The problem of co-occurring substance abuse and mental health disorders among the veteran population can impact numerous aspects of a veteran's life, including self-esteem, relationships, employment, and legal issues. The Mental Health Residential Rehabilitation Treatment Program (MH RRTP) at the Saint Cloud, Minnesota VA Healthcare System is a program that provides residential treatment for this population. Identifying practical and beneficial treatment methods promotes better coping mechanisms for veterans and impacts social change by providing timely and cost-efficient care for veterans, while also leading the way for overall changes and improvements in other VA residential treatment programs. This study identified how using the integrated treatment model in the MH RRTP impacted depression, anxiety, and sobriety protective factors among 1,136 veterans who completed the program between 2016 and 2017, and if there were any significant differences in outcomes among various age groups and lengths of stay in the program. Outcome measures taken at pre and post treatment, using BDI-II, BAI, and BAM, were analyzed by using six one-within one-between (mixed-model) Analysis of Variance (ANOVA) tests. Significant interaction effects were noted for protective factors in length of stay and age group categories and for depression and length of stay. Significant main effects for within-subjects factors were consistently noted for all categories, indicating a reduction in depression and anxiety symptoms, while increasing protective factors for the veterans in this study. The results demonstrated that veterans responded favorably without regard to potential differences in age groups and lengths of stay.

Numerous studies have focused on the effectiveness of integrated treatment services for people with cooccurring disorders (CODs) within the criminal justice system (CJS). However, there has been a paucity of research on the effectiveness of community-integrated treatment services with CODs and influences on decreasing their interaction within the CJS. This study quantitatively examined the possible relationships between integrated treatment services and CODs and their effect on decreasing interactions within the CJS. The sample (N = 320) consisted of people with CODs from a community-based facility. The statistical analysis was a 2-way (2 x 2) and 3-way (2 x 2 x 2) mixed factorial analysis of variance. Results indicated a statistically significant difference in the number of interactions within the CJS between integrated treatment services and single treatment services, as well as a statistically nonsignificant difference between male and female. Future studies are recommended to examine the predictive value of the long-term effects of integrated treatment services in decreasing interactions within the CJS. The social implications of the study could be integral to community behavioral health care agencies and administrators of correctional institutions in demonstrating how pertinent integrated treatment services can be in decreasing the overrepresentation of people with CODs within the CJS. Furthermore, it will contribute to the continuous need for developing evidence-based programming and practices for CODs within community-based programs, increasing public safety to communities, and the tremendous cost-effectiveness to correctional programs.

No description available.

<p>This dissertation evaluated the complex inter-relatedness between co-occurring childhood maltreatment exposures, physical intimate partner violence (perpetration and victimization), substance use frequency, and molecular genetics for substance use, utilizing appropriate developmental models and theoretical approaches. Three studies were proposed within this dissertation. Data for the three studies come from a national longitudinal panel study: The National Longitudinal Study of Adolescent to Adult Health (Add Health; Harris, 2013). Across studies, latent profile analysis was used to evaluate co-occurring childhood maltreatment exposures based on type and severity of exposures, which resulted in three homogenous sub-groups. The first sub-group was composed of individuals that had high levels of physical abuse exposure and moderate levels of childhood neglect and emotional abuse exposures (high physical abuse sub-group). The second sub-group (high sexual abuse sub-group) included individuals with high severity of sexual abuse exposure and moderate severity of all other childhood maltreatment types (i.e., physical abuse, emotional abuse, and neglect). This second sub-group was, therefore, the most vulnerable in terms of their childhood maltreatment exposure. A final normative sub-group was also found that included a majority of individuals with low severity of childhood maltreatment exposure across types. Additionally, across all three studies, a probabilistic multifaceted genetic risk score (i.e., polygenic risk score) was created to evaluate substance use related genetic risk. The first study evaluated the role of co-occurring childhood maltreatment exposure on substance use development from adolescence to young adulthood while evaluating substance use related genetic moderation. Generalized estimating equations were used to test the proposed model in study 1. Findings suggest that the high physical abuse sub-group was more susceptible to genetic risk and had increases in substance use frequency only at high levels of genetic risk. In contrast, for the high sexual abuse sub-group, childhood maltreatment and environmental exposures were more ubiquitous for substance use development from adolescence to young adulthood. To elaborate, the high sexual abuse sub-group demonstrated increases in substance use from adolescence to young adulthood irrespective of genetic risk. In study 2, substance use frequency in young adulthood was tested as a mechanism between childhood maltreatment sub-groups and subsequent physical intimate partner violence perpetration in adulthood. Once again, genetic moderation for the direct association between childhood maltreatment sub-groups and substance use frequency in young adulthood was tested within the larger mediation model. In study 3, physical partner violence victimization in young adulthood was tested as a mediator of the association between childhood maltreatment sub-groups and substance use frequency in adulthood. In study 3, in addition to the above-mentioned genetic risk score, an additional substance use related dopamine polygenic risk score was also tested. Specifically, in study 3, genetic moderation by both genetic risk scores was tested on 1) the direct pathway from childhood maltreatment sub-groups to substance use frequency in adulthood, and 2) the direct pathway from physical intimate partner violence victimization in young adulthood to substance use frequency in adulthood. In both studies 2 and 3, product of co-efficient method was used to estimate mediation hypothesis, and moderated-mediation models were used to test for genetic moderation within the mediation model. Research aims for studies 2 and 3 were largely not supported. However, supplementary models indicate that substance use frequency may not be a causal mechanism but may be a contextual factor exacerbating the association between childhood maltreatment exposures and physical intimate partner violence perpetration. Implications for findings are discussed in detail. </p>

