions Perhaps not surprisingly the greatest challenges appear to be faced by large, lower-income countries that have prioritized more intensive but low-reach approaches to treatment, rather than developing basic infrastructure, including brief advice in primary care and quitlines. [source] The added risk of opioid problem use among treatment-seeking youth with marijuana and/or alcohol problem useADDICTION, Issue 4 2010Geetha A. Subramaniam Abstract Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14,21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment-funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex-related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15,17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth. [source] A randomized controlled trial of an internet-based intervention for alcohol abusersADDICTION, Issue 12 2009John A. Cunningham ABSTRACT Objective Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener ( http://www.CheckYourDrinking.net). Method Participants (n = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group. Results Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents. Conclusions The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment. [source] Changes in women's use of illicit drugs following imprisonmentADDICTION, Issue 2 2009Emma Plugge ABSTRACT Aim To provide data on changes in illegal drug use in women following imprisonment. Design Prospective cohort study. Setting Recruitment took place in two prisons in the Midlands and South-East England and follow-up in 13 prisons across England. Participants A total of 505 women prisoners participated, a response rate of 82%. Measurements Questions about drug use were contained within a questionnaire which examined broad aspects of health. On entry into prison, women answered questions about daily drug use and injecting drug use prior to imprisonment. One month later the questionnaires examined drug use during this period of imprisonment. Findings Prior to imprisonment, 53% [95% confidence interval (CI): 49,58%] of women took at least one illegal drug daily and 38% (CI: 34,42%) said they had ever injected drugs. Following imprisonment, some women continued to use drugs; 14% (CI: 10,20%) of women reported using at least one illegal drug daily and 2% (CI: 0.7,5%) of women had injected drugs. There were important changes in the types of drugs used; there was a change in use from crack and heroin to benzodiazepines and opiate substitutes. Prior to imprisonment, women most commonly used crack and heroin, but in prison the two most commonly used illegal drugs were benzodiazepines and opiate substitutes. Conclusions The study provides quantitative evidence of the impact of imprisonment on drug use among women. It highlights the need for enhanced drug treatment services and stronger measures to reduce the availability of illegal drugs to women in prison. [source] A survey of tobacco dependence treatment services in 36 countriesADDICTION, Issue 2 2009Martin Raw ABSTRACT Aims This paper reports the results of a survey of national tobacco dependence treatment services in 36 countries. The objective was to describe the services and discuss the results in the context of Article 14 of the Framework Convention on Tobacco Control, which asks countries to promote adequate treatment for tobacco dependence. Design, setting and participants A questionnaire on tobacco dependence treatment services was e-mailed to a convenience sample of contacts in 2007. Completed questionnaires were received from contacts in 36 countries. Measurements The survey instrument was a 10-item questionnaire asking about treatment policy and practice, including medications. Findings According to our informants, fewer than half the countries in our survey had an official written policy on (44%), or a government official responsible for (49%), treatment. Only 19% had a specialized national treatment system and only 24% said help was easily available in general practice. Most countries (94%) allowed the sale of nicotine replacement therapy (NRT), bupropion (75%) and varenicline (69%) but only 40% permitted NRT on ,general sale'. Very few countries responding to the question fully reimbursed any of the medications. Fewer than half (45%) fully reimbursed brief advice and only 29% fully reimbursed intensive specialist support. Only 31% of countries said that their official treatment policy included the mandatory recording of patients' smoking status in medical notes. Conclusion Taken together, our findings show that few countries have well-developed tobacco dependence treatment services and that, at a national level, treatment is not yet a priority in most countries. [source] A comparison of the effectiveness of group-based and pharmacy-led smoking cessation treatment in GlasgowADDICTION, Issue 2 2009Linda Bauld ABSTRACT Aim To compare the characteristics and outcomes of users accessing pharmacy and group-based smoking treatment. Design Observational study of administrative information linked with survey data. Setting Glasgow, Scotland. Participants A total of 1785 service users who set a quit date between March and May 2007. Intervention Smoking treatment services based in pharmacies providing one-to-one support, and in the community offering group support. Measurements Routine monitoring data included information about basic demographic characteristics, deprivation category of residence, nature of intervention and smoking status at 4-week follow-up determined by carbon monoxide (CO) readings ,10. These data were supplemented by information about socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers. Findings In the pharmacy-based service 18.6 % of users (n = 1374) were CO-validated as a quitter at 4 weeks, compared with 35.5 % (n = 411) in the group-based service. In a multivariate model, restricted to participants (n = 1366) with data allowing adjustment for socio-demographic and behavioural characteristics and