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Bibliography #7 – Substance Use Disorders
– May 2007
 printer-friendly
version | back
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 Order #: 15361
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Authors: |
Dickson-Gomez,
J., Convey, M., Hilario, H., Cortbett, A.M., Weeks, M.
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Title: |
Unofficial Policy: Access to Housing, Housing
Information, and Social Services Among Homeless Drug Users in Hartford,
Connecticut. |
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Source: |
Substance Abuse Treatment,
Prevention, and Policy 2:8, 2007. (Journal
Article: 14 Pages)
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Abstract: |
This paper will look at
the "unofficial" housing policies that affect drug users' access
to housing. Much research has shown
that the homeless have higher rates of substance abuse problems than
housing populations and that substance abuse increases individuals'
vulnerability to homelessness.
However, the effects of housing policies on drug users' access to
housing have been understudied to date.
Qualitative interviews were conducted with 65 active users of heroin
and cocaine at baseline, 3 and 6 months.
Participants were purposively sampled to reflect a variety of
housing statuses including homeless on the streets, in shelters,
"doubled-up" with family and friends, or permanently housed in
subsidized, unsubsidized, or supportive housing. Key informant interviews and two focus
group interviews were conducted with 15 housing caseworkers. Data were analyzed to explore the
processes by which drug users receive information about different housing
subsidies and welfare benefits, and their experiences in applying for
these. A number of unofficial policy
mechanisms limit drug users' access to housing, information and services,
including limited outreach to non-shelter using homeless regarding housing
programs, service provider priorities, and service provider discretion in
processing applications and providing services. Unofficial policy, i.e. the mechanisms
used by caseworkers to ration scarce housing resources, is as important as
official housing policies in limiting drug users' access to housing. Drug users' descriptions of their
experiences working with caseworkers to obtain permanent, affordable
housing, provide insights as to how access to supportive and subsidized housing
can be improved for this population (authors). |
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Order #: 15336 |
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Authors: |
Post, P.,
Perret, Y., Anderson, S., Dalton, M., Zevin, B.
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Title: |
Documenting Disability for Persons with Substance
Use Disorders and Co-occurring Impairments: A Guide for Clinicians. |
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Source: |
Nashville: National Health
Care for the Homeless Council, Inc., 2007. (Guide:
42 pages)
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Abstract: |
This guide was written to
assure that individuals with substance use disorders and co-occurring
impairments that meet Social Security disability criteria receive Federal
disability assistance under the Supplemental Security Income (SSI) program
or the Social Security Disability Insurance (SSDI) program. The guide
focuses on the complex issues involved in documenting impairments that co-occur
with substance use disorders - particularly for homeless SSI/SSDI
applicants, who are more likely than those with stable housing to be denied
benefits for procedural rather than medical reasons (authors). Available
From: HCH Clinicians' Network, National Health Care for the Homeless
Council, Inc., P.O. Box 60427, Nashville, TN, 37206-0427, Phone: (615)
226-2292, www.nhchc.org/Publications (COST: $10.00). |
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Order #: 15142 |
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Authors: |
Burnam,
A., Watkins, K.
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Title: |
Substance Abuse with Mental Disorders: Specialized
Public Systems and Integrated Care. |
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Source: |
Health Affairs 25(3):
648-658, 2006. (Journal Article: 10 pages)
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Abstract: |
Separate public financing
and regulation of substance (SA) abuse treatment distinct from mental
health (MH) treatment preserves a focus on the special needs of those with
substance abuse but creates challenges to providing appropriate care for
the large number of people with co-occurring conditions. This paper review
recent efforts to overcome these challenges through clinical and systems
approaches that better integrate care. Although much progress has been made
for some subgroups of people with co-occurring disorders, further efforts
to develop and sustain clinically integrated service delivery approaches
within separate systems, particularly in SA treatment settings, are needed
(authors). |
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Order #: 15362 |
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Authors: |
Chassler,
D., Lundgren, L., Lonsdale, J.
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Title: |
What Factors are Associated with High-Frequency
Drug Treatment Use Among a Racially and Ethnically Diverse Population of
Injection Drug Users? |
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Source: |
American Journal on
Addictions 15(6): 440-449, 2006. (Journal
Article: 10 Pages)
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Abstract: |
This study explored the
frequency of drug treatment utilization by 36,081 injection drug users
(IDUs) in Massachusetts, 1996-2002.
A number of multiple and logistic regression analyses examined the
relationship between demographic characteristics, parental status, level of
and type of drug use, history of mental health treatment use, types of drug
treatment entered, and the number of times and IDU had entered drug
treatment for the seven-year time period.
Homelessness, using heroin as the primary drug of choice, and health
insurance status were all associated with number of treatments
entered. Logistic regression analysis
identified that health insurance was a key factor associated with more
frequent treatment: those with private health insurance were ten times more
likely to be in the 90th percentile (12-107 entries) with respect to the
number of treatment entries (authors).
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Order #: 15019 |
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Authors: |
Essock,
S. M., Mueser, K. T., Drake, R. E., Covell, N. H., McHugo, G. J., Frisman,
L. K., Kontos, N. J., Jackson, C. T., Townsend, F., Swain, K.
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Title: |
Comparison of ACT and Standard Case Management for
Delivering Integrated Treatment for Co-Occurring Disorders. |
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Source: |
Psychiatric Services
57(2):185-196, 2006. (Journal Article:
12 pages)
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Abstract: |
This study compared
integrated treatment delivered within two different models of
community-based case management (assertive community treatment and standard
clinical case management). A total
of 198 clients in two urban sites who had co-occurring disorders and were
homeless or unstably housed were randomly assigned to one of two treatment
conditions and were followed for three years. Participants in both treatment conditions
improved over time in multiple outcome domains, and few differences were
found between the two models. Decreases in substance use were greater than
would be expected given time alone.
At the site that had higher rates of institutionalization, clients
who received standard case management were more likely to be
institutionalized. However, in the
site that had lower rates of institutionalization, no differences in the
rate of institutionalization were found between the two treatment
conditions. Integrated treatment can
be successfully delivered either by assertive community treatment or by
standard clinical case management (authors). |
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Order #: 15233 |
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Authors: |
Greig,
R.L., Baker, A., Lewin, T.J., Webster, R.A., Carr, V.J.
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Title: |
Long-term Follow-up of People With Co-existing
Psychiatric and Substance Use Disorders: Patterns of Use and Outcomes. |
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Source: |
Drug and Alcohol Review
25: 249-258, 2006. (Journal Article: 10 pages)
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Abstract: |
This article states that
the aims of this study were to document long-term patterns of substance use
among people with co-existing psychiatric and substance use disorders and
to explore differences in psychosocial outcomes for groups with different
substance use outcome profiles (persistent hazardous, intermittent
hazardous and non-hazardous users). An opportunistic long-term (4-6 years)
follow-up interview was conducted with participants from a previous study
who were recruited during their inpatient admission at a public psychiatric
hospital in Newcastle, New South Wales, Australia. Follow-up data were
obtained from 47 people from the original study and combined with their
existing baseline, 6-month and 12-month data. The follow-up interview
included demographic variables and measures of substance use, psychiatric
symptomatology and a range of psychosocial variables. Alcohol, cannabis and
amphetamines were the most commonly misused substances. Persistent
hazardous users experienced poorer outcomes in the domains of social
functioning and psychiatric symptomatology, including depression, than
intermittently hazardous or non-hazardous users. An unusually high
mortality rate of 10% among the males in the original sample (12/120) was
an unexpected finding, particularly as this was likely to be an
underestimate. Given the differences in outcomes between groups with varied
gradations of substance use, a harm minimization approach for research and
practice among people with co-existing psychiatric and substance use disorders
is endorsed (authors). |
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Order #: 14897 |
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Authors: |
Institute
of Medicine.
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Title: |
Improving the Quality of Health Care for Mental and
Substance Use Conditions: Quality Chasm Series. |
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Source: |
Washington DC: Institute
of Medicine, 2006. (Executive Summary:
40 Pages)
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Abstract: |
This report examines the
distinctive characteristics of health care for mental and substance-use
conditions, including payment, benefit coverage, and regulatory issues, as
well as health care organization and delivery issues. Each year, more than
33 million Americans receive health care for mental or substance-use
conditions, or both. Together, mental and substance-use illnesses are the
leading cause of death and disability for women, the highest for men ages
15-44, and the second highest for all men. Effective treatments exist, but
services are frequently fragmented and, as with general health care, there
are barriers that prevent many from receiving these treatments as designed
or at all. The consequences of this are serious for these individuals and
their families; their employers and the workforce; for the nation's
economy; as well as the education, welfare, and justice systems. This new
volume in the Quality Chasm series puts forth an agenda for improving the
quality of this care based on this analysis. Patients and their families,
primary health care providers, specialty mental health and substance-use
treatment providers, health care organizations, health plans, purchasers of
group health care, and all involved in health care for mental and substance
use conditions will benefit from this guide to achieving better care
(authors). Available From: Institute of Medicine, National Academies Press, 500 Fifth Street NW, Washington DC 20001, (202) 334-2352, iomwww@nas.edu, www.iom.edu |
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Order #: 15192 |
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Authors: |
Qureshi,
S., Tyler, D., Post, P.
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Title: |
Hypertension and Homelessness: What Interferes with
Treatment. |
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Source: |
Homeless Health Care Case
Report: Sharing Practice-Based Experience 2(2): 1-6, 2006. (Journal Article: 6 Pages)
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Abstract: |
This article examines the
factors that interfere with the treatment of hypertension and other
cardiovascular diseases in homeless adults, who are two-to-four times more
likely to have these afflictions at younger ages than either the general
population or low-income adults with stable housing. Among the factors that increase their
risk are poor diet and excessive use of alcohol, nicotine and other drugs
that exacerbate heart attack and stroke, or kidney failure. Management of cardiovascular diseases is
particularly challenging for individuals who are homeless. Dietary limitations, transience, and
co-occurring behavioral disorders exacerbate hypertension and frequently
interfere with treatment adherence and lifestyle modifications. Approximately one in three homeless
Americans has a substance use disorder, compared to one in five adults in
the general population. Nonadherance
is one of the most difficult challenges that clinicians face in caring for
displaced individuals, as this case vividly illustrates (authors). |
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Order #: 15395 |
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Authors: |
Substance
Abuse and Mental Health Services Administration
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Title: |
Detoxification and Substance Abuse Treatment: A
Treatment Improvement Protocol TIP 45. |
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Source: |
Rockville, MD: Substance
Abuse and Mental Health Services Administration, 2006. (Manual: 168
Pages)
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Abstract: |
This TIP is a revision of
TIP 19, Detoxification From Alcohol and Other Drugs, and was created by a
panel of experts with diverse experience in detoxification
services-physicians, psychologists, counselors, nurses, and social workers.
This revision provides up-to-date information about changes in the role of
detoxification in the continuum of services for patients with substance use
disorders, increased knowledge of physiology of withdrawal, pharmacological
advances in the management of withdrawal, patient placement procedures, and
new issues in the management of detoxification services within
comprehensive systems of care. It also expands on the administrative,
legal, and ethical issues commonly encountered in the delivery of
detoxification services and suggests performance measures of detoxification
programs (authors). |
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Order #: 14509 |
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Authors: |
Bernstein,
J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., Hingson, R.
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Title: |
Brief Motivational Intervention at a Clinic Visit
Reduces Cocaine and Heroin Use. |
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Source: |
Drug and Alcohol
Dependence 77(1): 49-59, 2005. (Journal
Article: 11 Pages)
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Abstract: |
This study looks at brief
intervention, which has been effective for alcohol misuse, but not
adequately tested in the clinical setting with drug using patients. This
study tested the impact of a single, structured encounter targeting
cessation of drug use, conducted between peer educators and
out-of-treatment cocaine and heroin users screened in the context of a
routine medical visit. A randomized,
controlled trial was conducted in inner-city teaching hospital outpatient
clinics with 3 and 6 months follow-up by blinded observers. Drug abstinence
was documented by RIA hair testing. Analysis was limited to enrollees with
drug-positive hair at baseline.
Among 23,669 patients screened 5/98-11/00, 1232 were eligible, and
1175 enrolled. Enrollees (mean age 38 years) were 29% female, 62%
non-Hispanic black, 23% Hispanic, 46% homeless. Among those with positive
hair at entry, the follow-up rate was 82%. The intervention group was more
likely to be abstinent than the control group for cocaine alone, heroin
alone, and both drugs, with adjusted OR of 1.51-1.57. Cocaine levels in
hair were reduced by 29% for the intervention group and only 4% for the
control group. Reductions in opiate levels were similar. Brief motivational intervention may help
patients achieve abstinence from heroin and cocaine (authors). |
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Order #: 14731 |
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Authors: |
Bradford,
D.W., Gaynes, B.N., Kim, M.M., Kaufman, J.S., Weinberger, M.
|
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Title: |
Can Shelter-Based Interventions Improve Treatment
Engagement in Homeless Individuals With Psychiatric and/or Substance Misuse
Disorders? |
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Source: |
Medical Care 43(8):
763-768, 2005. (Journal Article: 5 Pages)
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Abstract: |
This study sought to
evaluate the effectiveness of a shelter-based intervention, including
intensive outreach by a psychiatric social worker and availability of
weekly psychiatrist visits with continuity of care to engage homeless
individuals with psychiatric and substance use problems. Individuals
receiving the intervention were more likely to attend and to participate in
a substance abuse program than those in the control group. Shelter-based
interventions hold promise for improving treatment engagement in homeless
populations with psychiatric and substance use problems. Further study
should address how to foster care beyond an initial community mental health
center (CMHC) appointment and clarify key program components using a wider
range of outcome measures (authors).
