Adult Drug Users Research Articles

Substance Abuse in Older Adults.

Hale, Deborah MSN, RN, ACNS-BC; Marshall, Katherine DNP, NP, PMHCNS-BC, CNE Author Information

Advancing Research to Inform Practice within Community "supporting interventions for young people and families’ affected by substance misuse"

Issues and trends in relation to substance misuse normally develop in the transitional phase of adolescence, as young people begin looking towards their peers for direction and are less subject to parental authority (1.2). Risk factors are predictors of the likelihood that an individual or group will be involved in activity leading to adverse consequences. Research indicates that some young people are beginning to initiate alcohol and drug use earlier than many adults suspect (3). In relation to substance misuse it is observed that risk and protection factors exist in equal measure within different context including within the individual, family, peer group, school and community settings (4.5.6). In 2015 the Adolescent Addiction Service worked with 58 young people and their families with a mean age of 15.5years, comprising new referrals, re-referrals and continuances. The majority (76%) were male and the numbers attending the service of school going age who were out of education/training at time of referral was 18% while the number of young people who had previous/current contact with CAMHS was at 60%. The extent to which substance misuse featured within families was at 36% while the incidence of parental separation was 66%. The enhancement of decision making by young people could delay or inhibit their engagement in harmful activity including substance misuse. If young people experiences substance use as enjoyable and without any negative consequences then it is likely they will not perceive risks relating to such use (7). Parental disapproval of substance misuse is a strong predictor of delayed initiation, whereas family instability and parental or sibling substance misuse, are identified as significant risk factors placing young people at greater danger of developing lifetime trajectories involving substance misuse ( 8.9). As an approach to working with young people and families within community, assessment is central to the identification of needs. The four tier model of addiction treatment intervention (10) fits with the four tier model of family support (11) distinguishing between different levels and types of support/intervention. Integrated care plans framed within the context of multi-disciplinary and inter-agency collaboration encourages protective/preventative interventions towards improving health outcomes. The Hidden Harm Action Plan identifies that not all families who encounter substance misuse will experience problems but emphasises that routine assessment will help to identify those who do. The plan describes actions that can be taken to ensure children and young people who experience compromised parenting receive the care they need. As such research ought to be viewed as a work in progress and be made available to the widest possible audience in order to inform practice and decision making at an individual level and between practitioners/agencies especially when the welfare of children is considered. Practitioner research can make a significant contribution to practice as key finding from research and practice can be updated to inform policy, practice and service plans towards addressing inequalities and focusing on improving access to health care.

Trends in substance use admissions among older adults

BackgroundSubstance abuse is a growing, but mostly silent, epidemic among older adults. We sought to analyze the trends in admissions for substance abuse treatment among older adults (aged 55 and older).MethodsTreatment Episode Data Set - Admissions (TEDS-A) for period between 2000 and 2012 was used. The trends in admission for primary substances, demographic attributes, characteristics of substance abused and type of admission were analyzed.ResultsWhile total number of substance abuse treatment admissions between 2000 and 2012 changed slightly, proportion attributable to older adults increased from 3.4% to 7.0%. Substantial changes in the demographic, substance use pattern, and treatment characteristics for the older adult admissions were noted. Majority of the admissions were for alcohol as the primary substance. However there was a decreasing trend in this proportion (77% to 64%). The proportion of admissions for following primary substances showed increase: cocaine/crack, marijuana/hashish, heroin, non-prescription methadone, and other opiates and synthetics. Also, admissions for older adults increased between 2000 and 2012 for African Americans (21% to 28%), females (20% to 24%), high school graduates (63% to 75%), homeless (15% to 19%), unemployed (77% to 84%), and those with psychiatric problems (17% to 32%).The proportion of admissions with prior history of substance abuse treatment increased from 39% to 46% and there was an increase in the admissions where more than one problem substance was reported. Ambulatory setting continued to be the most frequent treatment setting, and individual (including self-referral) was the most common referral source. The use of medication assisted therapy remained low over the years (7% - 9%).ConclusionsThe changing demographic and substance use pattern of older adults implies that a wide array of psychological, social, and physiological needs will arise. Integrated, multidisciplinary and tailored policies for prevention and treatment are necessary to address the growing epidemic of substance abuse in older adults.

