An evaluation of child welfare inservice training: The relative effectiveness of substance abuse content in improving worker knowledge and attitudes

Given the seriousness of substance abuse as a child welfare problem, the purpose of this study was to examine the relative effectiveness of an inservice training curriculum for child welfare workers. The training was designed to improve worker knowledge and attitudes in working with substance abusing families. Seventy (70) child welfare workers from public and private agencies in two south Florida counties participated in a pretest/posttest control group design that also trained and retested the control group. The literature review supports that the general preparedness of child welfare workers for the issues presented by substance abusing families is in question. Confounding this problem is a lack of understanding of substance abuse dynamics, worker biases, and predispositions. The two research hypotheses focused on whether inservice training could increase worker knowledge and improve worker attitudes in working with this population. Training delivery was in the form of a five-day inservice focusing on an array of substance abuse knowledge and attitudinal topics. Separate knowledge and attitude instruments were developed for the research and were administered, before and after training, to a purposive sample of participants that were randomly assigned to the experimental and control groups. The data analysis supported the research hypotheses but raised a question. Specifically, the experimental group demonstrated significant improvement in posttest scores on both instruments after receiving the training; whereas the control group, with training withheld, also demonstrated a significant improvement at posttest, but only on the knowledge instrument. Although the question was unanswered, when examined at a more critical significance level, only the experimental group remained significant. The hypotheses were reconfirmed when, after training and retesting, the control group also displayed significant improvement on both instruments. The findings support the conclusion that this substance abuse inservice was effective in improving worker knowledge and attitudes regarding working with substance abusing families. As an implication for social work practice, it suggests that similar inservice training can be a viable training resource when formal substance abuse training is unavailable. Additional research is suggested regarding to what degree increased substance abuse knowledge and improved worker attitudes correlate with improved practice.

Gender differences in behavioral and psychosocial correlates of substance abuse among adolescents in residential treatment

This dissertation reports the results of a study that examined differences between genders in a sample of adolescents from a residential substance abuse treatment facility. The sample included 72 males and 65 females, ages 12 through 17. The data were archival, having been originally collected for a study of elopement from treatment. The current study included 23 variables. The variables were from multiple dimensions, including socioeconomic, legal, school, family, substance abuse, psychological, social support, and treatment histories. Collectively, they provided information about problem behaviors and psychosocial problems that are correlates of adolescent substance abuse. The study hypothesized that these problem behaviors and psychosocial problems exist in different patterns and combinations between genders.^ Further, it expected that these patterns and combinations would constitute profiles important for treatment. K-means cluster analysis identified differential profiles between genders in all three areas: problem behaviors, psychosocial problems, and treatment profiles. In the dimension of problem behaviors, the predominantly female group was characterized as suicidal and destructive, while the predominantly male group was identified as aggressive and low achieving. In the dimension of psychosocial problems, the predominantly female group was characterized as abused depressives, while the male group was identified as asocial, low problem severity. A third group, neither predominantly female or male, was characterized as social, high problem severity. When these dimensions were combined to form treatment profiles, the predominantly female group was characterized as abused, self-harmful, and social, and the male group was identified as aggressive, destructive, low achieving, and asocial. Finally, logistic regression and discriminant analysis were used to determine whether a history of sexual and physical abuse impacted problem behavior differentially between genders. Sexual abuse had a substantially greater influence in producing self-mutilating and suicidal behavior among females than among males. Additionally, a model including sexual abuse, physical abuse, low family support, and low support from friends showed a moderate capacity to predict unusual harmful behavior (fire-starting and cruelty to animals) among males. Implications for social work practice, social work research, and systems science are discussed. ^

An evaluation of coping ability as a guide to the treatment of persons diagnosed with schizophrenia and substance abuse

