Need For Substance Abuse Treatment Research Articles

Sex Differences in Violent Death During Incarceration and Legal Intervention

IntroductionThis study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury pattern, and perpetrator. MethodsThe data used are from the National Violent Death Reporting System database from 2003 to 2019. All victims were either in custody, in the process of custody, or in prison. Sex was coded as female or male and as assigned at birth. All analyses were conducted using SAS 9.4 software using chi-square tests, with an alpha of 0.05 to test significant differences in the circumstances of mortality and demographic characteristics for each group. ResultsOur findings show that suicide was the most common cause of death during incarceration for both females and males (89.8% versus 77.4%; P < 0.001). Homicide was less common in females (1.6% versus 14.8%; P < 0.001) and legal intervention only occurred in males (2.2%; P < 0.001). Male victims were more likely to be of non-White race/ethnicity compared to females, while females were more likely to be experiencing homelessness, have documented mental illness, and comorbid substance abuse. ConclusionsVictim sex is significantly associated with circumstances of violent death among the incarcerated and highlights the need for appropriate mental health and substance abuse treatment.

A prospective longitudinal study of child custody status among homeless population mothers

ABSTRACT Most women in homeless populations are mothers, the majority being single mothers. Retaining child custody is challenging in homeless circumstances. Prospective longitudinal studies are needed to follow the moving pieces of housing and child custody in the context of carefully-assessed psychiatric and substance use disorders over time. A 2-year prospective longitudinal study of an epidemiologic sample of individuals with literal homelessness included 59 mothers. Annual assessments included structured diagnostic interviews, detailed assessment of homeless circumstances, urine drug testing, and service use documented by both self report and data from agencies serving these individuals. More than one-third of the mothers consistently lacked child custody throughout the course of the study and the proportions of mothers with child custody did not increase significantly. Nearly one-half of the mothers had a current year drug use disorder at baseline, mostly including cocaine disorder. Continuing lack of child custody over time was associated with longitudinal lack of housing and use of drugs. The importance of drug use disorders in the longitudinal course of child custody points to a critical need for formal substance abuse treatment, not just initiatives to decrease drug use, in helping mothers regain and maintain custody of their children.

Religious Beliefs, Treatment Seeking, and Treatment Completion among Persons with Substance Abuse Problems.

BackgroundReligious beliefs can assist with the success of treatment in persons with substance abuse problems by providing social support, confidence, and hope.MethodsAs such, a secondary analysis using 2013 National Survey on Drug Use and Health (NSDUH), of 20219 participants with self-identified illicit substance use problems was conducted. Survey was weighted bivariate and multivariate regression analysis was used to adjust for potential confounders.FindingsApproximately, 15.0% of the study sample were between ages of 18-25 years and 71.5% were Non-Hispanic Black, 11.3% were Non-Hispanic White, and 12.1% were Hispanic. About 10.3% had less than a high school education, 28.0% graduated high school, 30.0% had some college education, and 32.0% were college graduates. Only 1.3% reported receiving substance abuse treatment in the past 12 months and 5.4% perceived a need for substance abuse treatment in the last 12 months. 65.0% reported that religious beliefs were an important part of their life and 62.5% reported that their religious beliefs influenced their decision making. After adjustment for sociodemographic factors, both the importance of religious beliefs and the influence of religious beliefs on decision making were associated with increased odds of having treatment [odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.14-2.14 and OR = 1.51, 95% CI: 1.11-2.05, respectively]. However, there was no association between the importance of religious beliefs or the influence of religious beliefs on decision making and perceived need for substance abuse treatment.ConclusionThese findings suggest that religious beliefs may be an important determinant in receiving treatment among substance abusers and also have implications for exploration of faith-based and faith-placed interventions.

