Victoria L. Brown and Micah A. Riley.  Social support, drug use, and employment among low-income women.  American Journal of Drug and Alcohol Abuse 31(2):203-223, March 2005.

Summary: Social support and its association with employment, income, and drug use was examined in a 2-year study of low-income women (N = 534). Functional support was defined as the perceived quality of one's interactions with others. Structural support was defined as the number of individuals within social, employment, drug, close, and emergency networks. Over the study period, significant increases were observed in hours worked, income from work, income from other sources, and total income. There was also a significant decrease in welfare income. Results suggest that the perceived quality of support received is an important factor in achieving positive employment outcomes. NIAAA Glossary Terms :  social support, employment, income, AOD use, income effect, poverty, interpersonal interaction, welfare recipient, female, human study

Sherry Lipsky, Raul Caetano, Craig A. Field, and Shahrzad Bazargan.  The role of alcohol use and depression in intimate partner violence among black and Hispanic patients in an urban emergency department.  American Journal of Drug and Alcohol Abuse 31(2):225-242, March 2005.

Summary: The role of alcohol use and depression in intimate partner violence (IPV) victimization and perpetration was assessed in a cross-sectional study of blacks and Hispanics in an underserved urban emergency department (ED) population. Male and female patients presenting to an urban emergency department were surveyed. The outcome measures were physical or sexual IPV victimization and perpetration in the previous 12 months. The independent predictors included demographic variables, alcohol and drug use, and depressive symptoms. Logistic regression analyses were used to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for predictors of IPV victimization and perpetration in separate models. The prevalences of IPV victimization among Blacks and Hispanics were similar (14% and 10% respectively) but blacks were nearly twice as likely to report IPV perpetration (17% versus 9%. Predictors of IPV perpetration were Black race, married or living with a partner, heavy drinking, illicit drug use, and current depression. Depression, but not substance use, also predicted IPV victimization, in addition to Black race, married or living with a partner, and younger age. The authors conclude that screening for substance abuse and depression in an inner city ED population may help to identify individuals at high risk of IPV, particularly IPV perpetration. NIAAA Glossary Terms :  emotional and psychiatric depression, alcoholic beverage, AOD use, heavy AOD use, illicit drug, violence, spouse or significant other, spouse abuse, sexual abuse, marital conflict, cohabitation of unmarried partners, victimization, Black, Hispanic, emergency care, survey, risk analysis, risk factors, relative risk, statistical association, predictive factor, regression analysis, demographic characteristics, prevalence, human study

Wesley E. Hawkins, Carl Latkin, and Diane L. Green.  Depression therapy with injection drug users: Results of a pilot study.  American Journal of Drug and Alcohol Abuse 31(2):243-251, March 2005.

Summary: A pilot study was conducted to determine if a depression therapy component to reduce depressive symptoms in injection drug users should be added as an adjunct to a social-network human immunodeficiency virus (HIV) risk reduction program.This article reports the study's methods, results, and conclusions. The major conclusion was that depression therapy appears to be effective in reducing depressive symptoms in injection drug users and should be tested to improve treatment outcome of depressed drug users participating in HIV risk reduction programs. NIAAA Glossary Terms :  emotional and psychiatric depression, symptom severity, intravenous drug user, human immunodeficiency virus, treatment outcome, prevention program, human study

Eva M. Shipp, Susan R. Tortolero, Sharon P. Cooper, Elizabeth G. Baumler, and Nancy F. Weller.  Substance use and occupational injuries among high school students in South Texas.  American Journal of Drug and Alcohol Abuse 31(2):253-265, March 2005.

Summary: The association between self-reported nonfatal occupational injuries and self-reported general use of substance was examined in a cross-sectional study of high school students (N = 3,365) in South Texas. Data for the study were collected using a self-administered, anonymous questionnaire. The independent variables included alcohol, marijuana, cocaine, inhalant, and steroid use. The dependent variable was occupational injury. Odds ratios (ORs) were calculated using logistic regression, with adjustment for grade, sex, ethnicity, and work intensity. Supporting an association with each substance, odds ratios consistently strengthened as use increased. The associations for inhalant (OR = 5.61) and steroid (OR = 7.63) use argue for their inclusion in future research, which the authors conclude is merited given the small number of previous studies. NIAAA Glossary Terms :  workplace accident, injury, AOD use, self report, cross-sectional study, high school student, adolescent, questionnaire, alcoholic beverage, marijuana in any form, cocaine, inhaled substance, anabolic steroids, risk analysis, risk factors, relative risk, regression analysis, human study

John W. Welte, Grace M. Barnes, Joseph H. Hoffman, William F. Wieczorek, and Lening Zhang.  Substance involvement and the trajectory of criminal offending in young males.  American Journal of Drug and Alcohol Abuse 31(2):267-284, March 2005.

