<p>Substance abuse is a major public health concern. Scholars predict a growing proportion of people aged 50 years and older suffering from addiction to alcohol, prescription or over-the-counter medications and/or illegal substances (Wu & Blazer, 2011; Han et al., 2009). Available Canadian statistics reveal that 6-10% of older adults experience alcohol problems, 1% use illegal substances and approximately 6% seek addiction treatment for prescription opioids (Public Health Agency of Canada, 2010; Tjepkema, 2004; CAMH, 2008). Older adults face personal, social, and structural barriers to treatment, which result in a significant number of people living with addiction and remaining undiagnosed and untreated in the community (Crome & Bloor, 2005b). Nevertheless, this issue is significantly understudied and under-recognized, particularly within Canadian literature.</p> <p>This qualitative research study examined the perspectives of addiction service providers regarding the issue of addiction among older adults. A descriptive, qualitative research design was used to explore the perspectives of addiction service providers using in-depth, semi-structured personal interviews. Purposive sampling techniques were used to recruit 24 service providers employed by Hamilton addiction services. Semi-structured interviews included questions on (a) the current provision of addiction services for older adults, (b) characteristics of older adults (c) perceived barriers to treatment, and (d) recommendations for addressing the needs of older adults living with addiction. The interview also collected demographic information to describe the demographic profile of agencies and research participants involved in the study.</p> <p>By using Braun and Clarke’s (2006) phases of thematic analysis, this study observed several key themes that confirmed and extended existing literature. New contributions highlight the following: (1) according to service providers, older adults demonstrate a greater readiness for change and stronger commitment to their treatment plan regardless of whether they are enrolled in a mixed-age or age-specific program. (2) Some older adults use substances to cope with cumulative shame that stems from unresolved, traumatic early-life experiences. This new finding supports principles of the life course perspective by highlighting the impact of early life events on late life experiences. (3) Service providers can address some of the age-specific needs of older adults by assigning them to an older counselor in treatment. (4) In order to enhance treatment outcomes, older adults should <em>direct</em> their care and be viewed as experts in their treatment needs. (5) From the perspective of service providers, older and younger adults benefit from interactions with each other when the older adult is in recovery and the younger adult is recovering. Older adults recovering also benefit from interactions with older peers in recovery, particularly when they are in mixed-age programs. Opportunities for peer interaction during and after treatment can produce favourable recovery outcomes.</p> / Master of Arts (MA)

Treating people with co-occurring or dual diagnosis disorders requires an integrated treatment approach due to the complex health and social needs of people who suffer from mental illness and drug addiction. An integrated approach is not only necessary but crucial to treat both the drug addiction and mental illness concurrently. The aim of this study is to explore the impact that non- integrated care can have on the number of relapses that dually diagnosed people can have. The study found that there is no correlation between concurrent treatment and the number of relapses that dually diagnosed people may have. Social workers will need to be able to recognize mental illness that co-occurs with substance use in order to effectively treat clients to determine what treatment approach should be used. Social workers are trained to use a biopsychosocial approach to capture all aspects of the client’s life. This I especially important for clients that may be dually diagnosed.

Along with the numerous physical benefits of exercise, past research has shown that physical activity can alleviate symptoms of anxiety and depression in both clinical and non-clinical populations. Yet, it has been suggested less than half of American adults exercise at public health recommended levels. Therefore, it is important to identify factors that may lead to an increase in physical activity and, subsequently, improvements in mental health. Previous research, for the most part, has neglected to investigate how preference for attentional focus strategy during exercise influences mood. In addition, previous studies that involved attentional focus and exercise have focused more on participant’s resulting performance than affect. Therefore, the purpose of this study was to determine whether or not preference for attentional focus strategy would moderate the amount of affective change and enjoyment experienced during and after exercise. Participants (N=100) were recruited from psychology courses at Western Kentucky University. They were asked to run on a treadmill for 20 minutes on two separate days, one week apart. On one of the days they were asked to engage in their most preferred attentional focus strategy and another day their least preferred attentional focus strategy. The order of these sessions was counterbalanced. Participant’s preference for attentional focus strategies was used as an independent variable. The first dependent variable of interest was changes in affect, measured by the Activation-Deactivation Adjective Checklist (AD-ACL). The second dependent variable of interest was enjoyment, measured by the interest/enjoyment subscale of the Intrinsic Motivation Inventory (IMI). A 2 (Preference Condition) X 4 (Time) ANOVA was conducted for affect. There were no significant main effects and no significant interactions for preference. Yet, there was a significant change in affect across time. A one way ANOVA was conducted on enjoyment and autonomy levels. There were no significant main effects for preference. Results of the study indicated preference for attentional focus strategy does not influence the level of affective benefits typically associated with exercise, nor does it influence perceived enjoyment and autonomy. In addition, the study indicated individuals acquire affective benefits from engaging in moderate intensity exercise regardless of attentional focus strategy. Following from the findings of the current study, it is suggested that researchers continue to identify factors of the exercise experience that may lead to an increase in physical activity and, subsequently, improvements in mental health.

