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Rivera D, Dueker D, Amaro H. Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:21. [PMID: 33653374 PMCID: PMC7927366 DOI: 10.1186/s13011-021-00357-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
Background Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. Trial registration ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.
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Affiliation(s)
- Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA, 90089, USA.
| | - Donna Dueker
- Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Miami, FL, 33199, USA
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2
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Little JD. On being paternalistic. Australas Psychiatry 2020; 28:164-166. [PMID: 31564132 DOI: 10.1177/1039856219878641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE What does 'being paternalistic' mean? CONCLUSION Being paternalistic embodies a complex set of ideas that are currently viewed pejoratively, but which retain at its core, the goal of doing something good.
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Affiliation(s)
- John D Little
- Consultant Psychiatrist, Kapiti Community Mental Health Team, Paraparaumu, New Zealand
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Hachtel H, Vogel T, Huber CG. Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors. Front Psychiatry 2019; 10:219. [PMID: 31031658 PMCID: PMC6474319 DOI: 10.3389/fpsyt.2019.00219] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/26/2019] [Indexed: 12/23/2022] Open
Abstract
Court-mandated treatments imply a dual role for therapy providers not only of caring for, but also of having control over, involuntary clients. The impact of legal coercion on the therapeutic relationship and feelings of stigma is widely regarded as negative and detrimental for treatment outcomes. This point of view stands in contrast to advocates of the perspective that involuntary treatment can ameliorate social functioning and thus promote a better quality of life. Regarding other outcome measures, there is evidence that offender treatment is effective and leads to reduced recidivism in criminal behavior. This narrative review provides an overview of research assessing the effects of mandatory treatment on therapeutic process and outcome factors. We conclude that legal mandatory treatment does not have to necessarily result in perceived coercion and reduced satisfaction with treatment and that a caring and authoritative treatment style aids a favorable therapeutic alliance, motivation, and therapy outcomes.
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Affiliation(s)
- Henning Hachtel
- Forensic Department, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Tobias Vogel
- Forensic Department, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
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Cosden M, Sanford A, Koch LM, Lepore CE. Vicarious trauma and vicarious posttraumatic growth among substance abuse treatment providers. Subst Abus 2018; 37:619-624. [PMID: 27163485 DOI: 10.1080/08897077.2016.1181695] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Practitioners working with clients who have experienced trauma are vulnerable to experiencing both vicarious trauma and vicarious posttraumatic growth (PTG). A survey was conducted in which treatment providers who work with adults seeking help for substance abuse were asked about their experience of vicarious trauma and vicarious PTG. It was hypothesized that vicarious trauma and vicarious PTG would be positively associated with each other, that personal history of trauma and years of working with clients who had experienced trauma would be positively associated with vicarious trauma, and that in addition to those variables, personal counseling, training, and supervision would be associated with vicarious PTG. METHODS Surveys were sent to the directors of 15 social service agencies in one county in central California. Surveys included questions about the respondent's history of substance use and trauma and experience with clients who had experienced trauma. In addition, the survey contained 3 scales: the Trauma History Screen, the Posttraumatic Growth Inventory, and the Impact of Event Scale-Revised. RESULTS Survey data were obtained from 51 counselors. There was a significant positive association between vicarious trauma and vicarious PTG, and both were significantly associated with respondents' history of trauma. Providers who were in recovery were more likely than others to report a history of trauma and to report higher levels of vicarious trauma and vicarious PTG. CONCLUSION Counselors working with clients in substance abuse treatment may experience vicarious trauma and vicarious PTG. Implications for preparing counselors to work with this population are discussed.
