SUBSTANCE ABUSE SERVICES ACROSS THE CONTINUUM

Prevention, Screening and Assessment

This webpage identifies the major literature in the field of substance abuse and child welfare practice: prevention, screening and assessment. The time frame is from January 2000 through December 2014.

Appleyard, K., Berlin, L.J., Rosanbalm, K.D., & Dodge, K.A. (2011). Preventing early child maltreatment: Implications from a longitudinal study of maternal abuse history, substance use problems, and offspring victimization. Prevention Science, 12(2), pp. 139-149. DOI: 10.1007/s11121-010-0193-2

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, and 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.

Berger, L. M. (2002). Estimating the benefits and costs of a universal substance abuse screening and treatment referral policy for pregnant women. Journal of Social Service Research, 29(1), pp. 57-84.

This paper provides a cost-benefit analysis of a universal substance abuse screening and treatment referral policy for pregnant women. The results indicate that mothers and children are likely to benefit economically from a universal substance abuse screening and intervention policy. The extent to which society and non-participants would incur economic costs or reap economic benefits from such a policy, however, is dependent on CPS reporting practices and investigation rates, as well as foster care entry rates. Results suggest that the monetary benefits of such a policy will only outweigh its costs if it does little to increase post-birth child protective services reporting and/or foster care placement rates. Thus, additional policies regarding the ways in which screening results are utilized may be important factors in determining the effects of a universal substance abuse screening policy for pregnant women.

Chan, L. K. (2012). Evaluating the Risk of Child Abuse: The Child Abuse Risk Assessment Scale (CARAS). Journal of Interpersonal Violence, 27(5), pp. 951–973. DOI: 10.1177/0886260511423252

The present study developed the Child Abuse Risk Assessment Scale (CARAS), an actuarial instrument for the assessment of the risk of physical child abuse. Data of 2,363 Chinese parents (47.7% male) living in Hong Kong were used in the analyses. Participants were individually interviewed with a questionnaire assessing their perpetration of child abuse and some theoretically or empirically tested factors associated with child abuse. When applying to the second half of the split sample, the CARAS had a sensitivity of 81.9%, a specificity of 77.8%, and an overall accuracy of 78.1%. The area under the receiver operating characteristic curve (AUC) was .91. Overall, our findings showed that the CARAS is a simple, systematic and validated instrument identifying at-risk population of child maltreatment in Chinese societies.

Chasnoff, I. J., McGourty, R. F., Bailey, G. W., Hutchins, E., Lightfoot, S. O., Pawson, L. L., et al. (2005). The 4P’s Plus screen for substance use in pregnancy: Clinical application and outcomes. Journal of Perinatology, 25(6), pp. 368-374.

The purpose of this study was to evaluate the performance of a new screening instrument in five diverse populations of pregnant women enrolled in prenatal care. The 4P’s plus is a five-question screen specifically designed to quickly identify obstetrical patients in need of in-depth assessment or follow-up monitoring for risk of alcohol, tobacco, and/or illicit drug use. Those women with a positive screen underwent an assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit. Among 7818 women in five communities, 2555 (32.7%) had a positive screen for substance use in pregnancy. Four of the communities conducted a follow-up assessment on all women with a positive screen (n = 1548). Among these women, 717 (15% of the total population) had continued use after learning of the pregnancy. Overall, 21% of the pregnant women used alcohol prior to recognition of the pregnancy, and 11% continued use after knowledge of the pregnancy. Among the 512 women who continued to use alcohol, 2% were drinking daily, 7% were drinking 3 to 6 days per week, 27% were drinking 1 to 2 days per week, and 63% were drinking less than 1 day per week. The rates of marijuana use and other illicit drug use among the women were 7 and 2%, respectively, prior to knowledge of pregnancy and dropped to 3 and 1% after learning of the pregnancy. The results indicate that the 4P's Plus identifies not only those pregnant women whose drinking or drug use is at a high enough level to impair daily functioning, but provides an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of substance use.