A randomized, experimental pilot study of QUATRO Adherence Therapy examined differences at baseline and follow up in the dependent variables of severity of psychiatric symptomatology and medication concordance as measured by the Positive and Negative Symptom Scale and the Personal Evaluation of Transitions in Treatment for subjects with schizophrenia and schizoaffective disorder at a community mental health center. The sample was 23 subjects. A questionnaire developed for the study collected data at follow-up. Data were analyzed using descriptive statistics, /-tests, and repeat Anova to compare groups and determine significance of change following completion of the intervention. Program evaluation was positive. Statistical comparison indicated no significant differences were found in change scores for either group. Implications for further research are that a larger scale randomized controlled study is needed to produce statistical significance.

The pattern of frequent discharges and readmissions which characterizes most psychiatric hospitalization in this country today was described, and it was argued that the costs of this “revolving door” outweigh such benefits as might be derived from it. An alternative stepwise progression model of aftercare was proposed. This model identified community tenure as the most appropriate goal for initial aftercare efforts. Attempts to identify correlates of the establishment of community tenure by mental hospital releasees were reviewed. It was found that the ex-patient's ability to remain in the community is not highly correlated with the extent to which he manifests deviant behavior. This finding was interpreted as an indication that environmental factors may play significant part in ex-patients’ avoidance of rehospitalization. Data were presented which indicated that a clear majority of mental hospital releasees take up residency immediately with family members. It was hypothesized, then, that measurable family variables are correlated with the ability of the ex-patient to achieve community tenure. An attempt was made to examine this hypothesis in the light of relevant research. Studies of the issue which contained substantive empirical support were categorized into four topic areas: family tolerance of the ex-patient's symptomatic behavior, kin role which the family affords to the ex-patient, familial expectations of the ex-patient's performance, and family attitudes and personality characteristics. After reviewing the studies of authors who attempted to assess the degree of correlation between the capacity of the ex-patient’s family to tolerate symptomatic behavior on the part of the ex-patient and the ex-patient’s ability to avoid rehospitalization, it was concluded that the linear correlation between the two variables which would be predicted logically may not exist. A review of studies of the relationship between the kin role which the ex-patient's family affords to him and the ex-patient's ability to achieve community tenure yielded a tentative conclusion that returning to the social biological role of “child” (son or daughter) as opposed to the kin role of spouse was positively correlated with remaining in the community. After examining studies which attempted to explore the relationship between familial expectations of instrumental performance on the part of the ex-patient and the ability of the ex-patient to avoid rehospitalization, it was concluded that little support was provided for the hypothesis that the two variables are related. A survey of attempts to identify family attitude and personality characteristic correlates of ex-patient achievement of community tenure resulted in arrival at the conclusion that such efforts, as a whole, have met with little success, although significant correlations between two general family attitudes toward mental illness and ex-patient avoidance of rehospitalization were found. Considering the findings which were reviewed as a whole, it was concluded that little support was provided for the hypothesis that measurable family variables are correlated with the ability of the ex-patient to achieve community tenure. The rather limited aftercare practice applications which could be drawn from the few correlations that have been discovered were described, and implications of the over-all finding for future research were discussed.

Little is systematically known about the collective health and well-being of Virginia American Indian people. This study sought to explore the meaning of health and healing among Virginia American Indian people in the context of a reservation-based, non-federally funded health clinic. Using an emergent approach to qualitative research grounded in a constructivist inquiry paradigm and guided by Indigenous research principles, a total of 24 in-depth, semi-structured interviews were conducted with 17 American Indian service-users of the Clinic. Through an inductive thematic analysis of participant stories, a framework for understanding responsive and responsible health and healing was derived. The framework includes seven dimensions: spirituality, physical processes, mental and emotional processes, social relationships, access to resources, contextual factors, and the interconnection among the dimensions. Personal and collective identity was a significant element woven through the dimensions. From the stories told by participants, health seems to be a continuum and healing seems to be a cycle. With constant motion in each of the dimensions, health has to do with sustained engagement in healing processes that continually seek to bring about functional balance in one’s whole health system. Ill health has to do with when a change in any one of the dimensions overtakes one’s ability to bring about a functional balance in the whole health system. The framework is context-dependent, true for the people who participated in the study at the time of the study.

Posttraumatic stress disorder (PTSD) is a psychiatric condition affecting approximately 8% of the adult U.S. population with rates twice as high in women than men. Increasingly, evidence has suggested a close relationship between PTSD and increased risk of metabolic diseases. However, the literature on PTSD and metabolic disease risk factors has been limited by the lack of investigation of the potential influence of race on this relation. The current study examined the possible effect of race on the relation between PTSD and metabolic risk. Data for this study were provided from sample of that included 50 African American women and 39 Caucasian women, 56.2% and 43.8% respectively. Results support the importance of race in the relationship between PTSD and metabolic disease risk factors. Future research would benefit from analysis of cultural factors to explain how race might influence the course of metabolic disease risk and development in women with PTSD.

