Treatment, Rehabilitation and Recovery

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

Anderson, H. O., & Libby, A. M. (2011). Depression with and without comorbid substance dependence in a child welfare sample of young adults. Depression Research and Treatment, 2011, Article ID: 475248. DOI: 10.1155/2011/475248

The objective of this study was to estimate the prevalence of depression with and without substance dependence and examine the effect of risk factors on subsequent disorders among a cohort of young adults in the US Child Welfare System (CWS). We used longitudinal data for 834 young adults age 18–21 from the National Survey of Child and Adolescent Well-being. Depressive symptoms and substance use were measured at baseline (age 11–15); diagnoses of depression and substance dependence were identified at the last wave of data collection (age 18–21). Likelihood of subsequent depression with or without substance dependence was three times higher for those with clinically significant depressive symptoms at baseline. Frequent use of substances at baseline significantly increased the likelihood of subsequent depression with comorbid substance dependence compared to depression alone. These results support screening youth in the CWS at younger ages for both depressive symptoms and substance use with the hope that these disorders can be detected earlier.

Berrick, J. D., Young, E. W., Cohen, E., & Anthony, E. (2011). ‘I am the face of success’: peer mentors in child welfare. Child & Family Social Work, 16(1), pp. 179-191. DOI: 10.1111/j.1365-2206.2010.00730.x

This article presents the findings of a focus group with parent clients and interviews with peer mentors in order to identify characteristics of peer mentoring programs that are helpful to parent clients and to identify the mechanisms that allow peer mentors to be effective in their work. The results showed three themes including the value of shared experiences, communication and support.

Blodgett, J. C., Maisel, N. C., Fugh, I. L., Wilbourne, P. L., & Finney, J. W. (2014). How effective is continuing care for substance use disorders? A meta-analytic review. Journal of Substance Abuse Treatment, 46, pp. 87-97.

This article seeks to expand the knowledge on the effectiveness of continuing care for substance use disorders by reviewing the current literature, testing treatment characteristics previously identified and expanding the sample of literature reviewed to include 2011. The results show that that continuing care can provide at least modest benefit after initial treatment. The authors discuss study characteristics that may have reduced the magnitude of the overall continuing care effect estimate.

Brecht, M. L., Greenwell, L., von Mayrhauser, C., & Anglin, M.D. (2006). Two-year outcomes of treatment for methamphetamine use. Journal of Psychoactive Drugs, Supplement 3, pp. 415-426.

While evaluation research supports the general effectiveness of substance abuse treatment, there is not a comprehensive literature on treatment effectiveness for methamphetamine (MA) use. The authors consider three outcome measures - MA use, criminal activity, and employment-compared across three periods: 24-months pretreatment, during treatment, and 24-months post-treatment. Data are from an intensive natural history interview conducted two to three years after treatment for 349 randomly selected admissions to treatment for MA abuse in a large publicly-funded county treatment system. Results showed reduction in MA use and crime during and following treatment and increased employment following treatment over pretreatment levels. Analyses showed higher levels of education and more time in treatment related to more positive post-treatment outcomes for all three measures. Lower percentage of post-treatment months with MA use also was related to more pretreatment MA-related problems, lower pretreatment MA use, and residential (compared to outpatient) treatment modality. Lower post-treatment criminal activity was also related to gender (being female), lower pretreatment criminal activity, and residential modality. Higher percentage of post-treatment months with employment also was related to gender (being male), ethnicity (not African-American), and higher pretreatment employment. The authors conclude that the study results for all three outcome measures showed benefits of treatment for MA users, a pattern of findings that is consistent with results of general large-scale treatment outcomes studies of community-based treatment of other substances.

Brice, Jr., George, H., Swarbrick, M. A., & Gill, K. J. (2014). Promoting wellness of peer providers through coaching. Journal of Psychosocial Nursing and Mental Health Services, 52(1), pp. 41.

This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. The article lays out some of the issues peer providers face in their careers including burnout, physical health concerns, etc., and how wellness coaching helped them focus on self-care practices. Promising results of this new approach are presented.

Cadet, J. L., Bisagno, V., & Milroy, C. M. (2014). Neuropathology of substance use disorders. Acta Neuropathologica, 127(1), pp. 91-107.

This article provides a summary of the evidence that has accumulated over the past few years to implicate brain dysfunctions in the varied manifestations of drug addiction. The authors review data on cerebrovascular alterations, brain structural abnormalities, and postmortem studies of patients who abuse cannabis, cocaine, amphetamines, heroin, and “bath salts”. They also discuss potential molecular, biochemical, and cellular bases for the varied clinical presentations of these patients. Elucidation of the biological bases of addiction will help to develop better therapeutic approaches to these patient populations.

Casanueva, C., Stambaugh, L., Urato, M., Fraser, J. G., & Williams, J. (2011). Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system. Children and Youth Services Review, 33(10), pp. 1939-1949. DOI: 10.1016/j.childyouth.2011.05.025

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1,004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.