Summary: The influence of substance involvement on the trajectory of delinquency was investigated in males aged 16–19 (N = 625) in Buffalo, New York, who were interviewed three times at 18-month intervals. Hierarchical linear models were fit separately for respondents with increasing and declining delinquency. In the group with increasing delinquency, alcohol involvement was associated with a higher starting point (intercept), and alcohol dependence and drug consequences were associated with a faster increase. In the group with declining delinquency, alcohol dependence and drug consequences were associated with a higher starting point, and frequency of drug use was associated with a slower decline. Alcohol involvement is important in the early delinquent career whereas illicit drug use delays maturing out of delinquency. In a further analysis, substance involvement variables were time-varying covariates in the within-subjects model and controls in the between-subjects model. Respondents' alcohol and other drug use varied across time in synchrony with their criminal offending. NIAAA Glossary Terms :  juvenile delinquency, underage AOD use, underage drinking, adolescent, young adult, AOD dependence, AOD associated consequences, AOD use frequency, alcoholic beverage, illicit drug, controlled study, interview, regression analysis, criminality, human study

Jeffrey S. Simons, Raluca M. Gaher, Gerard A. Jacobs, David Meyer, and Erika Johnson-Jimenez.  Associations between alcohol use and PTSD symptoms among American Red Cross disaster relief workers responding to the 9/11/2001 attacks.  American Journal of Drug and Alcohol Abuse 31(2):285-304, March 2005.

Summary: Associations between alcohol use and post-traumatic stress disorder (PTSD) symptoms were examined among Red Cross workers who responded to the September 11, 2001 attacks against the United States. The participants were Red Cross paid and volunteer staff (N = 6,055; 64% women) who responded during the first 3 months. Participants were randomly assigned to receive one of four questionnaire packets. This study is based on the fourth group, who received the alcohol questionnaires. Overall, PTSD symptoms and alcohol use were low. Hyperarousal and intrusion symptoms on the Impact of Events Scale - Revised (IES-R) were associated with alcohol consumption, hazardous alcohol consumption, and change in alcohol consumption when controlling for age, gender, and worksite. Positive associations between Intrusion and Avoidance scores and hazardous consumption were stronger for younger participants. Individuals who reported increasing or decreasing alcohol use had higher IES-R scores than those who maintained their normal rate of alcohol consumption, though effects were stronger for increasing alcohol use. Associations between alcohol variables and avoidance symptoms were minimal. The results suggest the existence of a functional relation between posttraumatic stress symptoms and alcohol consumption. The study indicates that efforts to cope with traumatic stress symptoms may manifest in either increased or decreased alcohol consumption. NIAAA Glossary Terms :  AOD consumption, trauma, posttraumatic stress disorder, survey, questionnaire, hazardous drinking, age differences, human study

Sheila Sarkar, Marie Andreas, and Fabio de Faria.  Who uses safe ride programs: An examination of the dynamics of individuals who use a safe ride program instead of driving home while drunk.  American Journal of Drug and Alcohol Abuse 31(2):305-325, March 2005.

Summary: Even though a majority of people have either been a designated driver or used one, most designated drivers have still consumed some alcohol. Another safety option is a safe ride program in which a free safe ride is offered by taxis or volunteers. One such program offers a ride home for both the driver and the driver's vehicle. This investigation examined the population who uses such a program, using data from two studies from two major California cities (N = 1,985; 1,206 male, 744 female) in which the volunteer drivers gathered data during their rounds (between January 2002 and September 2002). If the current safe ride program not been in place, 632 participants (44%) reported that they would have driven themselves home. Use of back roads in the past to avoid being stopped by the police was reported by 582 participants (40%); on average they used back roads 3.4 times in the past month. When asked about having control over not drinking and driving 455 participants (32%) said they felt they did not have control over the choice to avoid drinking and driving. Participants who reported having driven back roads in the past to avoid confrontation with the police after drinking had significantly higher estimated blood alcohol concentrations than those who said they had never done so. NIAAA Glossary Terms :  safety, designated driver, alcohol safety action program, highway safety, drinking and driving, impaired driver, survey, law enforcement, human study

David Teplin, Barak Raz, Jeff Daiter, Michael Varenbut, Constantine T Zachos, Paul Whang, Stan Herman, Saj Chaudry, and Manuel Yung,  Measurement of symptom withdrawal severity in a 24-hour period after the anesthesia-assisted rapid opiate detoxification procedure.  American Journal of Drug and Alcohol Abuse 31(2):327-335, March 2005.

Summary This study examined  withdrawal symptom severity within a 24-hour period after use of the anesthesia-assisted rapid detoxification (AAROD) procedure. The Clinical Opiate Withdrawal Scale (COWS) was used at various time intervals after detoxification. The study demonstrated that all patients who underwent the AAROD procedure had post-detoxification withdrawal symptoms in the mild range of severity, unlike traditional detoxification procedures. The authors recommend further studies to measure withdrawal symptoms longer than 24 hours after detoxification and to compare the differences between various detoxification protocols. NIAAA Glossary Terms :  AOD withdrawal syndrome, symptom severity, anesthesia, detoxification, treatment method, treatment outcome, self report, human study

Mary-Lynn Brecht, M. Douglas Anglin, and Michelle Dylan.  Coerced treatment for methamphetamine abuse: Differential patient characteristics and outcomes.  American Journal of Drug and Alcohol Abuse 31(2):337-356, March 2005.

