About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study explored the lived experiences of 10 behavioral health service recipients to identify the benefits and challenges of the PPACA on behavioral health services. Participants from Anne Arundel County, Maryland, were purposefully selected and interviewed face-to-face. Relative advantage, compatibility, and complexity were characteristics of the diffusion of innovation theory used for the exploration of this research. Based on the interpretive phenomenological approach, Nvivo 11 Pro was used for data coding, management, organization, and analysis. There was the shared belief among participants that the PPACA improved their access to adequate and affordable behavioral healthcare. Effective network of care and having health insurance seemed to have improved health outcomes. Findings from this study highlight issues of common interest to healthcare stakeholders while providing reasonable platforms for objectively addressing complex challenges, which tend to undermine the possibility of adopting policies that could yield positive dividends for all parties involved.

The objectives of the community-based Early Developmental Stages of Psychopathology (EDSP) Study are described along with a detailed account of the overall design, special design features, sample characteristics and instruments used. The EDSP employed a prospective-longitudinal design to study substance use and other mental disorders in a representative population sample of 3,021 subjects aged 14–24 years (birth cohorts 1970–1981) at ‘baseline’ – the outset of the study. Two follow-up investigations were conducted after the baseline investigation covering an overall period of 3–4 years. Special design features are the linkage with a family supplement (EDSP-FS) as well as neurobiological laboratory studies of high-risk subjects.

Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options. The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia. In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design. In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking. Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition. / Substansberoende är en allvarlig störning och samsjuklighet ofta förekommande Den stora variationen av svårigheter kräver olika behandlingsalternativ. Syftet med avhandlingen var att undersöka affekters roll i psykoterapi för populationen. Ytterligare syften var att undersöka betydelsen av gemensamma faktorer i psykoterapi samt normera ett självskattningsformulär för affektfobi. I studie I undersöktes skillnaden mellan patienters förväntningar, erfarenheter av terapi och allians. I studie II utvärderades de psykometriska egenskaperna hos affektfobitestet. I studie III och IV undersöktes genomförbarheten av affektfobiterapi individuellt och i grupp. Resultaten av studierna visade att större skillnad mellan rollförväntningar inför- och erfarenheter av terapi var signifikant korrelerade med lägre allians i gruppterapi. Affektfobitestets psykometriska egenskaper var tillfredsställande avseende skalan som helhet. Affektfobiterapi visade sig öka adaptiv affektiv förmåga och självmedkänsla, men behandlingen gav inget säkert stöd för påverkan på substansbruket. Slutsatserna är att fokus på affekter i terapi för substansberoende har betydelse och att affektfobiterapi är en genomförbar behandling för populationen. Genom att undersöka förväntningar och rädslor inför terapi kan avhopp förhindras. / <p>Information om opponent saknas Information about opponent is missing</p>

Hintergrund: Die Psychotherapierichtlinien ermöglichen erst seit 2011 unter bestimmten Bedingungen eine ambulante psychotherapeutische Behandlung bei Substanzstörungen. Empirische Ergebnisse zu diagnostischen Charakteristika der auf dieser Grundlage behandelten Patienten und zu Erfolgsraten fehlen weitgehend. Methoden: Wir untersuchten N = 59 konsekutive Patienten einer Spezialambulanz, von denen n = 34 eine Behandlung begannen (Intent-to-Treat(ITT)-Stichprobe) und n = 28 sie abschlossen (Completer), mit standardisierten diagnostischen Interviews und ermittelten die Erfolgsraten nach ambulanter Kognitiver Verhaltenstherapie (Einzeltherapie) auf der Basis von Symptomskalen (Brief Symptom Inventory (BSI); Beck Depression Inventory (BDI)) sowie Patienten- und Therapeuten-Ratings, einschließlich einer klinischen Beurteilung der Abstinenz. Ergebnisse: 40% aller anfragenden Patienten nahmen keine Psychotherapie auf. Bei den behandelten Patienten kam es zu signifikanten Veränderungen (ITTAnalysen: d = 0,8 (BSI) bis d = 1,2 (BDI)). Mehr als zwei