Cash Ghee, A., Bolling, L. C., & Johnson, C. S. (2009). The efficacy of a condensed seeking safety intervention for women in residential chemical dependence treatment at 30 days post-treatment. Journal of Child Sexual Abuse, 18(5), pp. 475-488. DOI: 10.1080/10538710903183287

This study examined the efficacy of a condensed version of the Seeking Safety intervention in the reduction of trauma-related symptoms and improved drug abstinence rates among women in residential chemical dependence treatment. One hundred and four women were randomly assigned to treatment including a condensed (six session) Seeking Safety intervention or the standard chemical dependence intervention. The Seeking Safety participants reported lower sexual-abuse-related trauma symptoms at 30 days post-treatment as compared to participants who received only standard treatment. However, the condensed Seeking Safety intervention was not more advantageous in reducing overall trauma symptoms or relapse 30 days after treatment ended.

Cattapan, O., & Grimwade, J. (2008). Parental illicit drug use and family life: Reports from those who sought help. Australian & New Zealand Journal of Family Therapy, 29(2), pp. 77-87.

Family histories of abuse and neglect are common among persons with substance addictions. Clearly such family backgrounds impact on future lifestyle choices. How this early life experience then impacts on the substance user as a parent and on their children has not been considered in the literature in any detail. Clients of local community drug services were invited to participate in a study evaluating the family life of parents who were dependent on illicit substances. Fifteen parents participated in a qualitative, longitudinal study about their family life, treatment and drug of choice. Four aspects of parental perception of family life were examined: the perceived impact of the family of origin on the parent drug user, self-perception, the impact of parental illicit drug use on the family environment, the impact of parental illicit drug use on children.

Chan, Y., Huang, H., Bradley, K., & Unutzer, J. (2014). Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care. Journal of Substance Abuse Treatment, 46(2), pp. 106-112.

This study examined the relationship between substance treatment referrals and depression improvement among 2,373 participants with concurrent substance use and depressive disorders enrolled in an integrated behavioral health program. Results show that patients accessing substance treatment were significantly more likely to achieve depression improvement than those who declined receiving treatment services and those without a referral for. Study findings highlight the need of enhancing early treatment contact for co-occurring substance use disorders in primary care.

Choi, S., Adams, S. M., MacMaster, S. A., & Seiters, J. (2013). Predictors of Residential Treatment Retention among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders. Journal of Psychoactive Drugs, 45(2), pp. 122-131. DOI: 10.1080/02791072.2013.785817

The purpose of this study was to identify factors in treatment which retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. The study found a relationship between types of mental health disorders and retention in treatment, as well as the role location of facilities played in treatment retention. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.

Claus, R. E., Orwin, R. G., Kissin, W., Krupski, A., Campbell, K., & Stark, K. (2007). "Does gender-specific substance abuse treatment for women promote continuity of care? Journal of Substance Abuse Treatment, 32(1), pp. 27-39.

Research has stressed the value of providing specialized services to women and suggests the importance of treatment duration. This quasi-experimental retrospective study reports on the continuity of care for women with children who were admitted to long-term residential substance abuse treatment. Women were admitted to 7 agencies offering specialized, women's only treatment (SP, n = 747) or to 9 agencies that provided standard mixed-gender treatment (ST, n = 823). Client and treatment data were gathered from administrative sources. The authors hypothesized that women in specialized treatment would demonstrate higher continuing care rates after controlling for treatment completion and length of stay. Results indicated that women in SP programs (37%) were more likely than those in ST programs (14%) to continue care. Analyses revealed that SP clients who completed treatment with longer stays were most likely to continue care. The authors conclude that the findings show that specialized treatment for women promotes continuing care and demonstrate the importance of treatment completion.

Connecticut juvenile courts test using recovery coaches to help addicted parents. (2009). Alcoholism & Drug Abuse Weekly, 21(14), pp. 1-3.

The article focuses on the Recovery Specialist Voluntary Program (RSVP) in Connecticut to aid the recovery of addicted parents and reunified them with their children. Parents are guided to help them stay in the treatment by trained recovery specialists. RSVP specialists provide 9 to 12 months of coaching, a monitor of attendance and monitor drug tests for addicted parents. Reunification of removed children and the addicted parents is impossible if the latter does not respond well to treatments.

Conners, N.A., Grant, A., Crone, C.C., & Whiteside-Mansell, L. (2006). Substance abuse treatment for mothers: Treatment outcomes and the impact of length of stay. Journal of Substance Abuse Treatment, 31(4), pp. 447-456.

This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. Longer treatment stays were associated with abstinence from AOD, reductions in cigarette use, employment and higher income, a reduced likelihood of being arrested, a reduction in symptoms of depression, and more positive parenting attitudes.

