Acceptance and Commitment Therapy: Increasing Psychologists' Willingness to Assess and Treat Substance-abusing Clients.

The high prevalence of substance abuse in the United States and the low rates of assessment and treatment of these disorders by mental health providers points to a growing need to understand the factors that prevent substance-abusing individuals from receiving adequate services. Psychologists are one group of mental health providers that show little interest in working with this population and receive little research attention on the topic. This paper explores the potential role that education, previous experience, and the impact that holding stigmatizing beliefs towards substance-abusing individuals has on psychologists' willingness to provide clinical services for clients struggling with addiction. Acceptance and Commitment Therapy (ACT) is explored as a potential intervention for psychologists.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in Sao Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special programfor victimized children in Sao Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth

The List of Social Situation Problems: Reliability and validity in an adolescent Spanish-speaking sample

The aim of this study was to analyze the psychometric properties of the Spanish translation of the List of Social Situation Problems (LSSP; S. H. Spence, 1980). The questionnaire was administered to a sample of 388 adolescents between the ages of 12 and 18. Exploratory factor analysis identified four factors: Social Anxiety, Adult Oppositional, Assertiveness, and Making Friends, which accounted for 26.64% of the variance. Internal consistency of the total scale was high (alpha = .86). Correlations between the LSSP and two self-report measures of social anxiety, the Questionnaire about Interpersonal Difficulties for Adolescents (r = .45) and the Social Phobia and Anxiety Inventory (r = .48), were statistically significant. A significant difference was found between LSSP total scores for adolescents with and without social anxiety (d = 1.14), supporting the construct validity of the scale.

DASA youth study on substance use : comparing the 1990, 1993, and 1995 studies /

"Funding for this report was provided by a contract with the Illinois Department of Alcoholism and Substance Abuse"--P. ii.

Attachment in relation to affect regulation and interpersonal functioning among substance use disorder inpatients

Attachment theory has been conceptualised as an affect regulation theory, proposing that attachment is associated with the expression and recognition of emotions as well as interpersonal functioning. Previous research has reported affect regulation difficulties in substance use disorders and addiction has been considered an attachment disorder. However, scarce empirical research exists on the relationship of attachment in relation to affect regulation and interpersonal functioning in those with substance use problems. Thus, the objective of the present study was to investigate potential associations between attachment, negative mood regulation (NMR) expectancies, fear of intimacy and self-differentiation in substance abusers. The revised adult attachment scale (RAAS), the NMR expectancies scale, the fear of intimacy scale and the differentiation of self inventory were administered to a sample of 100 substance use disorder inpatients. Attachment accounted for significant variance in NMR expectancies and was also a strong predictor of fear of intimacy. The predictive utility of attachment also extended to self-differentiation, suggesting that attachment was strongly related to overall self-differentiation score, Emotional reactivity, Emotional cut-off and I position. These findings support attachment theory suggesting that attachment is associated with and predicts affect regulation abilities and difficulties in interpersonal functioning in a sample of substance use disorder inpatients. The inclusion and assessment of attachment appears to be important in the development of treatment programmes for substance abusing individuals.

Pathways to health : Determinants of health, health behaviour and health inequalities in early adulthood

