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The impact of syringe deregulation on sources of syringes for injection drug users: preliminary findings

Deren, Sherry; Cleland, Charles M; Fuller, Crystal; Kang, Sung-Yeon; Des Jarlais, Don C; Vlahov, David
In 2001, New York State enacted legislation to allow the provision of syringes by pharmacies and healthcare providers without prescription (ESAP, the Expanded Syringe Access Demonstration Program). A longitudinal study of IDUs (n=130) found that pre-ESAP, about half used only the safest source (needle exchange programs [NEPs]). Post-ESAP implementation, ESAP sources were initiated by 14%. Frequency of injection was related to ESAP use and those who used unsafe (or possibly unsafe) sources were as likely to use ESAP as those who had previously used only NEPs. The findings indicate that providing multiple sources of safe syringes for IDUs is necessary.
PMID: 16642418
ISSN: 1090-7165
CID: 157071

Factor structure of the Conners Adult ADHD Rating Scale (CAARS) for substance users

Cleland, Charles; Magura, Stephen; Foote, Jeffrey; Rosenblum, Andrew; Kosanke, Nicole
Adult substance users are known to have above average rates of Attention Deficit-Hyperactivity Disorder (ADHD), but the psychometric properties of self-report measures of ADHD symptoms for adult substance users are unknown. Subjects (206 adults with a DSM-IV substance abuse disorder) were administered the Conners Adult ADHD Rating Scales (CAARS) upon enrolling in outpatient treatment. A factor structure similar to that reported for other populations was obtained and internal consistency reliabilities for the subscales and the overall index were high. Compared with CAARS norms, substance users scored significantly above average on all subscales as well as on the overall index. The CAARS may prove useful for measuring ADHD symptomatology among substance users, but additional reliability and validity evidence is needed. The CAARS should not be used by itself to diagnose individuals for ADHD.
PMID: 16169157
ISSN: 0306-4603
CID: 4258892

Counselor confounds in evaluations of vocational rehabilitation methods in substance dependency treatment

Staines, Graham L; Cleland, Charles M; Blankertz, Laura
Evaluation research on vocational counseling in substance dependency treatment should distinguish between the effects of counselors and counseling methods on clients' employment outcomes. Three experimental designs permit investigation of possible confounds between these types of effects: (a) nested designs (each counselor delivers one counseling method so counselors are nested under methods), (b) crossed designs (each counselor delivers all counseling methods so counselors are crossed with methods), and (c) no-treatment control group designs (experimental group's counselors all deliver the same method). Each design is optimal for one stage of evaluation research. No-treatment control group designs are best for exploratory evaluations of new types of vocational counseling. Nested designs are best for outcome evaluations of different types of interventions. Crossed designs are best for (causal) process evaluations of counseling methods of demonstrated efficacy. Despite the importance of methodological issues and problems, vocational rehabilitation in substance dependency treatment has a greater need for stronger interventions than better evaluation designs.
PMID: 16492996
ISSN: 0193-841x
CID: 157072

Changes in women's sexual risk behaviors after therapeutic community treatment

Cooperman, Nina A; Falkin, Gregory P; Cleland, Charles
This study examines sexual risk behaviors among 197 women mandated to substance abuse treatment in therapeutic communities. The women's risk behaviors after treatment are compared with their behaviors prior to treatment, and risk behaviors among those who completed treatment are compared with those who did not. The women had a high prevalence of sexual risk behaviors (i.e., multiple partners, unprotected sex, sex trade, not asking partners to use condoms, sex with injection drug users [IDUs]) and relationship violence and conflict before treatment and a significant decrease in unprotected sex, sex trade, sex with multiple partners, and relationship violence or conflict after treatment. Those who completed treatment were significantly less likely to participate in sex trade or have sex with IDUs and were more likely to have a new sexual partner and only one sexual partner after treatment as compared with those who did not complete treatment. The present study shows that therapeutic community treatment is associated with the reduction of sexual risk behaviors among female substance abusers mandated to treatment.
PMID: 15899753
ISSN: 0899-9546
CID: 2640762

The combined effects of treatment intensity, self-help groups and patient attributes on drinking outcomes

Magura, Stephen; Fong, Chunki; Staines, Graham L; Cleland, Charles; Foote, Jeffrey; Rosenblum, Andrew; Kosanke, Nicole; DeLuca, Alexander
Better understanding of the diverse factors that predict alcoholism treatment outcomes is essential to improving treatment strategies. Patients accepted for treatment at a multimodality program were interviewed and followed-up at three months and one year after admission. The study tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, modality matching, treatment retention, aftercare, self-help group participation and patient attributes at admission. Drinking frequency diminished substantially between baseline and the two follow-ups. Outcomes for inpatient were better than for outpatient treatment in bivariate analysis, but outcomes for these modalities were equal after adjusting for the effect of patient-treatment mismatching. Aftercare treatment, time in treatment for outpatients, community 12-Step group participation, and several patient attributes such as motivation for change and psychiatric severity significantly predicted drinking outcomes at one or both follow-ups. Clinical implications of the results are discussed.
PMID: 15916254
ISSN: 0279-1072
CID: 4258882