Chariot, P., Lepresle, A., Lefevre, T., Boraud, C., Barthes, A., & Tedlaouti, M. (2014). Alcohol and substance screening and brief intervention for detainees kept in police custody. A feasibility study. Drug and Alcohol Dependence, 134(1), pp. 235-241.

Screening and brief intervention programs related to addictive disorders have proven effective in a variety of environments. Both the feasibility and outcome of brief interventions performed in police custody by forensic physicians are unknown. Our objectives were to characterize addictive behaviors in detainees and to evaluate the feasibility of a brief intervention at the time of the medical examination in police custody. This prospective study included 1000 detainees in police custody who were examined by a physician for the assessment of fitness for detention. We used a standardized questionnaire and collected data concerning individual characteristics, addictive disorders, and reported assaults or observed injuries. 944 men and 56 women (94–6%) were studied. We found an addictive disorder in 708 of 1000 cases (71%), with the use of tobacco (62%), alcohol (36%), cannabis (35%), opiates (5%), and cocaine (4%) being the most common. A brief intervention was performed in 544 of these 708 cases (77%). A total of 139 of the 708 individuals (20%) expressed a willingness to change and 14 of 708 (2%) requested some information on treatment options. The main reasons why brief interventions were not performed were aggressive behaviors, drowsiness, or fanciful statements by the detainee. Brief interventions and screening for addictive behaviors in police custody are feasible in the majority of cases. The frequent link between addictive behaviors and the suspected crimes highlights the value of such interventions, which could be incorporated into the public health mission of the physician in police custody.

Chasek, L. C., Jorgensen, M., & Maxson, T. (2012). Assessing counseling students’ attitudes regarding substance abuse and treatment. Journal of Addictions and Offender Counseling, 33(2), pp. 107-114.

Undergraduate counselors-in-training completed the Substance Abuse Attitude Survey, which measures treatment intervention, treatment optimism, and non-stereotypical attitudes. Treatment optimism was positively correlated with non-stereotypical attitudes and treatment intervention. Results indicated that treatment intervention and non-stereotypical attitudes must be addressed in addiction counseling courses.

Cheon, J. W. (2008). Best practices in community-based prevention for youth substance reduction: Towards strengths-based positive development policy. Journal of Community Psychology, 36(6), pp. 761-779.

Substance use among youth remains a major public health and safety concern. One fundamental way to address youth substance use prevention is to keep young people on a positive trajectory by engaging them in positive activities from early years of their childhood. In this article, the author offers a best practice analysis of systematic review about 12 selected community-based preventions, and proposes policy changes towards incorporating a strengths perspective. A substantive, methodological, and value-based critical analysis of the strongly effective preventions was conducted. A strengths-based positive youth development perspective is specified as one feasible needed improvement and subsequent policy changes in the school district as well as in the local, state, and federal levels are proposed along with the suggestion of a mandated community youth participation strategy.

Denvir, M. P. (2012). When patients portray their conduct as normal and healthy: An interactional challenge for thorough substance use history taking. Social Science & Medicine, 75(9), pp. 1650-1659.

This article presents findings of a study aimed at addressing the following three questions: 1) what interactional resources did patients use to enact normal/healthy” stances? 2) How did physicians respond to patients’ “normal/Healthy” stances? 3) What are some potential functions of patients’ “normal/healthy” stances? Researchers and medical practitioners have argued that routine substance use histories are performed less frequently and less thoroughly than they should be. The paper explores some reasons why physicians treated these as appropriate and sufficient responses and did not seek additional details even when the information provided was quite superficial. Two social functions of patients’ “normal/healthy” stances are discussed: 1) redirecting the physician’s history taking to other topics and 2) presenting oneself as a health-conscious patient. “Normal/healthy” stances can represent an expression of patient agency, but can also present a dilemma for physicians, who must balance a concern for thoroughness with a concern for rapport. Recommendations for navigating this dilemma are discussed.

Edlund, M. J., Sullivan, M. D., Han, X., & Booth, B. M. (2013). Days with pain and substance use disorders is there an association? Clinical Journal of Pain, 29(8), pp. 689-695.