Help seeking behaviors of Latinos with substance use disorders who perceive a need for treatment: Substance abuse versus mental health treatment services

ObjectivePerceiving a need for substance abuse treatment is a strong predictor of substance abuse treatment utilization among those with substance use disorders (SUD). Studies have found that when persons with SUD perceive a need for treatment, they are more likely to use mental health treatment rather than substance abuse treatment. Substance abuse treatment utilization is low among Latinos, relative to other racial/ethnic groups. It is unknown if Latinos with SUD who perceive a need for treatment are more likely to use mental health or substance abuse treatment. MethodsData were pooled from the National Survey on Drug Use and Health survey years 2014, 2015, 2016, and 2017. Analyses were limited to adult Latino participants who met DSM-IV criteria for a past-year substance use disorder (n = 1889). Multinomial logistic regression analyses examined the role of perceived treatment need on the past-year use of (1) no treatment, (2) substance abuse treatment only, and (3) mental health treatment only. Important covariates included socio-demographics, problem severity, currently being on parole or probation, and poor mental health status. ResultsOnly 5% of Latinos with SUD reported perceiving a need for treatment. Treatment utilization was also low: 83% reported not using any treatment in the past-year. In multinomial logistic regressions, compared to not using any treatment, Latinos with SUD who perceived a need for substance abuse treatment were more likely to report using mental health treatment only. Perceiving a need for treatment and using substance abuse treatment services only was not statistically different from not using any treatment. ConclusionsFindings underscore the need for better integration of substance abuse and mental health treatment services to address the health needs of Latinos.

The Role of Familismo and Acculturation as Moderators of the Association Between Family Conflict and Substance Abuse on Latino Adult Males.

The significant research gap on Latino adults who completed substance abuse treatment (SAT) impacts the provision of substance use prevention and treatment for this population. Given the need for culturally-appropriate SAT for Latinos, research that examines the role of cultural constructs and acculturation in relation to substance use behavior is warranted. The purpose of the present study is to test, based on the social control theory, a multiple moderation model using the PROCESS macro1 to examine the moderating effect of Familismo on the association between history of family conflict and years of substance abuse on Latino males who completed SAT at different levels of acculturation (i.e., cultural orientation). Generational status (i.e., immigrant, U. S. born) and age are used as covariates. A total of 117 Latino male participants (Mage= 37, 54% non-U.S. born with a mean length of stay of 19 years in the U.S.) who completed SAT from facilities located in the metropolitan area of Chicago completed self-report measures. Results from the multiple moderation analysis showa significant three-way interaction (family conflict × Familismo × acculturation), indicating that participants with Latino and bicultural orientation who endorse average to high levels of Familismo have fewer years of substance abuse compared to those with U.S. mainstream culture orientation and low Familismo. Findings illustrate the need for SAT that assesses for family conflict and integrates cultural aspects to reduce substance use behavior on Latino males.

Nonsuicidal self-injury and suicide attempts among ED patients older than 50 years: comparison of risk factors and ED visit outcomes

BackgroundAlthough the number of older adults who engage in nonsuicidal self-injury (NSSI) is not insignificant, research on older adults' NSSI is scant. The current study examined the prevalence and characteristics of NSSI compared to suicide attempt (SA) in adults older than 50 years who were seen at Emergency Departments (EDs) and their ED visit outcomes. MethodsData came from the 2012 Nationwide Emergency Department Sample. We used binary logistic regression analysis to examine demographic and clinical characteristics of NSSI versus SA among 67,069 visits with a diagnosis of either SA or NSSI, and multinomial logistic regression analysis to examine associations between NSSI versus SA and ED outcomes. ResultsOf self-inflicted intentional injuries, 76.89% were SA and 23.11% were NSSI. Visits for NSSI were associated with lower levels of psychiatric disorders and alcohol use disorders than SA and were more likely than SA visits to occur among older age groups (65-74 and 75+), females, and those with multiple injuries and drug use disorders. NSSI visits were also associated with greater risks of hospital admission (relative risk ratio [RRR]=1.45, 95% CI=1.36-1.54) and death (RRR=18.64, 95% CI=14.19-24.49), as opposed to treat-and-release, but lower risks of facility transfer/discharge with home health care (RRR=0.77, 95% CI=0.72-0.83). ConclusionsThe findings of higher hospitalization and death rates among those with NSSI than SA show how lethal intentional self-destructive behaviors in late life can be even if they are not classified as suicide attempts. The need for mental health and substance abuse treatment is discussed.