including interaction terms, users who accessed the group-based services were almost twice as likely (odds ratio 1.980; confidence interval 1.50,2.62) as those who used pharmacy-based support to have quit smoking at 4-week follow-up. Conclusions Specialist-led group-based services appear to have higher quit rates than one-to-one services provided by pharmacies but the pharmacy services treat many more smokers. More research is needed to determine what can be done to bring the success rates of pharmacy services up to those of specialist-led groups and how to expand access to group-based services. [source] Visiting America: notes from an alcohol-focused study tour made in 1961ADDICTION, Issue 12 2008Griffith Edwards ABSTRACT Aims This paper has as its focus a study tour made by the author in 1961. Diary notes are used to capture a historical moment in the evolution of alcohol studies. The paper will argue for the continuing value today of such experiences in support of career development and the building of ,the field'. Data sources Diary notes and personal recollection. Findings The United States was at the time more active than the United Kingdom in its response to alcohol problems. There was, however, a disjunction between the elite American research world and the world of action, which was not informed greatly by research. For the most part, treatment services and prevention strategies seemed driven by opinion rather than by evidence. But at the level of serious scientific endeavour there was opportunity to meet influential figures including Seldon Bacon, Morris Chafetz, Milton Gross, Ebbe Curtis Hoff, Harris Isbell, E. M. Jellinek, Mark Keller, Benjamin Kissen, Robert Strauss, Wolf Schmidt and Abraham Wikler, who generously made their time available. Conclusions These diary notes provide a snapshot of a field of endeavour at a critical stage of transition from uninformed assumptions towards establishment of a research base which can inform public action. The visit was of tangible value to the visitor in several different identified ways. Such an experience is inevitably time-bound and personal, but there are general conclusions to be drawn as to the benefits which will be derived from early travel opportunities in a field such as alcohol studies, which is all too easily culture-bound in its horizons and assumptions. Alcohol science needs to be more reflective on its history and the mechanisms that help to make it happen. [source] Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up studyADDICTION, Issue 1 2008Michael Gossop ABSTRACT Aims This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. Methods Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4,5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. Findings Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. Conclusions NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups. [source] A national strategy for smoking cessation treatment in EnglandADDICTION, Issue 2005Ann McNeill ABSTRACT In 1998 the UK government published a White Paper on tobacco which set out the development of smoking cessation treatment services across England. This paper presents a detailed analysis of the events leading up to the inclusion of smoking cessation treatment services within the White Paper, and the background to the evaluation of those services, the results of which are the subject of the remaining papers in this supplement. [source] Implementing a national treatment service for dependant smokers: initial challenges and solutionsADDICTION, Issue 2005Tim Coleman ABSTRACT Background Before 1999, few treatment services for nicotine-addicted smokers existed in England. When national treatment services were introduced, those responsible for setting them up liaised closely with primary care health services. Setting up an entirely new national service, treating a new category of patient (smokers motivated to stop) was an ambitious aim and this paper documents the problems encountered in the early stages of this process. Objectives To describe the principal challenges encountered and solutions employed by those setting up the services during the initial period of smoking cessation service implementation. Methods Qualitative, semistructured interviews with 50 smoking cessation staff in two former English health regions conducted in autumn 2001. Findings Two principal factors which slowed the initial development of smoking cessation services were: (i) the lack of a work-force with experience in smoking cessation methods and (ii) the fact that services were set up outside existing primary and secondary care health services in England. As few training courses in smoking cessation were available, many services provided their own in-house training for staff appointed as smoking cessation advisers. Consequently, senior service staff devoted a lot of effort to training new staff which meant that they had less time to spend on other important tasks which were necessary for service implementation. Smoking cessation services needed to develop relationships with primary care health services in order to generate referrals and find venues for the delivery of smoking cessation interventions. Liaising with primary care physicians was time-consuming, however, and some primary care physicians were opposed to the ideas that service staff had for the interface between primary care and smoking cessation services. As new smoking cessation services were not set up within existing primary or secondary health care services, service staff had to spend large amounts of time on this process of negotiation and overcoming scepticism from some primary health care physicians. Conclusions If smoking cessation services are set up in other countries, rapid implementation would be facilitated by ensuring that adequate numbers of health professionals trained in smoking cessation methods are available to staff services. Additionally, locating new smoking cessation services