Patterns of abuse and routes of administration for immediate-release hydrocodone combination products.

PurposePrescriptions for hydrocodone immediate‐release (IR) combination products have recently decreased, yet they represent the majority of opioid prescriptions dispensed and are commonly abused analgesics among both adults and adolescents. Little data exist to understand the contribution of IR products to the problem of prescription opioid abuse. This study aimed to better understand abuse patterns for hydrocodone IR combination products among adult and adolescent substance abusers.MethodsThis cross‐sectional study examines abuse prevalence (including abuse adjusted for prescription volume and morphine milligram equivalents) and abuse characteristics for hydrocodone IR combination products and other prescription opioids among separate samples of adults and adolescents assessed for substance abuse problems or entering treatment from January 2012 through June 2015.ResultsResults indicate higher abuse for hydrocodone IR combination products than other opioid categories per 100 assessments but lower per prescriptions dispensed. Hydrocodone IR combination products had similar abuse prevalence to all extended‐release and long‐acting opioids when considering abuse measured per morphine milligram equivalents dispensed. An upward trend in hydrocodone IR combination product abuse was observed among adult substance abusers comparing the period prior to and after Drug Enforcement Administration rescheduling of these products in October 2014. Most individuals reported oral abuse of hydrocodone IR combination products, but snorting, reported by 23% of hydrocodone IR combination product abusers, also appears to be a route of abuse that may have public health relevance.ConclusionsGiven their high prescription volume, hydrocodone IR combination products, even at a relatively low prevalence of abuse, may contribute substantially to the overall problem of prescription opioid abuse. Additional public health interventions, including development of abuse‐deterrent formulations for these types of opioid products may aid in reducing their abuse.

Findings from a Large-Scale Empirical Research on Substance Abuse Prevention in Greece

Research indicates that combined psychosocial interventions aiming at reducing or postponing substance use and abuse in schools can be effective. Confronted with a rising number of both young and adult drug users successive geek governments have established an extensive network of prevention centers all over the country end especially in Attica where most citizens live. Our own empirical study –the first of its kind in Greece and with such a large number of both providers and receivers who participated in the research project- has taken a detailed look at both the inner workings of those centers and the actual effects of the psychosocial interventions that aim to reduce substance problems in youth as perceived by both implementers and receivers at school level. Our findings suggest that the majority of the students who participated in the psychosocial interventions expressed the views that they have been taught new coping mechanisms and have enjoyed the whole experience. Proposals are made for the role of policy makers and those involved in planning, implementing and evaluating prevention programs along with the need for more systematic research into methodological issues in the performance stages of substance prevention programs in Greece.

Interpersonal pathoplasticity and trajectories of change in routine adolescent and young adult residential substance abuse treatment.

Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal and the field broadly) with regard to patient interpersonal factors that influence working alliance and acute SUD residential treatment outcome trajectories. To (a) examine interpersonal pathoplasticity and identify interpersonal subtypes in a naturalistic sample of adolescent and young-adult patients presenting for routine residential SUD treatment and (b) investigate the association between identified interpersonal subtypes and working alliance and acute treatment outcome trajectories. N = 100 patients (Mage = 17.39 years, 68% male, 84% White) completed self-reports of symptom and functioning outcomes, interpersonal problems, and the working alliance on multiple occasions between admission and discharge. Multiple methods were used to identify interpersonal subtypes and test pathoplasticity. Interpersonal subtype was entered as a predictor in respective multilevel models of working alliance and symptom outcome. Interpersonal subtypes of vindictive and exploitable patients demonstrated pathoplasticity. Subtype did not predict working alliance trajectories; however, a significant interaction between interpersonal subtype and a quadratic effect for time demonstrated that exploitable patients with longer than average treatment lengths experienced attenuated symptom change over the course of treatment whereas vindictive patients appeared to demonstrate steady progress. Interpersonal assessments should be integrated into residential SUD treatment to identify patients with an exploitable interpersonal style who might require additional attention or alternative interventions. (PsycINFO Database Record