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Order #: 15079 |
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Authors: |
Brands,
B., Leslie, K., Catz-Biro, L., Li, S.
|
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Title: |
Heroin Use and Barriers to Treatment in
Street-Involved Youth. |
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Source: |
Addiction Research and
Theory 13(5): 477-487, 2005. (Journal
Article: 10 pages)
|
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Abstract: |
High rates of drug use and
risk behaviors have been reported among street involved youth. The present
study examined the drug use and risk behaviors in adolescent heroin users,
assessed motivation for treatment, and identified barriers to accessing
treatment. Forty-nine heroin-using adolescents from four youth community
agencies in Toronto were interviewed.
Participants reported having used, on average, four different
substances in the previous month. Seventy-nine percent had engaged in
injection drug use and of these, 58% had shared their injecting equipment.
Significant gender differences were found in the prevalence of psychiatric
and family problems, the type of drug programs used, and perceived barriers
to treatment. Although more than
half of the sample had sought treatment for their substance use problems
and were knowledgeable about the treatment options available, many believed
factors such as lack of housing, finances, and contact with drug-using
acquaintances would hamper their rehabilitation. Treatment programs for
these youth should include the assessment and treatment of comorbid
psychiatric disorders, and the provision of comprehensive services
including 'safe' housing, vocational guidance and financial supports
(authors). |
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Order #: 14733 |
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Authors: |
Cooper,
H., Moore, L., Gruskin, S., Krieger, N.
|
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Title: |
The Impact of a Police Crackdown on Drug Injectors'
Ability to Practice Harm Reduction: A Qualitative Study. |
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Source: |
Social Science &
Medicine 61(3): 673-684, 2005. (Journal
Article: 9 Pages)
|
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Abstract: |
This paper employs
qualitative methods to explore the ramifications of a police drug crackdown
on drug injectors' ability to practice harm reduction. Between August and
December 2000, the authors conducted open-ended interviews with 40
illicit-drug-injecting residents of a New York City police precinct
undergoing a crackdown. Interview topics included participants' experiences
with police in the precinct and their drug use practices. The analysis
suggests that particular crackdown tactics, notably frequent police
searches of participants' bodies and elevated surveillance of the
precinct's public spaces, reconfigured participants' experiences of their
bodies and the public spaces comprising the precinct in ways that adversely
affected their capacity to engage in harm reduction. Frequent police
searches, for example, discouraged participants from carrying the injection
equipment they needed to ensure that they could inject with a sterile
syringe. Constant monitoring of local public spaces made it difficult for
homeless women and men to inject safely. Simultaneously, participants
expressed support for police actions that reduced public drug activity.
Given these findings, the authors recommend the implementation of
strategies, designed by partnerships of community groups and governmental
and non-governmental organizations, which reduce public drug activity
without imperiling injectors' health. Possible strategies include improving
access to treatment and establishing safe injection spaces (authors). |
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Order #: 14761 |
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Authors: |
Domino,
M.E., Morrissey, J.P., Chung, S., Huntington, N., Larson, M.J., Russell,
L.A.
|
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Title: |
Service Use and Costs for Women with Co-Occurring
Mental Health and Substance Use Disorders and a History of Violence. |
|
Source: |
Psychiatric Services
56(10): 1223-1232, 2005. (Journal Article:
10 pages)
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Abstract: |
This study examined the
12-month cost of the array of services used by women with co-occurring
mental health and substance use disorders and an history of violence and
trauma who participated in the Women, Co-Occurring Disorders, and Violence
Study (WCDVS). The study compared
costs of the intervention and external services for women in the WCDVS
intervention in outpatient and residential settings - which provided
comprehensive, integrated, and trauma-informed services - with the costs
for women in the usual-care comparison group. The study also compared costs with recorded
clinical outcomes. Costs of service
use were examined for 2, 026 women who participated in the WCDVS (N=1,018)
and in the comparison group (N=1,008).
Women were interviewed three, six, nine, and twelve months after
baseline about any service use in the past three months. Costs for these services, along with
indirect costs (participants' time and transportation) were estimated by
using a variety of services. A
number of cost estimates were analyzed by using either ordinary least
squares regression or two-part models.
The average participant had almost $43,000 in costs related to their
service use during the twelve months after baseline. Women in the intervention group had lower
service costs and higher overall costs than those in the comparison group,
but the null hypothesis of no difference in any cost measure between groups
was not rejected. Also, the null
hypothesis of no difference in the probability of accessing services
external to the study intervention was not rejected. Because no differences were detected in
costs but improvements were seen in clinical outcomes, the interventions
offered in the WCDVS may be more efficient than usual care (authors). |
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Order #: 14867 |
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Authors: |
Drake,
R.E., Wallach, M.A., McGovern, M.P.
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Title: |
Future Directions in Preventing Relapse to Substance
Abuse Among Clients with Severe Mental Illnesses. |
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Source: |
Psychiatric Services
56(10): 1297-1302, 2005. (Journal Article:
6 pages)
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Abstract: |
The article reviews the
literature on substance use disorders among persons with severe mental
illnesses, including the other papers in this special section on relapse
prevention, and suggests future directions.
Although prevention of relapse to substance abuse has a
well-developed theoretical and empirical base, this perspective has rarely
been applied to persons with co-occurring severe mental illness. Research indicates that clients with
co-occurring disorders are highly prone to relapse to substance abuse, even
after they have attained full remission.
Their risk factors include exacerbations of mental illness, social
pressures within drug-using networks, lack of meaningful activities and
social supports for recovery, independent housing in high-risk
neighborhoods, and lack of substance abuse or dual diagnosis
treatments. The evidence in hand
suggests several steps: developing health and protective environments that
are experienced as nurturing of recovery; helping people make fundamental
changes to their lives, such as finding satisfying jobs, abstinent friends,
networks of people who are in the process of recovery, and a sense of
meaning; providing specific and individualized treatments for mental
illnesses, substance use disorders, and other co-occurring problems; and
developing longitudinal research on understanding and preventing relapse
that addresses social context as well as biological vulnerabilities and
cognitive strategies (authors). |
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Order #: 14866 |
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Authors: |
Harris,
M., Fallot, R.D., Wolfson Berley, R.
|
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Title: |
Qualitative Interviews on Substance Abuse Relapse
and Prevention Among Female Trauma Survivors. |
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Source: |
Psychiatric Services
56(10); 1292-1296, 2005. (Journal Article:
5 pages)
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Abstract: |
This study examined key
themes in sustaining recovery among women with co-occurring disorders who
had survived trauma. In
semi-structured interviews conducted at one of the nine sites of the Women,
Co-Occurring Disorders, and Violence Study, 27 female trauma survivors
described the influences they considered most important in sustaining and
hindering their recovery, with an emphasis on recovery from substance
abuse. Recurring themes in the
interviews were identified. Four of
these themes supported recovery: connection, self-awareness, a sense of
purpose and meaning, and spirituality.
Three others served as obstacles to recovery: battles with depression
and despair, destructive habits and patterns, and lack of personal
control. The women in this study
reported that, although caring relationships provided important supports
for sustained recovery, some of these same relationships increased emotional
stress and conflict and thus may impede recovery. It is important for women to and
clinicians to place a high priority on the development of boundary
management and relationship skills.
In addition, clinicians need to attend to negative feelings such as
boredom and loneliness and to help women develop a range of meaningful
activities that are consistent with a strong sense of identity. Individual relapse prevention skills by
themselves seem insufficient to sustained abstinence (authors). |
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Order #: 14754 |
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Authors: |
Kertesz,
S.G., Larson, M.J., Horton, N.J., Winter, M., Saitz, R., Samet, J.H.
|
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Title: |
Homeless Chronicity and Health Related Quality of
Life Trajectories Among Adults With Addictions. |
|
Source: |
Medical Care 43(6):
574-585, 2005. (Journal Article: 11 Pages)
|
|
Abstract: |
This study used data from
a 2-year cohort of addicted persons to test whether changes in mental and
physical health-related quality of life (HRQOL) differed according to
homeless chronicity. Using self-reported homelessness, this study
classified subjects as chronically homeless, transitionally homeless, or as
housed comparison subjects. New federal initiatives target funds toward
chronically homeless as distinct from other homeless persons. Few data
exist, however, to substantiate the implications of chronic homelessness
for major health outcomes. The study concluded that chronic homelessness
was associated with especially poor mental but not physical HRQOL over
time. These findings reinforce a new typology of homelessness (authors). |
|
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Order #: 14721 |
|
Authors: |
Lankenau,
S.E., Clatts, M.C., Welle, D., Goldsamt, L.A., Gwadz, M.V.
|
|
Title: |
Street Careers: Homelessness, Drug Use, and Sex
Work Among Young Men Who Have Sex With Men. |
|
Source: |
International Journal of
Drug Policy 16(1): 10-18, 2005. (Journal
Article: 8 Pages)
|
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Abstract: |
This article formulates
the concepts of "street capital" and "street
competencies" to describe how 10 young men who have sex with men
(YMSM) in New York City accumulated various knowledge and skills throughout
their childhood and adolescence, and later entered into homelessness and
the street economy as sex workers. While half of these young men described
themselves as gay or bisexual, sexual identity was not a primary
consideration amongst these youth. All were homeless and/or users of
illegal drugs, and all survived through intimate involvement in the
"street economy" - an informal system of exchange that circulates
drugs, sex, and money across a range of settings and participants. Based
upon an analysis of life history accounts gained through ethnographic
interviews, the authors describe common pathways into the street economy
with an emphasis on understanding how these 10 young men of diverse
backgrounds became involved in homelessness, drugs, and sex work. In doing
this, the authors document the differential sources of knowledge and
particular childhood experiences that launched these youth into coherent
street careers (authors). |
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Order #: 15185 |
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Authors: |
Linn,
J.G., Brown, M., Kendrick, L.
|
|
Title: |
Injection Drug Use Among Homeless Adults in the
Southeast With Severe Mental Illness. |
|
Source: |
Journal of Health Care for
the Poor and Underserved 16: 83-90, 2005. (Journal
Article: 8 Pages)
|
|
Abstract: |
This study examined
injection drug use and HIV risk behaviors in a predominantly African
American sample of homeless men with mental illness. Personal interviews focusing on injection
drug use and sexual risk behaviors were completed with 240 homeless mentally
ill men in two shelters in a southeastern city. Sixty-two of the 240 men injected
drugs. Among the injection drug
users (IDUs), most reported high-risk behaviors, including needle sharing
and participation in shooting galleries.
Very few performed risk reduction activities (e.g., cleaning needles
with bleach or using a needle exchange program). Within the preceding 6 months, most of
the IDUs had had sex with women or men without a condom. This investigation reported a high
lifetime occurrence of injection drug use in a sample of predominantly
African American homeless men with mental illness. The IDUs reported intravenous drug use
and sexual activities with great risk of HIV transmission and provided
little evidence of risk-reduction efforts.
These men are outside of most social service and health care systems
but must be included in special programs to decrease the transmission of
HIV (authors). |
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Order #: 14878 |
|
Authors: |
Little,
M., Shah, R., Vermeulen, M.J., Gorman, A., Dzendoletas, D., Ray, J.G.
|
|
Title: |
Adverse Perinatal Outcomes Associated With
Homelessness and Substance Use in Pregnancy. |
|
Source: |
Canadian Medical
Association Journal 173(6): 615-618, 2005. (Journal
Article: 4 Pages)
|
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Abstract: |
This study's objective was
to provide preliminary estimates of the risk of adverse perinatal outcomes
among Canadian women who are homeless or marginally housed during
pregnancy, and the effect of concomitant substance use. The authors conducted a retrospective
cohort study at a single downtown hospital from October 2002 to December
2004, involving women who, during pregnancy, were homeless or underhoused,
substance users or neither. Neonatal
measures such as birth weight and gestational age were noted. The main study outcomes were preterm
birth before 37 weeks' gestation, birth weight less than 2000 g and small
for gestational age at birth.