In this study, the authors investigated possible associations between pain frequency and the 5 most common substance use disorders: alcohol abuse/dependence, cocaine abuse/dependence, methamphetamine abuse/dependence, opioid abuse/dependence, and marijuana abuse/dependence. Data from the Rural Stimulant Study, a longitudinal (7 waves), observational study of at-risk stimulant users (cocaine and methamphetamine) in Arkansas and Kentucky (n=462) was used. Compared with time periods when individuals had no pain days in the past 30 days, time periods when individuals had 16+ pain days were more likely to have a diagnosis of opioid abuse/dependence (OR=3.32, P=0.02). Number of days with pain was not significantly associated with other substance use disorders. Pain frequency seems to be associated with an increased risk for alcohol abuse/dependence and opioid abuse/dependence in this population, and the magnitude of the association is medium to large. Further research is needed to investigate this in more representative populations and to determine causal relationships.

Floyd, R. L., O'Connor, M. J., Bertrand, J., & Sokol, R. (2006). Reducing adverse outcomes from prenatal alcohol exposure: A clinical plan of action. Alcoholism-Clinical and Experimental Research, 30(8), pp. 1271-1275.

Fetal alcohol spectrum disorders (FASDs) are among the leading preventable causes of developmental disorders in the United States; however, recognition and prevention of these conditions cannot be achieved without informed and educated health providers. This commentary addresses the importance of recognition and prevention of FASDs through the use of well-established standardized practices of diagnosis, screening, and brief alcohol reduction counseling. This article includes diagnostic guidelines for FAS, prevention strategies, methods for establishing alcohol use, and brief interventions. The authors suggest that routine formal screening for alcohol use should be conducted with all women of child bearing age and that screening can be done in both physicians’ offices and in community health settings.

Guterman, N. B., Tabone, J. K., Bryan, G. M., Taylor, C. A., Napoleon-Hanger, C., & Banman, A. (2013). Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: Six-month findings from a randomized clinical trial. Child Abuse & Neglect, 37, pp. 566-577.

This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents. Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services. Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect. As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect. Practice implications: These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk.

Hasin, S. D., Fenton, C. M., Beseler, C., Park, J., & Wall, M. M. (2012). Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients. Drug and Alcohol Dependence, 122(1-2), pp. 28– 37. DOI: 10.1016/j.drugalcdep.2011.09.005

A number of changes have been proposed and investigated in the criteria for substance use disorders in DSM-5. However, although clinical utility of DSM-5 is a high priority, relatively little of the empirical evidence supporting the changes was obtained from samples of substance abuse patients. Proposed changes were examined in 663 patients in treatment for substance use disorders, evaluated by experienced clinicians using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Factor and item response theory analysis was used to investigate the dimensionality and psychometric properties of alcohol, cannabis, cocaine and heroin abuse and dependence criteria, and craving. The seven dependence criteria, three of the abuse criteria (hazardous use; social/interpersonal problems related to use; neglect of roles to use), and craving form a unidimensional latent trait for alcohol, cannabis, cocaine and heroin. Craving did not add significantly to the total information offered by the dependence criteria, but adding the three abuse criteria and craving together did significantly increase total information for the criteria sets associated with alcohol, cannabis and heroin. Among adult patients in treatment for substance disorders, the alcohol, cannabis, cocaine and heroin criteria for dependence, abuse (with the exception of legal problems), and craving measure a single underlying dimension. Results support the proposal to combine abuse and dependence into a single diagnosis in the DSM-5, omitting legal problems. Mixed support was provided for the addition of craving as a new criterion, warranting future studies of this important construct in substance use disorders.

Hill, N. (2008). Adolescent substance use prevention interventions outside of classroom settings. Child & Adolescent Social Work Journal, 25(6), pp. 451-467.