The Role of Perceived Need and Health Insurance in Substance Use Treatment: Implications for the Affordable Care Act

The expansions in insurance coverage under the Patient Protection & Affordable Care Act (ACA) that took full effect in 2014 have been projected to increase the number of users of behavioral health services. By analyzing data from the 2008–2012 National Survey on Drug Use and Health, this paper examines whether health insurance expansion may result in an increase in substance use disorder (SUD) treatment utilization. The study sample includes 18,600 adults with SUD but no diagnosable mental health condition. The analysis finds that over 80% of that population receives no treatment and 97% do not perceive a need for treatment. When they do receive treatment, they are more likely to receive mental health treatment. Using multinomial logistic regression, the study finds that having Medicaid or private insurance is associated with higher likelihood of receiving SUD treatment, but only when individuals perceive a need for it, compared to being uninsured and not perceiving a need for treatment (the reference category). These results indicate that increased service utilization is associated with perceiving a need for substance abuse treatment, implying that outreach initiatives to raise awareness about SUD and the effective role of substance use treatment are needed to enhance the impact of the structural changes to the substance abuse treatment system resulting from the ACA.

Profile and Programming Needs of Federal Offenders With Histories of Intimate Partner Violence

This study presents data on male perpetrators of domestic violence (DV) in the Correctional Service of Canada (CSC) using two samples: (a) a snapshot of all male offenders in CSC who had been assessed for DV (n = 15,166) and (b) a cumulative sample of male offenders in CSC from 2002-2010 who had been assessed as moderate or high risk for further DV (n = 4,261) DV offenders were compared to a cohort sample of non-DV offenders (n = 4,261). Analyses were disaggregated for Aboriginal and non-Aboriginal offenders. Results indicated that 40% of the federal male population had a suspected history of DV and were therefore screened in for in-depth DV risk assessment. Of these, 45% were assessed as moderate or high risk for future DV. DV offenders had higher risk and criminogenic need ratings, more learning disabilities, more mental health problems, and more extensive criminal histories than those without DV histories. Aboriginal DV offenders had high levels of alcohol dependence, suggesting a need for substance abuse treatment as part of DV programming. Most federal offenders with DV histories would be described as belonging to the Antisocial/Generalized Aggressive typology and, therefore, adhering to the Risk-Need-Responsivity principles of the effective correctional literature, cognitive-behavioral treatment that focuses on teaching skills of self-management, and changing attitudes supporting relationship violence would be recommended.

Utilization of Pastoral Care Services for a Screening, Brief Intervention, and Referral-to-Treatment Program at an Urban Level I Trauma Center

Excessive alcohol consumption is currently the third leading cause of preventable death within the United States, accounting for roughly 80,000 deaths each year. 1 Maier RV Controlling alcohol problems among hospitalized trauma patients. J Trauma. 2005; 50: S1-S2 Crossref Scopus (19) Google Scholar Excessive alcohol consumption also takes a toll on hospitals and health care centers, specifically emergency departments and trauma units. Each year, over 20 million adults in the United States sustain injuries requiring emergency care, and 15% to 20% screen positive for alcohol. 2 Rockett IH Putnam SL Jia H et al. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 2003; 41: 802-813 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 3 Teplin LA Abram KM Michaels SL Blood alcohol level among emergency room patients: a multivariant analysis. J Stud Alcohol. 1989; 50: 441-447 PubMed Google Scholar , 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar These figures increase further within the trauma department, where up to half of all trauma accidents are linked to alcohol use (25%-50%). 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar , 6 Babor TF McRee BG Kassebaum PA Grimaldi PL Ahmed K Bray J Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28: 7-30 Crossref PubMed Scopus (673) Google Scholar Tiffany L. Overton is Trauma Research Associate, JPS Health Network, Fort Worth, TX. Gary Williams is SBIRT Program Coordinator, JPS Health Network, Fort Worth, TX. Shahid Shafi is Consultant, JPS Health Network, Fort Worth, TX. Rajesh R. Gandhi is Trauma Medical Director, JPS Health Network, Fort Worth, TX.