Drittel der Patienten erreichten eine klinisch relevante Verbesserung der Symptomatik gemäß Patienten- oder Therapeutenbeurteilungen (zwischen 68 und 76%, ITTStichprobe). Alle Completer mit Abhängigkeitssyndrom (n = 11) sowie 86% der diesbezüglichen ITT-Stichprobe erreichten zumindest unter der Behandlung eine Abstinenz. Schlussfolgerungen: Die Erfolgsraten bei Patienten, die die Therapie abschließen, sind gut. Sie sprechen für den Nutzen des ambulanten Settings. / Effectiveness of Outpatient Cognitive-Behavioral Therapy for Substance Use Disorders – Evaluation of a Specialized Outpatient Clinic Background/Aim: Given a number of conditions, the revision of the German psychotherapy guidelines in 2011 facilitates treating substance use disorders in outpatient psychotherapy. Empirical results on the diagnostic characteristics of the patients treated within this setting and about the effectiveness of the treatment are lacking. Material and Methods: We examined N = 59 consecutive patients, diagnosed with standardized diagnostic interviews, of a specialized outpatient clinic for cognitivebehavioral therapy. Of these, n = 34 started the treatment (intent-to-treat (ITT) sample) and n = 28 completed it. The outcome (including clinical judgement of abstinence) was assessed with established symptom scales (Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI)) as well as therapist and patient ratings. Results: About 40% of the patients who contacted the clinic did not start the therapy. In therapy completers, clinically relevant improvement was reached. Based on ITT analyses, effect sizes ranged from d = 0.8 (BSI) to d = 1.2 (BDI). Based on therapist and patient ratings, the percentage of successful therapies was high (between 68 and 76%, ITT analyses). All therapy completers diagnosed with a dependence syndrome reached abstinence at least temporarily. Conclusion: Effectiveness rates are high in completers. These results show that treatment can be efficient in an outpatient setting.

Background: Given the increasing number of military deployments in modern forces and the high individual and social costs of substance use disorders, the risk of substance use (alcohol, nicotine, illegal drugs) and substance use disorders (abuse, dependence) associated with deployment and deployment-related stressful experiences is an important area of research. Main questions in this area are: Are deployment and deployment-related stressful experiences associated with problematic substance use patterns and substance use disorders? Are there high-risk groups for deploymentrelated increases in substance use and the occurrence of substance use disorders? Do other mental disorders such as posttraumatic stress disorder play a role for the risk of substance use disorders? This dissertation thesis aims to contribute to these questions. The thesis is based on a research program in German military personnel deployed to Afghanistan. The program includes a crosssectional and a prospective-longitudinal study component. In the cross-sectional component, a random, stratified sample of 1483 was assessed twelve months after return from deployment. As a control group, 889 never deployed soldiers were also assessed. In the prospective-longitudinal component, another sample of 358 male soldiers was assessed directly before and twelve months following deployment. Information about substance use and substance use disorders was obtained using a standardized diagnostic interview. Deployment-related stressful experiences and other relevant variables were assessed with additional scales and questionnaires. Based on this study program, the following research questions were addressed: (1) Do deployed and never deployed soldiers differ regarding the prevalence of problematic substance use patterns (alcohol, nicotine, illegal drugs) and substance use disorders (alcohol, nicotine)? (2) How are soldiers with deployment-related changes in alcohol use characterized? (3) Are posttraumatic stress disorder symptoms related to the risk for substance use disorders (alcohol, nicotine)? (4) Are soldiers with prior mood and anxiety disorders at higher risk for the onset of substance use disorders (alcohol, nicotine) following deployment-related stressful experiences? Main results: Regarding these research questions, the following main results were observed: (1) Deployed and never deployed do not differ considerably regarding the prevalence of substance use and substance use disorders. (2) There was evidence for both deployment-related increases and decreases in alcohol use in specific subgroups. Compared to