No description available.

Les personnes en situation d’itinérance, principalement des hommes, représentent pour certains une culture au sein de laquelle on identifie des personnes atteintes de troubles concomitants de santé mentale et d’abus de substances. Déjà vulnérables de par leur statut domiciliaire précaire, les personnes atteintes de cette concomitance le sont davantage et tendent à être plus isolées de leur famille que celles ne rencontrant pas cette double problématique. Le soutien familial est toutefois reconnu comme un élément favorisant l’engagement de comportements de santé et réduisant l’itinérance. Le but de cette étude était alors de décrire, du point de vue des hommes en situation d’itinérance atteints de troubles concomitants de santé mentale et d’abus de substances, les relations qu’ils entretiennent avec leur famille. Pour ce faire, le devis choisi fût une ethnographie ciblée. Différents degrés d’observation participante au sein de la Mission Old Brewery et des entrevues avec neuf informateurs-clés ont été les principales méthodes de collecte des données. L’analyse des données qualitative était soutenue par le guide proposé par Roper et Shapira (2000) ainsi que l’épistémologie constructiviste et l’approche systémique familiale de Calgary (Wright & Leahey, 2013) qui furent les cadres de référence de cette étude. Les résultats font ressortir trois thèmes explicitant 1) l’influence du contexte de vie dans les relations familiales, 2) la teneur conflictuelle de ces relations ainsi que 3) le soutien familial perçu. Finalement, des recommandations pour la pratique infirmière ainsi que des pistes pour de futures recherches sont suggérées. / Homeless people are largely represented of men and account for some culture in which we identify people with co-occurring mental health and substance abuse. Already vulnerable because of their precarious housing status, people with this conjunction are even more vulnerable and tend to be more isolated from their families than those who don’t meet this dual challenge. Family support is however recognized as an element favoring the commitment of health behaviors and reducing homelessness. The purpose of this targeted ethnography was to described, in terms of men experiencing homelessness suffering from co-occurring mental health and substance abuse, their relationships with their families. Different degrees of participant observation in the Old Brewery Mission and interviews with nine key informants were the main data collection methods. The analysis of qualitative data was supported by the guide proposed by Roper and Shapira (2000) and constructivist epistemology and the family systematic approach of Calgary (Wright & Leahey, 2013) who were the frameworks of this study. The results highlight three themes explaining 1) the influence of the living environment in family relationships, 2) the conflictual content of these relations and 3) the perceived family support. Finally, recommendations for nursing practice and ways to future research are suggested.

Offender reentry, felony declassification, and the opioids epidemic have led to quick and widespread implementation of substance abuse and mental health treatment programming in justice settings. This tremendous increase in offender treatment programming has outpaced applied research on program quality and treatment efficacy. This study examined whether designated evidence-based practices are actually delivered in funded treatment initiatives. Secondary data was utilized from the National Institute of Justice’s CrimeSolutions.gov, a national evidence-based practice and program registry. A content analysis methodology examined CrimeSolutions.gov program profiles and topical refereed literature through systematic analysis of five offender treatment evidence-based practices (actuarial screening, co-occurring disorders treatment, medication assisted treatment, individual treatment planning, and isolated therapeutic communities). Findings indicate a variable degree of evidence-based practice delivery and orient discussion around how to improve the implementation of evidence-based practices toward enhancing offender substance abuse programming.