This dissertation introduced substance abuse to the Dynamic Vulnerability Formulation (DVF) and the social competence model to determine if the relationship between schizophrenic symptomatology and coping ability in the DVF applied also to the dually diagnosed schizophrenic or if these variables needed to be modified. It compared the coping abilities of dually and singly diagnosed clients in day treatment and identified, examined, and assessed the relative influence of relevant mediating variables on two dimensions of coping ability of the dually diagnosed: coping skills and coping effort. These variables were: presence of negative and nonnegative symptoms, duration of mental illness, type of substance used, and age of first substance use.^ A priori effect sizes based on previous empirical research were used to interpret the results related to the comparison of demographic, socioeconomic, and treatment characteristics between the singly and dually diagnosed study samples. The data suggested that the singly diagnosed group had higher coping skills than the dually diagnosed group, particularly in the areas of housing stability, work affect, and total social adjustment. The dually diagnosed group had lower scores on one aspect of coping effort--agency or self-efficacy. The data supported the presence of an inverse relationship between symptom severity and coping skills, particularly for the dually diagnosed group. The data did not support the presence of an inverse relationship between symptom severity and coping effort, but did suggest a positive relationship between symptom severity and one measure of coping effort, agency, for the dually diagnosed group. Regression equations using each summary measure of coping skill--social adjustment and role functioning--yielded statistically significant F-ratios. Thirty-six percent of the variance in social adjustment and thirty-one percent of the variance in role functioning were explained by the relative influence of the relevant variables. Both negative and non-negative symptoms were the only significant predictors of social adjustment. The non-negative symptoms variable was the sole significant predictor of role functioning. The results of this study provided partial support for the use of the Dynamic Vulnerability Formulation (DVF) with the dually diagnosed. ^

A phenomenology of crack abuse

The aim of this dissertation is to identify, describe, and explain the common experiences defining the crack abuser's life-world. Its method is phenomenological. Using basic cybernetic premises, a neurophysiologically oriented phenomenological framework concerning the constitution of thoughts, memories, and perceptions is first written. The framework is designed to hypothetically represent the neuropathology of crack abuse within a perspective that prescinds and describes the constitution, flow, and interdependence of experience. After the framework is written, the dissertation outlines the neuro-psychopharmacology of crack abuse and delimits crack abusers as a specific group within the more general population of cocaine users. It then represents the neuropathology of crack abuse within its phenomenological framework and uses the first-person accounts of forty-two crack dependents to actualize a phenomenological sketch of the crack abuser's life-world. The ethnographies afford the possibility of writing a “thick” description of the crack abuser's daily life—one that communicates the substance, order, and subjective and cultural dimensions of the dependent's defining experiences. ^ The dissertation's goals are successfully realized. The framework written and the ethnographies recorded and transcribed, the dissertation is able to identify, describe, and to a certain extent explain some of the common experiences defining the crack abusers life-world. The dissertation concludes that the crack abuser's life-world is organized around three primary and four secondary experiences. His primary experiences include: (1) an almost complete, yet fleeting, satisfaction of the ego's innate insufficiency and sublime, erotic-like stimulation of its core, (2) a fundamental inclination and expansion of the uniquely oriented euphoria-dysphoria dynamic that vivifies and orients the flow of consciousness, and (3) a change in the ego's innate structure. His secondary experiences include: (a) a characteristic aiming of projects, actions, and conduct toward the procurement and consumption of crack, (b) a denigration in the hold of legitimations and institutionalizations on the thematic field, (c) a strict alignment and a contraction in the scope of logical types pointing to the salient experiences within the stock of knowledge, and (d) for some crack abusers, ontological insecurity, despair, and exhaustion. ^

Relational predictors of condom use among adolescents in outpatient substance abuse treatment