soldiers with a stable consumption, soldiers with increased alcohol use were characterized by lower ranks, less acceptance, less social support, more sleeping problems after deployment and more deployment-related negative cognitions. Soldiers with deployment-related decreases in alcohol use were characterized by fewer posttraumatic stress disorders symptoms prior deployment and less childhood emotional neglect. (3) Posttraumatic stress disorder symptoms were related to the risk for substance use disorders. These associations were partially attributable to other comorbid mental disorders. However, several posttraumatic stress disorder symptoms were related to substance use disorders above the contribution of comorbidity. (4) Specific constellations of prior mood and anxiety disorders and high degrees of certain deploymentrelated stressful experiences predicted the onset of alcohol use disorders. Conclusions: Based on these findings it can be concluded that German soldiers deployed to Afghanistan do not have an overall elevated risk for substance use and substance use disorders. However, several subgroups with a deployment-related increase in substance use and substance use disorders could be identified for specific substances. These subgroups include soldiers with low ranks, low social support and other mental disorders, of which several posttraumatic stress disorder symptoms might be particularly relevant. In addition, soldiers who experience mood and anxiety disorders prior to deployment as well as high degrees of specific deployment-related stressful experiences might be at higher risk for the onset of alcohol use disorders. It is also noteworthy that some soldiers show a deployment-related decrease in alcohol consumption. These findings might contribute to an improved identification of high-risk groups and suggest targets for possible interventions and preventive efforts. Because of some limitations, mainly regarding crosssectional designs and limited statistical power, some observed associations have to be interpreted with caution. Further prospective studies in high-risk populations or larger samples are necessary to replicate and extend the suggested findings. Moreover, the generalizability of findings to non-military samples and other types of stressful experiences should be investigated. These investigations might help to further reduce the prevalence of excessive substance use and substance use disorders.:Content Zusammenfassung 10 Summary 13 0 Preface 15 1 General introduction 16 1.1 Substance use and substance use disorders 16 1.2 Stressful experiences 23 1.3 Stressful experiences and substance use in deployed military personnel 28 2 Aims 34 3 Methods 36 3.1 Design 36 3.2 Sampling 37 3.3 Study instruments 38 4 Substance use and substance use disorders in recently deployed and never deployed soldiers 40 4.1 Abstract 40 4.2 Introduction 41 4.3 Methods 43 4.4 Results 47 4.5 Discussion 52 5 Predictors of changes in daily alcohol consumption in the aftermath of military deployment 57 5.1 Abstract 57 5.2 Introduction 58 5.3 Methods 60 5.4 Results 64 5.5 Discussion 68 6 Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD 73 6.1 Abstract 73 6.2 Introduction 74 6.3 Methods 78 6.4 Results 80 6.5 Discussion 85 7 Stress exposure and the risk for the onset of alcohol use disorders and nicotine dependence: The role of prior internalizing disorders 89 7.1 Abstract 89 7.2 Introduction 90 7.3 Methods 92 7.4 Results 96 7.5 Discussion 103 7.6 Conclusions 105 8 General discussion 106 8.1 Summary of main findings 106 8.2 Discussion of main findings 109 8.3 Critical discussion of methodology 117 8.4 Practical implications 120 8.5 Directions for future research 122 9 Conclusion 125 10 References 126 11 Appendix 157 / Hintergrund: Das Risiko für den Konsum psychotroper Substanzen (Alkohol, Nikotin, illegale Drogen)und das Auftreten von Substanzstörungen (Missbrauch, Abhängigkeit) im Zusammenhang mit Belastungen in militärischen Einsätzen ist angesichts der Zunahme militärischer Einsätze sowie der hohen individuellen und sozialen Kosten von Substanzstörungen ein Forschungsthema von hoher Relevanz. Wichtige Fragen sind dabei: Stehen Auslandseinsätze generell im Zusammenhang mit problematischen Konsummustern und Substanzstörungen? Gibt es bestimmte Risikogruppen für Anstiege im Substanzkonsum und das Auftreten von Substanzstörungen? Welche Rolle spielen andere psychische Störungen, wie z.B. die posttraumatische Belastungsstörung (PTBS), für das Auftreten einer Substanzstörung? Diese Dissertationsschrift behandelt verschiedene Aspekte dieser