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users

Cleland, Charles; Magura, Stephen; Foote, Jeffrey; Rosenblum, Andrew; Kosanke, Nicole
OBJECTIVE:To determine the psychometric properties of the Toronto Alexithymia Scale (TAS-20), an established self-report measure of alexithymia, for a substance user sample participating in a clinical trial of outpatient cognitive-behavioral therapies (N=230). METHODS:Confirmatory and exploratory factor analyses were used to determine the number and nature of the factors underlying the TAS-20 in a sample of substance users. Structural equation modeling was used to determine the predictive validity of the TAS-20. RESULTS:A factor structure comparable, but not identical, with TAS-20 psychometric results with other populations was found; alpha coefficients were .88 for the feelings factor, .62 for the external thinking factor, and .87 for the total score. Although, on average, the substance users did not appear to have elevated alexithymia scores compared with the undergraduate students, alexithymia predicted less treatment engagement, i.e., fewer sessions attended and weaker helping alliance. Alexithymia also predicted alcohol use outcomes but not drug use outcomes. The relation between alexithymia and drinking outcome was conditional on whether the patient was using solely alcohol at baseline. CONCLUSION/CONCLUSIONS:The TAS-20 has reasonably good psychometric properties in this sample, which might be improved by dropping several marginal questionnaire items. Alexithymia appears to attenuate substance abuse treatment engagement. More clinical and research experience with this construct and specific instrument in substance user samples is needed.
PMID: 15865955
ISSN: 0022-3999
CID: 4258862

Substance use among young adolescents in HIV-affected families: resiliency, peer deviance, and family functioning

Rosenblum, Andrew; Magura, Stephen; Fong, Chunki; Cleland, Charles; Norwood, Christine; Casella, Doris; Truell, Jennifer; Curry, Phyllis
This study examines the association of risk and protective factors with substance use among 77 early adolescents (11-15 years old) with an HIV-infected parent who were interviewed in 2000-2001 in the South Bronx, a HIV high-prevalence area of New York City. The subjects were 49%female, 53% African American, and 30% Hispanic; mean age was 13 years old. A face-to-face interview was used to administer a battery of instruments representing community, family, peer, and resiliency factors. Forty percent reported ever using tobacco, alcohol or drugs; 71% were aware of their parent's HIV seropositivity. An age-adjusted path analytic model was constructed which showed: 1) family functioning predicted resiliency (a composite measure of psychological adjustment and personal competencies); 2)positive community factors and resiliency predicted less affiliation with deviant peers; and 3) poorer family functioning and affiliation with deviant peers predicted substance use. These results underscore the need for interventions that address social influence factors among vulnerable early adolescents with HIV-positive parents.
PMID: 15887592
ISSN: 1082-6084
CID: 4258872

Moderators of effects of motivational enhancements to cognitive behavioral therapy

Rosenblum, Andrew; Foote, Jeffrey; Cleland, Charles; Magura, Stephen; Mahmood, Daneyal; Kosanke, Nicole
Patient treatment matching hypotheses were tested for substance users randomly assigned to a group cognitive behavioral therapy (CBT; n= 114) or a group motivational intervention (GMI; n= 116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15-week follow-up, the study predicted that alexithymia, antisocial personality disorder (ASPD), and network support for alcohol and drug use would be associated with less substance use for CBT subjects and that hostility and lower treatment motivation would be associated with less substance use for GMI subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and ASPD. Results indicate the use of assessing specific patient attributes to better inform treatment recommendations.
PMID: 15768570
ISSN: 0095-2990
CID: 4258852

Social support mediates the effects of dual-focus mutual aid groups on abstinence from substance use

Laudet, Alexandre B; Cleland, Charles M; Magura, Stephen; Vogel, Howard S; Knight, Edward L
BACKGROUND: Specialized 12-step based groups have emerged to address the needs of persons recovering from both substance abuse and psychiatric illness. OBJECTIVE: This study investigates the role of social support in mediating the association between mutual aid participation and subsequent substance use for dually diagnosed persons. METHOD: A cohort of Double Trouble in Recovery (DTR) members in New York City were studied prospectively over a two-year period. FINDINGS: Longer DTR participation during the first year of the study was associated with lower substance use in the second year; that effect was partially explained by the maintenance of high level of social support. CONCLUSION: These findings speak of the enduring influence of 12-step attendance on reducing substance use, and underline the importance of both 12-step attendance and supportive networks for dually diagnosed persons.
PMCID:1868663
PMID: 15663205
ISSN: 0091-0562
CID: 157073

The effect of 12-step based fellowship participation on abstinence among dually diagnosed persons: a two-year longitudinal study

Laudet, Alexandre B; Magura, Stephen; Cleland, Charles M; Vogel, Howard S; Knight, Edward L; Rosenblum, Andrew
A large percentage of individuals are dually-diagnosed with a psychiatric disorder and a substance use disorder. Such persons typically face more difficulties and have poorer outcomes than do single disorder substance users. Among noncomorbid substance users, treatment and participation in 12-Step groups have been shown to enhance the likelihood of abstinence from substance misuse. Specialized 12-Step based fellowships have recently emerged to address the recovery needs of dually-diagnosed persons. The present study is a longitudinal investigation of the effect of such 12-Step based groups on abstinence among dually-diagnosed persons. Participants were members of Double Trouble in Recovery (DTR) who were recruited at community-based meetings in New York City and reinterviewed twice at yearly intervals. Generalized estimating equation analysis indicated that, over the two-year study period, ongoing DTR attendance was significantly associated with a greater likelihood of abstinence after controlling for other pertinent variables, such as mental health symptoms. For clinicians, these findings underline the importance of fostering stable affiliation with specialized 12-Step based groups among their clients.
PMCID:1797895
PMID: 15369202
ISSN: 0279-1072
CID: 157074