Early Intervention May Ward Off Need for Substance Abuse Treatment

Reducing substance use among adolescents takes a multitude of strategies, from interventions in the first grade to treatment in jail.

Using the Massachusetts Youth Screening Instrument–Version 2 on a Community Sample of African American and Latino/a Juvenile Offenders to Identify Mental Health and Substance Abuse Treatment Needs

The Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2) is a brief screening tool used to identify youth in the juvenile justice system who are at-risk of mental-health-related difficulties. The MAYSI-2 was administered to 5,205 African American and Latino/a youth throughout Chicago, Illinois, who were on probation and residing in the community. This study investigated differences (i.e., legal status, gender, age, race/ethnicity) in reporting of mental health symptoms and substance use on the MAYSI-2. Females scored above the clinical cutoffs more frequently than males, and there were few differences found between diverted and adjudicated youth. Age comparisons revealed mixed results. Overall, youth in the current sample scored above the clinical cutoffs less often than youth in the MAYSI-2 norm reference groups. Nonetheless, during the first phase of this study, the MAYSI-2 demonstrated effectiveness by accurately identifying a substantial portion of youth in need of mental health and/or substance abuse treatment.

Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment

Clients in substance abuse treatment need, in addition to evidence-based and sensitive treatment services in general, a system of care that takes into account the impact of trauma and violence in so many of their lives. In addition, services need to be delivered in a way that avoids triggering trauma memories or causing unintentional re-traumatization. To that end, this article describes an agency self-assessment process that combines a trauma-informed assessment, a NIATx process of “walking-through” and use of the Institute of Healthcare Improvement's Plan-Do-Study-Act (PDSA) cycles, and a user-friendly format. The trauma-informed assessment is designed to address issues of safety of clients and staff members, reduction of re-traumatization, consistency in practice, and client empowerment. It brings a non-judgmental, collaborative approach to process and practice improvement. The article describes how the assessment process can be—and has been—used to develop an Action Plan, including trainings and the identification of “trauma champions”; i.e., staff who will continue to spread trauma-informed changes and new evidence-based practices throughout the agency. As we enter a period of healthcare reform, addressing trauma as an integral part of addiction treatment also allows us to better deal with the totality of our clients’ health problems.

When Older Adult Substance Abuse Affects Others: What Helps and What Doesn't?

The abuse of alcohol and other drugs in the older adult population, which includes the aging “baby boomers,” is escalating. It is anticipated that the need for substance abuse treatment will grow t...

2754 – Title: a study to assess the stress, coping strategies and domestic violence in wives of alcohol dependent individuals

Divorce rates are high among wives of alcoholics and the most frequently identified cause is domestic strife in the form of harassment, torture or beating from the husband and or in-laws. However, there is only limited literature in this regard. To study the stress, various coping styles and domestic violence among the wives of alcohol dependent individuals, who are admitted to the de-addiction centre of a tertiary care psychiatric centre in India. An exploratory descriptive design was adopted. Wives of 75 alcohol dependent individuals, admitted in the deaddiction centre of National Institute of Mental Health and Neuro Sciences, Bangalore were selected. Data was collected by personal interviews with all 75 wives using socio-demographic information schedule, Perceived Stress Scale, Coping with Drinking Questionnaire, and Domestic Violence Questionnaire. Wives of alcohol dependent patients had high levels of perceived stress. Avoidance, discord, fearful withdrawal and sexual withdrawal were the most common coping components identified. Domestic violence was experienced by 90% women, mostly intellectual (69%), emotional (59%), social (58%), physical (47%), economic (42%) and sexual violence (27%). Domestic violence was found to increase the stress and influences the coping styles of these women. Domestic violence is a major problem in wives of alcoholics. Routine screening for domestic violence is needed during the intake of alcoholic for substance abuse treatment so that appropriate interventions can be planned. There is a need for substance abuse treatment providers to be trained on the issue of domestic violence.