Substance use prevention programs empowering individual adolescents to resist substance use through education and skills training are crucial to reducing substance use within this population. However, existing programs of this type are designed primarily for classroom use, and may not meet the needs of social workers intervening with adolescents outside classroom settings. A literature review identified six programs that have demonstrated statistically significant reductions in substance use when implemented outside the classroom. The current study describes these programs, identifies their common characteristics, and draws on additional prevention research to outline recommendations for practitioners seeking to apply the field’s most current knowledge base in community settings.

Hunter, B. A., Jason, L. A., & Keys, C. B. (2013). Factors of Empowerment for Women in Recovery from Substance Use. American Journal of Community Psychology, 51(1-2), pp. 91-102. DOI: 10.1007/s10464-012-9499-5

Empowerment is an interdisciplinary construct heavily grounded in the theories of community psychology. Although empowerment has a strong theoretical foundation, few context-specific quantitative measures have been designed to evaluate empowerment for specific populations. The present study explored the factor structure of a modified empowerment scale with a cross-sectional sample of 296 women in recovery from substance use who lived in recovery homes located throughout the United States. Results from an exploratory factor analysis identified three factors of psychological empowerment which were closely related to previous conceptualizations of psychological empowerment: self-perception, resource knowledge and participation. Further analyses demonstrated a hierarchical relationship among the three factors, with resource knowledge predicting participation when controlling for self-perception. Finally, a correlational analysis demonstrated the initial construct validity of each factor, as each factor of empowerment was significantly and positively related to self-esteem. Implications for the application of psychological empowerment theory and research are discussed.

Kerker, B. D., Horowitz, S. M., & Leventhal, J. M. (2004). Patients' characteristics and providers attitudes: Predictors of screening pregnant women for illicit substance use. Child Abuse and Neglect, 28(2), pp. 209-223.

This study's aim was to determine how patients' and providers' characteristics affect hospital providers' decisions to screen pregnant and postpartum women for illicit substances. Participants included low-income women (N = 1, 100) who delivered at an urban teaching hospital over a 12-month period and the providers (N = 40) who provided prenatal and delivery care for these women. Medical records were abstracted to obtain demographic, medical, social, and substance use information and providers were interviewed to obtain data on their attitudes. Results indicated that women who were single, Black, received prenatal care at the prenatal clinic, saw fewer providers, or had a placental abruption, preterm labor, inadequate prenatal care, a history of involvement with Child Protective Services, a high social/Mental Health Risk Factor Score, a past or present history of illicit drug use, or a present history of tobacco use were more likely to be screened than women without these characteristics. Women whose providers scored medium or high on the Professionalism Scale were more likely to be screened than women whose providers scored low on this scale. This study indicates that providers' decisions to screen pregnant women for illicit substance use are influenced by both patients' characteristics and providers' personal attitudes. Universal hospital protocols might help reduce the potentially biased impact of attitudes on screening decisions.

Laux, M. J., Piazza, J. N., Salyers, K., & Roseman, P. C. (2012). The Substance Abuse Subtle Screening Inventory–3 and Stages of Change: A screening validity study. Journal of Addictions & Offender Counseling. 33(2), pp. 82-92.

The sensitivity of the Substance Abuse Subtle Screening Inventory—3 (SASSI-3) was examined among substance-dependent adults enrolled in a family drug court. The SASSI-3 had a high sensitivity rate with this population, even across varying levels of motivation to change.

Martin, E. G., & Wang, K. H. (2013). Integrating substance abuse treatment into HIV care: Missed opportunities in the AIDS drug assistance program. Journal of Acquired Immune Deficiency Syndromes, 62(4), pp. 421-429.

Untreated substance use disorders (SUD) among HIV patients contribute to worse HIV care outcomes and increased HIV transmission. Although there are clinical and policy recommendations for integrated SUD and HIV treatment, payment issues including complex funding streams are a barrier. In this article, the authors assessed the availability of guideline-concordant medication-assisted therapies to treat alcohol, tobacco, and opioid dependence on state-administered AIDS Drug Assistance Programs (ADAPs), an important source of drug coverage for low-income HIV patients. They examined which medication-assisted therapies are most likely to be included on formularies and variation of these therapies across states. The most frequently included medication-assisted therapies were those to treat tobacco dependence, followed by opioid dependence. Few states covered alcohol dependence medications. In each year, 10% of states covered all recommended medications and 50% covered a partial formulary for at least 1 SUD. Conclusions: ADAPs could provide access to medication-assisted therapies for SUD for a significant number of HIV patients, but these medications have not been widely covered throughout the program’s history. Increased availability of medication-assisted therapies through ADAP could facilitate integrated HIV and SUD care.