Crits-Christoph, P., Ring-Kurtz, S., Hamilton, L. J., Lambert, J. M., Gallop, R., et al. (2012). A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42(3), pp. 301–309. DOI: 10.1016/j.jsat.2011.09.003

The purpose of this study was to examine the effects of feedback provided to counselors on the outcomes of patients treated at community based substance abuse treatment programs. A version of the Outcome Questionnaire (OQ-45), adapted to include drug and alcohol use, was administered to patients (N = 304) in 3 substance abuse treatment clinics. Phase I of the study consisted only of administration of the assessment instruments. Phase II consisted of providing feedback reports to counselors based on the adapted OQ-45 at every treatment session up to Session 12. Patients who were found to not be progressing at an expectable rate (i.e., “off-track”) were administered a questionnaire that was used as a second feedback report for counselors. For off-track patients, feedback compared with no feedback led to significant linear reductions in alcohol use throughout treatment and also in OQ-45 total scores and drug use from the point of the second feedback instrument to Session 12. The effect for improving mental health functioning was evident at only 1 of the 3 clinics. These results suggest that a feedback system adapted to the treatment of substance use problems is a promising approach that should be tested in a larger randomized trial.

Conca, A. J., & Worthen, D. R. (2012). Nonprescription Drug Abuse. Journal of Pharmacy Practice, 25(1), pp. 13-21.

Nonprescription drug, also referred to as over-the-counter (OTC) abuse, is a serious and growing global health challenge. Drugs from many different therapeutic classes and numerous dosage forms and drug delivery systems are implicated in nonprescription drug abuse. Individuals who commonly abuse certain nonprescription medications are likewise diverse, varying in age, demographics, and overall health status. The clinician is in a unique position to assist in identifying those patients at risk for nonprescription drug abuse and those who are abusers, and may play an important role in intervention, patient care, and in the treatment of nonprescription drug abuse. A concise review of nonprescription drug abuse may be of use to the clinician in this regard.

Donohue, B., Azrin, N., Allen, D. N. (2009). Family behavior therapy for substance abuse and other associated problems. Behavior Modification, 33(5), pp. 495-519.

A comprehensive evidence-based treatment for substance abuse and other associated problems (Family Behavior Therapy) is described, including its application to both adolescents and adults across a wide range of clinical contexts (i.e., criminal justice, child welfare). Relevant to practitioners and applied clinical researchers, topic areas include its theoretical and empirical background, intervention protocols, methods of enhancing motivation for treatment, and future directions.

Douglas-Siegel, J. A., & Ryan, J. P. (2013). The effect of recovery coaches for substance-involved mothers in child welfare: impact on juvenile delinquency. Journal of Substance Abuse Treatment, 45(1), pp. 381-387.

This article presents the findings of a study which tested the impact of intensive case management in the form of a recovery coach for substance-involved mothers on youth delinquency outcomes. The findings show that the provision of recovery coaches to parents curbed delinquency among child-welfare involved youth.

Evans, E., Spear, S. E., Huang, Y. C., & Hser, Y. I. (2006). Outcomes of drug and alcohol treatment programs Among American Indians in California. American Journal of Public Health, 96(5), pp. 889-896.

The authors examined differences in substance abuse treatment outcomes between American Indians and their non-American Indian counterparts in California, during 2000 to 2002. A total of 368 American Indians and a matched sample of 368 non-American Indians from 39 substance abuse treatment programs in 13 California counties were assessed at multiple time points. Records on arrests, driving while under the influence of alcohol or drugs, and mental health care were obtained 1 year before and 1 year after treatment entry. Differences in pretreatment characteristics, services received, treatment satisfaction, treatment completion and retention, and outcomes were examined. The results indicated that pretreatment problems were similarly severe among American Indians and non-American Indians. About half in both groups either completed treatment or stayed in treatment more than 90 days; American Indians in residential care had significantly shorter treatment retention. American Indians received fewer individual sessions and out-of-program services, especially for alcohol abuse, but were nevertheless generally satisfied with their treatment. Both groups improved after treatment, with American Indians demonstrating greater reductions in arrests than non-American Indians. The authors suggest that American Indians benefit from substance abuse treatment programs, although the type and intensity of services offered could be improved.

Gallardo, M. E., & Curry, S. J. (2009). Shifting perspectives: Culturally responsive interventions with Latino substance abusers. Journal of Ethnicity in Substance Abuse, 8(3), pp. 314-329.

In 2001, there were 35 million Latinos living in the United States. It is estimated that by 2050 Latinos will comprise 97 million people in the United States, or one-fourth of the U.S. population, establishing this ethnic group as the fastest growing and soon to be largest in the country (U.S. Census Bureau, 2001). These numbers highlight the need for a multicultural paradigm shift, or the inclusion of culture-specific skills and culturally responsive interventions in psychological practice. Latinos face challenges as a racial/ethnic group that the traditional Euro-American model of treatment neither addresses nor validates. Unfortunately, substance abuse serves a purposeful function for many Latinos as a means of escape from the problems related to the social, environmental, and political structures. The current article adapts the model set forth by Parham (2002) as a strength-based therapeutic framework for intervention. The following stages are outlined to serve as the basis for most therapeutic encounters with clients from all racial and ethnic groups presenting with substance abuse problems: therapeutic alliance building, culturally appropriate assessment, sociopolitical awareness and liberation, creating collaborative change, and addressing sustainability of change.

Godlaski, T. M., Butler, L., Heron, M., Debord, S., & Cauvin, L. (2009). A qualitative exploration of engagement among rural women entering substance user treatment. Substance use & Misuse, 44(1), pp. 62-83.