Summary: The increased prevalence of methamphetamine use and the associated social costs (e.g., crime and child abuse and neglect) have led to a growing number of methamphetamine users being mandated to substance abuse treatment by the criminal justice system (CJS) or child protective service (CPS) agencies. However, empirical evidence remains sparse about treatment outcomes specifically for methamphetamine users who report that their treatment admission occurred under such pressures. This analysis used natural history interview data from 350 clients treated for methamphetamine use in Los Angeles County to examine clients' self-reported CJS/CPS pressure to enter treatment, comparing background and treatment characteristics and selected treatment outcomes across groups defined by existence of such perceived pressure and source of pressure. Approximately half the clients reported legal pressure to enter the index (used for sampling) treatment episode. Those reporting pressure were younger, less likely to have received residential treatment, and had longer treatment episodes than those not reporting pressure. Outcomes (treatment completion, relapse within 6 months, time to relapse, and percentage of days with methamphetamine use in 24 months following treatment) did not differ significantly in simple comparisons between the pressured and nonpressured groups. However, when client and treatment characteristics were controlled, the short term outcome of relapse within 6 months was worse for those reporting legal pressure. Outcomes did not differ by source of pressure. NIAAA Glossary Terms :  methamphetamine, AODR crime, child abuse, justice system, mandatory treatment, treatment outcome, interview, case history, self report, treatment completion, AODD relapse, age differences, comparative study, controlled study, human study

Matthew L Hiller, J. Matthew Webster, Egle Narevic, Michele Staton, Thomas F Garrity, and Carl Leukefeld.  Prisoners with substance abuse and mental health problems: Use of health and health services.  American Journal of Drug and Alcohol Abuse 31(1):1-20, January 2005.

Summary: Because relatively little is known about the health or health services use of prison and jail inmates with substance abuse and mental health problems, this study focused on prison inmates who reported receiving a prior diagnosis from a physician or psychologist of (1) substance abuse problems only, (2) mental health problems only, and (3) substance abuse plus mental health problems. A fourth group of prisoners who reported no diagnoses was included as the “no problems” group. The groups were compared on reports of lifetime health problems, use of preventive health services, and use of medical services. Prisoners in group 3, the substance abuse and mental health problems group, were found to have the most serious health problems profiles. Use of preventive health services was similar across all four groups, but the substance abuse and mental health problems group reported significantly greater use of emergency room care and more hospital stays both for their lifetime and in the year prior to their current incarceration. The policy and practical relevance of the findings are discussed. NIAAA Glossary Terms :  jail inmate, physical health, health care utilization, AOD abuser, mentally ill, mental health, medical history, diagnosis, prevention program, comparative study, controlled study, human study

John M Roll, Joy E Chudzynski, and Gina Richardson.  Potential sources of reinforcement and punishment in a drug-free treatment clinic: Client and staff perceptions.  American Journal of Drug and Alcohol Abuse 31(1):21-33, January 2005.

Summary: Contingency management interventions are quite successful at initiating abstinence from drugs of abuse but are often criticized because of their perceived cost. One way to reduce the cost of these interventions would be to use nonmonetary sources of reinforcement or punishment. A number of reports have discussed the availability of potential sources of reinforcement in opiate replacement clinics. This report describes the availability of potential sources of reinforcement and punishment available in drug-free treatment programs. Both clients and clinic staff rated a number of items on their potential reinforcing and punishing efficacy. Results suggest that there are several sources of reinforcement and punishment available in drug-free clinics that could be used in contingency management programs. The results also suggest that the clinic staff perceives potential sources of punishment as more aversive than do the clients. NIAAA Glossary Terms :  contingency management , AOD abstinence, AODR behavioral problem, treatment cost, treatment program, reinforcement, aversion conditioning, aversion therapy, human study

Andrew Rosenblum, Jeffrey Foote, Charles Cleland, Stephen Magura, Daneyal Mahmood, and Nicole Kosanke.  Moderators of effects of motivational enhancements to cognitive behavioral therapy.  American Journal of Drug and Alcohol Abuse 31(1):35-58, January 2005.