Past HIV interventions have been critiqued for their failure to incorporate relational factors linked to condom use. Furthermore, few studies have focused on the relational context of sexual risk behavior among adolescents at elevated risk for HIV/STI exposure in the context of substance use. Therefore, this study evaluated the influence of three key relational factors (rejection sensitivity, intimacy dating goals, intercourse-related anxiety) salient for understanding condom use among adolescents in outpatient substance abuse treatment in South Florida. Structural equation modeling was used to test relational factors as direct and indirect predictors of condom use. Specifically, the current study investigated the influence of rejection sensitivity and intimacy dating goals on percentage of protected intercourse, with intercourse-related anxiety modeled as a mediator of this association. ^ Results obtained from the hypothesized structural model suggest rejection sensitivity and intimacy dating goals are significant predictors of percentage of protected intercourse. As expected, rejection sensitivity was related to lower levels of percentage of protected intercourse via heightened levels of intercourse-related anxiety and was not related directly to percentage of protected intercourse. Intercourse-related anxiety was indicated as a partial mediator between rejection sensitivity and percentage of protected intercourse. In contrast, intimacy dating goals was related to lower levels of percentage of protected intercourse directly. The findings demonstrate the importance of relational factors in condom use among adolescents in outpatient substance abuse treatment. Levels of protected intercourse are likely to increase when relational factors are targeted among adolescents in this high-risk population. Implications for prevention strategies targeting this high-risk subgroup of adolescents are discussed. ^

Hispanic adolescents with severe substance abuse problems: Parental involvement, acculturation-related factors, and attachment

The main objective of the study was to investigate the relationship between parent-related, acculturation-related, and substance use-related variables found within individual, familial/parental, peer and school adolescent ecological domains, in a clinical sample (i.e. adolescents who met criteria for a Diagnostic Statistical Manual-IV [DSMIV] clinical diagnosis of substance abuse/dependence) of Hispanic adolescents from Miami, Florida. ^ The sample for this study consisted of 94 adolescent-mother pairs. The adolescent sample was 65% male, and 35% female, with a mean age of 15 years. More than half of the adolescents were born in the United States (60%) and had resided in the U.S. for an average of 12 years; 80% of the caregivers (primarily mothers) were foreign-born and lived in the U.S. for an average of 21 years. ^ Correlation and hierarchical regression were used to answer the research questions. The findings indicate that the hypothesized model and corresponding anticipated effect of the relationship between parental school and peer involvement on adolescents’ frequency of alcohol, marijuana and cocaine use was not supported by the data. Parental “acculturation-related” variables did not explain any of the variance in adolescent substance use frequency in this sample. Mediation and moderation models were not supported either. However, some interesting relationships were found: ^ The larger the acculturation gap, the lower the parental involvement in school tended to be (r = -.21, p < .05). Adolescents who experienced a greater acculturation gap with their parents (-.81, p >.01) had an earlier onset of marijuana (-.33, p < .01) and cocaine use (r = -.24, p <.01). The less acculturated parents experienced more parenting stress (r = -.31, p = < .01). Attachment was positively associated with parental peer involvement (r = .24, p < .05) and inversely associated with parenting acculturative stress (r = -.24, p < .05). Attachment was also positively associated with marijuana (r = .39, p < .01) and cocaine use (r = .33, p < .01). Adolescent males reported being more attached to their mothers when compared to adolescent females (r = .22, p >.05), they also reported using marijuana more frequently than females (.21, p >.05). ^

The effects of peer teaching of infant massage on general elf-efficacy and mother infant attachment among mothers in a residential rehabilitation facility for drug addiction and substance abuse