Homelessness or inadequate housing was associated with an odds ratio
(adjusted for maternal age, gravidity and being a current smoker of
tobacco) of 2.9 for preterm delivery, 6.9 for infant birth weight under
2000 g and 3.3 for delivery of a newborn small for gestational age. Adjusted odds ratios for substance use
during pregnancy were similar. In
the combined presence of an underhoused or homeless state and maternal
substance use, the adjusted risk estimates were 5.9, 16.6 and 5.6,
respectively. Homelessness and
maternal substance use may reduce neonatal well-being through prematurity
and low birth weight (authors). |
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|
Order #: 14808 |
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Authors: |
Lorvick,
J., Bluthenthal, R., Kral, A.H.
|
|
Title: |
Urban Health Study. |
|
Source: |
San Francisco, CA: Urban
Health Study, 2005. (Report: 2 Pages)
|
|
Abstract: |
This study's preliminary
findings suggest that IDUs who received SSI benefits were more stably
housed, less reliant on illegal income, used drugs less frequently, and
shared needles less often than IDUs without SSI benefits. SSI benefits
contribute to general life stability and a reduction in drug-related harm.
This finding is consistent with other studies that have shown that drug
users who receive income supports and/or subsidized drug treatment are less
likely to be homeless, engage in illegal activities, or use drugs.
Conversely, penalizing drug users by withholding benefits may in fact
increase the severity of homelessness, incarceration, illegal activity, and
unsafe drug use (authors). Available From: Urban Health Study, 3180 18th
Street, Suite 302, San Francisco, CA 94110, (415) 476-3400,
www.ucsf.edu/uhs |
|
|
Order #: 14862 |
|
Authors: |
McGovern,
M.P., Wrisley, B.R., Drake, R.E.
|
|
Title: |
Relapse of Substance Use Disorder and Its
Prevention Among Persons with Co-Occurring Disorders. |
|
Source: |
Psychiatric Services
56(10): 1270-1273, 2005. (Journal Article:
4 Pages)
|
|
Abstract: |
This article summarizes
the scientific literature on the relapse process, describes the basic
principles of relapse prevention treatment, highlights the major empirical
studies, and offers suggestions for future research and application,
especially in terms of ongoing care for persons with co-occurring
disorders. Relapse prevention treatments
have a well-established efficacy and effectiveness for persons with
substance use disorders. Key
ingredients include reducing exposure to substances, fostering motivation
for abstinence, self-monitoring, recognizing and coping with cravings and negative
affect, identifying thought processes with relapse potential, and
deploying, if necessary, a crisis plan.
Relapse prevention approaches may be best suited for persons in the
action of maintenance stages of treatment or recovery. Further research is needed to examine
relapse prevention therapies as a key component to continuing care for
persons with co-occurring substance use and psychiatric disorders
(authors). |
|
|
Order #: 14696 |
|
Authors: |
Milby,
J.B., Schumacher, J.E., Wallace, D., Freedman, M.J., Vuchinich, R.E.
|
|
Title: |
To House or Not to House: The Effects of Providing
Housing to Homeless Substance Abusers in Treatment. |
|
Source: |
American Journal of Public
Health 95(7): 1259-1264, 2005. (Journal
Article: 6 Pages)
|
|
Abstract: |
This study examined how
substance abuse treatment outcomes were affected under three different
housing provision conditions. 196
cocaine-dependent participants who received day treatment and no housing
(NH), housing contingent on drug abstinence (ACH), or housing not contingent
on abstinence (NACH) were studied.
Drug use was monitored with urine testing. The ACH group had a higher prevalence of
drug abstinence than the NACH group (after control for treatment
attendance), which in turn had a higher prevalence than the NH group. All three groups showed significant
improvement in maintaining employment and housing. The results of this and previous trials
indicate that providing abstinence-contingent housing to homeless substance
abusers in treatment is an efficacious, effective, and practical
intervention. Programs to provide
such housing should be considered in policy initiatives (authors). |
|
|
Order #: 14774 |
|
Authors: |
Morrissey,
J.P., Ellis, A.R., Gatz, M., Amaro, H., Reed, B.G., Savage, A.,
Finkelstein, N., Mazelis, R., Brown, V., Jackson, E.W., Banks, S.
|
|
Title: |
Outcomes for Women with Co-Occurring Disorders and
Trauma: Program and Person-Level Effects. |
|
Source: |
Journal of Substance Abuse
Treatment 28: 121-133, 2005. (Journal
Article: 13 pages)
|
|
Abstract: |
In this paper from the
Women, Co-Occurring Disorders, and Violence Study (WCDVS), six-month
outcomes are evaluated from a nine-site quasi-experimental study of women
with mental health and substance use disorders who have experienced
physical or sexual abuse who enrolled in either comprehensive, integrated,
trauma-informed, and consumer/survivor/recovering person-involved services
or usual care. Mental health,
post-traumatic stress symptoms, and substance use outcomes are assessed
with multilevel regression models, controlling for program and personal
characteristics. Person-level
variables predict outcomes independent of intervention condition and, to a
small extent, moderate intervention and program effects. In sites where the intervention condition
provided more integrated counseling than the comparison condition, there
are increased effects on mental health and substance use outcomes; these
effects are partially mediated by person-level variables. These results encourage further research
to identify the longer-term effects of integrated counseling for women with
co-occurring disorders and trauma histories (authors). |
|
|
Order #: 14758 |
|
Authors: |
Morrissey,
J.P., Jackson, E.W., Ellis, A.R., Amaro, H., Brown, V.B., Najavits, L.M.
|
|
Title: |
Twelve-Month Outcomes of Trauma-Informed
Interventions for Women with Co-Occurring Disorders. |
|
Source: |
Psychiatric Services
56(10): 1213-1222, 2005. (Journal Article:
10 pages)
|
|
Abstract: |
This study examined how
for women with co-occurring mental health and substance abuse disorders,
who frequently have a history of interpersonal violence, past research has
suggested that they are not served effectively by the current service
system. The goal of the Women,
Co-Occurring Disorders, and Violence Study (WCDVS) was to develop and test
the effectiveness of new service approaches specifically designed for these
women. A quasi-experimental
treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as
treatment length and modality varied across sites, each site used a
comprehensive, integrated, trauma-informed, and consumer-involved approach
to treatment. Substance use problem
severity, mental health symptoms, and trauma symptoms were measured at baseline,
and follow-up data were analyzed with prospective meta-analysis and
hierarchical linear modeling. A
total of 2,026 women had data at the 12-month follow-up: 1,018 in the
intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was
found. The meta-analysis
demonstrated small but statistically significant overall improvement in
women's trauma and mental health symptoms in the intervention relative to
the usual-care comparison condition.
Analysis of key program elements demonstrated that integrating substance
abuse, mental health, and trauma-related issues into counseling yielded
greater improvement, whereas the delivery of numerous core services yielded
less improvement relative to the comparison group. A few person-level characteristics were
associated with increases or decreases in the intervention effect. These neither moderated nor supplanted
the effects integrated counseling.
Outcomes for women with co-occurring disorders and a history of
violence and trauma may improve with integrated treatment (authors). |
|
|
Order #: 14863 |
|
Authors: |
Rollins,
A.L., O'Neill, S.J., Davis, K.E., Devitt, T.S.
|
|
Title: |
Substance Abuse Relapse and Factors Associated with
Relapse in an Inner-City Sample of Patients with Dual Diagnoses. |
|
Source: |
Psychiatric Services
56(10): 1274-1281, 2005. (Journal Article:
8 pages)
|
|
Abstract: |
This study documented
rates of substance abuse relapse and explored factors associated with
sustained remission among consumers with severe mental illness in a large,
urban clinical sample. Existing
clinical records of consumers with severe mental illness and co-occurring
substance use disorders who had achieved remission and who were interviewed
at two or more subsequent follow-up points (12 months after remission) were
reviewed. Consumers who relapsed
within 12 months after remission were compared with those who maintained
remission on demographic, clinical, and functional indicators. Of the 133 consumers who achieved
remission, 91 (68 percent) had maintained remission at 6-month follow-up,
and 69 (52 percent) maintained remission at 12-month follow-up. The strongest factors associated with
maintenance of remission at 12 months were older age and living in
Thresholds residential programs.
Multivariate analysis showed that consumers who were older, held
jobs, and lived in Thresholds residential programs had a higher likelihood
of maintaining remission at 12 months.
To explore the potential impact of program dropout on the results,
supplemental analyses using a third group without 12-month follow-up data
were conducted. These analyses
indicated that program dropouts were younger and less likely to live in
Thresholds residential programs at initial remission. Age, therapeutic residential programming,
and, to a lesser degree, employment appear to be potential factors to
consider in the development of relapse prevention models (authors). |
|
|
Order #: 14887 |
|
Authors: |
Rosenblum,
A., Magura, S., Kayman, D.J., Fong, C.
|
|
Title: |
Motivationally Enhanced Group Counseling for
Substance Users in a Soup Kitchen: A Randomized Clinical Trial. |
|
Source: |
Drug and Alcohol
Dependency 80(1): 91-103, 2005. (Journal
Article: 13 Pages)
|
|
Abstract: |
This study randomly
assigned 289 soup kitchen guests who reported drug or alcohol problems to
information and referral (I&R) plus peer advocacy (peers encouraging
subjects to participate in other services) or to an experimental 12-session
motivational group followed by a 36-session cognitive-behavioral group plus
I&R and peer advocacy.
Experimentals were significantly more likely than the controls to
have increased their participation in some type of substance abuse
intervention during the follow-up period.
In addition, experimentals were significantly more likely than
controls to have reduced both drinking and heavy drinking at follow-up
(there was no difference between groups in reduction of cocaine use). Interaction analysis indicated that the
experimental intervention was more effective for participants with higher
rather than lower substance abuse severity at baseline. These results support the concept that
motivationally enhanced group counseling, provided as a low-threshold
outreach intervention, can help to increase participation in formal
treatment and 12-step groups and to reduce substance abuse, particularly
for those starting with high severity of use (authors). |
|
|
Order #: 14886 |
|
Authors: |
Tucker,
J.S., D'Amico, E.J., Wenzel, S.L., Golinelli, D., Elliott, M.N.,
Williamson, S.
|
|
Title: |
A Prospective Study of Risk and Protective Factors
for Substance Use Among Impoverished Women Living in Temporary Shelter
Settings in Los Angeles County. |
|
Source: |
Drug and Alcohol
Dependence 80(1): 35-43, 2005. (Journal
Article: 9 Pages)
|
|
Abstract: |
This study identified
psychosocial, behavioral, and economic predictors of drinking to
intoxication, crack use, and marijuana use in a probability sample of 402
women living in temporary shelter settings in Los Angeles County with a
simple majority of homeless residents.
Engaging in sexual risk behavior and having depressive symptoms were
risk factors for more frequent intoxication, marijuana use, and crack
use. Drinking to intoxication was
additionally predicted by perceived HIV susceptibility, lower social
support, more avoidant and less active coping, and lower self-esteem. Additional predictors of marijuana use
included partner alcohol misuse and less social support, whereas more
frequent crack use was additionally predicted by partner alcohol misuse,
lack of economic resources, and more avoidant and less active coping. These findings suggest that effective
substance use programs may need an integrative approach that addresses
other types of risk behaviors, assists women in strengthening their support
networks and learning effective coping skills, and provides access to basic
services (e.g., housing, health care). For women in relationships, there
may be a further need to address issues of partner substance use (authors). |
|
|
Order #: 14864 |
|
Authors: |
Xie, H.,
McHugo, G.J., Fox, M.B., Drake, R.E.
|
|
Title: |
Substance Abuse Relapse in a Ten-Year Prospective
Follow-Up of Clients with Mental and Substance Use Disorders. |
|
Source: |
Psychiatric Services
56(10): 1282-1287, 2005. (Journal Article:
6 Pages)
|
|
Abstract: |
This study addressed the
rate and predictors of substance abuse relapse among clients with severe
mental illness who had attained full remission from substance abuse. In a ten-year prospective follow-up study
of clients with co-occurring severe mental and substance use disorders, 169
clients who had attained full remission, defined according to DSM-III-R as
at least 6 months without evidence of abuse or dependence, were
identified. The Kaplan-Meier
survival curve was developed to show the pattern of relapse, and a
discrete-time survival analysis was used to identify predictors of
relapse. Approximately one-third of
clients who were in full remission relapsed in the first year, and
two-thirds relapsed over the full follow-up period. Predictors of relapse included male sex,
less than a high school education, living independently, and lack of
continued substance abuse treatment.