Summary: Patient treatment matching hypotheses were tested for substance users randomly assigned to group cognitive behavioral therapy (n  = 114) or group motivational intervention (n  = 116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15-week follow-up, the study predicted that alexithymia, antisocial personality disorder, and network support for alcohol and drug use would be associated with less substance use for cognitive behavioral therapy subjects and that hostility and lower treatment motivation would be associated with less substance use for group motivational intervention subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and antisocial personality disorder. The results indicate the use of assessing specific patient attributes to inform treatment recommendations. NIAAA Glossary Terms :  patient-treatment matching, hypothesis testing, cognitive therapy, behavioral therapy, motivation, motivational interviewing, group therapy, predictive factor, alexithymia, antisocial personality disorder, social support, clinical study, human study

Thomas E Hanlon, Kevin E O'Grady, Terry Bennett-Sears, and Jason M Callaman.  Incarcerated drug-abusing mothers: Their characteristics and vulnerability.  American Journal of Drug and Alcohol Abuse 31(1):59-77, January 2005.

Summary: There has been substantial growth in recent years in the number of mothers with histories of drug addiction who are incarcerated, yet little is known about their unique characteristics and vulnerability. This study therefore examined data on incarcerated drug-abusing mothers (N = 167) from Baltimore City who had volunteered for a parenting program offered at a Maryland correctional facility. Prior to entering the program, mothers who consented to participate completed a battery of assessment measures, which included an extensive interview covering their early developmental and current experiences, along with standardized instruments measuring psychological adjustment and parenting satisfaction. Data analysis focused on the link between risk/protective factor information drawn from the early development experiences of the mothers and their current adjustment status. Significant relationships were found between higher risk levels and less favorable current adjustment. Implications of the study findings for prevention and clinical intervention efforts targeting both mothers and their children are discussed. NIAAA Glossary Terms :  jail inmate, mother, AOD dependent, AOD abuser, addiction, interview,  individual needs assessment, patient history, psychological assessment, case history, parent-child relations, satisfaction, risk factors, protective factors, prevention, intervention (persuasion to treatment), human study

Thomas J McMahon, Justin D Winkel, Suniya S Luthar, and Bruce J Rounsaville.  Looking for Poppa: Parenting status of men versus women seeking drug abuse treatment.  American Journal of Drug and Alcohol Abuse 31(1):79-91, January 2005.

Summary: Individuals seeking methadone maintenance treatment were surveyed to document the parenting status of drug-dependent men and clarify ways their status as parents differs from that of drug-dependent women. Data on demographic characteristics, drug abuse history, and parenting status were systematically coded from the medical records of men (n = 362) and women (n = 162) seeking methadone maintenance treatment during a 12-month period. Analysis of parenting status by gender indicated that, although a greater proportion of women were the parent of at least one biological child, there were actually more fathers than mothers within the cohort. Among the parents, fathers were more likely to have been abusing opioids when they first became a parent, and they were more likely to be living away from their children. There were no significant gender differences in the number of children or the average age of children. The results suggested that fathering may be an important, but largely neglected, treatment issue for drug-abusing men. NIAAA Glossary Terms :  methadone, drug therapy, AOD abuse, AOD dependence, parent, parental AOD use, cohort study, opioids, opiates, gender differences, father, mother, treatment issues, human study

Joseph Westermeyer and Paul Thuras.  Association of antisocial personality disorder and substance disorder morbidity in a clinical sample.  American Journal of Drug and Alcohol Abuse 31(1):93-110, January 2005.

Summary: The aims were to determine whether patients with substance use disorder (SUD) and concurrent antisocial personality disorder (ASPD), in comparison with SUD patients without ASPD,exhibit less, the same, or more of the following: (1) temporal course of substance use, (2) severity of substance-related symptoms and problems, (3) familial SUD, (4) number and type of SUD diagnoses, and (5) extent of SUD treatment. Scheduled interviews using standard diagnostic criteria were used to determine ASPD. The participants were voluntary patients (N = 606) aged ≥18 years who met criteria for SUD and were enrolled in an alcohol-drug treatment program. Patients with SUD plus ASPD reported more substance-related problems in 7 of 8 areas of the interview-based Minnesota-Substance Abuse Problems Scale. The ASPD group reported slightly, but significantly, more relatives with SUD and greater lifetime use of tobacco and most illicit drugs. Age at first use of alcohol and tobacco was lower in the ASPD group, but the two groups did not differ in age at first use of other substances and in indicators of SUD course, such as years of use, days of use in the last year, duration of periods of abstinence, and number of self-help efforts. Although types and numbers of SUD diagnoses did not differ, all treatment indicators (i.e., lifetime number of admissions, modalities of care, days of care, and cost of care) were significantly higher in the ASPD group. Regression analysis revealed that family and legal problems remained strongly associated with ASPD, but other substance-related problems and SUD treatment dropped out. Despite the many similarities in SUD among those with and without ASPD, the morbidity in the ASPD group was considerably greater. Legal and family problems appear to be powerfully associated with ASPD and predictive of other problems as well as SUD treatment. NIAAA Glossary Terms :  AODR disorder, antisocial personality disorder, dual diagnosis, comorbidity, disease course, symptom severity, problem severity, family AODU history, treatment program, psychiatric status rating scales, tobacco in any form, illicit drug, regression analysis, legal issues, treatment cost, treatment model, AOD abstinence, family dysfunction, program dropout, statistical association, morbidity, predictive factor, comparative study, human study

Eric E. McCollum, Thorana S. Nelson, Robert A. Lewis, and Terry S. Trepper.  Partner relationship quality and drug use as predictors of women's substance abuse treatment outcome.  American Journal of Drug and Alcohol Abuse 31(1):111-127, January 2005.