Fragestellungen auf der Grundlage eines Forschungsprogramms zur psychischen Gesundheit bei in Afghanistan eingesetzten deutschen Soldaten. Das Programm umfasste eine querschnittliche und eine prospektiv-longitudinale Studie. In der Querschnittstudie wurde eine randomisierte, stratifizierte Stichprobe von 1483 Soldaten zwölf Monate nach Rückkehr aus einem Einsatz in Afghanistan untersucht. Als Kontrollgruppe wurden zudem 889 Soldaten untersucht, welche niemals im Einsatz waren. In der prospektiv-longitudinalen Studie wurde eine weitere Stichprobe von 358 männlichen Soldaten unmittelbar vor und zwölf Monate nach Einsatzrückkehr aus Afghanistan untersucht. Information zu Substanzkonsum und Substanzstörungen nach DSM-IV wurden mittels standardisierter diagnostischer Interviews erfasst. Einsatzbezogene belastende Ereignisse und andere relevante Variablen wurden mit zusätzlichen Skalen und Fragebögen erhoben. Auf Basis dieses Studienprogramms wurden unter anderem die folgenden Fragestellungen bearbeitet: (1) Unterscheiden sich Soldaten mit und ohne Auslandseinsatz hinsichtlich der Prävalenz von kritischen Konsummustern (Alkohol, Nikotin, illegale Drogen) und Substanzstörungen (Alkohol, Nikotin)? (2) Durch welche Merkmale sind Soldaten mit einsatzbezogenen Veränderungen im Alkoholkonsum gekennzeichnet? (3) Sind Symptome der PTBS mit dem Risiko für Substanzstörungen (Alkohol, Nikotin) assoziiert? (4) Haben Soldaten mit bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen ein höheres Risiko für das Auftreten einer Substanzstörung (Alkohol, Nikotin) nach belastenden Einsatzereignissen? Hauptergebnisse: In Bezug auf diese Fragestellungen ergaben sich folgende Ergebnisse: (1) Soldaten mit und ohne Auslandseinsatz unterschieden sich kaum hinsichtlich der Prävalenz von Substanzkonsum und Substanzstörungen. (2) Allerdings ergaben sich Hinweise auf Zu-, wie auch Abnahmeeffekte im Alkoholkonsum in unterschiedlichen Subgruppen. Soldaten mit einem Anstieg im Alkoholkonsum waren im Vergleich zu Soldaten mit stabilem Konsum durch einen niedrigeren Dienstgrad, ein geringeres Ausmaß an Akzeptanz, weniger soziale Unterstützung, mehr Schlafprobleme nach Einsatzrückkehr sowie ein höheres Ausmaß an negativen einsatzbezogenen Bewertungen gekennzeichnet. Bei Soldaten mit einer einsatzbezogenen Reduktion im Alkoholkonsum fanden sich weniger PTBS-Symptome vor dem Einsatz sowie ein geringeres Ausmaß an emotionaler Vernachlässigung in der Kindheit. (3) Es gab Zusammenhänge zwischen PTBS-Symptomen und Substanzstörungen, die jedoch teilweise durch andere komorbide psychische Störungen erklärt werden konnten. Allerdings blieben einige PTBS-Symptome über andere komorbide Störungen hinaus mit Substanzstörungen assoziiert. (4) Bestimmte Konstellationen von bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen sagten bei hohem Ausmaß an einigen einsatzbezogenen Belastungen das Auftreten einer Störung durch Alkoholkonsum vorher. Schlussfolgerungen: Auf Grundlage dieser Befunde lässt sich schlussfolgern, dass in Afghanistan eingesetzte Bundeswehrsoldaten kein generell erhöhtes Risiko für kritische Konsummuster und das Auftreten von Substanzstörungen aufweisen. Allerdings konnten Subgruppen identifiziert werden, die in Bezug auf bestimmte Substanzen ein erhöhtes Risiko für einen erheblichen Anstieg im Substanzkosum oder das Auftreten einer Substanzstörung haben. Dazu gehören unter anderem Soldaten mit niedrigen Dienstgrad, geringer sozialer Unterstützung und anderen psychischen Störungen, wobei bestimmte Symptome der posttraumatischen Belastungsstörung von besonderer Relevanz sein könnten. Zudem scheint das Risiko für Störungen durch Alkoholkonsum bei Soldaten erhöht, bei denen bereits vor dem Einsatz Angst- und affektive Störungen auftraten und die gleichzeitig ein hohes Ausmaß an bestimmten Einsatzbelastungen erleben. Bemerkenswert ist aber auch, dass einige Soldaten nach dem Einsatz eine erhebliche Reduktion des Alkoholkonsums aufweisen. Die Befunde könnten zu einer verbesserten Identifikation von Risikogruppen beitragen und Ansatzpunkte für mögliche Interventionen und präventive Maßnahmen liefern. Aufgrund einiger Limitationen, die vor allem querschnittliche Designs und eine eingeschränkte statistische Power betreffen, sollten einige der beobachteten Zusammenhänge vorsichtig interpretiert werden. Weitere prospektive Untersuchungen an größeren Stichproben sowie Hochrisikokohorten sind nötig, um die Befunde zu replizieren und zu erweitern. Weiter sollte die Übertragbarkeit der Befunde auf nichtmilitärische Stichproben unter Einbezug anderer Arten von belastenden Ereignissen