After attaining full remission, clients with severe mental disorders
continue to be at risk for substance abuse relapse for many years. Relapse prevention efforts should
concentrate on helping clients to continue with substance abuse treatment
as well as on developing housing programs that promote recovery (authors). |
|
|
Order #: 14438 |
|
Authors: |
Amaro,
H., McGraw, S., Larson, M.J., Lopez, L., Nieves, R., Marshall, B.
|
|
Title: |
Boston Consortium of Services for Families in
Recovery: A Trauma-Informed Intervention Model for Women's Alcohol and Drug
Addiction Treatment. |
|
Source: |
Alcoholism Treatment
Quarterly 22(3/4): 95-119, 2004. (Journal
Article: 25 Pages)
|
|
Abstract: |
This article examines the
Boston Consortium of Services for Families in Recovery, a collaboration of
service agencies through which the Boston Public Health Commission
implemented an integrated model of trauma-informed services that is
culturally and linguistically appropriate to its service population of
primarily poor urban Latina and African American women. The enhanced intervention was implemented
in five Consortium-affiliated alcohol and drug addiction treatment programs
providing outpatient, residential, and methadone services. Programs adopted trauma-informed service
system enhancements and offered study participants a package of
trauma-specific and trauma-informed clinical services. The assessment and consensus-building
processes, enhanced model components, implementation process, challenges
and lessons learned are described (authors). Available From: Haworth Document Delivery Service, (800)-HAWORTH,
docdelivery@haworthpress.com. |
|
|
Order #: 14282 |
|
Authors: |
Bourgois,
P., Prince, B., Moss, A.
|
|
Title: |
The Everyday Violence of Hepatitis C Among Young
Women Who Inject Drugs in San
Francisco. |
|
Source: |
Human Organization 63(3):
253-264, 2004. (Journal Article: 12 Pages)
|
|
Abstract: |
This article examines a
theoretical understanding of the gendered contours of structural, everyday,
and symbolic violence which suggests that young addicted women are
particularly vulnerable to the infectious diseases caused by injection drug
use- especially Hepatitis C.
Participant observation among heroin and speed injectors in San Francisco's Haight Ashbury neighborhood reveals that extreme
levels of violence against women are normalized in the common sense of
street-based youth drug culture.
Physical, sexual, and emotional violence, as well as the pragmatics
of income generation, including drug and resource sharing in the moral
economy of street addicts, oblige most young homeless women to enter into
relationships with older men. These
relationships are usually abusive and economically parasitical to the
women. Sexual objectification and a
patriarchal romantic discourse of love and moral worth lead to the
misrecognition of gender-power inequities by both the men and women who are
embroiled in them, as well as by many of the public services and research
projects designed to help or control substance abusers. Despite deep epistemological,
theoretical, and logistical gulfs between quantitative and qualitative
methods, applied public health research and the interventions they inform
can benefit from the insights provided by a theoretical and cross-methodological
focus on how social power contexts shape the spread of infectious disease
and promote disproportional levels of social suffering in vulnerable
populations (author). |
|
|
Order #: 14443 |
|
Authors: |
Cadiz, S., Savage, D., Bonavota, D., Hollywood, J., Butters, E., Neary, M.,
Quiros, L.
|
|
Title: |
Portal Project: A Layered Approach to Integrating
Trauma into Alcohol and Other Drug Treatment for Women. |
|
Source: |
Alcoholism Treatment
Quarterly 22(3/4): 121-139, 2004. (Journal
Article: 18 pages)
|
|
Abstract: |
This article examines
Palladia, Inc., a not-for-profit, multi-service agency, located in New York City, serving primarily African-American and Latino
communities. Palladia's Portal
Project, in collaboration with the evaluation team from Hunter College School
of Social Work, participated in the national Women, Co-Occurring Disorders
and Violence study. The authors
studied 270 women with co-occurring issues of alcohol and other drug
problems and mental illness, who had histories of violence, and were high
end users of service. Palladia built
an integrated system of care and implemented a comprehensive
trauma-informed intervention that is designed to put trauma and safety
first to assist women remaining in treatment. The collaborative work of this project has
produced a replicable model that configures specific direct service
enhancements and service system improvements, using the active involvement
of consumers, practitioners, service providers and policy makers (authors).
Available From: Haworth Document Delivery Service, (800)-HAWORTH,
docdelivery@haworthpress.com |
|
|
Order #: 13685 |
|
Authors: |
Dawson, J.F., Liening, J.
|
|
Title: |
Closing the Revolving Door for Chronic Public
Inebriates: San Diego's
Collaborative Solution to a Community Problem. |
|
Source: |
Law Enforcement Quarterly
32(1): 5-8, 2004. (Journal Article: 4 pages)
|
|
Abstract: |
This article discusses the
success of the Serial Inebriate Program (SIP) in San Diego, CA. This
program was created to cost-effectively divert the chronic inebriate off
the street and into treatment. The goals of SIP were to: create a model
that offered alcohol abuse rehabilitation as an alternative to jail time;
utilize existing court proceedings to process "drunk in public"
arrests; introduce chronic inebriates into the treatment community; reduce
community disorder calls for police; and reduce the overall costs
associated with homeless chronic inebriates. |
|
|
Order #: 13734 |
|
Authors: |
Finkelstein,
N., VandeMark, N., Fallot, R., Brown, V., Cadiz, S., Heckman, J.
|
|
Title: |
Enhancing Substance Abuse Recovery Through
Integrated Trauma Treatment. |
|
Source: |
Sarasota, FL: National Trauma Consortium, 2004. (Report: 12
pages)
|
|
Abstract: |
This paper describes the
four models developed and tested in the SAMHSA-funded Women with
Co-Occurring Disorders and Violence Study (WCDVS) as well as another
frequently used model that can be integrated within substance abuse
treatment and provides guidance for providers in choosing a model for their
agency. There is a critical need to address trauma as part of substance
abuse treatment. Four trauma-specific and integrated models of treatment
for substance abuse clients with trauma histories, symptoms, or
posttraumatic stress disorder were utilized in the WCDVS study. Each of
these models focused on the first stage of treatment: establishing safety
and stabilization (authors). Available From: National Trauma Consortium, 520 Ralph Street, Sarasota, FL 34242, (941) 312-9795, akblanch@verizon.net,
www.nationaltraumaconsortium.org |
|
|
Order #: 14098 |
|
Authors: |
Lam,
W.K.K., Wechsberg, W., Zule, W.
|
|
Title: |
African-American Women Who Use Crack Cocaine: A
Comparison of Mothers Who Live With and Have Been Separated From Their
Children. |
|
Source: |
Child Abuse and Neglect
28: 1229-1247, 2004. (Journal Article:
19 Pages)
|
|
Abstract: |
This study examined
factors that influenced caregiver status for African-American mothers who
use crack cocaine but are not receiving drug treatment and participated in
an HIV prevention study in North Carolina. Caregiver
mothers who were living with at least one of their children at intake were
compared with non-caregivers who were separated from all of their
children. Bivariate analyses and
logistic regression were used to compare these mothers at intake on current
drug use, risky sex practices, psychological symptoms, victimization, and
aggression. Compared with caregiver
mothers, non-caregivers reported higher frequencies of drug use, risky sex
practices, psychological distress, and victimization experiences. Caregiver mothers were more likely than
non-caregiver mothers to have health insurance, but were less likely to
have received drug treatment.
Logistic regression found that non-caregiver mothers were
significantly more likely than caregiver mothers to be older, to have been
physically abused as children, to trade sex more frequently, to be
homeless, and to have no health insurance.
Recent crack use, psychological symptoms, and victimization were not
significantly related to caregiver status.
Findings that socio-environmental factors were more strongly
associated with caregiver status than crack use underscore the importance
of contextual issues such as housing, victimization history, and resources
in serving maternal crack users.
Community outreach and interventions that engage mothers who use
drugs and live with their children may be more effective strategies than
formal office-based services to link mothers who use crack and their
children to needed drug treatment and family and child services (authors). |
|
|
Order #: 14841 |
|
Authors: |
Masson,
C.L., Sorensen, J.L., Phibbs, C.S., Okin, R.L.
|
|
Title: |
Predictors of Medical Service Utilization Among
Individuals with Co-Occurring HIV Infection and Substance Abuse Disorders. |
|
Source: |
AIDS Care 16(6): 744-755,
2004. (Journal Article: 11 Pages)
|
|
Abstract: |
This study examined
factors affecting medical service use among HIV-infected persons with a
substance abuse disorder. The sample comprised 190 participants enrolled in
a randomized trial of a case management intervention. Participants were
interviewed about their backgrounds, housing status, income, alcohol and
drug use problems, health status and depressive symptoms at study entry.
Electronic medical records were used to assess medical service use. Poisson
regression models were tested to determine the effects of need, enabling
and predisposing factors on the dependent variables of emergency department
visits, inpatient admissions and ambulatory care visits. During a two-year
period, 71% were treated in the emergency department, 64% had been
hospitalized and the sample averaged 12.9 ambulatory care visits.
Homelessness was associated with higher utilization of emergency department
and inpatient services; drug use severity was associated with higher
inpatient and ambulatory care service use; and alcohol use severity was
associated with greater use of emergency medical services. Homelessness and
substance abuse exacerbate the health care needs of HIV-infected persons
and result in increased use of emergency department and inpatient services.
Interventions are needed that target HIV-infected persons with substance
abuse disorders, particularly those that increase entry and retention in
outpatient health care and thus decrease reliance on acute hospital-based
services (authors). |
|
|
Order #: 14301 |
|
Authors: |
Nyamathi,
A., Longshore, D., Galaif, E.R., Leake, B.
|
|
Title: |
Motivation to Stop Substance Abuse and
Psychological Environmental Characteristics of Homeless Women. |
|
Source: |
Addictive Behaviors 29:
1839-1843, 2004. (Journal Article: 5 Pages)
|
|
Abstract: |
This study examined the
characteristics associated with 748 women wanting to permanently quit their
alcohol, cocaine or heroin use. Only
a third of Latinas wanted to stop using alcohol; they were also at
relatively high risk for continued heroin use. Recognition that their substance use was
an extremely serious problem was a consistent predictor of wanting to quit
substance use. Other important
predictors of desiring to quit two substances included not hanging out with
other drug users, lifetime hospitalization for drug use and recent
substance use treatment. Findings
from this study may be helpful for selecting relatively good candidates for
the limited number of substance abuse treatment slots available for
homeless women and providing supplementary assistance to those already in
treatment (authors). |
|
|
Order #: 14093 |
|
Authors: |
Nyamathi,
A., Longshore, D., Galaif, E.R., Leake, B.
|
|
Title: |
Motivation to Stop Substance Use and Psychological
and Environmental Characteristics of Homeless Women. |
|
Source: |
Addictive Behaviors 29:
1839-1843, 2004. (Journal Article: 5 Pages)
|
|
Abstract: |
In this article,
characteristics associated with wanting to permanently quit their alcohol,
cocaine or heroin use were examined in 748 women who are homeless. Only a third of Latinas wanted to stop
using alcohol; they were also at relatively high risk for continued heroin
use. Recognition that their
substance use was an extremely serious problem was a consistent predictor of
wanting to quit substance use.
Other important predictors of desiring to quit two substances
included not hanging out with other drug users, lifetime hospitalization
for drug use and recent substance use treatment. Findings from this study may be helpful
for selecting relative good candidates for the limited number of substance
abuse treatment slots available for homeless women and providing
supplementary assistance to those already in treatment (authors). |
|
|
Order #: 13957 |
|
Authors: |
Office of
Applied Studies.
|
|
Title: |
The DASIS Report: Characteristics of Homeless
Female Admissions to Substance Abuse Treatment Episodes: 2002. |
|
Source: |
Rockville, MD: Office of Applied Studies, 2004. (Report: 3
Pages)
|
|
Abstract: |
This report focuses on
living arrangements. Of the
admissions for whom living arrangement were recorded in 2002, 13% were
homeless at the time of admission. Females comprised 20% of the homeless
admissions. Compared with all female admissions, the service setting for
women who were homeless at time of substance abuse treatment admission was
more likely to be detoxification or residential/rehabilitation and less
likely to be ambulatory settings. Homeless female admissions were more
likely than all female admissions to report cocaine/crack or heroin as
their primary substance of abuse (authors). Available From: Office of
Applied Studies, Substance Abuse and Mental Health Services Administration,
1 Choke Cherry Road, Rockville, MD 20857, info@samhsa.hhs.gov,
http://oas.samhsa.gov/2k4/femHomeless/femHomeless.cfm |
|
|
Order #: 13473 |
|
Authors: |
O'Toole,
T., Gibbon, J., Hanusa, B., Freyder, P., Conde, A., Fine, M.
|
|
Title: |
Self-Reported Changes in Drug and Alcohol Use After
Becoming Homeless. |
|
Source: |
American Journal of Public
Health 94(5): 830-835, 2004. (Journal
Article: 6 pages)
|
|
Abstract: |
In this article, the
authors identified substance use patterns and factors associated with
increased substance use after users become homeless. The article states that seventy-eight
percent of the adults interviewed met the Diagnostic and Statistical Manual
of Mental Disorders, Revised Third Edition criteria for substance abuse or
dependence, and reported using drugs and alcohol less since they became
homeless, commonly because they were in recovery. The article also states
that factors independently associated with increased use were no health
insurance, alcohol abuse or dependence, and selling plasma or panhandling
to acquire drugs. The authors conclude that becoming homeless plays a role
in self-reported substance use, and that multiservice treatment programs
and tailored interventions for homeless persons are needed (authors). |
|
|
Order #: 14440 |
|
Authors: |
O'Toole,
T.P., Conde-Martel, A., Gibbon, J.L., Hanusa, B.H., Freyder, P.J., Fine.