A semi structured interview was administered to a purposive sample of 12 rural women early in substance misuser treatment in a gender specific, intensive outpatient treatment program from March 2001 through March 2003. The interview used open-ended questions about the women's state of mind before entering treatment, the experiences that helped them feel more comfortable with treatment, the experiences that caused them some discomfort in treatment, and any changes they would recommend to the program content or process in an attempt to gain understanding about factors that might facilitate a subjective comfort and engagement with the treatment experience. In approaching treatment, the women almost uniformly expressed a mixture of anxiety about the requirements of treatment and cynicism about its effectiveness. Although aware of the content and structure of the treatment program, the women focused on interpersonal experiences as the critical factors in their level of comfort once in treatment. The most frequently mentioned factors adding to comfort with the treatment experience were the welcoming, accepting, and non-judgmental attitudes of the staff; having their perceptions of their problems taken seriously by the treatment staff; being with other women who shared much of their experiences; and a respectful and generally positive attitude on the part of both the staff and the patients. The only factor that consistently caused some of the women discomfort in treatment was a difficulty in trusting that some of the other women in treatment would keep the matters discussed in group sessions confidential. The women were not completely satisfied with the program content and structure, but this seemed of very little importance to them in relation to their experience of comfort with their treatment experience.

Grella, C. E., Scott, C. K., & Foss, M. A. (2005). Gender differences in long-term drug treatment outcomes in Chicago PETS. Journal of Substance Abuse Treatment, 28, pp. S3-S12.

Few long-term follow-up studies of substance abusers have examined gender differences. In the current study, gender differences were examined at 36 months following residential or outpatient drug-free treatment among 951 participants in the Chicago Target Cities Project, the majority of whom were female (62%) and African American (93%). There were no differences in the proportion of men and women who reported any alcohol or drug use at the 36-month follow-up, with an overall reduction of 41% from intake. Greater proportions of men were incarcerated or employed, whereas greater proportions of women had returned to treatment, lived with their children, lived with a substance user, or had interpersonal problems. Women, as a group, had greater increases over time in self-help participation, free time spent with family, non-using family/friends, and employment. Although both men and women showed significant improvements following treatment, gender differences persisted in several areas of psychosocial functioning related to recovery. This study confirms significant reductions in substance use following treatment and corresponding improvements in psychological functioning, social, and family relationships. This study also demonstrates that gender differences persisted in domains of functioning that are relevant to drug treatment processes and outcomes. These findings have implications for treatment provides and program planning.

Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., Lincoln, M., Hien, D., & Miele, G.M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), pp. 1-21.

This article reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. The authors conclude that gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. The authors’ state that while women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

Gurewich, D., Sirkin, T. J. & Shepard, S. D. (2012). On-site provision of substance abuse treatment services at community health centers. Journal of Substance Abuse Treatment, 42(4), pp. 339–345. DOI: 10.1016/j.jsat.2011.09.012

In this study the authors examined on-site and off-site referral-based provision of substance abuse (SA) treatment services among a sample of community health centers (CHCs). Results of the study reflect that the provision of intensive outpatient treatment services on site was associated with significantly higher engagement rates. It was also associated with higher initiation rates. The authors argue that with limited resources, agencies should invest in more intensive services on site as these may yield better outcomes for CHC patients than lower level services.

Hser, Y. I., Evans, E., & Huang, Y. C. (2005). Treatment outcomes among women and men methamphetamine abusers in California. Journal of Substance Abuse Treatment, 28(1), pp. 77-85.

This prospective longitudinal study examined treatment outcomes among 1,073 methamphetamine-abusing patients (567 women, 506 men) from 32 community-based outpatient and residential programs in 13 California counties. Data were collected at intake and at 3 months and 9 months after admission. With one exception, improvements from baseline to follow-up were observed in all areas measured by the Addiction Severity Index for both women and men in either modality. Compared to men, women demonstrated greater improvement in family relationships and medical problems, and similar improvement in all other areas, despite the fact that more women were unemployed, had childcare responsibilities, were living with someone who also used alcohol or drugs, had been physically or sexually abused, and reported more psychiatric symptoms. Study findings confirmed that these meth abusers were a highly troubled group with problems in multiple key life areas, most noticeably employment, legal/criminal, parenting, and psychological distress. Improved intervention strategies should target both substance use and other related needs that are necessary for rehabilitation. Women in the sample, most of whom were of childbearing age or had children, demonstrated more severe problems than did men. Developing and delivering adequate services to address the problems and needs of women will undoubtedly improve treatment outcomes.

Jerry, J. M., & Collins, G. B. (2013). Medication-assisted treatment of opiate dependence is gaining favor. Cleveland Clinic Journal of Medicine. 80(6), pp. 345. DOI: 10.3949/ccjm.80a.12181

The authors of this article claim that individuals addicted to opiates are more likely to avoid returning to these drugs if they participate in programs that include taking maintenance doses of methadone or buprenorphine tan with an abstinence program alone.