untersucht werden. Diese Untersuchungen könnten langfristig zur Senkung von problematischen Substanzkonsum und Substanzstörungen beitragen.:Content Zusammenfassung 10 Summary 13 0 Preface 15 1 General introduction 16 1.1 Substance use and substance use disorders 16 1.2 Stressful experiences 23 1.3 Stressful experiences and substance use in deployed military personnel 28 2 Aims 34 3 Methods 36 3.1 Design 36 3.2 Sampling 37 3.3 Study instruments 38 4 Substance use and substance use disorders in recently deployed and never deployed soldiers 40 4.1 Abstract 40 4.2 Introduction 41 4.3 Methods 43 4.4 Results 47 4.5 Discussion 52 5 Predictors of changes in daily alcohol consumption in the aftermath of military deployment 57 5.1 Abstract 57 5.2 Introduction 58 5.3 Methods 60 5.4 Results 64 5.5 Discussion 68 6 Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD 73 6.1 Abstract 73 6.2 Introduction 74 6.3 Methods 78 6.4 Results 80 6.5 Discussion 85 7 Stress exposure and the risk for the onset of alcohol use disorders and nicotine dependence: The role of prior internalizing disorders 89 7.1 Abstract 89 7.2 Introduction 90 7.3 Methods 92 7.4 Results 96 7.5 Discussion 103 7.6 Conclusions 105 8 General discussion 106 8.1 Summary of main findings 106 8.2 Discussion of main findings 109 8.3 Critical discussion of methodology 117 8.4 Practical implications 120 8.5 Directions for future research 122 9 Conclusion 125 10 References 126 11 Appendix 157

Hintergrund und Fragestellung: Weiter steigende Raten des Konsums psychotroper Substanzen und klinisch bedeutsamer Substanzstörungen vor allem bei Jugendlichen und jungen Erwachsenen, veränderte Gebrauchs- und Problemkonstellationen der Konsumentengruppen und die Einführung neuer Therapien und Versorgungsmodelle (Prävention, Frühintervention, Therapie und Rehabilitation) erfordern insbesondere angesichts der begrenzten Finanz- und Versorgungsressourcen neue Bedarfs- und Allokationsmodelle. Diese sollen praxisnah und effizient zu entscheiden helfen wann, bei welchen Rahmenbedingungen, welche Interventionsart und -strategie die individuell erfolgversprechendste ist. Diese Fragen werden in einem Forschungsprojekt des Suchtforschungsverbundes ASAT bearbeitet, das in einer umschriebenen Region mittels schrittweiser, epidemiologisch basierter Bedarfsund Bedürfnisanalysen die Ableitung und Priorisierung von institutionellen und therapeutischen Zuordnungsstrategien untersucht. Methodik: Basierend auf einem prospektiv-epidemiologischen Design wurden (1) bei einer repräsentativen regionalen Bevölkerungsstichprobe (EDSP-Studie) Inzidenzmuster, Spontanverlauf, Risikofaktoren und Konsequenzen des Substanzgebrauchs, -missbrauchs und der -abhängigkeit sowie Inanspruchnahmeverhalten, gedeckter und ungedeckter Bedarf beurteilt. (2) Ergänzt wird diese Erhebung durch eine Gesamterfassung und Evaluation des regionalen Suchthilfesystems. (3) Über statistische Analysen von Verläufen und Suchthilfeangeboten in der Region sollen "natürliche" Allokationsprozesse dargestellt und "outcome"-orientiert bewertet werden. (4) Anhand der dabei sichtbaren Mängel und Defizite können dann zusammen mit den Einrichtungen verbesserte Allokationsrichtlinien für einzelne sowie Gruppen von Patienten abgeleitet werden. Die Ergebnisse sollen in das regionale Suchhilfesystem übertragen werden. Ergebnisse und Diskussion: Erste Ergebnisse des Projekts bestätigen die Möglichkeit, Risikogruppen über spezifische Verlaufsanalysen zu identifizieren (z.B. regelmäßige Cannabiskonsumenten, Mehrfachkonsumenten, mehr weibliche Konsumenten mit einem höherem Abhängigkeitsrisiko). Die Inanspruchnahmemuster deuten in Teilbereichen (Frühintervention) auf ein hohes Ausmaß ungedeckten Bedarfs hin und scheinen neue Allokationsentwürfe zu erfordern. Den Einrichtungsträgern und regional Verantwortlichen der Suchthilfe können nach Auswertung weiterer Daten umfassende Bedarfsabschätzungen und verschiedene alternative Allokationsmodelle basierend auf der Perspektive von KlientInnen/ PatientInnen bereitgestellt werden. / Background and Aims: Increasing rates of substance use and substance use disorders especially in adolescents and young adults, changing patterns of use and associated problems and the introduction of new therapies and programs of care (prevention, early intervention, therapy, rehabilitation) require new need and allocation models especially because of restricted financial and care resources. These models should provide a rational basis for the improvement of allocation processes as well as setting priorities in the provision and restructuring of community and