M.J.
|
|
Title: |
Substance-Abusing Urban Homeless in the Late 1990s:
How do they Differ from Non-Substance-Abusing Homeless Persons? |
|
Source: |
Journal of Urban Health:
Bulletin of the New
York Academy of Medicine 81(4): 606-617, 2004. (Journal
Article: 12 Pages)
|
|
Abstract: |
This study reports data
from a two-city, community-based, populations-proportionate sample of 531
randomly selected homeless adults; the study was conducted in 1997 and
compared substance-abusing to non-substance abusing respondents. Most met criteria for substance
abuse/dependence and were abusing either cocaine or alcohol and
cocaine. In the multiple logistic
regression model, male gender, less than a 12'th grade education, and
identifying a need to learn how to manage one’s money were independently
associated with substance abuse/dependence.
Drug abuse/dependence and polysubstance use among urban homeless
persons became a more prevalent issue in the late 1990s. These individuals have unique needs that
will require tailored interventions (authors). |
|
|
Order #: 14290 |
|
Authors: |
Sehwan,
K., Cruthcfield, C.
|
|
Title: |
An Evaluation of Substance Abuse Aftercare Program
for Homeless Women With Children Using Confounding Variable-Control Design. |
|
Source: |
Journal of Drug Education
34(3): 213-233, 2004. (Journal Article:
11 pages)
|
|
Abstract: |
This evaluation of a
substance abuse aftercare program for homeless women with children was
conducted using confounding variable-control evaluation design. The confounding variables were chosen
from pre-treatment and other contextual variables of the clients that were known
to have significant influence on the program outcome, but those that could
not have been influenced a priori by the client involvement in in-treatment
program activity at Transition House (TH).
The latter was the independent variable of the evaluation
design. The pre-treatment variables
were measured by severity of alcohol and other drug (AOD) problems of the
clients, their mental health status, age, and their job status before
enrollment in the program. The
contextual confounding variables were composed of family and social support
available to the clients before and during recovery. While applying multiple regression
analysis, the authors were able to explain 50.8% of the total variance in
program outcome by four pre-treatment variables. By adding two contextual variables of
family and social support, the total variance in program outcome explained
increased to 64.1%. Finally, by
adding the degree of client involvement in in-treatment program activity,
they were able to augment the total variance of the program outcome to
69.7%. By estimating the changed
variance of program outcome by the in-treatment program activity during the
final step, controlling for all other variables previously entered, they
were able to establish that clients involvement in in-treatment program had
unique and positive impact on the program outcome distinct from those
explained by the confounding variables.
The additional variance uniquely added by in-treatment program
activity was 5.6%. It was determined
that the degree of client involvement in in-treatment program had positive
and systematic impact on the program outcome (authors). |
|
|
Order #: 14217 |
|
Authors: |
Tull, T.
|
|
Title: |
The Housing First Approach for Families Affected by
Substance Abuse. |
|
Source: |
Los Angeles, CA: Beyond
Shelter, 2004. (Newsletter Article: 4 Pages)
|
|
Abstract: |
The Housing First
methodology provides a vital resource for the child welfare system. This
innovative approach to housing high-risk and vulnerable families with
children provides a systematic, direct means for families in which a
head-of- household is in recovery to return to independent living and
stability in the community, with a time-limited relationship designed to
empower, without engendering dependence. This methodology facilitates
long-term stability and provides formerly homeless families with the
support necessary to remain in permanent housing (author). Available From: Beyond
Shelter, 520 South Virgil Avenue, Los Angeles, CA 90020, (213) 252-0772,
www.beyondshelter.org/aaa_initiatives/The%20Source%20article.pdf |
|
|
Order #: 13605 |
|
Authors: |
Van Ness,
P., Davis, W., Johnson, B.
|
|
Title: |
Socioeconomic Marginality and Health Services
Utilization Among Central Harlem Substance Users. |
|
Source: |
Substance Use & Misuse
39(1): 61-85, 2004. (Journal Article:
24 pages)
|
|
Abstract: |
The article examines
whether decrements in socioeconomic measures in a poor, substance using
population predict changes in health services utilization. The authors
analyzed a sample, consisted of 658 "hard drug" (crack, powder
cocaine, and heroin) users drawn from Central Harlem in New York City
during 1998 and 1999, and was stratified according to operational measures
indicating socioeconomic marginality.
The authors assert that in this sample socioeconomic marginality
reflected by low levels of income, education, and employment sometimes
predicts greater rates of health services utilization and, in other cases,
it predicts lower rates. The authors also state that when the sample is
stratified according to an operational measure of homelessness, the
gradient of greater utilization and self-reported morbidity for the
homeless is more marked and consistent. The article concludes that results
are supportive of a public health model of drug user treatment that recommends
that it occur as part of an integrated strategy addressing poverty,
homelessness, violence, and related social problems (authors). |
|
|
Order #: 15094 |
|
Authors: |
Baumohl,
J., Speiglman, R., Swartz, J., Stahl, R.
|
|
Title: |
Substance Abuse and Welfare Policy at the New
Century. |
|
Source: |
Contemporary Drug Problems
30: 501-537, 2003. (Journal Article: 36 Pages)
|
|
Abstract: |
Drawing on findings from
the SSI Study and other research, this paper takes up various policy
questions fundamental to any welfare program for substance abusers. The paper considers the place of
disability benefits in the U.S. system of categorical aid and the problems
raised by substance abuse for the disability category. It discusses the desirable objectives of
a welfare program for substance abusers and the various mechanisms by which
they might be achieved. And finally, it considers how any new program might
be positioned in the context of categorical aid and American federalism
(authors). |
|
|
Order #: 12698 |
|
Authors: |
Bride,
B., Real, E.
|
|
Title: |
Project Assist: A Modified Theraputic Community for
Homeless Women Living with HIV/AIDS and Chemical Dependency. |
|
Source: |
Health and Social Work
28(2): 166-168, 2003. (Journal Article:
3 pages)
|
|
Abstract: |
This article describes a
substance abuse treatment program for homeless women who abuse substances
and are living with HIV/AIDS. A
therapeutic community model was modified to meet the unique needs of this
population, and incorporates a variety of HIV support and education
services, and provides enhanced health services to address the multiple
medical needs of this population. To
date, limited treatment options have been available to address the unique
issues of women who are homeless, chemically dependent, and HIV-positive
(authors). |
|
|
Order #: 13250 |
|
Authors: |
Clarke,
S., Delamere, S., McCullough, L., Hopkins, S., Bergin, C., Mulcahy, F.
|
|
Title: |
Assessing Limiting Factors to the Acceptance of
Antiretroviral Therapy in a Large Cohort of Injecting Drug Users. |
|
Source: |
HIV Medicine 4(1): 33-37,
2003. (Journal Article: 5 pages)
|
|
Abstract: |
In this article, the
authors assess the knowledge and understanding of injecting drug users
(IDUs) regarding their HIV disease, and determine any factors that may
increase the acceptance of antiretroviral therapy (ART) by this group. This study highlights the chaotic
lifestyle and complex social background of the IDU. The authors assert that
such factors were not, however, associated with acceptance of highly active
antiretroviral therapy (HAART). The article states that there was a
statistically significant association between patients receiving HAART and
both attendance at a primary care physician for methadone maintenance
therapy, and weekly take-outs of methadone. There was also an association
between adherence to HAART and attendance at a methadone maintenance
clinic. The article concludes that the primary factor associated with both
the acceptance of and adherence to HAART was regular and stable attendance
for methadone therapy (authors). |
|
|
Order #: 12696 |
|
Authors: |
Ettner,
S., Argeriou, M., Carty, D., Dilonardo, J., Liu, H.
|
|
Title: |
How Did the Introduction of Managed Care for the
Uninsured in Iowa Affect
the Use of Substance Abuse Services? |
|
Source: |
Journal of Behavioral
Health Services and Research 30(1): 26-40, 2003. (Journal Article: 14 pages)
|
|
Abstract: |
In this article, the
authors discuss the concerns raised about access under managed care for
vulnerable populations such as publicly funded patients with substance
abuse problems. According to the
article, to estimate the effects of the Iowa Managed Substance Abuse Care
Plan (IMSACP) on substance abuse service use by publicly funded patients,
service use before and after IMSACP was compared; adjustments were made for
changes in population sociodemographic and clinical characteristics. The authors state that between fiscal
years 1994 and 1997, patient case mix was marked by a higher burden of
illness and the use of inpatient, residential non-detox, outpatient
counseling, and assessment services declined, while use of intensive
outpatient and residential detox services increased. The authors also state that these
findings were similar among women, children, and homeless persons. The article concludes that without
knowing the impact on treatment outcomes, these changes cannot be
interpreted as improved provider efficiency versus simply cost containment
and profit maximization (authors). |
|
|
Order #: 13084 |
|
Authors: |
Health
Care for the Homeless Clinicians' Network.
|
|
Title: |
A Comprehensive Approach to Substance Abuse and
Homelessness. |
|
Source: |
Healing Hands 7(5): 1-6,
2003. (Newsletter: 6 pages)
|
|
Abstract: |
In this edition, the
authors discuss the issue of substance abuse and homelessness as
inextricably intertwined for many individuals. According to the authors,
substance use is often both a precipitating factor and a consequence of
being homeless. Further, individuals
who are homeless rarely have substance use disorders alone. Many have serious mental illnesses, acute
and chronic physical health problems, and histories of trauma. They require
safe and appropriate housing, multiple interventions, and client-centered
care (authors). Available From: National Health Care for the Homeless
Council, P.O.
Box 60427, Nashville, TN 37206, (615) 226-2292,
www.nhchc.org/Network/HealingHands/2003/hh-1003.pdf. |
|
|
Order #: 13599 |
|
Authors: |
Milby,
J., Schumacher, J., Frison, S., McNamara, C., Usdan, U., Wallace, D.,
Michael, M.
|
|
Title: |
Day Treatment With Contingency Management for
Cocaine Abuse in Homeless Persons: 12 Month Follow-Up. |
|
Source: |
Journal of Consulting and
Clinical Psychology 71(3): 619-621, 2003. (Journal
Article: 3 pages)
|
|
Abstract: |
In this article,
abstinence, employment, and homelessness treatment outcomes at twelve-month
follow-up are presented from a study comparing behavioral day treatment
plus abstinence-contingent housing and work therapy with behavioral day
treatment only among homeless persons who abuse crack cocaine. The authors assert that within-group
improvements were revealed, but group differences for drug abstinence found
in J. B. Milby et al. (2000) failed to persist at twelve months, and that
within- but not between-group differences were found for employment and
homelessness outcomes at long-term follow-up. Drug use measurement and
treatment termination explanations are discussed, and research extending
abstinence contingencies and continuous drug use monitoring is recommended
by the authors. Questions about effectiveness of contingency management
alone, role of coexisting psychiatric disorders on treatment outcome, and
individualized treatment dosing are offered (authors). |
|
|
Order #: 13071 |
|
Authors: |
National
Health Care for the Homeless Council.
|
|
Title: |
Providing Treatment for Homeless People With
Substance Use Disorders: Case Studies of Six Programs. |
|
Source: |
Nashville, TN: National Health Care for the Homeless Council,
2003. (Report: 46 pages)
|
|
Abstract: |
The National Health Care
for the Homeless Council conducted a study of programs recognized for
providing effective substance abuse treatment for people who are
homeless. Council staff visited six
of twenty programs nominated by administrators and clinicians in the field.
