Faculty Bibliography

This article evaluates the efficacy of a 14-session social-cognitive behavioral intervention on problem drinking (and where applicable, drug use) among urban HIV-infected and uninfected mothers, in comparison to a single-session social/motivational intervention, and explores the relationships of initial substance use problem severity and HIV status to efficacy. A randomized controlled trial design was used. Participants (N = 118) were mothers with problem drinking, both HIV-infected (55%) and uninfected, and primarily from racial/ethnic minority and low socioeconomic status backgrounds. Participants were interviewed five times over 18 months. Both intervention arms yielded reductions in alcohol and drug use frequency, alcohol quantity, and alcohol/drug problems, with moderate effect sizes. Those with greater initial substance use maintained reductions over a longer period of time in response to the more intensive social-cognitive intervention. Treatment efficacy did not vary by HIV status. The utility of targeting intervention intensity to the level of substance use is supported.

Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment. The present paper extends this work to treatment outcomes. Secondary analysis of data from a "Beliefs About Abstinence Scale," used in the Drug Abuse Treatment Outcomes Study (DATOS), was conducted for 76 programs, including outpatient methadone treatment, outpatient drug-free, short-term inpatient, and long-term residential programs. Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality. The implications of the results for substance abuse treatment are discussed.

Despite considerable effort to develop matching strategies and client placement protocols, research studies fail to yield compelling results regarding the benefits of matching to treatment. The most consistent findings suggest a matching paradigm, which defines a successful placement as the least treatment intensity required addressing the severity of the disorder. The purpose of the present study is to provide further empirical support for the validity of a severity-intensity paradigm utilizing data from the Drug Abuse Treatment Outcome Studies. A 'passive match' approach employed the Client Matching Protocol decision algorithm, which recommended clients to long-term residential or outpatient drug-free treatment. One-year outcomes for clients matched to long-term residential treatment were better on all outcome variables compared to those undertreated in outpatient drug-free treatment. Findings supported the validity of the severity-intensity paradigm in that undertreated clients showed less improvement compared to matched and overtreated clients

Previous research has shown the performance of the CJDATS Co-Occurring Disorders Screening Instruments (CODSI-MD and SMD)--six- and three-item instruments to screen for any mental disorder (CODSI-MD) and for severe mental disorders (CODSI-SMD), respectively--to be comparable or superior to other, longer instruments. This study tested the stability of the performance of the CODSI-MD and SMD across three racial/ethnic groups of offenders entering prison substance abuse treatment programs (n = 353), consisting of 96 African American, 120 Latino, and 137 White admissions. The Structured Clinical Interview (SCID) was used to obtain DSM-IV Axis I and II diagnoses; a lifetime SCID diagnosis of a mental disorder or a severe mental disorder was the criterion against which the CODSI-MD and SMD were validated. Results showed no statistical differences in sensitivity or specificity for either the CODSI-MD or SMD across the African American, Latino, and White prisoner groups. The value of the CODSI-MD and SMD as brief screens for mental disorders among offenders with diverse racial/ethnic backgrounds is discussed.

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.