McNamara, T. K., Orav, E. J., Wilkins-Haug, L., & Chang, G. (2005). Risk during pregnancy - Self-report versus medical record. American Journal of Obstetrics and Gynecology, 193(6), pp. 1981-1985.

This study was undertaken to compare the frequencies with which physicians and patients report medical and behavioral risk factors during pregnancy, with particular attention to identification of women at risk for prenatal alcohol use. The sample included 278 women, drawn from a randomized trial of T-ACE (alcohol screening questionnaire) positive pregnant women receiving obstetric care. Medical records and participants' self-reports were available for comparison. Results indicated that physicians identified only 10.8% of women recognized as at risk for alcohol consumption by the T-ACE screening measure. In contrast, the physicians' records were more inclusive for medical risk factors than the participant's self-reports. Physicians were significantly more likely to correctly identify nonwhite participants as being at risk for prenatal alcohol use, compared with their white counterparts. The authors concluded that self-report on the T-ACE questionnaire is more effective than medical records in identifying women at risk for prenatal alcohol use.

O’Brien, P. L. (2014). Performance measurement: a proposal to increase use of SBIRT and decrease alcohol consumption during pregnancy. Maternal and Child Health Journal, 18(1), pp.1-9. DOI: 10.1007/s10995-013-1257-2

In this article, the authors argue that the development and use of performance measures to assure implementation of SBIRT are key towards the effective intervention and reduction of alcohol consumption during pregnancy. This article seeks to address 1) guidelines recommending SBIRT for pregnant women; 2) appropriate screening instruments; 3) evidence regarding implementation of SBIRT for pregnant women and; 4) existing performance measures.

Oral, R., Bayan, L., Assad, A., Wibbenmeyer, L., Buhrow, J., Austin, A., & Bayman, E.O. (2011). Illicit drug exposure in patients evaluated for alleged child abuse and neglect. Pediatric Emergency Care, 7(6), pp. 490-495. DOI: 10.1016/j.drugalcdep.2011.05.020

The objective of this study was to analyze the presence of illicit drug exposure in the pediatric subpopulation admitted to pediatric inpatient and outpatient units for an evaluation for abuse/neglect. The study design is a retrospective chart review. Using hospital databases, every pediatric chart with a child abuse/neglect allegation was retrieved. The association between risk factors and clinical presentation and illicit drug test result was assessed. Excel and SAS were used for statistical analysis. Institutional review board approval was obtained to conduct this study. Six hundred sixty-five charts met study inclusion criteria for child abuse/neglect allegation. Of those, 232 cases were tested for illicit drugs between 2004 and 2008 per the testing protocol. There were long-term abuse findings in 129 children (55.6%). The results of this study showed that an illicit drug screening protocol used in the assessment of children evaluated for child abuse identified almost 15% of the population of allegedly abused and neglected children who were tested according to a protocol being exposed to illicit drugs. Thus, routine drug testing of at least children assessed for neglect and non-accidental burn and soft tissue injuries, children with a history of either parental drug use or domestic violence is recommended.

