The Satir Growth Model: A Systemic Framework for Supporting Families Affected by Substance Use Disorder

This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings. National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders. Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs. Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

Children of parents with substance use disorders are at risk for various adverse outcomes, and maladaptive parenting behaviors seem to be an important mediator of this risk. Although numerous research studies have highlighted the promise of parenting interventions in modifying parenting behavior, very little is known about the integration of parenting skills education and interventions into addiction treatment programs. In this study, a convenience sample of 125 addiction treatment programs in the United States was drawn. A key staff member was interviewed to gather basic information about the extent and nature of parenting skills education and interventions offered at their program. In addition, respondents were asked to rate the importance of parenting skills relative to other addiction treatment priorities. Descriptive analyses revealed that 43% reported some form of parenting classes, but few used a structured curriculum. Given the known beneficial influence of effective parenting practices on reducing adverse childhood outcomes, it is surprising that relatively few substance abuse treatment programs have adopted structured parenting skills interventions as part of their standard service offerings. More research is warranted on the extent to which parenting skills interventions are integrated into the continuum of services available to parents with a substance use disorder.

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Investigating the effects of peer association and parental influence on adolescent substance use: A study of adolescents in South Korea

Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration

Physician Education in Addiction Medicine

Back to table of contents Previous article Next article Government NewsFull AccessIs Substance Abuse Treated Adequately in Reform Bills?Rich DalyRich DalySearch for more papers by this authorPublished Online:21 Aug 2009https://doi.org/10.1176/pn.44.16.0018Substance abuse screening and treatment may get short shrift under health care reform, based on the provisions of leading legislative proposals, according to some treatment advocates.As health care reform leaders in Congress prepare for a final push to enact a sweeping overhaul of the nation's health care system, advocates worry that substance abuse may be left behind in some critical areas.All three of the major health reform plans working their way through Congress include features to increase access to substance abuse care, including the inclusion of addiction treatment under provisions requiring insurers to provide coverage at parity with general health care. Some of the measures also include general mental health and substance abuse care in the basic package required for policies included in planned insurance exchanges, or marketplaces.“All of the bills and concept papers say mental health and substance abuse coverage will be part of basic benefit packages,” said Charles Ingoglia, vice president of public policy of the National Council for Community Behavioral Health, at a July briefing on health care sponsored by the Alliance for Health Reform. The nonpartisan, nonprofit alliance advocates for universal coverage and cost-effective care.That's good news for the estimated 23 million Americans who, according to a 2007 national survey conducted for the Substance Abuse and Mental Health Services Administration, are addicted to alcohol or drugs. The expansion of services is important because only 1 in 10 people with an addiction now gets treatment.However, some mental health advocates are concerned that the legislative health reforms under consideration have comparatively little focus on substance abuse services.“There are a number of places [in the legislation] where mental health professionals are addressed, but there isn't a comparable definition or description or support for addictions recovery,” said Eric Goplerud, Ph.D., a research professor in the Department of Health Policy at George Washington University, at the alliance's forum. “They talk about mental health but they very rarely talk about substance abuse.”Areas where there is no mention of substance abuse in the reform bills include provisions that support the use of “medical homes,” fund training of health care professionals, and expand children's health programs. The lack of specific mention of addiction care in those and other areas likely will mean support for such care will not be included, he said.The omission of substance abuse care is significant, Goplerud said, because his research has consistently found substance abuse treatment faces more“ discriminatory coverage” by health insurers than any other area, including general mental health coverage.“It's not surprising that we have an underfunded, overworked, inaccessible, substance use treatment system, because it has not been part of [previous efforts at] health reform,” Goplerud said.Hope May Rest With RegulatorsAdvocates of substance abuse care hope that it eventually will be included in health reform programs by regulators who implement provisions of the final bill; however, the absence of specific and consistent mention of substance abuse care in the text of the bills makes that less likely.One area in which addiction prevention, treatment, and screening are not mentioned is in the reform bills' provisions to support school-based health programs. That omission comes despite research that has found high levels of substance use among youth. For example, about 15 percent of adolescents screened positive for substance abuse in a 2007 Harvard study published in the New England Journal of Medicine.Another area of the legislation that has drawn criticism from substance use treatment advocates is that the bills largely fail to provide development support to professionals who specialize in such care. Although several provisions provide training-assistance grants and tuition support for professionals in mental health, addiction professionals are not specifically included. Although some advocates hope that regulators will include these professionals when they issue guidelines implementing the various workforce support measures, the lack of their inclusion in the legislative language lessens the chances of that happening.Amendment Adds PreventionAddiction treatment has received support in other areas of the reform legislation, including an amendment to the House health reform bill, titled America's Affordable Health Choices Act of 2009 (HR 3200). It explicitly added substance abuse to the bill's prevention-related section. The bill also would cover screening and brief interventions for “problem drinking,” among preventive services.The same bill also added substance abuse treatment programs to the 340B Drug Pricing Program. That program requires drug manufacturers to provide discounted medications to qualifying facilities, which currently include public hospitals. Such a change has long been sought by substance use treatment advocates, and its inclusion in a reform bill “is a very major and important success,” Goplerud said.In addition, “Addiction treatment has an unforeseen benefit of making health reform more affordable,” said Victor Capoccia, director of the Closing the Addiction Treatment Gap initiative at the Open Society Institute (OSI), a liberal reform advocacy group. “When addictions go untreated, a person's medical care is fragmented, inefficient, and ultimately more costly.”Strong substance use treatment provisions could produce billions in annual health care savings, according to a white paper issued in July by the OSI. Expanded addiction treatment saves money through reduced hospital costs, according to the paper, because 1 of 14 hospital stays is addiction related. The paper also cited research showing that patients who received addiction treatment reduced their other medical costs by 26 percent.The OSI released a national survey in June that showed that addiction treatment would be a popular feature of health reform, with a solid majority of Americans supporting its inclusion. Almost three-quarters of 1,001 adults polled supported inclusion of alcohol and other drug treatment in national health care reform to make such care more affordable, while 68 percent of survey participants supported increasing federal and state funding for preventing and treating addiction.The OSI paper is posted at<www.soros.org/initiatives/treatmentgap/articles_publications/publications/paper1_20090714>. The OSI poll is posted at</www.soros.org/initiatives/treatmentgap/research/poll_20090616>.▪ ISSUES New Archived