Summary: The effect of relationship quality and partner's drug use on treatment outcomes was examined in women enrolled in outpatient drug treatment. The study sample consisted of predominately heterosexual couples where the female partner was in drug treatment. Both the partners' perception of relationship quality and the interaction of female client and her partner's perception of relationship quality were significant predictors of the client's posttest report of days of drug use during the previous 30 days. Interestingly, clients reported more days of drug use when their partners reported higher relationship quality. A similar pattern was found with the Addiction Severity Index Drug composite score as the dependent variable except that the interaction term was not significant in that analysis. In addition, partners' relationship quality scores were associated with female clients' treatment completion. A higher proportion of women whose partners reported higher relationship quality failed to complete treatment. Partners' reports of pretest and posttest drug use were not related to women's treatment outcomes. NIAAA Glossary Terms :  AOD dependent, AOD dependence, addiction, outpatient care, female, spouse or significant other, marital relations, marital satisfaction, AOD use, AOD abuse, treatment outcome, predictive factor, treatment completion, treatment factors, human study

Susan L. Ames, S. Sussman, C. W. Dent, and A. W. Stacy.  Implicit cognition and dissocative experiences as predictors of adolescent substance use.  American Journal of Drug and Alcohol Abuse 31(1):129-162, January 2005.

Summary: The authors evaluated the mediating role of implicit cognitive processes in the prediction of alcohol and marijuana use and examined the relationships between dissociative experiences, implicit processes, and sensation seeking in models of drug use and problem experiences. The participants were diverse at-risk adolescents (N = 467) in California. Results from latent variable models revealed that implicit cognition independently predicted alcohol and marijuana use and mediated the predictive effects of sensation seeking on drug use. Dissociative experiences did not predict implicit cognition or drug use, but they significantly predicted problem experiences and were positively correlated with sensation seeking. The results provide further evidence suggesting that implicit, associative memory processes are influential in drug-use motivation. NIAAA Glossary Terms :  evaluation study, AOD use, alcoholic beverage, marijuana in any form, predictive factor, cognitive process, sensation-seeking behavior, AODR disorder, motivation, human study

Josephine M Hawke, Joseph Hennen, and Peter Gallione.  Correlates of therapeutic involvement among adolescents in residential drug treatment.  American Journal of Drug and Alcohol Abuse 31(1):163-177, January 2005.

Summary: Although therapeutic involvement and the services that clients receive during treatment are among the best predictors of treatment retention and consequently better posttreatment outcomes, relatively few empirical studies have examined therapeutic involvement among adolescents in drug treatment. This study employed factor analysis with maximum likelihood extraction and oblique rotation using data on adolescent clients (N = 185) in five adolescent residential drug-treatment programs in New Jersey. Pearson's correlation coefficients and multivariate linear regression were used to explore the utility of using existing measures of therapeutic involvement developed on adult populations to examine the correlates of therapeutic involvement among adolescents. The majority of subjects (85%) were between 16 and 18 years of age (mean, 17 years), 79% were male, 20% were Hispanic, 36% were African-American, and 46% were Caucasian. Working alliance, self-esteem, spirituality, deviance, and substance use problem severity were associated with therapeutic involvement. There was evidence that there may be important subgroup gender and ethnic differences. Further research on the interplay between these factors, therapeutic involvement, and recovery among adolescents can inform the development of strategies to enhance the engagement and retention of adolescents in drug treatment. NIAAA Glossary Terms :  AOD dependence, adolescent, patient compliance, patient attitude toward treatment, adolescence, treatment outcome, factor analysis, regression analysis, AODD treatment unit, treatment program, residential facility, therapeutic community, problem severity, gender differences, ethnic differences, patient retention, human study

Natasha Slesnick and Jillian Prestopnik.  Dual and multiple diagnosis among substance using runaway youth.  American Journal of Drug and Alcohol Abuse 31(1):179-201, January 2005.

