No description available.

No description available.

In the United States (US), substance use, misuse, and substance use disorders are significant public health problems. Additionally, the difference between needing substance use treatment (SUT) and receiving treatment is becoming more pronounced. Therefore, the aims of this dissertation include, 1) to synthesize evidence of barriers and facilitators to integrating SUT into mainstream health care (MHC) after the Affordable Care Act was nationally implemented in 2014, 2) to examine the rate of treatment completion and dropout, along with its associated factors, among youth who received Medication-Assisted Opioid Therapy (MAT), 3) to determine the relationship between prior treatment episodes and length of stay (LOS) among adults in residential rehabilitation facilities (RRF) and explore other predictors of LOS and, 4) to determine whether experiencing multiple treatment episodes and being in certain age groups was associated with longer wait period to enter SUT. The literature synthesis involved data from five databases and was informed by PRISMA. Quantitative analysis (aims 2-4) included log-binomial, Poisson, and logistic regression models using the Treatment Episode Data Set-Admissions and Discharges. Andersen’s Behavioral Model for Health Services was the conceptual framework used to inform aims 2-4. For aim 1, several patient, provider, and program/system-level barriers and facilitators were identified, which highlights the need to use a comprehensive approach to improve SUT adoption in MHC. For aim 2, among youth who received MAT, 43.9% completed treatment and 56.1% dropped out. Factors positively associated with treatment completion included MAT use, males, self-help group participation, admission to detoxification and residential/rehabilitation settings, and being in the Midwest/Western US; while minority races (excluding Blacks/African Americans) and being in the South resulted in lower likelihood. For aim 3, the average LOS in RRF was 16.4 days, and having ≥ 1 prior SUT episode (PSUTE) was associated with slightly higher LOS. Some predictors associated with lower LOS included age (18-34 years), males, being employed, private insurance, and being in the Northeast. For aim 4, a longer wait period was identified among clients 25-49 years and those with ≥5 PSUTEs. These factors should be considered to improve SUT use, and future studies should corroborate these findings.

Background: Research suggests sexual minority women have higher rates of substance use and mental health problems than straight women. Specifically, past studies have shown alcohol consumption and dependence rates are higher among sexual minority women, in addition to use of some drugs. Similarly, research shows mental health problems such as anxiety, depression and suicide rates are elevated among sexual minority women. These differences in mental health and substance use characteristics by sexual orientation may be explained by the negative health effects of social marginalization and the common use of drinking establishments for sexual minorities. Objective: The objective of this thesis is to compare substance use and mental health characteristics between lesbian/bisexual women and straight women, including: a) demographic variables; b) alcohol and drug consumption and dependence; c) the social context of substance use (i.e., use with others, motivations to use and locations of use); and, d) mental health characteristics. Methods: Data were obtained from a sample of residential treatment clients in treatment for primarily alcohol and/or cocaine problems. Respondents were asked to fill out self-administered questionnaires, which included details on demographics, substance use, mental health and the social context of use, as well as information on sexual orientation and gender identity. Bivariate and logistic regression analyses were performed to examine differences by sexual orientation. Results: Some sexual orientation differences were found regarding alcohol consumption and dependence during bivariate analysis. In logistic regression results, methamphetamine use was significantly (p<.01) elevated among bisexual women and tranquilizers use was elevated among lesbian and bisexual women when compared to straight women. Bivariate analysis revealed lesbian and bisexual women reported higher levels on motivations to use, but this difference was not significant in multivariate regression results. After regression adjustments, lesbian and bisexual women had higher levels of anxiety and higher rates of suicide attempts. Lastly, lesbian and bisexual women reported substance use with sex workers and sex clients more often than straight women, but no other differences in location and motivations to use were seen in the regression results. Conclusion: Among this sample of residential treatment clients, some mental health and substance use characteristic differences were found. These finding can assist in determining the best treatment practices for sexual minority women. / Graduate / 0347