A Systematic Review of the mHealth Interventions to Prevent Alcohol and Substance Abuse

Substance abuse in young adults is a public health issue with costs to the individual and society. There is mounting evidence that the increased uses of mHealth approaches have promise as a way to facilitate reductions in substance use. This systematic review evaluated the recent body of research on mHealth-based interventions for substance use, with aims of (a) examining the functionality and effectiveness of these interventions, (b) evaluating the available research on the effectiveness of these interventions for substance use, and (c) evaluating the design, methodology, results, theoretical grounding, limitations, and implications of each study. We identified eligible studies by searching electronic databases using Boolean methods. The reviewed studies (N = 12) indicated that that a wide range of Internet-based, text messaging, and smartphone application interventions have been developed to address substance use. Interventions had an assortment of features; participants in each study highlighted the ease and convenience of the interventions; and the majority of studies provided support for the efficacy of mHealth in reducing substance use. Mobile technology is a promising tool for reducing substance use and warrants further development. Future practice including the use of mHealth interventions can be an integral part of reducing substance use.

Temporal trends in drug abuse in adults with acute myocardial infarction show worse outcomes

ObjectiveTo determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.BackgroundDA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.ConclusionsWe demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study.

To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). Randomized controlled trial on drug use outcomes at 3, 6 and 12months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. A total of 780 ED patients reporting recent drug use, 44% males, mean age=31years. Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. Primary outcome was past 90days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P=0.0844; Therapist BI+EUC-B: -26.7%, P=0.0041, for EUC-ED+EUC-B: -20.9, P=0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI)=-0.41, -0.07, P=0.0422] and weighted drug-days (95% CI=-0.41, -0.08, P=0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI=-0.42, -0.06, P=0.0104, Computer BI: 95% CI=-0.34, -0.01, P=0.0406). Booster effects were not significant. An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.

Dietary Intake Among Opioid- and Alcohol-Using Pregnant Women

ABSTRACTBackground: Substance abuse in nonpregnant adults has been associated with increased intake in calories and decreased intake of nutrient-dense foods; however, studies examining dietary intake in opioid-using and alcohol-using pregnant women are lacking. Objective: The objective of this study was to evaluate dietary intake in opioid-using pregnant women with or without concurrent light-to-moderate alcohol use as compared to abstaining controls. Methods: This prospective birth cohort included 102 pregnant women classified into four study groups: controls (n = 27), medication-assisted treatment (MAT; n = 26), alcohol (ALC; n = 22), and concurrent use of both substances (MAT + ALC; n = 27). Percentage differences in macro- and micronutrient intake were estimated from the food frequency questionnaire and compared among the study groups. Proportions of participants with intakes below the estimated average requirements (EAR) based on diet and diet with supplements were estimated. Results: Three exposed groups had lower prevalence of multivitamin use in periconceptional period (11.5–31.8%) than controls (44.4%). Unadjusted mean energy intake was significantly higher in the MAT + ALC group compared to controls, while micronutrient intake per 1000 kcal was the highest in the control group for almost all of the micronutrients analyzed. After adjustment for energy intake and sociodemographic characteristics, MAT group had lower estimated dietary intake of iron (−15.0%, p = 0.04) and folate (−16.8%, p = 0.04) compared to controls. A high proportion of participants in all study groups had dietary intake below the EAR for vitamin E, iron, and folate.Conclusion: Results highlight the need for targeted dietary interventions for opioid-using pregnant women.

An Ecodevelopmental Exploration of Mediators Between Maltreatment in Childhood and Drug use During Pregnancy.

