Purpose. The purpose of this study was to evaluate whether severe victimization experiences, and psychological and social resources were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. Method. Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. Results. Longer duration/frequent victimization, more than one type of victimization, recent victimization, low self-efficacy beliefs and available sources of emotional support were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. Conclusion. The findings show that some indicators of severe victimization experiences, psychological and social resources are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs. Particular emphasis may be placed on enhancing self-efficacy and social skills, so that adolescents may benefit from their available sources of support.

Substance use disorders (SUD) and mental health disorders are often thought of as completely separate problems even though these disorders commonly co-occur. Among adolescents who seek treatment for substance use problems, co-occurring mental health problems (MHP) are common. This is concerning because co-occurring disorders among adults have been associated with more severe MHPs, relapsing to substance use sooner, being less likely to maintain abstinence, and other problems. Despite the awareness that co-occurring disorders are problematic for adolescents, few studies have been conducted to understand these problems with an adolescent sample. The purpose of this study was to understand if factors commonly related to co-occurring disorders among adults were the same for adolescents and to examine two measurement models for the dependent variable, substance use. This secondary analysis of data first examined characteristics that are related to MHPs among a sample of adolescents (N=801) who use substances. Factors in three domains were examined: demographics, substance use, social factors. The results indicated that among these adolescents, MHPs were common. Two key factors related to having a MHP were gender and the severity of the SUD. Females and adolescents with more severe SUDs, like dependence, were more likely to have MHPs. Furthermore, severity of the SUD partially mediated the relationship between several of the other factors and MHPs. The type of substance an adolescent reported using was also important. In addition, adolescents who had more peers and more family members who participated in deviant activities had more severe substance use problems and were more likely to have a MHP. In addition to examining the factors related to mental health problems among a substance using population, this study modeled the dependent variable in two different ways which had not been done before and allowed for variance in the measure to be accounted for in the model. MHPs were measured both continuously and categorically. The results of the comparison indicated that there were not major differences between the two models. Implications for social work practice, policy and research are discussed.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support. / October 2007

Past research has highlighted the importance of better understanding the high rate of smoking among individuals exposed to trauma. However, few studies have investigated the cognitive mechanisms that may contribute to the smoking-trauma relationship. The primary goal of the present study was to examine the associative relationship between smoking and trauma at a cognitive level, by examining the extent to which trauma-relevant pictures primed attentional biases to smoking-related words on a modified Stroop task. Eighty trauma-exposed smokers (classified as having low, medium, or high levels of post trauma symptomatology) ink-named smoking-related and neutral words after being primed with trauma-related, positive, or neutral picture cues. Although participants did not display an overall significant difference in reaction time between smoking words and neutral words, we found a significant prime x word type interaction, with slower reaction time to smoking words after being primed by trauma-related pictures. In addition, we found a significant 3-way interaction between symptom severity level, prime category, and target type. Further analyses revealed that the prime x word type interaction was significant only among individuals with the lowest and highest levels of PTSD symptomatology. A secondary aim of the study was to evaluate the relationship between smoking-related variables and posttraumatic stress disorder symptoms on a dimensional range. We found that participants who were more severely impaired at the time of the study were more likely to report strong cravings to smoke. Overall, findings suggest that smokers who have experienced trauma exhibit an attentional bias to smoking words when primed with trauma-related picture, and that post-trauma symptoms are related to smoking motivation. Implications for treatment are discussed.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.

It is increasingly important to understand the factors associated with individuals struggling with addiction and their quality of life, especially with those struggling with co-occurring diagnoses (CODs). The purpose of this study was to explore the extent to which meaning, and CODs of anxiety and depression predict an individual's attitudes and beliefs about addiction among persons receiving treatment for substance use disorders (SUDs). The theoretical foundation used to guide this study was logotherapy, which emphasizes the importance of increasing meaning in life through choices, while also centering on being able to find meaning in all situations. A cross-sectional correlation design was employed, using a sample of patient admission records from a dual diagnosis treatment center in the western United States. The responses on 4 assessments related to meaning, symptoms of anxiety and depression, and attitudes about substances were analyzed using a multiple linear regression. There was no statistically significant relationship between an individual's attitudes and beliefs about addiction as predicted by that individual's meaning and CODs symptoms of anxiety and depression. A significant negative correlation existed between depression and meaning (p < .01), while a significant positive correlation existed between the depression and anxiety (p < .05) as well as the anxiety and attitudes about substances (p < .01). The findings from this study can assist counselor educators in understanding the correlation between SUD, increased depressive symptoms, and low personal meaning.

Youth with co-occurring mental illness and substance use disorders are at higher risk for vocational rehabilitation exclusion. This study aimed to (a) explore the personal factors associated with vocational outcomes of youth with co-occurring mental illness and substance use disorders and (b) highlight services that have shown the greatest promise for this population in the state-federal rehabilitation program in the United States. Our analytic sample was extracted from the Rehabilitation Services Administration's Case Service Report data set for 2013, 2014, and 2015 fiscal years. Multiple regression analyses results identified personal factors such as gender, race/ethnicity, level of education, and severity of disability as predictors of the achievement of competitive employment, hours worked, and income. The receipt of vocational rehabilitation services such as job search support, job placement assistance, vocational training, and on-the-job support are significantly associated with the achievement of competitive employment, higher work hours, and income. These finding have implications for vocational rehabilitation practice as they highlight who is at higher risk for poor outcomes, effective services, and additional factors to consider when working with youth with co-occurring mental illness and substance use disorders.

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