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Affiliation(s)
- Merith Cosden
- a Department of Counseling , Clinical and School Psychology, University of California Santa Barbara , Santa Barbara , California , USA
| | - Ashley Sanford
- a Department of Counseling , Clinical and School Psychology, University of California Santa Barbara , Santa Barbara , California , USA
| | - Lauren M Koch
- a Department of Counseling , Clinical and School Psychology, University of California Santa Barbara , Santa Barbara , California , USA
| | - Caitlin E Lepore
- a Department of Counseling , Clinical and School Psychology, University of California Santa Barbara , Santa Barbara , California , USA
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5
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Cimino AN, Mendoza N, Nochajski TH, Farrell MG. Examining the Relationship between Psychological Functioning, Childhood Trauma, and Types of Perceived Coercion Among Drug Court Enrollees: Results from A Pilot Study. COGENT PSYCHOLOGY 2017; 4. [PMID: 31008146 PMCID: PMC6474663 DOI: 10.1080/23311908.2017.1320859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Drug court interventions produce positive results—especially among mandated populations. Many criminal justice-involved persons, including drug court enrollees, have cooccurring substance abuse and childhood trauma disorders associated with psychological dysfunction. Given the coercive nature of mandated drug court treatment, it is important to understand whether childhood trauma and psychological functioning influence perceived coercion to enter treatment. Objectives: The purpose of this study was to describe the degree to which adverse childhood trauma and psychological functioning were associated with six domains of perceived coercion— self, family, legal, financial, health, and work—among a population of drug court enrollees. Methods: Data from 54 enrollees in a drug court pilot study were used to examine the relationship between childhood trauma, psychological functioning, and perceived coercion. Results: The pilot study data showed that psychological dysfunction and traumatic experiences in childhood were associated with higher perceived coercion to treatment, explaining 29% of the variance in coercion, controlling for gender and pre-arrest alcohol and drug use. Results indicated that the associations between psychological dysfunction and trauma were driven by non-legal types of coercion. In particular, childhood trauma was correlated with family (r = .32), financial (r = .32), and health (r = .47) types of coercion. Conclusions: Based on these preliminary findings, drug court practitioners are urged to assess perceived coercion, in addition to the behavioral health and childhood trauma of their clients, and to utilize non-legal types of coercion such as family, health, and financial impact to enhance treatment engagement.
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Affiliation(s)
- Andrea N Cimino
- Faculty Research Associate, Johns Hopkins University, School of Nursing, The State University of New York
| | - Natasha Mendoza
- Assistant Professor, Arizona State University, School of Social Work, The State University of New York
| | - Thomas H Nochajski
- Research Professor, Buffalo Center for Social Research, University at Buffalo, The State University of New York
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Cosden M, Larsen JL, Donahue MT, Nylund-Gibson K. Trauma symptoms for men and women in substance abuse treatment: a latent transition analysis. J Subst Abuse Treat 2014; 50:18-25. [PMID: 25306228 DOI: 10.1016/j.jsat.2014.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 11/17/2022]
Abstract
Differences in trauma symptoms among men and women in two court-involved substance abuse treatment programs were examined using latent transition analysis (LTA). It was hypothesized that women would be more likely to report clinical-level trauma symptoms than would men, but that both groups would show reductions in symptoms over time. Symptom classifications were determined by the LTA. Scores on the Trauma Symptom Inventory (TSI) were obtained on 381 program participants, 112 men and 269 women, at intake and after 6 months in treatment. Three ordered classes were obtained for men and women at each time point: non-clinical (no TSI scales elevated), moderate symptoms (1 or 2 scales elevated) and severe symptoms (all scales elevated). Men were more likely to be represented in the non-clinical class at intake, while women had higher representation in the severe symptoms classification. There was a reduction of trauma symptoms for most men and women, but some groupings had symptoms that remained the same or became worse over time. Using gender and trauma-symptoms to help determine interventions is discussed.