within existing health providers' services may speed up service implementation, but this option may not suit all health systems. [source] Recent life problems and non-fatal overdose among heroin users entering treatmentADDICTION, Issue 2 2005Joanne Neale ABSTRACT Aims To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings. Design Cross-sectional data from a longitudinal study investigating drug treatment effectiveness. Setting Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland. Participants Of a total of 793 primary heroin users commencing drug treatment during 2001,02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients. Measurements Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems. Findings Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A ,2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems,but not demographic characteristics,were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing. Conclusions Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users' life problems as part of a broad strategy of overdose prevention. [source] Physical Interventions with People with Intellectual Disabilities: Staff Training and Policy FrameworksJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 2 2003Glynis Murphy Background, Physical intervention or restraint with people who have intellectual disabilities is sometimes necessary, even though it is known to present dangers to both staff and service users (some service users have died as a result of restraint). Aims, This study aims to investigate the extent to which staff in intellectual disability services were trained in the use of physical interventions or restraint. Their views of a recent policy framework on physical interventions were also sought. Methods, There were three groups of participants: (i) group 1 included staff who had attended conferences on the Policy Framework (the conference sample); (ii) group 2 included staff from two geographical areas (the geographical sample); (iii) group 3 included staff in specialist assessment and treatment services (the SpAT sample). All participants were sent a questionnaire asking them about their training in (and use of) physical intervention methods and their opinions on the policy document. Results, There were at least 12 different types of training recorded, including a number of varieties of Control and Restraint (C&R). By no means did all the senior staff did have training in physical intervention methods. The degree of training varied with the sample and the type of training varied with the employing organization. Most participants in group 1 were very positive about the BILD & NAS Policy Framework but few staff in groups 2 and 3 had read the document. About two-thirds of the participants said their services had (or were developing) a written policy on physical interventions. Conclusions, There remained a clear need for further training in physical interventions and evidence on which the effectiveness of different methods of physical interventions could be judged. [source] Patterns of Treatment Services and Costs for Young Offenders with Mental DisordersJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2005Deborah Shelton PhD PROBLEM:,This study describes mental health treatment service delivery patterns and costs for youth in a juvenile justice system. METHODS:,A secondary data analysis on a random sample of juvenile offenders (N = 312) was completed. Service patterns and costs were described. Selected variables were examined for their ability to predict who received treatment. FINDINGS:,Only 23% of youth diagnosed with a mental disorder received any treatment. Older youth and African American youth received fewer services, and race was the only significant predictor for receiving treatment (p = .001). CONCLUSIONS:,Mental health treatment services were scarce, and the data reflects a race bias in the provision of services. Although the law protects the right to treatment for these individuals, provision of services remains a challenge. [source] Using technical innovations in clinical practice: The Drinker's Check-Up software programJOURNAL OF CLINICAL PSYCHOLOGY, Issue 2 2004Daniel D. Squires Interest in assessing and treating a variety of psychological conditions with software programs is increasing rapidly. This article reviews a software program for problem drinkers entitled the Drinker's Check-Up (DCU) and illustrates its use with three patients. The DCU is based on the principles of brief motivational interventions and can be used as a stand-alone intervention by therapists without expertise in substance abuse or as a prelude to alcohol treatment services. It is the first software program to provide integrated assessment, feedback, and assistance with decision making for individuals experiencing problems with alcohol. Preliminary data from an ongoing clinical trial of the DCU as a stand-alone intervention indicate that it is an effective intervention for a wide range of problem drinkers. © 2003 Wiley Periodicals, Inc. J Clin Psychol/In Session. [source] Perceptions about services and dropout from a substance abuse case management programJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 5 2007Michael R. Sosin This article uses event history analysis to examine certain determinants of dropout from a case management program that serves homeless adults with substance abuse problems. The examined determinants are perceptions of conventional treatment services: (a) client perceptions concerning the value of the conventional services that case managers help them to obtain, (b) the views of use services held by social contacts, and (c) client perceptions of the legitimacy of conventional services. The findings, some of which involve statistical interactions, suggest that clients drop out of case management services more slowly (a) when they favor pursuit of particularly efficacious conventional programs; (b) when they find conventional programs to be of low legitimacy; (c) when, under special conditions, they perceive that conventional services are less caring; or (d) when social contracts do not pressure them. These findings generally imply that clients look to case management services when they are more skeptical about conventional services. The variables predicting dropout from case management poorly predict continuation in conventional substance abuse services, indicating that dropout is linked to perceptions of services in context-specific ways. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 583,602, 2007. [source] Influence of a Drinking Quantity and Frequency Measure on the Prevalence and Demographic Correlates of DSM-IV Alcohol DependenceALCOHOLISM, Issue 5 2009Katherine M. Keyes Background:, Recent research suggests that adding a quantity/frequency alcohol consumption measure to diagnoses of alcohol use disorders may improve construct validity of the diagnoses for Diagnostic and Statistical Manual of Mental and Behavior Disorders (DSM-V). This study explores the epidemiological impact of including weekly at-risk drinking (WAD) in the DMS-IV diagnostic definition of alcohol dependence via 3 hypothetical reformulations of the current criteria. Methods:, The sample was the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample with 43,093 adults aged >18 in the U.S interviewed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule IV. The current (DSM-IV) definition of alcohol dependence was compared with 4 hypothetical alcohol dependence reformulations that included WAD: (1) WAD added as an eighth criteria; (2) WAD required for a diagnosis; (3) adding abuse and dependence criteria together, and including WAD with a 3 of 12 symptom threshold; (4) adding abuse and dependence criteria together, and including WAD with a 5 of 12 symptom threshold. Results:, The inclusion of at-risk drinking as an eighth criterion of alcohol dependence has a minimal impact on the sociodemographic correlates of alcohol dependence but substantially increases the prevalence of dependence (from 3.8% to 5.0%). At-risk drinking as a required criterion or as part of a diagnosis that combines abuse with dependence criteria with a higher threshold (5+ criteria) decreases prevalence and has a larger impact on sociodemographic correlates. Blacks, Hispanics, and women are less likely to be included in diagnostic reformulations that include WAD, whereas individuals with low-income and education are more likely to remain diagnosed. Conclusions:, Including WAD as either a requirement of diagnosis or as an additional criterion would have a large impact on the prevalence of alcohol dependence in the general population. The inclusion of a quantity/frequency requirement may eliminate false positives from studies of alcohol disorder etiology and improve phenotype definition for genetic association studies by reducing heterogeneity in the diagnosis, but may also reduce eligibility for treatment services among women and racial/ethnic minorities compared. [source] Mental health crisis at home: service user perspectives on what helps and what hindersJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2007C. HOPKINS rmn msc ma This paper presents data which emerged during the process of a participatory research study to identify the perspectives of previous users of a home treatment service. Feedback was sought in order to establish the criteria for the development of a service evaluation questionnaire. Seven themes emerged from the data which were then used as a framework for the evaluation questionnaire. These themes have also been used within this paper to present what our participants told us was important to them when they received a service at home at a time of mental health crisis. Although what is described here is the experience of one group of service users in the North of England, we hope that the views of these participants will create a resonance with providers of other home treatment services and expand the knowledge about which aspects of care at home during mental health crisis are viewed as helpful and those aspects which are not. [source] Long-Term Posttreatment Functioning Among Those Treated for Alcohol Use DisordersALCOHOLISM, Issue 2 2006Patrick R. Clifford This article summarizes the proceedings of a symposium that was organized and chaired by Patrick R. Clifford and presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California. The aims of the presentation were to focus on the prediction and explanation of longer-term functioning following alcohol use disorders (AUD) treatment. Along these lines, Stephen A. Maisto, PhD, presented data (i.e., Project MATCH outpatient sample) on the relationship between drinking behavior in the first year following AUD outpatient treatment initiation and functioning at 3-year follow-up. Robert L. Stout, PhD, using data from the Extended Case Monitoring Study, analyzed long-term drinking patterns using shorter-term information. James R. McKay, PhD, examined the relationship between treatment services received and problem severities across a 2-year follow-up period. J. Scott Tonigan, PhD, served as the panel discussant. [source] Substance Abuse Treatment and Hospitalization among a Cohort of HIV-Infected Individuals with Alcohol ProblemsALCOHOLISM, Issue 3 2005Anita Palepu Background: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. Methods: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. Results: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7,1.5), whereas homelessness (AOR 2.3; 95% CI 1.5,3.6), injection drug use (AOR 1.7; 95% CI 1.0,2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00,1.05), CD4 cell count (AOR 0.999; 95% CI 0.998,1.00), and HIV RNA (AOR 1.1; 95% CI 1.0,1.2) were independently associated with increased odds of hospitalization over time. Conclusions: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals. [source] | ||||||||||||||||||||||||||||