Substance Abuse-Related Mortality Among Middle-Aged Male VA Psychiatric Patients

64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

Background Addiction treatment evolved quickly during the first year of the COVID-19 pandemic in the United States, with changes likely increasing access to some forms of care (eg, medications for opioid use disorder) and reducing access to others (eg, inpatient treatments). Efforts to continue providing quality addiction treatment to veterans may have benefitted from the Veteran’s Healthcare Administration’s existing telehealth infrastructure. Veterans’ experiences of care during this time are key to evaluating these efforts. Objective This study aimed to examine veterans’ experiences of mental health and addiction treatment during the first year of the COVID-19 pandemic. Methods Cross-sectional self-report data were collected over 3 months starting in April 2021, using Qualtrics panels. Participants were 401 veterans who (1) endorsed one or more substance use–related problems and (2) reported attending one or more mental health or addiction treatment appointments since April 1, 2020. The survey included standardized assessments of the risk severity of substance use and treatment satisfaction, as well as study-specific questions assessing care in the past year, including the proportion of care received in person versus telehealth appointments and perceptions of treatment quality and access relative to before the pandemic. Results Overall, 22% of the participants were women and 67% were White and non-Hispanic, with an average age of 41.7 (SD 9.4) years. The majority were combat veterans (85%), and the army was the most commonly represented branch (61%). Most of them (98%) endorsed items consistent with a moderate to severe risk for one or more substance use disorders, with alcohol being the most common one (91%), and most (74%) met the risk criteria for 2 or more substances. One-fifth of participants (20%) reported that their past year appointments were evenly split between in-person and telehealth consultations, while 43% of them received care primarily via telehealth, and 37% of them attended mostly in person. The average satisfaction with mental health and addiction treatment was comparable with that reported in previous addiction treatment studies (mean 25.4, SD 4.1) and did not differ as a function of the proportion of care received via telehealth (F2,398=2.77; P=.06). Most participants rated treatment as much better (27%), slightly better (38%), or the same (26%), and overall health care access as better (51%) or the same (30%) relative to before the pandemic. The distribution of satisfaction, quality, and access did not differ as a function of treatment modalities accessed in the past year (eg, medications and inpatient care). Conclusions Veterans rated their treatment satisfaction, perceived quality of care, and overall health care access as largely better or the same relative to prepandemic care. These data should be interpreted in the context of web-based administration of care and the cross-sectional study design. Nevertheless, our findings align with those of recent work suggesting that veterans with substance use disorders are particularly open to telehealth treatment options. These results also suggest that health care providers’ efforts to continue providing care during the first year of the COVID-19 pandemic were well received. Conflicts of Interest None declared.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