Though each program is unique in its approach, some common themes
emerged. Treatment for people who
are homeless and have substance use disorders needs to be appropriate,
accessible, and effective. Based on
the experience of the six programs profiled, these expectations are best
met by prioritizing access to appropriate housing and providing comprehensive,
well-integrated, client-centered services with uniquely qualified staff
(authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/Advocacy/FactSheets/CA05RCaseStudies-FINAL5.pdf. |
|
|
Order #: 12548 |
|
Authors: |
Nyamathi,
A.M., Stein, J.A., Dixon, E., Longshore, D., Galaif, E.
|
|
Title: |
Predicting Positive Attitudes About Quitting Drug
and Alcohol Use Among Homeless Women. |
|
Source: |
Psychology of Addictive
Behaviors 17(1): 32-41, 2003. (Journal
Article: 10 pages)
|
|
Abstract: |
In this study, two
separate path models for alcohol and drugs were tested in which
psychosocial, environmental, and sociodemographic variables predicted
behavioral and substance abuse related factors as well as the key outcome
of positive attitudes about quitting drugs or alcohol in a sample of 709
homeless women. A positive attitude
about quitting alcohol was predicted by more addiction symptoms, fewer
positive effects from using alcohol and not having a partner who uses
alcohol. A positive attitude about quitting drugs was predicted by more
drug problems, greater drug use in the past 6 months, more active coping,
more education, less emotional distress, not having a partner who uses
drugs, and fewer addiction symptoms. Implications of the results for drug
and alcohol interventions are discussed (authors). |
|
|
Order #: 13251 |
|
Authors: |
Tam, T.,
Zlotnick, C., Robertson, M.
|
|
Title: |
Longitudinal Perspective: Adverse Childhood Events, Substance Use,
and Labor Force Participation Among Homeless Adults. |
|
Source: |
American Journal of
Alcohol Drug Abuse 29(4): 829-846, 2003. (Journal
Article: 17 pages)
|
|
Abstract: |
This article examines the
long-term effects of adverse childhood events on adulthood substance use,
social service utilization, and subsequent labor force participation. The authors discuss literature-based
relationships between adverse childhood events and labor force
participation, as well as mediating effects of adulthood substance use and
service use. The article asserts that adverse childhood events were
precursors to adulthood alcohol and drug use and that consistent substance
use was negatively associated with long-term labor force participation and
with social service utilization among homeless adults. The authors also
state that adverse events at childhood were positively associated with
service use. The authors conclude that adverse childhood events may
contribute to negative adulthood consequences, including consistent
substance use and reduced labor force participation. The authors suggest
that agencies involved in halting the abuse or neglect should participate
in more preventive interventions, and that job-related assistance is
particularly important to facilitate employment and labor force
participation among homeless adults (authors). |
|
|
Order #: 12264 |
|
Authors: |
Bird, C.,
Jinnett, K., Burnam, M., Koegel, P., Sullivan, G., Wenzel, S., Ridgely, M.,
Morton, S., Mui, A.
|
|
Title: |
Predictors of Contact with Public Service Sectors
Among Homeless Adults With and Without Alcohol and Other Drug Disorders. |
|
Source: |
Journal of Studies on
Alcohol 63(6): 716-725, 2002. (Journal
Article: 10 pages)
|
|
Abstract: |
This study examined the
predictors of contact with agencies in the health, mental health, social
welfare and criminal justice sectors by alcohol and other drug (AOD) status
among a probability sample of adults who are homeless in Houston, Texas. Structured
face-to-face interviews provided screening diagnoses for AOD disorders,
self-reported data on AOD treatment use and candidate predictors of
treatment use. The authors suggest
that AOD disorders hinder utilization of public sector services by people
who are homeless, and these disorders may be masking need or otherwise
acting as a barrier to accessing treatment and support (authors). |
|
|
Order #: 13474 |
|
Authors: |
Finnie,
A., Nicolson, P.
|
|
Title: |
Injecting Drug Use: Implications for Skin and Wound
Management. |
|
Source: |
British Journal of Nursing
11(6): 17-28, 2002. (Journal Article:
12 pages)
|
|
Abstract: |
This article, the first of
two parts, introduces the difficulties facing nurses working with injecting
drug users with skin problems. Drug abuse is increasing globally, and has
huge implications for healthcare practitioners. Increasing numbers of
tissue viability nurses are also encountering drug injection-induced wounds
in their practice, but there is a lack of evidence for management of
chronic skin problems in this patient group. Together with rising numbers
of injecting drug users, there are increased health implications such as
bacteraemia, septicaemia, amputation and skin breakdown. Abscesses and
chronic wounds as well as prolonged leg ulceration are common. Drug users
may demonstrate chaotic lifestyles, which may inhibit access to usual healthcare
provision. Issues relating to healing of these wounds are explored. The
second part describes the development of a specialist wound care clinic for
homeless drug users (authors). |
|
|
Order #: 11990 |
|
Authors: |
Galea,
S., Vlahov, D.
|
|
Title: |
Social Determinants and the Health of Drug
Users: Socioeconomic Status,
Homelessness, and Incarceration. |
|
Source: |
Public Health Reports
117(3): 135-145, 2002. (Journal Article:
10 pages)
|
|
Abstract: |
This article reviews the
evidence on the adverse health consequences of low socioeconomic status,
homelessness and incarceration among drug users. The authors discuss the effects of
availability on resources, access to social welfare systems,
marginalization, and compliance with medication have on drug users. Suggestions are made regarding the public
health system, and its need to address the social factors that accompany
and exacerbate the health consequences of illicit drug use (authors). |
|
|
Order #: 11239 |
|
Authors: |
Gonzalez,
G., Rosenheck, R.A.
|
|
Title: |
Outcomes and Service Use Among Homeless Persons
with Serious Mental Illness and Substance Abuse. |
|
Source: |
Psychiatric Services
53(4): 437-446, 2002. (Journal Article:
10 pages)
|
|
Abstract: |
This study compared
baseline characteristics and clinical improvement after 12 months among
homeless persons with a diagnosis of serious mental illness with and
without a comorbid substance use disorder.
The study subjects were 5,432 homeless persons with mental illness
who were participating in the Center for Mental Health Services' Access to
Community Care and Effective Services and Supports (ACCESS) program. Analysis of covariance was used to
compare clients who had dual diagnoses and those who did not and to
identify any association between service use and clinical improvement. Homeless persons with dual diagnoses had
poorer adjustment on most baseline measures and experienced significantly
less clinical improvement than those without dual diagnoses. However, those with dual diagnoses who
received extensive substance abuse treatment showed improvement similar to
those without at 12 months (authors).
|
|
|
Order #: 12576 |
|
Authors: |
Harris,
H., Young, D.
|
|
Title: |
Care of Injection Drug Users with Soft-Tissue
Infections in San Francisco, California. |
|
Source: |
Archives of Surgery
137(11): 1217-1222, 2002. (Journal Article:
6 pages)
|
|
Abstract: |
This article discusses the
serious soft tissue infections caused by illicit injection drug use, which
are the number one nonpsychiatric reason for admission to San Francisco General Hospital, in San
Francisco, California. The
authors established The Integrated Soft Tissue Infection Services Clinic
(ISIS), to provide coordinated surgical intervention, substance abuse
counseling, and social services for patients with soft tissue infections treated
in a public hospital. The authors
analyzed demographic information, treatment outcome, and hospital
utilization data. According to the
authors, in the clinic's first year of operation, there were 3365 patient
visits and 2255 surgical procedures.
A large number of the patients reported recent injection of illicit
drugs, were homeless, and either had hepatitis C, hepatitis B. or HIV. The authors conclude that this clinical
intervention was notably cost-effective while preserving a high quality of
medical services. The authors also
suggest that The ISIS Clinic serve as a model intervention and thus have
significant impact on the treatment of this prevalent but often overlooked
challenge (authors). |
|
|
Order #: 11642 |
|
Authors: |
Levounis,
P., Galanter, M., Dermatis, H., Hamowy, A., De Leon, G.
|
|
Title: |
Correlates of HIV Transmission Risk Factors and
Considerations for Interventions in Homeless, Chemically Addicted and
Mentally Ill Patients. |
|
Source: |
Journal of Addictive
Diseases 21(3): 61-72, 2002. (Journal
Article: 12 pages)
|
|
Abstract: |
A study was conducted to
ascertain correlates of HIV high risk behaviors and attitudes toward
HIV. A questionnaire was
administered to 103 men living in modified therapeutic community (TC) for
men who are homeless, chemically addicted and mentally ill. The psychiatric diagnoses of the sample
population included psychotic disorders, depressive disorders, and bipolar
disorders. Forty-two percent
reported that their primary substance of abuse was cocaine and another 40%
named alcohol as the substance to which they were most addicted. Two logistic regression analyses were
conducted, one with needle sharing as the outcome measure and one with
endorsement of the need for lifestyle changes to reduce risk of HIV
transmission. Cocaine users were 3.4
times more likely to have shared needles than the rest of the sample. Patients who had a history of sexually
transmitted diseases were 17 times more likely to endorse the need for
lifestyle changes. The level of HIV
transmission knowledge was unrelated to HIV risk behaviors or attitudes
(authors). |
|
|
Order #: 11723 |
|
Authors: |
Munoz,
M., Koegel, P., Vazquez, C., Sanz, J., Burnam, A.
|
|
Title: |
An Empirical Comparison of Substance and Alcohol
Dependence Patterns in the Homeless in Madrid and Los
Angeles. |
|
Source: |
Social Psychiatry and
Psychiatric Epidemiology 37(6): 289-298, 2002. (Journal Article: 10 pages)
|
|
Abstract: |
This article shows the
results of comparing the data concerning alcohol and other drug abuse and
dependence among people who are homeless in Madrid and Los Angeles. The data
collected is a product of two independently carried-out studies done in
each city. The data was then
combined in a unique database which allows global and item-to-item
comparison between the two studies. The result of the study show that there
are significant differences in social, emotional and health problems
associated with the consumption of alcohol and other drugs, between the two
areas (authors). |
|
|
Order #: 14229 |
|
Authors: |
Nwakeze,
P.C., Magura, S., Rosenblum, A.
|
|
Title: |
Drug Problem Recognition, Desire for Help, and
Treatment Readiness in a Soup Kitchen Population. |
|
Source: |
Substance Use and Misuse
37(3): 291-312, 2002. (Journal Article:
22 Pages)
|
|
Abstract: |
This study determined hypothesized
predictors of three components of motivation for change (drug problem
recognition, desire for help, and treatment readiness) in a high-risk,
drug-using population. The sample
consisted of 190 guests at two inner-city soup kitchens in Brooklyn, NY who reported drug/alcohol use and were not
participating in substance dependency treatment. Ever receiving addiction treatment,
having no trade/job skills, and more severe symptoms of depression were
associated with greater drug problem recognition. More recent days of drug/alcohol use,
intensive pattern of drug use, and greater problem recognition were
associated with greater desire for help.
Caring for children, more recent days of drug/alcohol use, physical health
problems, and desire for help were the direct predictors of treatment
readiness. Problem recognition had a
strong indirect effect on readiness mediated through desire for help. Knowledge of a drug user's motivational
state and the factors leading to it can help guide the development of more
effective interventions (authors). |
|
|
Order #: 14235 |
|
Authors: |
Schumacher,
J.E., Mennemeyer, S.T., Milby, J.B., Wallace, D., Nolan, K.
|
|
Title: |
Costs and Effectiveness of Substance Abuse
Treatments for Homeless Persons. |
|
Source: |
The Journal of Mental
Health Policy and Economics 5(1): 33-42, 2002. (Journal Article: 10 Pages)
|
|
Abstract: |
This study presents a cost
analysis of two randomized controlled studies comparing four drug addiction
interventions for homeless persons.
The studies controlled for some limitations of previous research in
this area including random assignment.
Findings are based on treatment costs obtained from actual
expenditures and treatment outcomes of drug abstinence from toxicology tests. Cost-effectiveness is considered from the
viewpoint of the treatment program.
Cost-effectiveness from a societal viewpoint is discussed, but not
calculated. When only the direct
costs of programs and their abstinence rates are considered, treatments
that involve abstinent contingent work and housing have incremental cost
ratios that are within the range of many other common social and medical
interventions. These enhanced
programs are more cost effective earlier in treatment than at 12-month
follow-up due to relapse common among existing drug treatment. A methodological limitation of this study
is that direct program costs do not measure the societal value of reducing
homelessness itself. Usual and
improved treatment methods offer a cost-effective approach to improving
abstinence among addicted homeless persons.
Policy makers might reasonably choose to implement enhanced
treatment programs that also reduce homelessness because the incremental
cost of these programs is within a reasonable range compared to other
common societal interventions.
Methods and data need to be developed to better measure the societal
benefit to communities of reducing the numbers of homeless persons with
addictive drug problems (authors). |
|
|
Order #: 14234 |
|
Authors: |
Shaffer,
H.J., Freed, C.R., Healea, D.
|
|
Title: |
Gambling Disorders Among Homeless Persons With
Substance Use Disorders Seeking Treatment at a Community Center. |
|
Source: |
Psychiatric Services
53(9): 1112-1117, 2002. (Journal Article:
6 Pages)
|
|
Abstract: |
This study examined the
prevalence of disordered gambling and its association with treatment of
psychiatric and substance use disorders among a cohort of homeless people
seeking treatment at a community services program. Between 1998 and 2000, intake workers evaluated
the level of gambling disorder among 171 consecutive homeless persons with
substance use disorders who sought treatment at the Moving Ahead Program in
Boston. Program
staff administered the DSM-IV subscale of the Massachusetts Gambling Screen
at intake. The prevalence rates of
level two and level three gambling disorders were 12.8 percent and 5.5
percent, respectively. These rates
are higher than that of the general adult population but comparable to
those of other patients with substance use disorders and psychiatric
diagnoses. Program participants with
level three gambling disorders had been homeless more often and at a
younger age and had had less substance abuse treatment and more psychiatric
treatment than participants with level one or level two gambling disorders. Participants with level two gambling
disorders had been homeless more often and for a longer duration than
participants without gambling disorders.