Roberts, S. C. M., & Nuru-Jeter, A. (2012). Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting. Journal of Behavioral Health Services & Research. 39(1), pp. 3-16. DOI: 10.1007/s11414-011-9247-x

This study examines racial disparities in Child Protective Services (CPS) reporting at delivery in a county with universal screening for alcohol/drug use in prenatal care. It also explores two mechanisms through which universal screening could reduce reporting disparities: Equitable Surveillance and Effective Treatment. Equitable Surveillance is premised on the assumptions that identification of drug use through screening in prenatal care leads to CPS reporting at delivery and that Black women are screened more than White women, which leads to disproportionate reporting of Black newborns. Universal screening would correct this by ensuring that prenatal providers screen and therefore also report White women to CPS, thereby reducing disparities. Effective Treatment is premised on the idea that identification of drug use through screening in prenatal care leads women to receive treatment during pregnancy, which thereby reduces CPS reporting at delivery. Universal screening would lead to prenatal providers screening more Black women and thereby to more Black women receiving treatment prenatally. The increase in treatment receipt during pregnancy would then decrease the number of Black newborns reported to CPS at delivery, thereby reducing disparities. County data were used to compare the racial/ethnic distribution of women and newborns in three points in the system (identification in prenatal care, treatment entry during pregnancy, and reporting to CPS at delivery related to maternal alcohol/drug use) and explore pathways to treatment. Despite Black women having alcohol/drug use identified by prenatal care providers at similar rates to White women and entering treatment more than expected, Black newborns were four times more likely than White newborns to be reported to CPS at delivery. This contradicts the premise of Effective Treatment. By default, findings were more consistent with Equitable Surveillance than Effective Treatment. Providers and policy makers should not assume that universal screening in prenatal care reduces CPS reporting disparities.

Salehi, H. S., As’adi, K., Musavi, J., Ahrari, F., Nemazi, P., Kamranfar, B., Gaseminegad, K., Faramarzi, S. & Shoar, S. (2012). Assessment of substances abuse in burn patients by using drug abuse screening test. ActaMedicaIranica, 50(4), pp. 257-264.

There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20). We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study’s inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05). The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.

Sharma, M. (2008). Substance abuse in minorities. Journal of Alcohol & Drug Education, 52(3), pp. 3-8.

The article discusses the prevalence of substance abuse among minority populations in the U.S. Data reveals that substance abuse in the form of alcohol and other drugs is high among Latinos, as well as in African American and Asian American populations. Such growth in substance use may be attributed to poverty, unemployment, crowded living conditions and single-parent families. According to the article, few prevention programs for youth in school and community settings have been successful for youth from different ethnic and socioeconomic backgrounds. The article outlines different prevention approaches and stresses the need for intervention efforts to take cultural backgrounds into account.

Stover, C. S., Easton, C. J., & McMahon, T. J. (2013). Parenting of men with co-occurring intimate partner violence and substance abuse. Journal of Interpersonal Violence, 28, pp. 2290. DOI: 10.1177/0886260512475312

No studies to date have compared parenting behaviors of men with co-occurring intimate partner violence (IPV) and substance abuse (SA) with community controls. This study was designed to document mediators of differences in parenting behavior of fathers and the emotional-behavioral problems of their children for men with co-occurring SA and IPV. The self-reported parenting (negative, positive and co-parenting behaviors) and the child emotional-behavioral problems of 43 fathers with children aged 2 to 6 years with a recent history of SA + IPV were compared to a sample of 43 community control fathers with the same socioeconomic and cultural backgrounds. Fathers completed measures on their parenting behavior with a target child, co-parenting behavior with the child’s mother, emotion regulation, romantic attachment, psychiatric symptoms, and the behavior of the target child. Men with co-occurring SA + IPV had significantly less positive co-parenting and more negative parenting behaviors than community control fathers did. Negative parenting and co-parenting were mediated by the fathers’ avoidant attachment problems. SA + IPV fathers also reported more emotional and behavioral problems in their children. These poor child outcome differences between groups were mediated by the negative parenting behaviors of the fathers. These results suggest areas of potential focus in interventions with fathers who have co-occurring SA + IPV issues. Focus on attachment difficulties with his co-parent, which may include affect regulation, coping with emotions, and communication skills training related to co-parenting, may yield significant changes in parenting behaviors and ultimately child functioning.

Stucky, B. D., Edelen, M. O., & Ramchand, R. (2014). A psychometric assessment of the GAIN Individual Severity Scale (GAIN-GISS) and Short Screeners (GAIN-SS) among adolescents in outpatient treatment programs. Journal of Substance Abuse Treatment, 46(2), pp. 165-173.