Summary: Although research on runaway and homeless youth is increasing, relatively little is known about the diagnostic profile of runaway adolescents. This study examined patterns of psychiatric dual and multiple diagnosis among a sample (N  = 226) of treatment-engaged substance-abusing youth (ages 13 to 17) who were residing at a shelter for runaways. As part of a larger treatment outcome study, the youths' psychiatric status was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-based computerized diagnostic interview schedule for children (CDISC). The majority of the sample (60%) met criteria for dual or multiple diagnosis with many (56%) having more than one substance-use diagnosis. The severity of mental-health and substance-use problems in this sample of substance-abusing runaways suggests the need for continued development of comprehensive services. The observed range and intensity of diagnoses indicates a need for greater focus on treatment development and strategies to address their multiple areas of risk. NIAAA Glossary Terms :  adolescent, adolescence, runaway youth, homeless, homelessness, AOD abuse, AOD abuser, AODR disorder, dual diagnosis, multiple pathologies, comorbidity, psychiatric status rating scales, diagnosis, psychodiagnostic interview, multiple drug use, human study

Cathy G. Cooke, Michelle L. Kelley, William Fals-Stewart, and James Golden.  A Comparison of the Psychosocial Functioning of Children with Drug- versus Alcohol-Dependent Fathers.  American Journal of Drug and Alcohol Abuse  30(4):695-710, November/December 2004.

Summary: The psychosocial functioning of children whose fathers primarily abused illicit drugs other than alcohol (n = 51) was compared with the psychosocial functioning of children from a demographically matched sample of families whose fathers abused alcohol (n = 51). Children with drug-abusing fathers exhibited significantly more negative child behaviors on a standardized child-rating scale than children from homes with alcohol-abusing fathers. A significantly greater proportion of children with drug-abusing fathers also met clinical cutoffs indicative of psychosocial impairment (n = 23; 45%) than children with alcohol-abusing fathers (n = 5; 10%). Mediation analyses indicated that severity of drug, legal, medical, employment, and family problems partially mediated the relationship between type of family (i.e., families with fathers who had an alcohol problem versus families with fathers who had a drug problem) and children's psychosocial adjustment. NIAAA Glossary Terms:  psychosocial environment, father, child, AOD abuse, illicit drug, alcoholic beverage, parent-child relations, childhood behavioral problem, AODR family problems, family AODU history, children of alcoholics, family dysfunction, disease severity, legal issues, employment status, medically necessary care, physical health, social adjustment, emotional adjustment, psychological development, comparative study, human study

Judith Landau, M. Duncan Stanton, David Brinkman-Sull, David Ikle, David McCormick, James Garrett, Gloria Baciewicz, Robert R. Shea, Ashley Browning, and Frederick Wamboldt.   Outcomes with the ARISE Approach to Engaging Reluctant Drug- and Alcohol-Dependent Individuals in Treatment.   American Journal of Drug and Alcohol Abuse  30(4):711-748, November/December 2004.

Summary: This study examined the effectiveness of a manual-driven, timely response method for helping “concerned others” get resistant substance abusers into treatment or self-help with minimum professional time/effort. The manual-driven protocol, “A Relational Sequence for Engagement (ARISE),” was applied at two upstate New York outpatient drug/alcohol clinics. Participants were concerned others who called regarding a cocaine, alcohol, or “other drug” abuser (N = 110), family and friends, and 110 substance abusers. The ARISE protocol is a graduated approach, starting with the least demanding option/stage and increasing effort as needed to engage substance abusers in treatment/self-help. Stage I: Coaching the concerned other to arrange a meeting of significant others, inviting the substance abuser; Stage II: 1 to 5 additional meetings (median = 2); Stage III: A modified Johnson “Intervention.” Primary outcome variables were substance abuser engagement (or not) in treatment/self-help; days between first call and engagement; clinician time/effort. Predictors were concerned other, substance abuser, and clinician demographics; number of participants per case; and Collateral Addiction Severity Index. ARISE produced an 83% success rate (55% at Stage I). Median days to engagement was 7 (IQR = 2 to 14). Average total time (telephone, sessions) per case was 1.5 hours. Treatment was selected by 95% and self-help by 5%. Number of family/friends involved correlated (r = 0.69) with a success/efficiency index. In conclusion, ARISE provides an effective, swift, and cost-efficient option for engaging substance abusers in treatment or self-help. The more significant others involved, the greater the success of treatment engagement. NIAAA Glossary Terms:  intervention (persuasion to treatment), AOD abuse, cocaine, alcoholic beverage, illicit drug, mutual help and support group, spouse or significant other, friend, family support, correlation analysis, demographic characteristics, caregiver, treatment factors, treatment outcome, cost-effectiveness, human study

Katherine E. Watkins, Sarah B. Hunter, Suzanne L. Wenzel, Wenli Tu, Susan M. Paddock, Anne Griffin, and Patricia Ebener.  Prevalence and Characteristics of Clients with Co-Occurring Disorders in Outpatient Substance Abuse Treatment.  American Journal of Drug and Alcohol Abuse  30(4):749-764, November/December 2004.