patientoriented interventions. In the present paper, we will present a project of the ASAT research network program which aims at a multi-staged, integrated epidemiology-based need and program evaluation in an area to determine institutional and therapeutical allocation processes. Methods: Based on a prospective epidemiological design, (1) prevalence and incidence, risk factors and course of substance use, abuse and dependence are investigated in a representative sample of the community-based EDSP study. Additionally, helpseeking behaviors, met and unmet need are assessed. (2) The investigation is supplemented by a survey of all substance use services in the area. (3) Course of substance use and service provision of substance use services in the area will be analyzed and reviewed to identify natural allocation processes and to determine the outcome. (4) With the knowledge of deficits and unmet need, improved allocation guidelines for specific groups of clients and patients will be developed. The results will be transferred into the regional health care system. Results and discussion: First results show that the identification of new risk groups with the help of course typologies is possible. The patterns of help-seeking point to a high rate of unmet need, especially with regard to the targeted early intervention, and a need of alternative allocation models. After the assessment and the overall data analyses, need evaluations and several alternative allocation models based on the clients'/patients' perspective will be provided.

The primary and secondary objectives of the Early Developmental Stages of Substance Abuse Study (EDSP) are described along with a detailed description of the overall design, special design features and instruments used. The EDSP is a 5-year prospective study with three waves of assessments. Special design features are the linkages with family genetic investigations as well as neuroendocrinological stress tests in high-risk subjects. Overall, 3,021 adolescents and young adults aged 14–24 years are included. The response rate for the baseline investigation was 71%. Diagnostic assessments were made by using a modified lifetime (baseline) and 12-month change version of the WHO-CIDI, adjusted for DSM-IV. Modifications refer to a more detailed quantitative assessment of symptoms and substance use variables as well as the inclusion of questions to assess course of disorders and subthreshold diagnostic conditions.

The objectives of the community-based Early Developmental Stages of Psychopathology (EDSP) Study are described along with a detailed account of the overall design, special design features, sample characteristics and instruments used. The EDSP employed a prospective-longitudinal design to study substance use and other mental disorders in a representative population sample of 3,021 subjects aged 14–24 years (birth cohorts 1970–1981) at ‘baseline’ – the outset of the study. Two follow-up investigations were conducted after the baseline investigation covering an overall period of 3–4 years. Special design features are the linkage with a family supplement (EDSP-FS) as well as neurobiological laboratory studies of high-risk subjects.

No description available.

Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more than 2 times the national average in 2017. The purpose of this descriptive cross-sectional non-experimental study was to examine how formal SUD nursing education, personal experiences, and participant characteristics predict attitudes and knowledge of nursing students and practicing perinatal nurses in Tennessee toward pregnant and perinatal women with an SUD. The sample consisted of 262 nursing students and 99 perinatal nurses across the west, middle, and eastern regions of Tennessee. A linear multiple regression showed that having a personal experience with a close friend with an SUD was predictive of improved knowledge scores of pregnant and perinatal SUDs. Independent samples t-tests were non-significant between formal SUD nursing education and attitudes and knowledge. Additionally, non-significant findings were seen between having a personal experience with a family member with an SUD and attitudes and knowledge. The findings suggest that Tennessee nursing education efforts were not influential in positively affecting attitudes and knowledge scores toward pregnant and perinatal women with an SUD. Future studies focused on exploring various educational interventions to promote knowledge, improve attitudes, and empathy in nursing populations toward pregnant and perinatal women with an SUD are warranted.