These findings should encourage clinicians working with homeless
people to screen for gambling-related problems and disorders (authors). |
|
|
Order #: 11644 |
|
Authors: |
Sosin,
M.R.
|
|
Title: |
Outcomes and Sample Selection: The Case of a Homelessness and Substance
Abuse Intervention. |
|
Source: |
British Journal of
Mathematical and Statistical Psychology 55(1): 63-91, 2002. (Journal Article: 29 pages)
|
|
Abstract: |
This article explores ways
of correcting for sample selection bias, with advanced correction
strategies, focusing on experiments in which clients refuse assignment into
treatment conditions. The sample
selection modeling strategy, which is highly recommended but seldom applied
to random sample psychosocial experiments, and some alternatives are
discussed. Data from an experiment
on homelessness and substance abuse are used to compare sample selection,
conventional control variable, instrumental variable, and propensity score
matching correction strategies. The
empirical findings suggest that the sample selection modeling strategy
provides reliable estimates of the effects of treatment, that it and some
other correction strategies are awkward to apply when there is a
post-assignment rejection, and that the varying correction strategies
provide widely divergent estimates.
In light of these findings, researchers might wish to compare
estimates across multiple correction strategies (author). |
|
|
Order #: 11901 |
|
Authors: |
Stein,
J., Leslie, M.B., Nyamathi, A.
|
|
Title: |
Relative Contributions of Parent Substance Use and
Childhood Maltreatment to Chronic Homelessness, Depression, and Substance
Abuse Problems Among Homeless Women: Mediating Roles of Self-Esteem and
Abuse in Adulthood. |
|
Source: |
Child Abuse and Neglect
26(10): 1011-1027, 2002. (Journal Article:
17 pages)
|
|
Abstract: |
This article is based on a
study that explores simultaneously the relative effects of childhood abuse
and early parental substance abuse on later chronic homelessness,
depression, and substance abuse problems in a sample of homeless
women. The authors also examine
whether self-esteem and recent violence can serve as mediators between the
childhood predictors and the dysfunctional outcomes (authors). |
|
|
Order #: 12086 |
|
Authors: |
Substance
Abuse and Mental Health Services Administration.
|
|
Title: |
Emergency Department Trends from the Drug Abuse
Warning Network: Preliminary Estimates January-June 2002. |
|
Source: |
Rockville, MD: Substance Abuse and Mental Heath Service
Administration, 2002. (Report: 471 pages)
|
|
Abstract: |
This report contains the
most recently available mid-year estimates from the 2002 Drug Abuse Warning
Network (DAWN), which collects data on estimates of drug-related emergency
department episodes and drug mentions.
It provides program administrators and health professionals with a
measurement of the health consequences of drug use and the impact of drugs
on the nation's health care system. DAWN relies on a sample of hospitals
operating 24-hour emergency departments (EDs) to capture data on ED visits
induced by or related to substance abuse.
DAWN data does not measure the prevalence of drug use in the
population, but the probability sample of hospitals is designed to produce
representative estimates of ED drug episodes and drug mentions for the
coterminous United States and for 21 metropolitan areas (authors). Available
From: Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, www.samhsa.gov. |
|
|
Order #: 11787 |
|
Authors: |
Thornquist,
L., Biros, M., Olander, R., Sterner, S.
|
|
Title: |
Health Care Utilization of Chronic Inebriates. |
|
Source: |
Academic Emergency
Medicine 9 (4): 300-308, 2002. (Journal
Article: 9 pages)
|
|
Abstract: |
This article examines the
effectiveness of three county programs developed to reduce emergency
resource utilization while still providing a safe environment. The authors determined the frequency,
cost, and types of health care services given to chronic inebriates living
on the streets, and similar data after they enrolled in one of the county
programs. The authors assert that
program enrollment would reduce medical visits and related expenditures for
this patient population (authors). |
|
|
Order #: 14236 |
|
Authors: |
Vangeest,
J.B., Johnson, T.P.
|
|
Title: |
Substance Abuse and Homelessness: Direct or
Indirect Effects? |
|
Source: |
Annals of Epidemiology
12(7): 455-461, 2002. (Journal Article:
7 Pages)
|
|
Abstract: |
This study’s objective was
to investigate whether substance abuse is a direct factor in the
explanation of homelessness or one that operates indirectly through
disaffiliation and human capital processes to place individuals at greater
risk of condition. Analyses were
conducted using data on substance abuse and homeless experiences from a
random probability sample of 481 homeless persons and those at risk of
homelessness in Cook
County, IL. Covariance
structure models were used to assess substance abuse, human capital, and disaffiliation
as potential precursors of homelessness, with particular attention paid to
the direct and indirect role of substance abuse in the loss of
domicile. Analysis of several nested
models of homelessness links substance abuse only indirectly to loss of
domicile, primarily through its impact on social and institutional
affiliations. Contrary to
expectations, substance abuse did not impact homelessness indirectly by
diminishing the accumulation of human capital. The role of disaffiliation as a proximate
cause of homelessness was confirmed.
This locates the phenomenon within the context of society itself, as
a direct result of a breakdown in the social bonds necessary for human
community. Substance abuse plays a
critical role in this breakdown, negatively influencing social as well as
institutional relationships (authors).
|
|
|
Order #: 8932 |
|
Authors: |
Appel,
P.W., Hoffman, J.H., Blane, H.T., Frank, B., Oldak, R., Burke, M.
|
|
Title: |
Comparison of Self-Report and Hair Analysis in
Detecting Cocaine Use in a Homeless/Transient Sample. |
|
Source: |
Journal of Psychoactive
Drugs 33(1): 47-55, 2001. (Journal Article:
9 pages)
|
|
Abstract: |
This article describes
results of a study in which detection of current drug use by analysis of
hair was examined along with self-reports of current use. This occurred in a 1994 treatment needs
assessment survey with a sample of 179 homeless/transient adults in New York State. Results of radioimmunoassay
of hair were used to evaluate the veracity of self-reports in current cocaine
use. Only 26% of those persons whose
hair tested positive for cocaine admitted to having used cocaine in the
past 30 days. Subjects eligible for
treatment, as indicated in the DSM-III-R diagnosis of cocaine dependency,
were nearly four times as likely to admit current cocaine use than those
who were not dependent. These
results are consistent with other studies of populations at high risk for
substance abuse (authors). |
|
|
Order #: 14237 |
|
Authors: |
Inciardi,
J.A., Surratt, H.L.
|
|
Title: |
Drug Use, Street Crime, and Sex-Trading Among
Cocaine-Dependent Women: Implications for Public Health and Criminal
Justice Policy. |
|
Source: |
Journal of Psychoactive
Drugs 33(4): 379-389, 2001. (Journal Article:
11 Pages)
|
|
Abstract: |
This article looks at the
linkages between the sex-for-crack exchanges, prostitution, and rising
rates of HIV and other sexually transmitted diseases among
cocaine-dependent women. As crack
began to disappear from the headlines during the 1990s, however, it was
assumed by many that crack had fallen on hard times in the street drug
culture. The article examines the
extent to which crack has remained primary in the culture of
cocaine-dependent women. Data are drawn
from a study of 708 cocaine-dependent women in Miami, Florida, during the years 1994 to 1996, and qualitative
data gathered during 1998 and 1999 in the same field areas. Analyses focus
on drug use, criminality and HIV/AIDS risk behaviors. Implications for
policy alternatives in criminal justice and public health approaches for
assisting this population are discussed (authors). |
|
|
Order #: 10066 |
|
Authors: |
Lopez-Zetina,
J., Kerndt, P., Ford, W., Woerhle, T., Weber, M.
|
|
Title: |
Prevalence of HIV and Hepatitis B and Self-Reported
Injection Risk Behavior During Detention Among Street-Recruited Injection
Drug-Users in Los Angeles County, 1994-1996. |
|
Source: |
Addiction 96(4): 589-595,
2001. (Journal Article: 7 pages)
|
|
Abstract: |
This study's aim is to
describe injection risk behaviors while in detention in a sample of drug
users (IDUs) in Los Angeles County. Cross-sectional, interviewer-administered,
face-to-face risk survey, and serological screening for HIV and hepatitis B
were conducted at four street locations in Los Angeles County between 1994 and 1996. All interviews were conducted in a
non-institutionalized setting. Measurements included ascertainment of
self-reported risk behavior during detention and screening for HIV and hepatitis B
surface antigen (HBsAg) and antibody to the core (HBcAb) seromarkers. Six
hundred and forty-two participants were street -recruited during the study period. Seventy-one per cent of
the sample was male, the median age was 43 years, 61% were
African-American, 27% were latino, 8% were white and 36% considered
themselves homeless. Overall HIV prevalence was 3.0%; 3.1% tested positive
for the hepatitis B surface antigen marker (HBcAg), and 80.3% for antibody
to hepatitis B core antigen (HBcAb). After adjustment for length of
injection drug use and recency of release from detention, HIV seroreactivity
was significantly associated with history of detention due to possession of
IDU paraphernalia. The presence of the hepatitis B HBcAb seromarker was
associated with injection drug use while in detention, having been ever
arrested for possession of IDU paraphernalia. IDU detainees constitute a
high risk group for blood-borne infections. Comprehensive prevention and
health promotion efforts in the
community need to include correctional facilities. |
|
|
Order #: 10186 |
|
Authors: |
McNamara,
C., Schumacher, J., Milby, J., Wallace, D., Usdan, S.
|
|
Title: |
Prevalence of Nonpsychotic Mental Disorders Does
Not Affect Treatment Outcome in a Homeless Cocaine-Dependent Sample. |
|
Source: |
American Journal of Drug
and Alcohol Abuse 27(1): 91-106, 2001. (Journal
Article: 15 pages)
|
|
Abstract: |
This study presents the
prevalence and treatment outcome of DUAL diagnoses (psychoactive substance
use disorders [PSUD] plus other nonpsychotic mental disorders) among a
population of homeless persons participating in a behavioral day treatment
and contingency management drug abuse treatment program. Cocaine and alcohol disorders were most
prevalent overall, and over half of participants had two or more
psychoactive substance use disorders.
DUAL participants had significantly more alcohol disorders than
PSUD's. The most prevalent mental
disorders, other than substance abuse, for the total and DUAL samples were
mood and anxiety. The DUAL group had
more severe problems than the PSUD group at baseline in alcohol, medical
condition, employment/support, and psychiatric status areas. Both groups showed treatment improvements
at 6-month follow-up, with the DUAL group showing greater mean change than
he PSUD group. These findings are
discussed in terms of effect of dual diagnoses on treatment outcome and
study limitations related to a retrospective design and select sample of
nonpsychotic mental disorders (authors).
|
|
|
Order #: 10138 |
|
Authors: |
Opler,
L., White, L., Caton, C., Dominguez, B., Hirshfield, S., Shrout, P.
|
|
Title: |
Gender Differences in the Relationship of
Homelessness to Symptom Severity, Substance Abuse, and Neuroleptic
Noncompliance in Schizophrenia. |
|
Source: |
Journal of Nervous and
Mental Disease 189(7): 449-456,
2001. (Journal Article: 8 pages)
|
|
Abstract: |
This study examined gender
differences in the relationship of homelessness in schizophrenia to symptom
severity, risk behaviors, and prognostic features. Homelessness for the entire sample was
associated with greater severity of positive, activation, and autistic
preoccupation symptoms, younger age at first hospitalization, and substance
abuse. For men only, homelessness
was associated with neuroleptic noncompliance. When neuroleptic noncompliance and
substance abuse were statistically controlled, symptom severity was not different
between the homeless and never homeless.
Women, independent of residential status, had more severe negative,
activation, and autistic preoccupation symptoms that were not associated
with prognostic features or risk behaviors.