Summary: The prevalence of probable mental health disorders was estimated among clients entering outpatient substance abuse treatment. The clinical characteristics of these patients and their past access to substance abuse and mental health care were also assessed. The subjects (N = 415) were entrants in three publicly funded outpatient substance abuse treatment facilities in Los Angeles County who were screened for a probable mental health disorder. Of the 210 persons (just over 50%) who screened positive for a probable mental health disorder, 195 (93%) were interviewed. The most common disorders were depression and anxiety, and more than a third had two or more probable disorders. Nearly 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. These results indicate high rates of co-occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access. NIAAA Glossary Terms:  mental health, mentally ill, prevalence, comorbidity, dual diagnosis, AOD abuse, AOD dependence, AODD treatment unit, outpatient care, identification and screening for actual disorder, interview, cocaine, crack cocaine, emotional and psychiatric depression, anxiety, addiction, health care availability and access, human study

Debra S. Harris, Steven L. Batki, and S. Paul Berger.  Fluoxetine Attenuates Adrenocortical but Not Subjective Responses to Cocaine Cues.  American Journal of Drug and Alcohol Abuse  30(4):765-782, November/December 2004.

Summary: Preclinical studies with rodents suggest a link between stress reactivity and cocaine self-administration. Serotonin appears to modulate the hypothalamic-pituitary-adrenal (HPA) axis. The present study examined the effects of chronic treatment with the serotonin reuptake inhibitor fluoxetine (40 mg/day) on subjective and hormonal responses to cocaine cues in 22 subjects participating in a controlled clinical trial for cocaine dependence. Fluoxetine antagonized the cue-induced increase in cortisol but increased subjects' ratings of the likelihood of cocaine use in response to cocaine cues. Cortisol response to cocaine cues was not related to subjective craving. Activation of the HPA axis by cocaine cues does not appear to be a necessary mediator of cue-induced craving. NIAAA Glossary Terms:  cocaine, self administration of drugs, stress, cue reactivity, serotonin, hypothalamic-pituitary-adrenal axis, serotonin uptake inhibitors, fluoxetine, subjective variables, hormones, antagonists, cortisol, AOD craving, human study

Janetta M. Astone, Shiela M. Strauss, Holly Hagan, and Don C. Des Jarlais.  Outpatient Drug Treatment Program Directors' Hepatitis C-Related Beliefs and Their Relationship to the Provision of HCV Services.  American Journal of Drug and Alcohol Abuse  30(4):783-797, November/December 2004.

Summary: Infection with hepatitis C virus (HCV) is especially prevalent among drug-abusers, who therefore need access to HCV testing and medical care. Drug treatment programs are well situated to provide these services. Because directors of drug treatment programs are gatekeepers who can influence decisions about service provision, their beliefs about the value of providing particular services for drug treatment program patients are of considerable importance. This article reports findings from an in-depth telephone survey conducted with directors of 121 outpatient drug treatment program throughout the United States. The survey included questions on directors' beliefs about providing HCV services in drug treatment programs. An eight-item scale was constructed to examine these beliefs and their relationship with the actual HCV services offered. Overall, directors were moderately supportive of providing HCV medical services (on-site or through referral) during drug treatment. The findings indicate a positive significant relationship between director's beliefs and the provision of HCV antibody testing, follow-up testing, and the provision of HCV medication. NIAAA Glossary Terms:  hepatitis C virus, viral hepatitis, prevalence, AOD abuse, AOD dependence, addiction, AODD treatment unit, survey, treatment program, treatment provider characteristics, health care availability and access, antibodies, drug therapy, human study

Christiane Brems, Mark E. Johnson, David Neal, and Melinda Freemon.  Childhood Abuse History and Substance Use Among Men and Women Receiving Detoxification Services.  American Journal of Drug and Alcohol Abuse  30(4):799-821, November/December 2004.

Summary: Data collected from women and adolescents indicate a strong link between substance abuse and a history of being abused in childhood. This study investigated whether the same pattern exists across genders and types of abuse. The participants were 274 women and 556 men receiving detoxification services. Results revealed 20% of men and over 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae regardless of gender. Individuals with abuse history reported earlier age of drinking onset; more problems associated with use of alcohol or drugs; more severe psychopathology; and more lifetime arrests, arrests related to substance use, and arrests related to mental health. The authors urge prevention and proactive intervention activities to prevent negative sequelae of childhood victimization. NIAAA Glossary Terms:  abused as child, AOD abuse, sexual abuse, child abuse, victim of abuse, early AODU onset, problematic AOD use, AODR disorder, pathologic process, disease severity, DWI arrest, mental health, gender differences, detoxification, human study

Robert J. Craig and Ronald E. Olson.  Predicting Methadone Maintenance Treatment Outcomes Using the Addiction Severity Index and the MMPI-2 Content Scales (Negative Treatment Indicators and Cynicism Scales).  American Journal of Drug and Alcohol Abuse  30(4):823-839, November/December 2004.