Approximately 200 million people, 5% aged 15-64 worldwide are illicit drug or substance abusers (World Drug Report, 2006). Between 2002 and 2005, an average of 8.2% of 12 year olds and older in the Miami, Fort Lauderdale metropolitan areas used illicit drugs (SAMHSA, 2007). Eight percent of pregnant women, aged 15 to 25, were more likely to have used illicit drugs during pregnancy than pregnant women aged 26 to 44. Alcohol use was 9.8% and cigarette use was 18% for pregnant women aged 15 to 44 (SAMHSA, 2005). Approximately a quarter of annual birth defects are attributed to the exposure of drugs or substance abuse in utero (General Accounting Office, 1991). Physical, psychological and emotional challenges may be present for the illicit drug/substance abuse (ID/SA) mother and infant placing them at a disadvantage early in their relationship (Shonkoff & Marshall, 1990). Mothers with low self efficacy have insecurely attached infants (Donovan, Leavitt, & Walsh, 1987). As the ID/SA mother struggles with wanting to be a good parent, education is needed to help her care for her infant. In this experimental study residential rehabilitating ID/SA mothers peer taught infant massage. Massage builds bonding/attachment between mother and infant (Reese & Storm, 2008) and peer teaching is effective because participants have faced similar challenges and speak the same language (Boud, Cohen, & Sampson 2001). Quantitative data were collected using the General Self-Efficacy and Maternal Attachment Inventory-Revised Scale before and after the 4-week intervention program. A reported result of this study was that empowering ID/SA mothers increased their self-efficacy, which in turn allowed the mothers to tackle challenges encountered and created feelings of being a fit mother to their infants. This research contributes to the existing database promoting evidence-based practice in drug rehabilitation centers. Healthcare personnel, such as nurse educators and maternal-child health practitioners, can develop programs in drug rehabilitation centers that cultivate an environment where the ID/SA rehabilitating mothers can peer teach each other, while creating a support system. Using infant massage as a therapeutic tool can develop a healthy infant and nurture a more positive relationship between mother and infant.

The effects of American Sign Language on general self-efficacy and anxiety among mothers in a residential rehabilitation facility for drug addiction and substance abuse

Globally, approximately 208 million people aged 15 and older used illicit drugs at least once in the last 12 months; 2 billion consumed alcohol and tobacco consumption affected 25% (World Drug Report, 2008). In the United States, 20.1 million (8.0%) people aged 12 and older were illicit drug users, 129 million (51.6%) abused alcohol and 70.9 million (28.4%) used tobacco (SAMHSA/OAS, 2008).Usually considered a problem specific to men (Lynch, 2002), 5.2% of pregnant women aged 15 to 44 are also illicit drug and substance abusers (SAMHSA/OAS, 2007). During pregnancy, illicit drugs and substance abuse (ID/SA) can significantly affect a woman and her infant contributing to developmental and communication delays for the infant and influencing parenting abilities (Budden, 1996; March of Dimes, 2006b; Rossetti, 2000). Feelings of guilt and shame and stressful experiences influence approaches to parenting (Ashley, Marsden, & Brady, 2003; Brazelton, & Greenspan, 2000; Ehrmin, 2000; Johnson, & Rosen, 1990; Kelley, 1998; Rossetti, 2000; Velez et al., 2004; Zickler, 1999). Parenthood is an expanded role that can be a trying time for those lacking a sense of self-efficacy and creates a high vulnerability to stress (Bandura, 1994). Residential treatment programs for ID/SA mothers and their children provide an excellent opportunity for effective interventions (Finkelstein, 1994; Social Care Institute for Excellence, 2005). This experimental study evaluated whether teaching American Sign Language (ASL) to mothers living with their infants/children at an ID/SA residential treatment program increased the mothers’ self-efficacy and decreased their anxiety. Quantitative data were collected using the General Self-Efficacy Scale and the State-Trait Anxiety Inventory showing there was both a significant increase in self efficacy and decrease in anxiety for the mothers. This research adds to the knowledge base concerning ID/SA mothers’ caring for their infants/children. By providing a simple low cost program, easily incorporated into existing rehabilitation curricula, the study helps educators and healthcare providers better understand the needs of the ID/SA mothers. This study supports Bandura’s theory that parents who are secure in their efficacy can navigate through the various phases of their child’s development and are less vulnerable to stress (Bandura, 1994).

Toward Prevention of Childhood Sexual Abuse: Preschoolers’ Knowledge of Genital Body Parts

This study examined preschool children’s knowledge of their genital and non-genital body parts. Results indicated that almost all preschool children knew the correct terms for their non-genital body parts, but few knew the correct terminology for their genitals. The importance of this skill in preventing childhood sexual abuse is discussed.