Knuuttilla, V., Kuusisto, K., Saarnio, P. & Nummi, T. (2012). Early working alliance in outpatient substance abuse treatment: predicting substance use frequency and client satisfaction. Clinical Psychologist, 16(3), pp. 1-13. DOI: 10.1111/j.1742-9552.2012.00049.x

This study examined the effect of the early working alliance on outcome in outpatient substance abuse treatment. One of the main findings of this study was that there was considerable between-therapist variation in the frequency of clients’ substance use and client satisfaction at follow-up. The authors argue that more research is needed on the client-therapist relationship as this relationship seems to be associated with patient outcomes.

Korcha, R. A., Polcin, D. L., Evans, K., Bond, J. C., & Galloway, G. P. (2014). Intensive Motivational Interviewing for women with concurrent alcohol problems and methamphetamine dependence. Journal of Substance Abuse Treatment, 46(2), pp. 113-119.

This article presents the results of a study which evaluated an intensive 9-session version of MI (Intensive MI) in 163 methamphetamine (MA) dependent individuals. The findings suggest that women with co-occurring alcohol problems in the Intensive IM group reduced the severity of their alcohol problems more than the women in the Standard MI group at a 6-month follow-up. This association is perceived to be the result of the strong alliance developed with the therapist and was inversely associated with alcohol problem severity scores. Findings indicate that Intensive MI is a beneficial treatment for alcohol problems among women with MA dependence.

Manchikanti, L., Fellows, B., Ailinani, H., & Pampati, V. (2010). Therapeutic use, abuse and nonmedical use of opioids: a ten-year perspective. Pain Physician, 13(1), pp. 401-435.

This manuscript provides a ten year perspective on the therapeutic use, abuse, and non-medical use of opioids and their consequences. The manuscript provides information on the nonmedical use of psychotherapeutic drugs, current nonmedical use, past year initiates, past year use, lifetime use, abuse based on age, gender, mental health problems, and others.

Marsh, J. C., Smith, B. D., & Bruni, M. (2011). Integrated substance abuse and child welfare services for women: A progress review. Children and Youth Services Review, 33(3), pp. 466-472. DOI: 10.1016/j.childyouth.2010.06.017

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.

McLemore, G., Lewis, T., Jones, C. H., Gauda, E. B. (2013). Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome. Seminars in Fetal & Neonatal Medicine, 18(1), pp. 35-41

This article focuses on three strategies that may be beneficial in the treatment of opioid dependence in pregnancy; it specifically focuses on three strategies including 1) pharmacotherapeutic strategies targeting the serotonergic system, 2) mixed opioid immunotherapeutic (vaccines); and 3) pharmacogenomics as a therapeutic strategy to insure personalized care. The authors review and discuss how these strategies may offer additional treatment modalities for the treatment of M-F/N during pregnancy and the treatment of the infant after birth.

McMahon, T. J., Winkel, J. D., Luthar, S. S., & Rounsaville, B. J. (2005). Looking for poppa: Parenting status of men versus women seeking drug abuse treatment. American Journal of Drug and Alcohol Abuse, 31(1), pp. 79-91.

This study was designed to document the parenting status of drug-dependent men seeking methadone maintenance treatment and to clarify ways their status as parents differs from that of drug-dependent women. Data concerning demographic characteristics, drug abuse history, and parenting status were systematically coded from the medical records of 362 men and 162 women seeking methadone maintenance treatment during a 12-month period. Results indicated that, although a greater proportion of women were the parent of at least one biological child, there were actually more fathers than mothers seeking treatment. Among the parents, fathers were more likely to have been abusing opioids when they first became a parent, and they were more likely to be living away from their children. There were no significant gender differences in the number of children or the average age of children. The results suggested that fathering may be an important, but largely neglected, treatment issue for drug-abusing men, one which requires clinical interventions to support them in their role as fathers. These results indicate a need to better document the ways the parenting behavior of drug-abusing men differs from both that of drug-abusing women and men with no history of drug and alcohol abuse. Lastly, there is a need to better document ways the parenting behavior of drug-abusing fathers affects the cognitive, emotional, and social development of their children.

Meade, C. S., Bevilacqua, L. A., Moore, E. D., Griffin, M. L., Gardin, J. G., Potter, J. S., Hatch-Maillette, M., & Weiss, R. D (2014). Concurrent Substance Abuse Is Associated with Sexual Risk Behavior among Adults Seeking Treatment for Prescription Opioid Dependence. The American Journal on Addictions. 23(1), pp. 27-33. DOI: 10.1111/j.1521-0391.2013.12057.x

This study examined the prevalence of sexual risk behavior among patients with opioid dependence who primarily use prescription opioids for non‐medical purposes. The majority of participants reported unprotected intercourse (76.5%), but few had multiple partners (11.3%). While the majority of sexually active participants engaged in unprotected intercourse, the proportion with multiple sex partners was low relative to other samples of persons who use illicit drugs. Among persons with non‐medical prescription opioid dependence, those who concurrently use other substances may be at elevated risk for HIV infection. Comprehensive assessment of substance abuse history among individuals dependent upon prescription opioids is critical for identifying patients who may require additional clinical interventions to reduce HIV sexual risk behavior.