Summary: This study evaluated the ability of the Minnesota Multiphasic Personality Inventory-2 Content Scales (Negative Treatment Indicators [TRT] and Cynicism [CYN]) and the domain scales of the Addiction Severity Index (ASI) to predict outcomes in a methadone maintenance program. The participants were African American males (N = 109) in a Veterans Administration outpatient methadone maintenance program who were followed for up to 1 year after admission. Six dependent variables were measured: (1) length of stay; (2) percentage of missed medication days; (3) toxicology urine samples free from illicit drugs; (4) full-time employment; (5) attendance at scheduled counseling sessions; and (6) counselor ratings of patient progress. Stepwise linear regression indicated that low drug severity scores on the ASI and low scores on percentage of missed medication predicted patients who were clean a year later; low scores on the psychological domain of the ASI predicted attendance at counseling sessions; a discriminant function analysis (consisting of percent of missed medication, percentage of clean urines, and ratings of patient progress) successfully predicted patient status (dropouts versus “active patients”) with 85% accuracy. Although the TRT and CYN were related to some ASI domains, they were not associated with any outcome variable. Results suggest that some ASI scores serve as important indicators of patient progress in methadone maintenance treatment. NIAAA Glossary Terms:  personality inventory, treatment outcome, methadone, treatment and maintenance, drug therapy, AOD dependence, addiction, opiates, illicit drug, African American, veteran, patient compliance, length of stay, urinalysis, employed, counseling, regression analysis, predictive factor, outpatient care, human study

Joan F. Epstein, Laurel L. Hourani, and David C. Heller.  Predictors of Treatment Receipt Among Adults with a Drug Use Disorder.  American Journal of Drug and Alcohol Abuse  30(4):841-869, November/December 2004.

Summary: Data from the 2000 and 2001 National Household Surveys on Drug Abuse were used to examine factors that contribute to the receipt of specialty substance abuse treatment, defined as treatment in rehabilitation facilities, hospitals, or mental health centers designed to help stop or reduce drug use. The study population was a nationally representative sample of 3,291 adults aged 18 or older with a drug use disorder in the past 12 months. Data were collected by computer-assisted interviews. Descriptive analyses and multivariate logistic regression models were used to compare sociodemographic, substance abuse, and psychosocial characteristics of those receiving treatment with those not receiving treatment. Factors that influenced treatment receipt were also examined, with control for potential confounders. Characteristics significantly contributing to treatment receipt among adults with a drug use disorder included the following: (1) a woman without social support; (2) a high school graduate with no college education; (3) those receiving insurance through Medicaid or a state Children's Health Insurance Program; (4) those on probation, parole, or supervised release in the past year; (5) a daily smoker of cigarettes; (6) those meeting at least three criteria for drug dependence; (7) those having past year dependence on or abuse of alcohol; and (8) those receiving any mental health treatment or counseling in the past year. Adults involved with the criminal justice system had a different pattern of treatment predictors from those who were not. NIAAA Glossary Terms:  household survey, interview, rehabilitation, hospital, mental health care, AOD dependence, AOD abuse, AODD treatment unit, treatment factors, regression analysis, confounding variable, gender differences, social support, educational level, high school student, Medicaid, health insurance, probation, parolee, cigarette, smoking, diagnostic criteria, justice system, psychosocial environment, alcoholic beverage, human study

Kitty S. Chan, Suzanne Wenzel, Maria Orlando, Chantal Montagnet, Wallace Mandell, Kirsten Becker, and Patricia Ebener.  How Important are Client Characteristics to Understanding Treatment Process in the Therapeutic Community?  American Journal of Drug and Alcohol Abuse  30(4):871-891, November/December 2004.

Summary: Therapeutic communities (TCs) have been shown to be effective at improving posttreatment outcomes for substance abusers, but little is known about the in-treatment experience for clients with different backgrounds, experiences, and needs. This study examined the in-treatment experience for different clients by exploring the relationships between treatment process and client characteristics. A comprehensive measure of treatment process, operationalized as Community Environment and Personal Change and Development and Change was administered to 447 adults and 148 adolescents in treatment at community-based TC programs in New York, California, and Texas. Demographic characteristics, substance use and treatment history, and client risk factors were extracted from intake interviews and analyzed separately for adolescent and adult residents. Multivariate general linear models were used to examine the effect of client variables on treatment process, after controlling for treatment duration and program effects. Within adult programs, clients who were 25 years or older, female, and had a prior drug treatment experience had higher Community Environment scores. Adolescents with one or more arrests within the past 2 years had lower scores on both process dimensions of Community Environment and Personal Development and Change. The findings indicate the need to understand why adult clients who are younger, male, and have no prior treatment history and adolescent clients with recent arrests reported lower ratings of treatment process. Future research should also examine the role of modifiable mediators so that appropriate strategies to enhance therapeutic engagement may be developed as necessary. NIAAA Glossary Terms:  therapeutic community, residential care, AOD dependence, AOD abuse, treatment factors, treatment outcome, demographic characteristics, individual differences, age differences, gender differences, adult, adolescent, history of AOD use, case history, arrest, survey, questionnaire, human study

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