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Affiliation(s)
- Merith Cosden
- Department of Counseling, Clinical & School Psychology, University of California Santa Barbara, Santa Barbara, CA 93106, USA.
| | - Jessica L Larsen
- Department of Counseling, Clinical & School Psychology, University of California Santa Barbara, Santa Barbara, CA 93106, USA
| | - Megan T Donahue
- Department of Counseling, Clinical & School Psychology, University of California Santa Barbara, Santa Barbara, CA 93106, USA
| | - Karen Nylund-Gibson
- Department of Education, University of California Santa Barbara, Santa Barbara, CA 93106, USA
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Larsen JL, Nylund-Gibson K, Cosden M. Using latent class analysis to identify participant typologies in a drug treatment court. Drug Alcohol Depend 2014; 138:75-82. [PMID: 24598121 DOI: 10.1016/j.drugalcdep.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/04/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Drug treatment courts serve a diverse population of adults. While all have engaged in criminal activities and have substance abuse problems, participants vary in the intensity of their problems as well as related concerns in other domains of functioning which also may require intervention. The purpose of this study was to identify differences among participants, which could have implications for the effectiveness of drug treatment courts. METHODS Latent class analysis (LCA) was used to identify subgroups from a sample of over 1000 adults attending two drug treatment courts in central California. Indicators measuring substance abuse, motivation for treatment, mental health concerns, education, employment, medical concerns, social supports, and demographic characteristics were obtained from the Addiction Severity Index while measures of prior criminal activity and treatment outcomes were obtained from probation; all were entered into the LCA. RESULTS The LCA yielded three groups, which were labeled a Psychological Problems group, an Early Delinquent group, and a Subthreshold Need group. Significant differences in graduation and recidivism rates were found across these groups, with the Early Delinquent group demonstrating the poorest outcomes. CONCLUSIONS This study provides evidence that there are significant differences among subgroups of drug treatment court participants. Implications for alternate treatment approaches based on participant characteristics are discussed.
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Affiliation(s)
- Jessica L Larsen
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA 93106, United States
| | - Karen Nylund-Gibson
- Department of Education, University of California, Santa Barbara, CA 93106, United States
| | - Merith Cosden
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA 93106, United States.
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Tamm L, Trello-Rishel K, Riggs P, Nakonezny PA, Acosta M, Bailey G, Winhusen T. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder. J Subst Abuse Treat 2012; 44:224-30. [PMID: 22889694 DOI: 10.1016/j.jsat.2012.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/19/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with substance use disorder (SUD) and is associated with poor substance-use treatment outcomes. A trial evaluating osmotic-release oral system methylphenidate (OROS-MPH) for adolescents with ADHD and SUD, concurrently receiving behavioral therapy, revealed inconsistent medication effects on ADHD or SUD. Clinical care for this population would be advanced by knowledge of treatment outcome predictors. Data from the randomized placebo-controlled trial (n = 299) were analyzed. Significant treatment predictors included: 1) Substance use severity, associated with poorer ADHD and SUD outcomes, 2) ADHD severity, associated with better ADHD and SUD outcomes, 3) comorbid conduct disorder, associated with poorer ADHD outcomes, and 4) court-mandated status, associated with better SUD outcomes but poorer treatment completion. An interaction effect showed that OROS-MPH improved SUD outcomes in adolescents with comorbid conduct disorder compared to placebo. While severe SUD may require more intensive psychosocial treatment, OROS-MPH may improve substance treatment outcomes in adolescents with co-morbid attention and conduct problems.
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Affiliation(s)
- Leanne Tamm
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Torchalla I, Nosen L, Rostam H, Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. J Subst Abuse Treat 2012; 42:65-77. [DOI: 10.1016/j.jsat.2011.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/23/2011] [Accepted: 09/15/2011] [Indexed: 01/08/2023]
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Peltan JR, Cellucci T. Childhood sexual abuse and substance abuse treatment utilization among substance-dependent incarcerated women. J Subst Abuse Treat 2011; 41:215-24. [DOI: 10.1016/j.jsat.2011.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 03/08/2011] [Accepted: 03/28/2011] [Indexed: 11/15/2022]
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Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. J Subst Abuse Treat 2011; 40:397-404. [DOI: 10.1016/j.jsat.2011.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/23/2010] [Accepted: 01/06/2011] [Indexed: 11/18/2022]
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