Impact of Substance Abuse: Human Resource Strategies for the Hospitality Industry

No hospitality organizations are immune from the negative effects of substance abuse in the workplace. Ownters and managers must confront the problem head on and, in order to accomplish this, they must be in possession of the facts regarding the problem, and regarding options for dealing with the problem in the most appropriate manner for their individual organizations. The authors include an assessment of this problem as well as a summary review of procedures for positive management of a potentially negative situation.

Drug Abuse in the Hospitality Industry

Drug and alcohol abuse in the hospitality industry is an ongoing problem, reflective of business as a whole. A series of surveys were conducted at national drug rehabilitation centers seeking information from patients currently or formerly employed in the hotel and restaurant industry. The author identifies a number of problem indicators and makes recommendations relevant to resolutions.

Covalent protein adduction by drugs of abuse

Recreational abuse of the drugs cocaine, methamphetamine, and morphine continues to be prevalent in the United States of America and around the world. While numerous methods of detection exist for each drug, they are generally limited by the lifetime of the parent drug and its metabolites in the body. However, the covalent modification of endogenous proteins by these drugs of abuse may act as biomarkers of exposure and allow for extension of detection windows for these drugs beyond the lifetime of parent molecules or metabolites in the free fraction. Additionally, existence of covalently bound molecules arising from drug ingestion can offer insight into downstream toxicities associated with each of these drugs. This research investigated the metabolism of cocaine, methamphetamine, and morphine in common in vitro assay systems, specifically focusing on the generation of reactive intermediates and metabolites that have the potential to form covalent protein adducts. Results demonstrated the formation of covalent adduction products between biological cysteine thiols and reactive moieties on cocaine and morphine metabolites. Rigorous mass spectrometric analysis in conjunction with in vitro metabolic activation, pharmacogenetic reaction phenotyping, and computational modeling were utilized to characterize structures and mechanisms of formation for each resultant thiol adduction product. For cocaine, data collected demonstrated the formation of adduction products from a reactive arene epoxide intermediate, designating a novel metabolic pathway for cocaine. In the case of morphine, data expanded on known adduct-forming pathways using sensitive and selective analysis techniques, following the known reactive metabolite, morphinone, and a proposed novel metabolite, morphine quinone methide. Data collected in this study describe novel metabolic events for multiple important drugs of abuse, culminating in detection methods and mechanistic descriptors useful to both medical and forensic investigators when examining the toxicology associated with cocaine, methamphetamine, and morphine.

The effectiveness of female -sensitive substance abuse treatment

This research investigated whether female-sensitive treatment was more effective than a traditional mixed-gender modal. The study participants were evaluated for levels of depression, self-esteem, social support, and presence and severity of addiction. Analyses were conducted to see which demographic, treatment, and service variables were associated with treatment survival rates. It was found that the chemical dependent treatments evaluated all produced equally ineffective results. The women surveyed did have significantly high levels of depression and presence and severity of addiction, yet moderate levels of self-esteem and social support. A mixed-gender chemical dependency model which provided mental health services focusing on depression was recommended. Ancillary services which provided self-esteem building and social support was also suggested. ^

Predictors of client retention in alternative -to -prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. ^ The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. ^ Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy. ^

Patriarchal ideology and frequency of partner abuse among men in batterer treatment groups

This research examined the relative influence of a number of factors, patriarchal ideology, age, socio-economic status, partner relationship, and problem behaviors on the frequency of partner abuse. Patriarchal ideology as measured by the Attitudes Toward Women Scale (AWS), and the Inventory of Beliefs about Wife Beating (IBWB) among men in batterer treatment programs did not have the strong influence expected on whether men in treatment are more frequent abusers of their partners. Instead, having a criminal record and having been identified as having a substance abuse problem stood out as being the most influential factors associated with frequent partner abuse. Questionnaires were administered to 283 men in batterer treatment programs in Dade County Florida who volunteered to participate in the study. Specifically, men in batterer groups who scored low on the AWS or high on the IBWB indicating an adherence to patriarchal ideology were predicted to report more frequent abuse of their partners. Conversely, men in treatment who scored high on the AWS or low on the IBWB indicating a tendency towards a non-patriarchal ideology were predicted to report less frequent abuse. ^