OBJECTIVE:The purpose of this study was to examine patterns of change in attributions for childhood sexual abuse (CSA) over a 6-year period and whether such patterns were related to abuse severity, age, gender, and subsequent symptoms of depression and PTSD. METHODOLOGY/METHODS:One-hundred and sixty children, 8-15 years old, were interviewed within 8 weeks of the time the CSA was reported to child protective services (i.e., the time of abuse discovery). Follow-up interviews were conducted 1-year later on 147, and 6 years later on 121 of the original participants. Abuse-specific attributions were obtained using two methods. Participants first responded to an open-ended interview question about why they believed the CSA had happened to them and then completed a rating scale about the extent to which possible attributions for the CSA applied to them (e.g., "Because I was not smart enough"). RESULTS:Over time, perpetrator-blame attributions were consistently more common than self-blame attributions for CSA (using both interview and rating measures). Youth were more likely to report self-blame attributions on the rating measure than the open-ended interview question. The interview method indicated that youth often felt confused about why the abuse happened up to a year following discovery but this response diminished by the third assessment. On average, ratings of perpetrator-blame attribution remained high over time (p<.05), whereas ratings of self-blame decreased (p<.01). Penetration was related to more self-blame (p<.05) and less perpetrator-blame (p<.05), and the use of force was related to more perpetrator-blame. The initial level of self-blame attribution ratings predicted subsequent symptoms of depression (p<.05) and intrusive experiences (p<.05) after controlling for age at abuse discovery, gender, and self-blame attributions for common events. Perpetrator-blame attributions were not related to symptoms. CONCLUSIONS:The findings of this study suggest that assessing responses to open-ended interview questions about the perceived reasons for the abuse and ratings of attributions are important for understanding how youth make sense of their abuse. Abuse-specific self-blame attributions at abuse discovery have a persistent effect on internalizing symptoms and should be assessed and the target of treatment as soon as possible after CSA has been reported to the authorities.

BACKGROUND: A number of studies suggest females may be more likely to engage in injection and sex risk behavior than males. Most data on gender differences come from industrialized countries, so data are needed in developing countries to determine how well gender differences generalize to these understudied regions. METHODS: Between 1999 and 2003, 2512 male and 672 female current injection drug users (IDUs) were surveyed in ten sites in developing countries around the world (Nairobi, Beijing, Hanoi, Kharkiv, Minsk, St. Petersburg, Bogota, Gran Rosario, Rio, and Santos). The survey included a variety of questions about demographics, injecting practices and sexual behavior. RESULTS: Females were more likely to engage in risk behaviors in the context of a sexual relationship with a primary partner while males were more likely to engage in risk behaviors in the context of close friendships and casual sexual relationships. After controlling for injection frequency, and years injecting, these gender differences were fairly consistent across sites. CONCLUSION: Gender differences in risk depend on the relational contexts in which risk behaviors occur. The fact that female and male risk behavior often occurs in different relational contexts suggests that different kinds of prevention interventions which are sensitive to these contexts may be necessary.

A multi-state survey of 5663 opioid dependent persons enrolling in 72 methadone maintenance treatment programs (MMTPs) was conducted to determine the prevalence of prescription opioid (PO) abuse, factors associated with PO abuse and sources for POs. Regions where PO abuse was believed to be prevalent were oversampled; primary opioid was defined as the drug used the most before coming to the MMTP. Among primary heroin abusers, 69% reported abusing POs. Opioid abuse frequencies among primary PO abusers were oxycodone (79%), hydrocodone (67%), methadone (40%), morphine (29%), heroin (13%), hydromorphone (16%), fentanyl (9%) and buprenorphine (1%). Correlates (p < or = .01) of PO abuse, using general estimating equations, were: low urbanicity (MMTPs located in comparatively low population density counties), white ethnicity, no history of injecting primary drug, no previous methadone treatment, younger age, chronic pain, and pain as a reason for enrollment. The most frequent sources of POs were dealer, friend or relative, and doctor's prescription; least frequent were Internet and forged prescription. One-third of PO abusers reported a history of injecting their primary drug. PO abuse is highly prevalent among MMTP patients. Future studies should describe HIV/HCV needle injection practices, characteristics that predict treatment outcomes, and factors that contribute to higher prevalence of persistent pain among PO abusers.

Although childhood sexual abuse (CSA) has been linked to risk for delinquency, research is limited on the potential pathways from CSA to subsequent delinquent outcomes. A total of 160 youth with confirmed CSA histories were interviewed at the time of abuse discovery, when they were 8 to 15 years of age, and again 1 and 6 years later. The findings supported the proposed relations from stigmatization following the abuse (abuse-specific shame and self-blame attributions) and internalizing symptoms to subsequent delinquency through anger and affiliation with deviant peers. This longitudinal research suggests that clinical interventions for victims of CSA must be sensitive to these affective and cognitive processes and how they affect delinquent activity.

Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.