過去許多研究著眼於探討英文介系詞的語意，其中許多學者專注在單一介系詞的探討（e.g., Boers, 1996; Lindstromberg, 2010），其它學者則分析由動詞與介系詞組成之動詞片語、由介系詞與名詞組成之介系詞片語的語意（e.g. Larsen-Freeman & Celce-Murcia, 1999; Lindner, 1983; Quirk, Greenbaum, Leech, & Svartik, 1985）。過去這些研究大多在單一介系詞的框架下進行，鮮少有包含雙介系詞的句構的研究。本論文所研究之句構為：一個由動詞及UP/DOWN組成之動詞片語加上一個由IN與名詞組成之介系詞片語，在本句構中包含兩個連用之介系詞，本研究的分析包含雙介系詞的語意、動詞片語以及介系詞片語的語意，另外還包含此句構中所有語意的語意關連。 本研究採納並調整前人對介系詞、動詞片語以及介系詞片語的語意類別，以調整過的語意類別分析句構。研究結果發現在此句構中，雙介系詞大多含有隱喻概念，而大多的動詞片語則用來表達完成的動作語意，介系詞片語則多描繪空間概念或狀態。除此之外，我們發現此句構中的語意間有所關連，另外我們更發現UP和DOWN在本句構中並沒有完全對比的語意。 在本研究中，我們不同於以往研究只專注於一個介系詞或一個片語的分析，而是由三個角度切入探討一個含有雙介系詞的句構，未來期望能將本研究的結果運用在對比學習者對此句構的語言表現，並對介系詞的教學有更多貢獻。

Η παρούσα διδακτορική διατριβή πραγματεύεται προβλήματα που αφορούν το χώρο της τεχνολογίας ομιλίας, με στόχο τη αναγνώριση συναισθημάτων από ομιλία με χρήση τεχνικών ψηφιακής επεξεργασίας σήματος και μηχανικής μάθησης. Πιο αναλυτικά, στα πλαίσια της διατριβής προτάθηκαν και μελετήθηκαν καινοτόμες μέθοδοι σε μια σειρά από εφαρμογές που αξιοποιούν σύστημα αναγνώρισης συναισθηματικών καταστάσεων από ομιλία. Ο βασικός στόχος των μεθόδων ήταν η αντιμετώπιση των προκλήσεων που παρουσιάζονται όταν ένα σύστημα αναγνώρισης συναισθηματικών καταστάσεων καλείται να λειτουργήσει σε πραγματικές συνθήκες, με αυθόρμητες αντιδράσεις, ανεξαρτήτως ομιλητή. Πιο συγκεκριμένα, στα πλαίσια της διατριβής, αξιολογήθηκε η συμπεριφορά ενός συστήματος αναγνώρισης συναισθημάτων σε προσποιητή ομιλία και σε διαφορετικές συνθήκες θορύβου, και συγκρίθηκε η απόδοση του συστήματος με την υποκειμενική αξιολόγηση των ακροατών. Επιπλέον, περιγράφηκε ο σχεδιασμός και η υλοποίηση βάση δεδομένων συναισθηματικής ομιλίας, όπως αυτή προκύπτει από την αλληλεπίδραση μη-έμπειρων χρηστών με ένα διαλογικό σύστημα και προτάθηκε ένα σύστημα το οποίο εντοπίζει αρνητικές συναισθηματικές καταστάσεις, στο ανεξάρτητου ομιλητή πρόβλημα, με χρήση μοντέλου Γκαουσιανών κατανομών. Η προτεινόμενη αρχιτεκτονική συνδυάζει παραμέτρους ομιλίας χαμηλού και υψηλού επιπέδου και εφαρμόζεται στα πραγματικά δεδομένα. Επίσης, αξιολογήθηκε και υλοποιήθηκε η πρακτική εφαρμογή ενός συστήματος αναγνώρισης συναισθημάτων βασισμένου σε οικουμενικό μοντέλο Γκαουσιανών κατανομών σε διαφορετικούς τύπους δεδομένων πραγματικής ζωής. Ακόμα, παρουσιάστηκε μια πρωτότυπη αρχιτεκτονική κατηγοριοποίησης για αναγνώριση συνυπαρχόντων συναισθημάτων από ομιλία προερχόμενη από αλληλεπίδραση σε πραγματικά περιβάλλοντα. Σε αντίθεση με γνωστές προσεγγίσεις, η προτεινόμενη αρχιτεκτονική μοντελοποιεί τις συνυπάρχουσες συναισθηματικές καταστάσεις μέσω της κατασκευής μιας πολυσταδιακής αρχιτεκτονικής κατηγοριοποίησης. Τα πειραματικά αποτελέσματα που διενεργήθηκαν υποδεικνύουν ότι η προτεινόμενη αρχιτεκτονική είναι πλεονεκτική για τις συναισθηματικές καταστάσεις που είναι πιο διαχωρίσιμες, γεγονός που οδηγεί σε βελτίωση της συνολικής απόδοσης του συστήματος. / In this doctoral dissertation a number of novel approaches were proposed and evaluated in different applications that utilize emotion awareness. The major target of the proposed methods was facing the difficulties existing, when an emotion recognition system is asked to operate in real-life conditions, where human speech is characterized by spontaneous and genuine formulations. In detail, within the present dissertation, the performance of an emotion recognition system was evaluated, initially, in acted speech, under different noise conditions, and this performance was compared to the one of human listeners. Further, the design and implementation of a real world emotional speech corpus is described, as this results from the interaction of naive users with a smart home dialogue system. Moreover, a system which utilizes low and high level descriptors was suggested. The suggested architecture leads to significantly better performance in some working points of the integrated system in the dialogue system. Furthermore, we propose a novel multistage classification scheme for affect recognition from real-life speech. In contrast with conventional approaches for affect/emotion recognition from speech, the proposed scheme models co-occurring affective states by constructing a multistage classification scheme. The empirical experiments performed indicate that the proposed classification scheme offers an advantage for those classes that are more separable, which contributes for improving the overall performance of the affect recognition system.