For both men and women, substance abuse was associated with
homelessness, but independent of residence, substance abuse was less severe
in women. Additionally, it was less
severe in homeless women than in never homeless men. Thus, symptom severity in homeless
individuals with schizophrenia appears as an interaction of symptom
profiles and risk behaviors that are gender specific. Although cross-sectional analyses cannot
distinguish cause from effect, these findings suggest gender-specific
routes to homelessness among indigent urban adults with schizophrenia
(authors). |
|
|
Order #: 10936 |
|
Authors: |
Seal,
K.H., Kral, A.H., Gee, L., Moore, L.D., Bluthenthal, R.N.,
Lorvick, J., Edlin, B.R.
|
|
Title: |
Predictors And Prevention of Nonfatal Overdose
Among Street-Recruited Injection Heroin Users In the San
Francisco Bay Area,
1998-1999. |
|
Source: |
American Journal of Public
Health 91(11): 1842-1846, 2001. (Journal
Article: 5 pages)
|
|
Abstract: |
This study sought to
determine prevalence of and risk factors for nonfatal recent overdose among
street-recruited injection heroin users. From August 1998 through July
1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods
in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be
associated with recent overdose were analyzed with logistic regression. Of
the 1427 participants, 684 had had an overdose, 466 had experienced 2 or
more overdose events, and 182 had had a recent overdose. In multiple
logistic regression, being younger, having been arrested 3 or more times in
the past year, drinking 4 or more alcoholic drinks per day, and having
participated in methadone detoxification during the past year, were
independently associated with recent overdose. Being homeless; identifying
as gay, lesbian, bisexual, or transgender; having spent 5 or more years in
prison or jail; and having engaged in sex work also were associated with
recent overdose. Targeted interventions that decrease risk for overdose are
urgently needed. |
|
|
Order #: 10142 |
|
Authors: |
Usdan,
S., Schmacher, J., Milby, J., Wallace, D., McNamara, C., Michael, M.
|
|
Title: |
Crack Cocaine, Alcohol, and Other Drug Use Patterns
Among Homeless Persons with Other Mental Disorders. |
|
Source: |
American Journal of Drug
and Alcohol Abuse 27(1): 107-120, 2001. (Journal
Article: 8 pages)
|
|
Abstract: |
This study examined the
co-occurrence of cocaine, alcohol, marijuana, and other drug use among
treatment-seeking homeless persons to determine whether alcohol use
predicted cocaine use differently than marijuana and other drugs predicted
cocaine use. Results supported the
assertion that cocaine use was strongly associated with extent of alcohol
use and the association between cocaine and alcohol was stronger than the
association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol
disorders were retained longer in treatment than disorders of cocaine only
with no differences in abstinence outcome.
The findings should drive further research into the use of alcohol
as a trigger or predictor of cocaine use, the deleterious effects of the
combined use of cocaine and alcohol, and specialized treatments for
polysubstance users (authors). |
|
|
Order #: 8814 |
|
Authors: |
Brush,
B.L., McGee, E.M.
|
|
Title: |
Evaluating the Spiritual Perspectives of Homeless
Men in Recovery. |
|
Source: |
Applied Nursing Research
13(4): 181-186, 2000. (Journal Article:
6 pages)
|
|
Abstract: |
The purpose of this study
was to describe the self-reported spiritual perspectives of 100 homeless
male residents living in a communal shelter. The residents, in recovery from substance
addiction, were asked to complete Reed's 10-item Spiritual Perspective
Scale (SPS) as part of their initial health database. Their responses were
described within the context of their participation in 12-Step recovery
programs, demographic characteristics, and perceived health status. Findings suggest that spirituality is an
important health component for this population. |
|
|
Order #: 8756 |
|
Authors: |
DeLeon,
G., Sacks, S., Staines, G., McKendrick, K.
|
|
Title: |
Modified Therapeutic Community for Homeless
Mentally Ill Chemical Abusers: Treatment Outcomes. |
|
Source: |
American Journal of Drug
and Alcohol Abuse 26(3): 461-480, 2000. (Journal
Article: 20 pages)
|
|
Abstract: |
This article compares
homeless mentally ill chemical abuser (MICA) clients, male and female,
sequentially assigned to either of two modified therapeutic community
programs (TC-1 and TC-2) and to a treatment as usual (TAU) control
group. Follow-up interviews were
obtained at 12 months post-baseline and at time F (on average more than two
years post-baseline). Outcome
measures assessed five domains: drug use, crime, HIV risk behavior,
psychological symptoms, and employment.
Individuals in both modified TC groups showed significantly greater
behavioral improvement than TAU at 12 months and time F, and the modified
TC-2, with lower demands and staff guidance, was superior to modified
TC-1. Completers of both TC programs
showed significantly greater improvement than dropouts and a subgroup of
TAU clients with high exposure (i.e., more than eight months) to other
treatment protocols. The present
findings support the effectiveness and longer term stability of effects of
a modified TC program for treating homeless MICA clients (authors). |
|
|
Order #: 8782 |
|
Authors: |
Jainchill,
N., Hawke, J., Yagelka, J.
|
|
Title: |
Gender, Psychopathology, and Patterns of
Homelessness Among Clients in Shelter-Based TCs. |
|
Source: |
American Journal of Drug
and Alcohol Abuse 26(4): 553-567, 2000. (Journal
Article: 15 pages)
|
|
Abstract: |
This article examines the
relationship among psychiatric disturbance, abusive experiences, and
homelessness among adult men and women admitted to shelter-based
therapeutic community (TC) drug treatment programs. The sample presents with extensive
psychopathology and a history of physical and sexual abuse. Gender differences indicate that, except
for antisocial personality disorder, females yield higher rates on measures
for both psychiatric disturbance and abuse.
The relationship between psychopathology and abuse also appears to
be much stronger for females than for males. However, the relationship between abuse
and adult homelessness appears to be similar for men and women. The findings suggest that, although there
may be a need for gender-specific interventions, treatment providers must
also recognize that the impact of abuse seems to transcend gender within
this population (authors). |
|
|
Order #: 9198 |
|
Authors: |
Magura,
S., Nwakeze, P.C., Rosenblum, A., Joseph, H.
|
|
Title: |
Substance Misuse and Related Infectious Diseases in
a Soup Kitchen Population. |
|
Source: |
Substance Use and Misuse
35(4): 551-583, 2000. (Journal Article:
33 pages)
|
|
Abstract: |
Representative samples of
female and male guests were selected at two inner city soup kitchens. In
the preceding month, 75% used cocaine/crack and 25% used heroin/opiates as
determined by hair analysis. Relatively few guests were in substance
dependency treatment. Infectious disease rates were: HIV, hepatitis B
exposure, hepatitis B carrier, syphilis exposure. Years of injecting drug
use and homelessness/marginal housing were associated with HIV infection
and hepatitis B exposure. Soup kitchens should be prime locations for
outreach to cocaine/crack and heroin users in need of treatment, medical
care, and interventions to prevent infectious disease transmission. |
|
|
Order #: 8654 |
|
Authors: |
Royse,
D., Leukefel, C., Logan, T.K., Dennis, M., Wechsberg, W.,
Hoffman, J., Cottler, L., Inciardi, J.
|
|
Title: |
Homelessness and Gender in Out-of-Treatment Drug
Users. |
|
Source: |
American Journal of Drug
and Alcohol Abuse 26(2): 283-295, 2000. (Journal
Article: 13 pages)
|
|
Abstract: |
This study examines 5,225
out-of-treatment crack users and drug injectors drawn from five different
geographic areas to examine selected factors associated with
homelessness. Of these crack users,
27% considered themselves undomiciled, and 60% had previously entered some
type of drug treatment. Logistic
regression found that substance abusers who were married, female, and persons
of color were less likely to be without a home when other variables were
controlled. Trading sex for money
and perceived chance of getting acquired immunodeficiency syndrome (AIDS)
were associated positively with homelessness, while participating in methadone
detoxification and methadone maintenance programs seemed to offer some
protection from homelessness (authors).
|
|
|
Order #: 8828 |
|
Authors: |
Schumacher,
J.E., Milby, J.B., Engle, M., Raczynski, J.M., Michael, M.
|
|
Title: |
Linking Practice and Science in the Substance Abuse
Treatment of Homeless Persons. |
|
Source: |
Journal of Applied
Behavioral Science 36(3): 297-313, 2000. (Journal
Article: 17 pages)
|
|
Abstract: |
This article describes the
collaboration between a university and a community health care agency in
substance abuse treatment for homeless persons. The Homeless I Project represents the
successful linking of practice and science in the development, delivery,
and evaluation of innovative interventions for substance abuse and
homelessness in a community setting.
Positive outcomes of the collaboration included productive research
and service delivery components, important project and community linkages,
national research and service delivery linkages, service enhancements,
development of an innovative abstinent-contingent work therapy and housing
program; significant participation rates, and continued practice and
research. Obstacles and solutions
relating to integrating science and practice, overcoming community
resistance, and maintaining linkages are presented (authors). |
|
|
Order #: 8663 |
|
Authors: |
Schumacher,
J.E., Usdan, S., Milby, J.B., Wallace, D., McNamara, C.
|
|
Title: |
Abstinent-Contingent Housing and Treatment
Retention Among Crack-Cocaine Dependent Homeless Persons. |
|
Source: |
Journal of Substance Abuse
Treatment 19(1): 81-88, 2000. (Journal
Article: 8 pages)
|
|
Abstract: |
This article examines
behavioral day treatment attendance in relation to treatment outcome among
homeless persons dependent on crack-cocaine. Days attended, activities attended, and
follow-up rates over a 12-month period were positively affected by the more
attractive treatment of providing immediate, rent-free,
abstinent-contingent housing during a two-month behavioral day treatment
program. Results replicated previous
findings that abstinence is a function of treatment attendance and more
treatment is associated with greater abstinence. The loss of predictive power at long-term
follow-up, limitations of a retrospective design, need to identify most
predictive therapeutic activity types, and potential influence of mental
disorders are discussed (authors). |
|
|
Order #: 12448 |
|
Authors: |
Scott-Lennox,
J., Rose, R., Bohlig, A., Lennox, R.
|
|
Title: |
The Impact of Women's Family Status on Completion
of Substance Abuse Treatment. |
|
Source: |
Journal of Behavioral
Health Services and Research 27(4): 366-379, 2000. (Journal Article: 13 pages)
|
|
Abstract: |
This article examines the
role of family status and demographic characteristics in explaining the
nearly sixty percent drop out rate for women in substance abuse
treatment. Data from the
administrative record files of the Illinois Office of Alcoholism and
Substance Abuse (OASA) for the fiscal year 1996-97 were analyzed for women
age 12 or older who completed intake for publicly funded substance abuse
treatment and whose outpatient treatment records were closed at
year-end. According to the authors,
multivariate logistic regression models found that the likelihood of not
completing treatment was greatest for women who were African American,
pregnant, had custody of minor children, or were younger than age 21. The article also states that African
American women who had children in foster care were more likely to complete
treatment. Implications for
treatment and research are discussed (authors). |
|
|
Order #: 11364 |
|
Authors: |
Velasquez,
M.M., Crouch, C., von Sternberg, K., Grosdanis, I.
|
|
Title: |
Motivation for Change and Psychological Distress in
Homeless Substance Abusers. |
|
Source: |
Journal of Substance Abuse
19(4): 395-401, 2000. (Journal Article:
6 pages)
|
|
Abstract: |
This study explores the
treatment needs of homeless individuals participating in a large urban day
shelter program. Alcohol and drug
use, psychological distress, and stage of change were assessed in 100
participants presenting for services.
The associations among substance use, risk perception, and readiness
to change were examined for alcohol and drugs separately. Participants had high levels of
psychological distress compared to "non-patient" samples. Eighty percent had used alcohol in the
past 6 months, with 65% of those drinking at higher-risk levels; 60% had
used drugs, with 82% in the higher-risk levels. While the majority felt that they drank
and/or used drugs "too much," most were in precontemplation or
contemplation stages of change.
Intervention efforts for this population should focus on motivation,
facilitation through the stages, and the associations between psychiatric
symptoms and substance use (authors).
|
|
|
Order #: 9181 |
|
Authors: |
Witbeck,
G., Hornfeld, S., Dalack, G.W.
|
|
Title: |
Emergency Room Outreach to Chronically Addicted
Individuals: A Pilot Study. |
|
Source: |
Journal of Substance Abuse
Treatment 19(1): 39-43, 2000. (Journal
Article: 5 pages)
|
|
Abstract: |
There is a dearth of
literature describing the treatment needs of substance-abusing or
chronically mentally ill homeless individuals who frequently utilize
emergency medical services (EMSs).
This study describes a pilot program, supported by local county public
funds and conducted by a nonprofit social work agency, that was designed to
provide intensive case management services to such a population. The broad goal of the Emergency Services
Outreach Program is to help clients establish greater functional stability
in order to facilitate movement to more traditional treatment
settings. Outreach and case
management activities resulted in linking clients to a broad range of
entitlements and community services.
The mean age of the 18 referrals was 45.7 yrs; all had a history of
alcohol dependence and 8 had substance abuse disorders. Among those receiving outreach and case
management services, EMSs (defined as ambulance response and transport
followed by emergency room admission and treatment) decreased by 58% in the
year following referral compared to the year before. Ss in the control group showed no
decrease in EMSs use. Results
suggest that such community-based outreach programs can significantly
improve client outcome and provide substantial cost savings. |
|
|
Order #: 9182 |
|
Authors: |
Brush, B.L.,
McGee, E.M.
|
|
Title: |
The Expanded Care for Healthy Outcomes (ECHO)
Project: Addressing the Spiritual Care Needs of Homeless Men in Recovery. |
|
Source: |
Clinical Excellence for
Nurse Practitioners 3(2): 116-122, 1999. (Journal
Article: 7 pages)
|
|
Abstract: |
As the nation's homeless
population continues to rise, new practice models will need to address the
specific health care needs of the homeless while providing cost-effective
wellness-oriented quality care. This article describes the early
development of one such model. The Expanded Care for Healthy Outcomes
(ECHO) Project is an interdisciplinary curriculum/practice mod | | | | | |