Melvin, M. A., Koch, D. S. & Davis, S. (2012) Employment as a predictor of substance abuse treatment. Journal of Rehabilitation, 78(4), pp. 31-37.

This study examines employment status as a factor that contributes to successful treatment outcomes. Traditional substance abuse treatment is discussed and shown to lack an employment component to counseling. Research is discussed and illustrates the benefits employment has on not only successful treatment completion but also reduction in substance use as well as many other benefits. The authors note that most treatment agencies do not incorporate a vocational training component despite research showing the important role employment plays in successful treatment outcomes.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of motivational interviewing on substance abuse treatment retention: A randomized control trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27(1), pp. 51-58.

This study sought to examine the impact of individual MI sessions on treatment retention and engagement in a treatment program serving clients under heavy child protective services pressure to participate. Seventy-one such women who used drugs during pregnancy were randomly assigned to either receive three MI sessions or to watch two educational videos and participate in a home visit. Treatment retention group attendance and random urine analysis results were evaluated in these women during the first 8 weeks of treatment. No differences were found between the two conditions on these variables. Possible reasons for these negative findings are discussed, including the possibility that MI may not provide any additional benefit when the population is coerced or when they are concerned that specific information about their progress will be shared with the court and with their child welfare worker.

Mullins, S. M., Bard, D. E., & Ondersma, S. J. (2005). Comprehensive services for mothers of drug-exposed infants: Relations between program participation and subsequent child protective services reports. Child Maltreatment, 10(1), pp. 72-81.

It is unclear whether intensive services for women using drugs during pregnancy can reduce child maltreatment. This article sought to address this question by evaluating the association between dose of program participation and subsequent reports to CPS in a sample of 142 women whose infants tested positive for illicit drugs at birth. The authors found that simply attending the program without exhibiting behavior changes was not sufficient to avoid future child maltreatment reports. The women’s termination status, however, was strongly related to follow-up CPS reports; such that those with higher participation in all aspects of the program had significantly lower risk of re-report. The findings suggest that program effects may be detectable using a treatment process-- based index that combines dose, duration, and quality of program involvement. In addition, the findings suggest that comprehensive interventions for mothers of drug-exposed infants may be efficacious, particularly when participant enthusiasm for a particular treatment approach is considered when conducting treatment planning.

Nayar, P., Yu, F., & Apenteng, B. (2014). Science-based and practice-based innovativeness and performance of substance abuse treatment facilities. Health Care Management Review, 39(1), pp. 66.

The purpose of this study is to examine the influence of the use of innovative organizational practices, both science based (psychosocial interventions) and practice based, on the organizational performance of substance abuse treatment facilities (SATF). The study uses cross-sectional data on 13,513 SATFs in the United States, obtained from the National Survey of Substance Abuse Treatment Services 2009 database. Results of the study show that substance abuse facilities that are high innovators in terms of implementing science based and practice-based innovative practices have higher organizational performance. Organizations that have institutionalized these practices have invested considerable resources in innovation. The shown higher organizational performance provides justification for the organizational investment in innovation.

Odenwald, M., and Semrau, P. (2013). Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load. Substance Abuse Treatment, Prevention, and Policy. 8(14), pp. 1-11.

This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change. Results of the study reflected that patients who dropped out reported more traumatic event types on average than completers. The authors believe that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load. In patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to change.

Ondersma, S. J., Chase, S. K., Svikis, D. S., & Schuster, C. R. (2005). Computer-based brief motivational intervention for perinatal drug use. Journal of Substance Abuse Treatment, 28(4), pp. 305-312.

Computer-based brief motivational interventions may be able to reach a high proportion of at-risk individuals and thus have potential for significant population impact. The present studies were conducted to determine the acceptability and preliminary efficacy of a computer-based brief motivational intervention (the motivation enhancement system, or MES). The goal of MES is to facilitate self-change, treatment engagement, and/or motivation to change via a single intervention session. In Study 1, quantitative and qualitative feedback from 30 postpartum women and 17 women in treatment for drug use were used to modify the software. In Study 2, 50 urban postpartum women who reported drug use in the month before pregnancy completed the intervention and provided repeated within-session ratings of state motivation. In Study 3, 30 women were randomly assigned to intervention or control conditions with 1-month follow-up. Overall, women rated the MES as highly acceptable and easy to use and reported significant increases in state motivation at post intervention and at 1-month follow-up. These preliminary results are encouraging and suggest that further work in this area is warranted.

Ortiz, E., Alvarez, J., Jason, L. A., Ferrari, J. R., & Groh, D. R. (2009). Abstinence social support: The impact of children in Oxford House. Journal of Groups in Addiction & Recovery, 4(1), pp. 71-81.

The present study compared the characteristics of individuals living with (42 men, 52 women) and without children (561 men, 241 women) residing in a communal-living recovery program called Oxford Houses. Results indicated that men living with children and women living without children had more general social support, compared to men living without children and women living with children. Additionally, women and residents of adult-only houses reported having more drug users in their social networks. However, men and women living with and without children reported similar levels of social support for abstinence. It is suggested that that men in recovery who take care of their children are in situations more advantageous to sustained recovery and have more resources compared to recovering women with children. Women in substance abuse recovery and taking care of children may require additional resources and assistance compared to men.