Child maltreatment is associated with increased risk of substance abuse in adulthood. However, prior investigations have not examined substance use specifically in pregnancy, and have relied on self-report of substance use. The present study addresses these gaps via secondary analysis of 295 primarily low-income, Black postpartum women who agreed to complete a brief questionnaire and subsequently provided urine and hair samples. A clear relationship emerged between self-reported maltreatment and positive toxicology (with drug use present in 37.2% of maltreated participants and 17.1% of non-maltreated participants; p < .001). Depression and violence exposure were positively associated with maltreatment and with drug use. The combined effect of violence exposure and depression mediated the association between maltreatment and drug use during pregnancy (the bootstrapped 95% confidence interval of total indirect effect ranged from .17-.86). This investigation is the first to show an association between childhood maltreatment and toxicological evidence of drug use in pregnancy.

Adverse childhood experiences and behavioral problems in middle childhood

Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. However, the proximal associations between ACEs and behavioral outcomes during the middle childhood years have been understudied. In addition, many of the ACE studies contain methodological limitations such as reliance on retrospective reports and limited generalizability to populations of lower socioeconomic advantage. The current study uses data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort, to prospectively assess the adverse experiences and subsequent behavior problems of over 3000 children. Eight ACE categories to which a child was exposed by age 5 were investigated: childhood abuse (emotional and physical), neglect (emotional and physical), and parental domestic violence, anxiety or depression, substance abuse, or incarceration. Results from bivariate analyses indicated that Black children and children with mothers of low education were particularly likely to have been exposed to multiple ACE categories. Regression analyses showed that exposure to ACEs is strongly associated with externalizing and internalizing behaviors and likelihood of ADHD diagnosis in middle childhood. Variation in these associations by racial/ethnic, gender, and maternal education subgroups are examined. This study provides evidence that children as young as 9 begin to show behavioral problems after exposure to early childhood adversities.

Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years

Given growing numbers of older adults with mental and substance use disorders (MSUDs), this study examined the association between ten types of adverse childhood experiences (ACEs) and lifetime MSUDs among those aged 50+. Data (N = 14,738 for the 50+ age group) came from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions. Using multivariable binary logistic regression analyses, we examined relationships between ten ACEs and six lifetime MSUDs (major depressive disorder (MDD) and anxiety, post-traumatic stress, alcohol use, drug use, and nicotine use disorders). Gender differences were examined using tests of interaction effects and gender-separate logistic regression models. Of the sample, 53.2% of women and 50.0% of men reported at least one ACE. For both genders, parental/other adult's substance abuse was the most prevalent (22.6%), followed by physical abuse, and emotional neglect. Child abuse and neglect and parental/other adult's mental illness and substance abuse had small but consistently significant associations with MSUDs (e.g., odds ratio = 1.28, 95% CI = 1.12-1.46 for parental/other adult's substance misuse and MDD). Although the relationship between total number of ACEs and MSUDs was cumulative for both men and women, the associations of physical abuse, sexual abuse, emotional neglect, and parental separation/divorce with MSUDs were stronger among men. This study underscores the significant yet modest association between ACEs and lifetime MSUDs in late life. More research is needed to investigate why ACEs seem to have greater effects on older men and to discern the sources of gender differences in ACEs' effects.

Quelles comorbidités psychiatriques dans la dépendance au cannabis à l’adolescence ? Comparaison de patients consultants et de témoins

BackgroundThe use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence. ObjectivesWe investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities. MethodsIn total, 100 young patients (80 males – mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males – mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use. ResultsStatistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ2=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38–16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ2=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41–46.87]), life-time panic attack disorder (χ2=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98–13.19]), alcohol abuse (χ2=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87–495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ2=7.46; P=0.006–OR=3.57; OR 95 % CI=[1.37–9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ2=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19–25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14–18years old; n=65) (70.8 % versus 94.3 %; χ2=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ2=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ2=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators. ConclusionThis study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.

SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry.

Dental caries is the most common chronic disease in children and is caused by poor oral health behaviors. These behaviors include high-sugar diet, inadequate exposure to topical fluorides, and irregular use of professional dental care services. A number of behavioral intervention approaches have been used to modify health behaviors. One example is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been widely used to reduce substance abuse in both adults and children. SBIRT is a promising behavior change approach that could similarly be used to address problematic oral health behaviors. In this paper, we will review oral health studies that have adopted SBIRT components, assess if these interventions improved oral health behaviors and outcomes, and outline considerations for researchers interested in developing and testing future oral health-related SBIRT interventions in dentistry.