Greenwald, McGhee, and Schwartz (1998) developed the Implicit Association Test (IAT), a measure of mental associations between target pairs and positive or negative attributes. Highly associative categories yield faster responses than the reverse mental associations, which is thought to reflect implicit attitudes toward stereotypes. The present study investigated the effect of ethnic group on one’s implicit attitudes toward aging and gender stereotypes by comparing two groups of older adults, Asian Americans and Caucasian Americans, that likely hold different culture values. Past qualitative studies have established the existence of mental health stigma in Asian American populations, including negative Asian American perceptions of aging, but have not yet established a quantitative measure of this phenomenon. The age-attitude and gender-science IATs were administered to 20 Asian American and 20 Caucasian American older adults in the Southern California region. The results from the age-attitude IAT found that Asian American older adults demonstrated higher implicit bias toward aging, evidenced by faster responses to the category pairings associating “old” + “bad” and “young” + “good”. In contrast, performance on the gender-science IAT was similar for both groups, showing no strong bias toward gender stereotypes. Potential implications on the wellbeing of older adults, as stereotype threat and other forms of bias are already established harmful constructs in the population, are discussed.

The development of the infant from birth to four years will approximately parallel the stages of development of the profoundly retarded children enrolled in the Development Centers for Handicapped Minors ( DCHM ) in California. The retarded child is a human being and may be assumed to have the same basic equipment as the normal child. If we expand and prolong the development stated of the normal child we will be able to lead the DCHM child through these states in slow motion to insure progress. To develop a curriculum, an assessment of the abilities of the child was necessary. A screening device as designed to measure the development of the child in four areas --- Gross Motor, Fine Motor, Social, and Language. Skills leading towards ambulation were included in the Gross Motor area; skills leading toward manipulation of objects in space were included in the Fine Motor area; skills leading toward independent living were included in the Social area, while skills leading to improvement in communication were included in the Language area. Tasks in the Social area were divided into sub-groups of social interaction, feeding, dressing, and toileting. Language included two sub-groups – Receptive Language and Expressive Language. Over 800 tasks were reviewed from 18 sources. Three hundred and fifty-nine tasks were finally chosen on the basis of criteria established. The tasks were to be observable, describable, and development. The tasks were then arranged into areas mentioned above and then into levels of development. Twenty-two levels of development were necessary to show the progress of development sufficiently to be useful in the DCHM. The tasks were organized so that the teacher could determine the child developmental level of the child with very little demand on the child. Most of the assessment could be done by observation or with knowledge of the child already possessed by the teacher. A card for recording the progress and the assessment of the child was designed that would also give the teacher a graphic picture of the level of the child and would also keep an ongoing record of the progress of the child with little interruption of the normal activities in the classroom. Each of the 359 tasks was listed on a separate 5X8 Activity Card. Each Activity Card included the abbreviated description of the task, the area, the level, and a three character code designed for that task. Under this information, a behavioral description of the task was given. Next, the tasks expected at the next level were listed, and then suggested classroom activities associated with the next level were given. The Activity Card was designed so that when a teacher observed a new behavior in a child, he could refer to the card on file to note the level and area of the behavior and plan lessons or activities accordingly. A Gestalt of all tasks is included in the Appendix. The tasks selected were from recognized source and because of this, no effort was made to standardize the results. There were three purposes for this study: (1) To provide a tool for the teachers in the DCGM that would allow them to look at the developmental levels of the children; (2) To assess the functioning level of the children; and (3) To provide information about the curriculum suitable for the various levels of development.

Qualitative phenomenological methodology was used to explore the lived experiences of African American women diagnosed with breast cancer. Phenomenology focuses on the meaning of the lived experiences of individuals experiencing a concept, structure, or phenomenon (Creswell, 2007). The purpose of phenomenological research is to identify phenomena as perceived by the individual. Utilizing an existential perspective, the focus of this study was to uncover meaning which defined the essence of the participants’ experiences. Seven African American women diagnosed with breast cancer participated in this study. The participants’ ages ranged from 33-63 years. A semi-structured interview process with open-ended questions was utilized to gain an understanding of the participants’ personal experiences related to the phenomenon. Data was analyzed using Interpretative Phenomenological Analysis (Smith, 2004) to ascertain emergent themes and to interpret the meaning of the participants’ breast cancer experience. Seven common themes emerged from the cases. Those themes included: spirituality; support systems; self-care; resiliency; existential meaning; education; and perception of counseling. These seven themes will help to provide insight into how counselors can help to facilitate emotional wellness within this particular population. Implications and recommendations for counselor educators, counselors, and counselors-in-training with this population are also addressed.