Pecoraro, A., Ma, M., & Woody, E. G. (2012). The Science and Practice of Medication-Assisted Treatments for Opioid Dependence. Substance Use & Misuse, 47(8-9), pp. 1026-1040.

This paper briefly reviews the evolution of opioid addiction treatment from humanitarian to scientific and evidence-based, the evidence bases supporting major medication-assisted treatments and adjunctive psychosocial techniques, as well as challenges faced by clinicians and treatment providers seeking to provide those treatments. The article provides a brief history of opioids, innovation in treatment, and the challenges faced by treatment providers. Attitudes, politics, policy, and financial issues are discussed.

Roberts, A. C., & Nishimoto, R. (2006). Barriers to engaging and retaining African-American post-partum women in drug treatment. Journal of Drug Issues, 36(1), pp. 53-76.

Little is known about barriers to engaging and retaining African-American women in drug treatment. This study examines (a) what barriers made it difficult for a sample of 221 African-American women to participate in treatment, (b) the extent to which those barriers differed by program modality, and (3) the extent to which those barriers were related to length of time in treatment and treatment completion. Findings revealed that barriers considered to be internal in nature (i.e., drug severity, did not feel like going, and felt I could manage on my own) were most frequently reported. Only a few program-related barriers were found to be related to length of time in treatment and both internal and programmatic barriers had an effect on treatment completion. Implications for policy decisions, future research, and clinical competence in addressing barriers to treatment for African-American women are discussed.

Romero, V., Donohue, B., & Allen, D. N. (2010). Treatment of concurrent substance dependence, child neglect and domestic violence: A single case examination involving family behavior therapy. Journal of Family Violence, 25(3), pp. 287.

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self-control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were "blind" to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.

Smith, B. D., & Marsh, J. C. (2002). Client-service matching in substance abuse treatment for women with children. Journal of Substance Abuse Treatment, 22(3), pp. 161-168.

This article addresses the relation between services matched to client-identified needs and substance abuse treatment outcomes for women with children. The study uses data collected for a program evaluation of an enhanced substance abuse services program for mothers involved with the child welfare system. In-person surveys were conducted with 183 women who were currently attending, or had recently completed substance abuse treatment. Matched counseling services (domestic violence services, family counseling) were associated with reports of reduced substance use; matched ancillary services (housing, job training, legal services) were associated with clients' satisfaction with treatment. However, the total number of services clients received had a stronger relationship to treatment outcomes than did services matched to client-identified needs. This study suggests that the substance abuse treatment clients have many service needs and that few of these needs were addressed by their treatment programs. Substance abuse treatment services are effectively enhanced when health and social services are also provided.

Somov, P. G. (2008). A psychodrama group for substance use relapse prevention training. Arts in Psychotherapy, 35(2), pp. 151-161.

The article reviews utilization of psychodrama group therapy in the context of drug and alcohol treatment and introduces a specific application of psychodrama group therapy for the purposes of relapse prevention. The proposed psychodrama group format features facilitator guidelines for directing relapse prevention behavioral role plays, substance-use specific role plays, and a format for post-role-play processing of group participants’ experiences.

Stevens, S. J., Andrade, R. A. C., & Ruiz, B. S. (2009). Women and substance abuse: Gender, age, and cultural considerations. Journal of Ethnicity in Substance Abuse, 8(3), pp. 341-358.

Historically, data has shown that a smaller percentage of women use alcohol and illicit substances compared to men, and that frequency of use has been lower among women compared to use among men. Although this data on usage may be true, researchers also acknowledge that substance use among women has been a hidden issue, one not realistically acknowledged by society, especially prior to the mid-1960s. Along with this, more recent data indicates that rates of substance use among women are increasing. Factors contributing to this increase in substance abuse have begun to receive considerable attention, and recent research suggests that many issues exist that are unique to substance use among women. The purpose of this article is to discuss gender specific considerations in women's substance abuse by examining the history of substance use among women; analyzing gender-specific factors, including physiological factors, trauma-related factors, mental health issues, and cultural considerations that impact on women's substance use; articulating treatment approaches for working with substance abusing women and girls; and providing recommendations for further research in this area.

Stover, S. C., Hall, C., McMahon, J. T., & Easton, J. C. (2012). Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors. Journal of Substance Abuse Treatment, 43(3), pp. 335–343

This study was designed to (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers. According to the authors’ findings there were no differences in severity of alcohol or drug use between fathers and non-fathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting. The authors suggest that more research is needed on the impact of trauma on parenting behaviors in substance-abusing men.

Sutherland, J. A., Cook, L., Stetina, P., & Hernandez, C. (2009). Women in substance abuse recovery: Measures of resilience and self-differentiation. Western Journal of Nursing Research, 31(7), pp. 905-922.