BackgroundSubstance use is generally initiated in adolescence or early adulthood and is commonly associated with several physical, psychological, emotional and social problems. The objective of this study is to assess the age of onset of substance use differences on psychosocial problems among individuals with substance use disorders (SUDs) residing in drug rehabilitation centers.MethodsA descriptive cross sectional research design was carried out. Probability Proportional to Size (PPS) sampling technique was used to select the drug rehabilitation centers and all the respondents meeting the inclusion criteria of the selected seven rehabilitation centers were taken as a sample and comprised of 221 diagnosed individuals with SUDs. A semi structured self administered questionnaires were used to collect the information regarding demographic and substance use related characteristics. A standard tool Drug Use Screening Inventory-Revised (DUSI-R) was used to assess the psychosocial problems among individuals with SUDs. Data were analyzed using both descriptive and inferential statistics. Multivariate general linear model (MANOVA and MANCOVA) was used to evaluate differences in psychosocial problems between early vs late onset substance users.ResultThe age of onset of substance use was significantly associated with psychosocial problems. The mean psychosocial problem scores were higher in early onset substance user (17 years or younger) than late onset substance user (18 years or higher) in various domains of DUSI-R even after controlling confounding factors. The two groups (early vs late) differed significantly in relation to age, gender, occupational status, current types of substance use, frequency of use, mode of substance use and relapse history.ConclusionThe study indicated that early onset substance users are at higher risk for psychosocial problems in various areas of life such as Behavior Pattern, Psychiatric disorder, Family system, Peer relationship, Leisure/Recreation and Work adjustment compared to late onset substance users. It highlights the need for early prevention, screening, and timely intervention among those individuals.

Co‐occurring substance dependence and depression: practical implications and next questions

Background and aimsEcological momentary assessment (EMA) studies have previously demonstrated a prospective influence of craving on substance use in the following hours. Conceptualizing substance use as a dynamic system of causal elements could provide valuable insights into the interaction of craving with other symptoms in the process of relapse. The aim of this study was to improve the understanding of these daily life dynamic inter‐relationships by applying dynamic networks analyses to EMA data sets.Design, setting and participantsSecondary analyses were conducted on time‐series data from two 2‐week EMA studies. Data were collected in French outpatient addiction treatment centres. A total of 211 outpatients beginning treatment for alcohol, tobacco, cannabis, stimulants and opiate addiction took part.MeasurementsUsing mobile technologies, participants were questioned four times per day relative to substance use, craving, exposure to cues, mood, self‐efficacy and pharmacological addiction treatment use. Multi‐level vector auto‐regression models were used to explore contemporaneous, temporal and between‐subjects networks.FindingsAmong the 8260 daily evaluations, the temporal network model, which depicts the lagged associations of symptoms within participants, demonstrated a unidirectional association between craving intensity at one time (T0) and primary substance use at the next assessment (T1, r = 0.1), after controlling for the effect of all other variables. A greater self‐efficacy at T0 was associated with fewer cues (r = −0.04), less craving (r = −0.1) and less substance use at T1 (r = −0.07), and craving presented a negative feedback loop with self‐efficacy (r = −0.09).ConclusionsDynamic network analyses showed that, among outpatients beginning treatment for addiction, high craving, together with low self‐efficacy, appear to predict substance use more strongly than low mood or high exposure to cues.

Two cross-sectional studies investigated media influences on adolescents' substance use and intentions to use substances in the context of exposure to parental and peer risk and protective factors. A total of 729 middle school students (n = 351, 59% female in Study 1; n = 378, 43% female in Study 2) completed self-report questionnaires. The sample in Study 1 was primarily African-American (52%) and the sample in Study 2 was primarily Caucasian (63%). Across the two studies, blocks of media-related cognitions made unique contributions to the prediction of adolescents' current substance use and intentions to use substances in the future above and beyond self-reported peer and parental influences. Specifically, identification with and perceived similarity to media messages were positively associated with adolescents' current substance use and intentions to use substances in the future, and critical thinking about media messages and media message deconstruction skills were negatively associated with adolescents' intention to use substances in the future. Further, peer influence variables (e.g., peer pressure, social norms, peer substance use) acted as risk factors, and for the most part, parental influence variables (e.g., parental pressure to not use, perceived parental reaction) acted as protective factors. These findings highlight the importance of developing an increased understanding of the role of media messages and media literacy education in the prevention of substance use behaviors in adolescence.