Mental Health Problems in Recently Incarcerated Male Adult Drug Users in Taiwan: Patterns, Rates, and Implications for Treatment

This study aimed to explore the extent of association between the classes and patterns (single vs. multiple) of drug use and the psychiatric disorders among recently incarcerated male drug users to help formulate drug policies for correctional facilities and provide adequate treatment for incarcerated drug users. Data were recruited from 414 male first-time incarcerated illicit drug users in one detention center in Taiwan. Their lifetime historical profiles of illicit drug use were then assessed and their associations with current psychiatric disorders were compared with 257 community controls. Heroin and meth/amphetamine were the most commonly used drugs among single and combined users. Heroin users were more likely to exhibit major depression and social phobia; meth/amphetamine users showed more psychotic disorder and antisocial personality disorder than community controls. Multiple drug users were associated with two-thirds of the psychiatric disorders. This study suggests that heroin and meth/amphetamine users require specific treatments, which may effectively address associated psychopathologic conditions. Interventions for mental disorders for some detainees are also recommended.

The behavioral economics of young adult substance abuse

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews of available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes.

Women Exiting Street-Based Sex Work: Correlations between Ethno-Racial Identity, Number of Children, and Violent Experiences

Through this article the authors examine data collected from 126 women seeking services at a transitional housing facility, primarily for women leaving street-based prostitution. Descriptive statistics on the women's ethno-racial identity, numbers of children, and experiences with violence are presented and analyzed to determine correlations and implications for social service providers working with this unique population of women. Nearly half of respondents are women of color, a majority have given birth to at least one child, and more than half are in a non-commercial intimate partnership, with a significant number reporting extensive experiences with violent trauma and abuse. Results indicate statistically significant differences in women's ethno-racial self-identification and their experiences of sex work and violence, as well as their marital status. Most notably, African-American and Hispanic women face the greatest and most diverse forms of intimate partner violence and negative sex industry experiences, with African-Americans more likely to engage in sex work as minors, be sexually abused as children, work for a pimp, and face physical assault and instances of sex trafficking. Results also support existing research showing correlations between traumatic childhood events and adult substance abuse, sexual assault, and other negative outcomes.

Childhood Adversity, Substance Abuse, and Violence: Implications for Trauma-Informed Social Work Practice

The purpose of this study was to explore the influence of adverse childhood experiences (ACEs) on adult substance abuse and violence in a sample of offenders (n = 180). Higher ACE scores were significantly correlated with substance abuse scores and violence scores. Substance abuse and violence were also significantly correlated with each other. The violent offenders had significantly higher ACE and substance abuse scores than the nonviolent offenders. In a hierarchical logistic regression model, the ACE score and substance score both emerged as significant predictors of violence. Better understanding of the links between early adversity and adult criminal and addictive behavior will help improve social work practice in forensic and correctional settings. Implications for trauma-informed social work practice and policy are discussed.

Not Just Academics: Paths of Longitudinal Effects From Parent Involvement to Substance Abuse in Emerging Adulthood

PurposeBy the 12th grade, half of American adolescents have abused an illicit drug at least once (Johnston et al., 2015). Although many substance misuse prevention programs exist, we propose an alternative mechanism for reducing substance use. There is evidence that parent involvement is related to reductions in children's behavior problems which then predict later substance abuse. We examine the Child-Parent Center (CPC) program, an early childhood intervention, as a strategy to impact substance abuse. MethodsWe conducted a path analysis from CPC to parent involvement through early adolescent problem behaviors and competencies to young adult substance abuse. Participants (N = 1,203; 51.5% female; 93.8% African-American) were assessed from age 3 to 26 years. ResultsCPC participation initiates a pathway to increased parent involvement and expectations, which positively impact adolescents' competencies and problem behaviors, lowering rates of substance abuse. ConclusionsThrough early childhood education, increasing early parental involvement and expectations can alter life-course outcomes by providing children with a foundation for positive behaviors and encouraging adaptive functioning in adolescence.