The Global Appraisal of Individual Needs (GAIN) - General Individual Severity Scale (GAIN-GISS), and GAIN Short Screener (GAIN-SS) are widely used diagnostic measures of internalizing disorders, externalizing disorders, substance abuse, and criminal and violent behavior. Although prevalent in clinical and research settings, there is only limited psychometric evidence of the dimensional structure of these scales. Our investigation used intake data from 6,909 adolescents presenting to outpatient substance abuse treatment facilities in the United States. Our analytic approach used exploratory and item factor analyses to evaluate the underlying factor structure. Multi- and unidimensional item response theory models were employed to evaluate the utility of the scales at providing precise score estimates at various locations of severity. Most scales were confirmed as unidimensional; scales with evidence of multidimensionality, identified as having a weak general dimension and strong specific dimensions using a bi-factor IRT model, include the Crime and Violence Scale and the GAIN-SS.

Urbanoski, A. K., & Kelly, F.J. (2012). Understanding genetic risk for substance use and addiction: A guide for non-geneticists. Clinical Psychology Review, 32(1), pp. 60–70. DOI: 10.1016/j.cpr.2011.11.002

There is considerable enthusiasm for the potential of genetics research for prevention and treatment of addiction and other mental disorders. As a result, clinicians are increasingly exposed to issues of genetics that are fairly complex, and for which they may not have been adequately prepared by their training. Studies suggest that the heritability of substance use disorders is approximately 0.5. Others report that family members of affected individuals experience a 4- to 8-fold increased risk of disorder themselves. Statements that addiction is “50% genetic” in origin may be taken by some to imply one's chances of developing the disorder, or that a lack of a positive family history confers immunity. In fact, such conclusions are inaccurate, their implications unwarranted given the true meaning of heritability. Through a review of basic concepts in genetic epidemiology, we attempt to demystify these estimates of risk and situate them within the broader context of addiction. Methods of inferring population genetic variance and individual familial risk are examined, with a focus on their practical application and limitations. An accurate conceptualization of addiction necessitates an approach that transcends specific disciplines, making a basic awareness of the perspectives of disparate specialties key to furthering progress in the field.

Wu, L., Blazer, D. G., Woody, E. G., Burchett, B., Yang. C., Pan, J., & Ling, W. (2012). Alcohol and drug dependence symptom items as brief screeners for substance use disorders: Results from the Clinical Trials Network. Journal of Psychiatric Research, 46(3), pp. 360-369. DOI: 10.1016/j.jpsychires.2011.12.002

To address an urgent need for screening of substance use problems in medical settings, the authors examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD). The sample included 920 opioid dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives). Study results suggest that withdrawal and time using are much less reliable indicators for a SUD than taking larger amounts than intended and inability to cut down and that the latter two items should be studied further for consideration in developing a simplified tool for screening patients for SUDs in medical settings. These findings have implications for the use of common health indicators in electronic health records systems to improve patient care.

Zemore, S. E., & Ajzen, I. (2014). Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior. Journal of Substance Abuse Treatment, 46(2), pp. 174-182.

We examined whether a 9-item scale based on the theory of planned behavior (TPB) predicted substance abuse treatment completion. Data were collected at a public, outpatient program among clients initiating treatment (N = 200). Baseline surveys included measures of treatment-related attitudes, norms, perceived control, and intention; discharge status was collected from program records. As expected, TPB attitude and control components independently predicted intention (model R-squared = .56), and intention was positively associated with treatment completion even including clinical and demographic covariates (model R-squared = .24). TPB components were generally associated with the alternative readiness scales as expected, and the TPB remained predictive at higher levels of coercion. Meanwhile, none of the standard measures of readiness (e.g., the URICA and TREAT) or treatment coercion were positively associated with treatment participation. Results suggest promise for application of the TPB to treatment completion and support use of the intention component as a screener, though some refinements are suggested.

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