The National Institute of Drug Abuse has promoted drug abuse research in the past two decades focusing on women and gender differences. One hundred twenty-eight Hispanic and White women have participated in this comparative descriptive study that has examined the differences between chemically dependent (CD) women in recovery and non-chemically dependent (non-CD) women in regard to resilience and self-differentiation-demographic variables associated with resilience and self-differentiation and recovery variables associated with resilience and self-differentiation in the CD women. Findings indicate that the CD women and Hispanic women have scored significantly lower on measures of resilience and self-differentiation. Among the recovery variables, resilience and self-differentiation are significant for children support but community support is not significant. The finding that Hispanic and White women in recovery score lower on resilience and self-differentiation is important for designing treatment strategies supportive of women in recovery.

Tang, Z., Claus, E. R., Orwin, G. R., Kissin, B. W. & Arieira, C. (2012). Measurement of gender-sensitive treatment for women in mixed-gender substance abuse treatment programs. Drug and Alcohol Dependence, 123(1-3), pp. 160– 166. oi:10.1016/j.drugalcdep.2011.11.003.

The present study examines the extent to which treatment programs vary in gender-sensitive (GS) programming for women in mixed-gender treatment settings. This is the first study to quantify GS treatment for substance abusing women. The identified treatment services and practices and the way they clustered together to form scales have practical implications for researchers, service providers, clinicians, and policy makers. The scales can be used to study treatment outcomes and to evaluate the effectiveness, cost-effectiveness, and cost-benefit of GS programming for women.

Tracy, E. M., Kim, H., Brown, S., Min, M., Jun, M., & McCarty, C. (2012). Substance Abuse treatment stage and personal networks of women in substance abuse treatment. Journal of Society for Social Work and Research, 3(2), pp. 65-79.

This study examined the relationship among 4 treatment stages (i.e., engagement, persuasion, active treatment, relapse prevention) and the composition, social support, and structural characteristics of personal networks. According to the findings, women in active treatment were less connected, whereas women in the persuasion stage had a higher degree of centralization. Overall, the authors find that social network relate to the stage of treatment, whereas network composition, type of social support, and socio-demographic variables (with a few exceptions) do not relate to treatment stage. The authors suggest that social context, particularly how social contacts are arranged around clients, should be incorporated into treatment programs, regardless of demographic background.

Tracy, M. E., Laudetb, B. A., Mina, O. M., Kima, H., Browna, S., Juna, K.M. & Singera, L. (2012). Prospective patterns and correlates of quality of life among women in substance abuse treatment. Drug and Alcohol Dependence, 124(3), pp. 242– 249 DOI: 10.1016/j.drugalcdep.2012.01.010

This study examines patterns and predictors of quality of life (QOL) at one and 6 months post treatment intake among women enrolled in a substance abuse treatment facility. According to the study findings, QOL had improved significantly, however it still remained below that of normal populations. This study suggests the usefulness of the WHOQOL measure as an indicator of functioning in substance abusing populations. Findings underline the importance of helping women deal with trauma symptoms and develop support for recovery. Further research is needed on the longitudinal relationship between QOL and substance use patterns.

Tsai, J., Salyers, M. P., Rollins, A. L., McKasson, M., & Litmer, M. L. (2009). Integrated dual disorders treatment. Journal of Community Psychology, 37(6), pp. 781-788.

Mental health programs are increasingly combining evidence-based practices to provide comprehensive services. Individuals with complex service needs, such as those dually diagnosed with mental illness and substance use disorders, are at high risk for numerous negative outcomes and may benefit from such comprehensive programs. This report describes the process and outcomes of a program that formally integrated assertive community treatment, supported housing, and integrated dual disorders treatment for a sample of clients with dual diagnoses. Over a 2-year period, this pilot program targeted 14 clients with 12 clients successfully transitioned out of a state hospital into the community. Results showed large reductions in hospitalization, homelessness, and incarceration, and increases in employment and later stages of treatment for substance abuse. This study demonstrates the potential of such an integrated program and points to areas for further research in housing services.

Vaughn, M. G., Shook, J. J., & McMillen, J. C. (2008). Aging out of foster care and legal involvement: Toward a typology of risk. Social Service Review, 82(3), pp. 419-446.

The article focuses on the study that shows the treatment models with the strongest evidence base for treating adolescent substance abuse. Researchers Sara J. Becker and John F. Curry reveals that the treatment models are ecological family therapy, brief motivational interventions, and cognitive behavioral therapy (CBT). The study evaluated 31 peer-reviewed randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality.

Walker, M. A. (2009). Program characteristics and the length of time clients are in substance abuse treatment. Journal of Behavioral Health Services & Research. 36(3), pp. 330-343.

Is there a relationship between the characteristics of drug addiction treatment programs and an important correlate of better outcomes, the length of time clients are in treatment? Previous research has consistently shown longer periods in treatment and a range of services each have a salutary effect on client outcomes after treatment. Much of this research has examined the characteristics of clients. Program attributes are another important consideration. Multivariate analysis of data collected from a national survey of outpatient drug addiction treatment programs shows offering a range of services along with several other program characteristics are relevant to the duration of treatment. When a range of services are available, this has a positive association with both the number of months programs report clients are in treatment and with the number of counseling sessions programs report clients receive over the course of treatment. Ultimately, this should lead to better outcomes for clients.

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