Risk factors for criminal recidivism – a prospective follow-up study in prisoners with substance abuse

BackgroundSubstance use in general has been shown to predict criminal recidivism. The present study aimed to examine potential predictors of criminal recidivism, including substance-specific substance use patterns, in prisoners with substance use.MethodsA cohort of prisoners with substance use problems (N = 4,152) were assessed with the Addiction Severity Index (ASI) in the Swedish criminal justice system. Clients were followed for an average of 2.7 years. Criminal recidivism was defined as any return to the criminal justice system.ResultsDuring follow-up, 69 percent (n = 2,862) returned to the criminal justice system. Recidivism was associated with amphetamine and heroin use, with an additive risk for injectors, and with polysubstance use. Also, recidivism was negatively associated with alcohol, other opioids than heroin/methadone and with hallucinogenic drugs, and positively associated with previous psychiatric in-patient treatment, violent behaviour, and with a shorter index sentence. Associations remained when controlling for type of crime.ConclusionsEven when controlling for type and severity of crime, and for psychiatric problems, risk of criminal relapse was increased by substance use variables, including amphetamine, heroin and polysubstance use, and an additional risk was shown for injection drug users. These findings have implications for the need for substance abuse treatment after release from prison.

Unmet need for treatment for substance use disorders across race and ethnicity

BackgroundThe objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment. MethodsData were analyzed from the 2002 to 2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance. ResultsAsians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need. ConclusionsThe findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.

Unmet Mental Health and Substance Abuse Treatment Needs of Sexual Minority Elders

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55–64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Ongoing Sexually Transmitted Disease Acquisition and Risk-Taking Behavior Among US HIV-Infected Patients in Primary Care: Implications for Prevention Interventions

To better understand the factors associated with HIV- and sexually transmitted disease (STD)-transmitting behavior among HIV-infected persons, we estimated STD prevalence and incidence and associated risk factors among a diverse sample of HIV-infected patients in primary care. We analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in 4 US cities. At enrollment and 6 months thereafter, participants completed an audio computer-assisted self-interview about their sexual behavior, and were screened for genitourinary, rectal, and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction. Thirteen percent of participants had a prevalent STD at enrollment and 7% an incident STD 6 months later. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men and trichomoniasis among the women. Other than trichomoniasis, 94% of incident STDs were identified in men who have sex with men. Polysubstance abuse other than marijuana, and having ≥4 sex partners in the 6 months before testing were associated with diagnosis of an incident STD. STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active men who have sex with men who used recreational drugs. These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care.

Comparing Injection and Non-Injection Routes of Administration for Heroin, Methamphetamine, and Cocaine Users in the United States

ABSTRACT Research examining the demographic and substance use characteristics of illicit drug use in the United States has typically failed to consider differences in routes of administration or has exclusively focused on a single route of administration—injection drug use. Data from National Survey on Drug Use and Health were used to compare past-year injection drug users and non-injection drug users' routes of administration of those who use the three drugs most commonly injected in the United States: heroin, methamphetamine, and cocaine. Injection drug users were more likely than those using drugs via other routes to be older (aged 35 and older), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared with methamphetamine or cocaine users.

Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems

This is a prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS. Data from the HIV Longitudinal Interrelationships of Viruses and Ethanol study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization. An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [95% CI] = 0.19–0.67), as did identifying sexual orientation other than heterosexual (AOR = 0.46, CI = 0.29–0.72) and having social supports that use alcohol/drugs (AOR = 0.62, CI = 0.45–0.83). Positive associations with SAT include presence of hepatitis C antibody (AOR = 3.37, CI = 2.24–5.06), physical or sexual abuse (AOR = 2.12, CI = 1.22–3.69), social supports that help with sobriety (AOR = 1.92, CI = 1.28–2.87), homelessness (AOR = 2.40, CI = 1.60–3.62), drug dependence diagnosis (AOR = 2.64, CI = 1.88–3.70), and clinically important depressive symptoms (AOR = 1.52, CI = 1.08–2.15). While reassuring that factors indicating need for SAT among people with HIV and alcohol problems (e.g., drug dependence) are associated with receipt, nonneed factors (e.g., sexual orientation, age) that should not decrease likelihood of receipt of treatment were identified.