Text in English / Against the background of high prevalence of substance abuse in the globe generally and South Africa in particular, research has shown an association between substance abuse and other mental disorders or vice-versa. With most rehabilitation centres offering separate diagnosis and treatment for the two disorders, the problem of relapse has been significant. The purpose of this study is to explore the perceived effectiveness of CBT as a treatment model for substance use disorders with co-occurring disorders. Subsequently, the research will add to the already existing research evidence. The study was conducted in five rehabilitation centres in Gauteng Province. The qualitative descriptive research approach was used to conduct the study. Both purposive and snowball sampling were used to recruit participants in this study. The sample consisted of CBT specialist participants from diverse race, gender, ethnicity, and age ranging from 30 to 65 years, with at least a minimum of five years’ experience. A pilot study with two specialist participants was conducted, and this enhanced trustworthiness and authenticity of the study. The primary method of qualitative data collection employed in this study was semi-structured individual interviews for specialist participants. Grounded theory analysis was employed to analyse data. The findings of the study emphasised a need to not separate treatment of substance use disorders and psychiatric pathologies. More importantly, the effectiveness of CBT in treating both disorders was established by the study. The study further encourages more time in therapy as the way to increase effective results accompanied by less relapse rate. Accordingly, the findings of this study encourage more research and use of CBT treatment for substance use disorders with co-occurring disorders in South Africa. This study found that the most used substances are both legal and illegal, and they are further classified as depressants, stimulants, opioids, and new psychoactive substances. A vulnerable population to abuse substances includes adolescent and young adults, individuals with co-occurring disorders, and low socio-economic status. The disorders that normally co-exist with substance use disorder ranges from depression, bipolar disorder, schizophrenia, sleeping disorder, impulsivity, antisocial behaviour, borderline disorder, paranoia, panic disorder, and suicide behaviour. The study found that genetic predisposition, depression, parental neglect and financial problems, experimentation with substances for relaxation, peer group pressure, and co-occurring disorders are high risk causes for substance abuse. The experience of participants in treating substance use disorder with co-occurring disorders involves which disorders get treated first, and the mental state of patients for effective treatment. The various substance abuse treatment models includes person centred approach, bio-psychosocial approach, holistic approach, eclectic therapy, integrated approach, resilient approach, rational emotive behavioural therapy, family therapy, motivational interviewing, 12-step programme, and cognitive behavioural therapy. The participants’ experience with CBT entails its usability in both individual and group therapy, the use of CBT skills after therapy, and CBT effectiveness in relapse prevention. Accessibility and affordability of CBT treatment is influenced by access to rehabilitation centres and cost of rehabilitation centres. Lastly, individual factors, family factors, and environmental factors are part of the contributing factors towards high relapse rates. / Psychology / M.A. (Psychology)