There is increasing evidence that the origins of poor adult health and health inequalities can be traced back to circumstances preceding current socioeconomic position and living conditions. The life-course approach to examining the determinants of health has emphasised that exposure to adverse social and economic circumstances in earlier life or concurrent adverse circumstances due to unfavourable living conditions in earlier life may lead to poor health, health-damaging behaviour, disease or even premature death in adulthood. There is, however, still a lack of knowledge about the contribution of social and economic circumstances in childhood and youth to adult health and health inequalities, and even less is known about how environmental and behavioural factors in adulthood mediate the effects of earlier adverse experiences. The main purpose of this study was to deepen our understanding of the development of poor health, health-damaging behaviours and health inequalities during the life-course. Its aim was to find out which factors in earlier and current circumstances determine health, the most detrimental indicators of health behaviour (smoking, heavy drinking and obesity as a proxy for the balance between nutrition and exercise), and educational health differences in young adults in Finland. Following the ideas of the social pathway theory, it was assumed that childhood environment affects adult health and its proximal determinants via different pathways, including educational, work and family careers. Early adulthood was studied as a significant phase of life when many behavioural patterns and living conditions relevant to health are established. In addition, socioeconomic health inequalities seem to emerge rapidly when moving into adulthood; they are very small or non-existent in childhood and adolescence, but very marked by early middle age. The data of this study were collected in 2000 2001 as part of the Health 2000 Survey (N = 9,922), a cross-sectional and nationally representative health interview and examination survey. The main subset of data used in this thesis was the one comprising the age group 18 29 years (N = 1,894), which included information collected by standardised structured computer-aided interviews and self-administered questionnaires. The survey had a very high participation rate at almost 90% for the core questions. According to the results of this study, childhood circumstances predict the health of young adults. Almost all the childhood adversities studied were found to be associated with poor self-rated health and psychological distress in early adulthood, although fewer associations were found with the somatic morbidity typical of young adults. These effects seemed to be more or less independent of the young adult s own education. Childhood circumstances also had a strong effect on smoking and heavy drinking, although current circumstances and education in particular, played a role in mediating this effect. Parental smoking and alcohol abuse had an influence on the corresponding behaviours of offspring. Childhood circumstances had a role in the development of obesity and, to a lesser extent, overweight, particularly in women. The findings support the notion that parental education has a strong effect on early adult obesity, even independently of the young adult s own educational level. There were marked educational differences in self-rated health in early adulthood: those in the lowest educational category were most likely to have average or poorer health. Childhood social circumstances seemed to explain a substantial part of these educational differences. In addition, daily smoking and heavy drinking contributed substantially to educational health differences. However, the contribution of childhood circumstances was largely shared with health behaviours adopted by early adulthood. Employment also shared the effects of childhood circumstances on educational health differences. The results indicate that childhood circumstances are important in determining health, health behaviour and health inequalities in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing the unfortunate pathways leading to the development of poor health, health-damaging behaviour and health inequalities. It is crucially important to recognise the needs of children living in adverse circumstances as well as children of substance abusing parents. In addition, single-parent families would benefit from support. Differences in health and health behaviours between different sub-groups of the population mean that we can expect to see ever greater health differences when today s generation of young adults grows older. This presents a formidable challenge to national health and social policy as well as health promotion. Young adults with no more than primary level education are at greatest risk of poor health. Preventive policies should emphasise the role of low educational level as a key determinant of health-damaging behaviours and poor health. Keywords: health, health behaviour, health inequalities, life-course, socioeconomic position, education, childhood circumstances, self-rated health, psychological distress, somatic morbidity, smoking, heavy drinking, BMI, early adulthood

The relative influence of social support, rehabilitation program participation, and inmate preincarceration characteristics on incarcerated substance abusers' perceptions of adjustment to community reintegration

This dissertation identifies, examines, and assesses the relative influence of identified empirically and conceptually relevant variables on incarcerated substance abusers' expectations of postrelease adjustment. A purposive sampling procedure was used to recruit 101 male and female substance-abusing offenders participating in prison- and jail-based drug treatment programs in south Florida. A 92-item survey questionnaire was used to collect basic demographic data; measure inmate preincarceration characteristics, social support, and rehabilitation program participation; and record archival data. Regression equations were developed utilizing ten different measures of the participants' expectations of their postrelease adjustment. Two equations yielded statistically significant F ratios; maintaining a stable living and maintaining abstinence. Twenty-two percent of the variance in respondents' expectations of maintaining a stable living was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 1.89; df = 13,87; p $<$.05). The only significant predictor variable was perception of social support (b = $-$.05; t = $-$3.6; p $<$.001). Twenty-three percent of the variance in respondents' expectations of maintaining abstinence from substances was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 2; df = 13,87; p $<$.05). Once again, the only significant predictor variable was perception of social support. The results of the analyses indicate that social support was the only important variable for understanding these respondents' efficacy expectations of postrelease abstinence and stable living. The results of this investigation demonstrate the complexity of the social support variable for prisoners, and identify social support as a potential rehabilitative resource for substance-abusing inmates. The results of this investigation underscore the importance of continued, detailed empirical study in order to understand and clarify how social support, efficacy expectations, and actual postrelease performance interrelate for this population of offenders.

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.

Substance use and sexual risk behaviors among adolescent detainees

There is a commonly presumed link among sexual risk behavior, substance use, and other psychosocial factors among adolescents. However, these relationships have been relatively understudied in detained, low-income, minority, substance abusing adolescents. This study addresses this gap in the literature with a secondary data analysis based on a sample of adolescent offenders in two detention and treatment centers in Miami-Dade County. Univariate, bivariate statistical analysis and multivariate logistic regressions were conducted on baseline data from structured interviews with 455 adolescents participating in an NIH funded prevention intervention. Data were analyzed to assess relationships among self-reported substance use, STD history, HIV/AIDS knowledge, condom use, condom use attitudes, and skills, peer and parental approval to use condoms, and race/ethnicity. The adolescent sample was 74.1% male, and 25.9% female and 35.4% African American, 25.1% non-African American Latino, 11.2% White, and 28.4% of other race/ethnicity categories. The mean age was 15.6 years. Results suggested that alcohol use (p < 0.001) and use of marijuana, cocaine and other drugs (p < 0.001) are significant variables when explaining the variability in sexual risk behaviors. Results also suggested that unprotected vaginal, anal, and oral sex increased with higher alcohol and drug use (p < 0.001) and that positive attitudes about personally using condoms (p < 0.001) were also significantly related to condom use. Logistic regressions showed that race/ethnicity was a significant control variable when explaining the variability of condom use. Being White and Latino were significantly associated with less condom use during oral and anal sex when compared to other racial/ethnic groups. These results indicated that risky sexual behavior and HIV infection risk are significantly associated with substance use, particularly alcohol use. Therefore, proper screening and identification of alcohol use, and condom use attitudes could maximize the efficacy of referrals to programs targeting both issues and increase the potential for appropriate primary and secondary prevention and treatment among adolescent detainees.

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. ^

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.

Symposium - How effective are brief motivational interviewing interventions : Are they necessary? Do they require enhancement? Can they be translated into routine clinical practice?

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. Design and methods: This study aimed to determine how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change among adults with comorbid depression and alcohol misuse (n=202) participating in a clinical trial. The primary focus was on changes in Beck Depression Inventory fastscreen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. Results: There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Discussion and Conclusion: Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity...

Patterns and correlates of tobacco use among young adults at college and university

This thesis describes college and university students' smoking behaviours and examines whether socioenvironmental and personal characteristics experienced during adolescence are differentially associated with their smoking participation. Results show more college students than university students currently smoke (37% and 21 % respectively) and more began smoking prior to post-secondary school (93% and 84% respectively). Early age of onset of alcohol use increased the odds of current smoking (main effect model, OR = 8.56 CI = 6.47, 11.33), especially for university students (interaction effect model, b = 2.35 CI = 7.50, 14.64). Lower levels of high school connectedness were associated with increased odds of current smoking but for university students only (interaction effect model, b = -0.15 CI = 0.84, 0.88). While limitations associated with convenience sampling and low response rate exist, this is the first Canadian study to examine college and university students separately. I t reveals that tobacco control programming needs to differ for college and university students, and early alcohol prevention and school engagement programs for adolescents may influence tobacco use. Given that both educational pathway and use of tobacco are associated with SES, future research may consider examining in more detail, SES-related socioenvironmental variables.

Perspectives des libérés conditionnels présentant une double problématique de délinquance et de consommation d'alcool et/ou de drogues

Rapport de stage présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de Maîtrise en criminologie