Introduction: Drug dependence is a chronic medical illness that often requires multiple treatment episodes and the use of health services. However, patterns related to substance use and abuse treatment are not well known. Two critical factors that have not been explored in relation to the number of prior substance use treatment episodes (PSUTEs) are multiple age groups and waiting periods. Hence, the first aim of this study was to examine if the frequency of prior substance use treatment episodes varies by different age categories. The second aim was to assess the extent to which the waiting period prior to receipt of substance use treatment services influences the likelihood of experiencing multiple treatment episodes. Methods: Data used for this research was the 2018 Treatment Episodes Data Set— Admissions (TEDS-A) (N= 1,935,541), which comprised of admissions to alcohol or drug treatment facilities across the United States. Descriptive statistics of participants was conducted. Bivariate and Zero-Inflated Poisson regression (ZIPR) analyses were performed to evaluate the number of PSUTEs associated with age and days waiting to enter a treatment facility while adjusting for other potential confounders. Andersen's healthcare utilization model was used to categorize covariates into predisposing, enabling, needs, and environmental factors. P-value ≤ 0.01 was considered the criteria for rejection of all null hypotheses. Results: Among participants, the average frequency of PSUTE was 1.60. About 34.2% were 25-32 years old, while 19.2% had a waiting period of between 1 to 7 days. Bivariate analysis showed that the number of PSUTEs (0 to ≥ 5) was significantly associated with all age groups and waiting periods, respectively. The results for age showed that 1.4% (12-17 years old), 8.4% (18-24 years old), 14.7% (25-34 years old), 16.7% (35-49 years old), and 18.1% (≥ 50 years old) reported ≥ 5 PUSTEs. For individuals with a waiting period of ≥ 31 days, the number of PSUTEs included 36.5% (no PUSTE), 20.2% (1 PUSTE), 12.3% (2 PUSTEs), 6.8% (3 PUSTEs), 4.2% (4 PUSTEs), and 20.0% (≥ 5 PUSTEs). ZIPR analysis demonstrated that the predicted log count of PSUTE increased significantly for every increase in age category. While for every increase in the number of days waiting to enter treatment, the predicted log count of PSUTEs significantly decreased. All potential confounders including, gender, race, living arrangement, type of treatment or service setting at admission, primary substance used, presence of co-occurring mental & substance use disorder, health insurance, and census region, were significantly associated with the frequency of previous substance use treatment episodes (P-value ≤0.01). Conclusion: This study demonstrated that multiple age categories and wait periods are significant predictors of the number of previous substance use treatment episodes. Notably, younger participants showed fewer prior episodes than older participants. These factors should be considered in order to develop effective strategies to improve treatment use and access to substance use treatment facilities. Therefore, more research is needed to explore these factors as well as other unknown predictors influencing multiple substance use treatment episodes.

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The relationship between counsellor and client has been extensively researched ever since the founding of psychotherapeutic treatment. Subsequently, it has been established as an integral and essential part of successful therapy. Yet, in regards to substance use treatment aforementioned research is still lacking. Few studies shed light on such relationships – even fewer on relationships formed within the unique settings of live-in treatment centres. Furthermore, the emotional handling of inter-relational work from the perspective of the professional is still remarkably absent from the scholarly world. Notably, professional perspectives are mainly presented in situations of boundary breaking behaviour and ethical misconduct. The aim of the present study was, consequently, to research how professionals conduct, care, and convey the phenomena of counsellor-client connections that are constituted within the above stated context. In order to fully capture the lived experiences of addiction counsellors, a hermeneutic-phenomenological approach was applied throughout – acting as both theoretical and methodological ground. Accordingly, a total of five semi-structured qualitative interviews were carried out and analysed through a hermeneutic-phenomenological lens. The result presents several significant findings in regards to how the professionals view boundaries, closeness and control in substance use treatment settings, which primarily include a certain all-encompassing duality: role changing is perceived as beneficial, albeit debilitating; closeness is seen as imperative, yet distance as integral; working with the self equates to working on the self. Overall, professional progression appears to echo that of the client’s – a supporting network, along with being earnest and daring, presents itself as keys for facilitating conducive change. Implications of above-mentioned co-occurrences are discussed, including suggestions for future research.

No description available.

The aim for this study was to examine how social workers perceive the social network’s function and involvement in an adolescent’s process toward changing a substance use. The study is based on seven qualitative interviews with social workers in Mini-Maria facilities, working with youths/adolescents in psychosocial substance use treatment. The interviews were analysed with a brief inspiration from the approach of thematic analysis. The ecological systems theory as well as a perspective on the theory of social capital were used for interpretation of the result. The overall conclusion is that adolescents’ networks have a large impact on their substance use treatment, both in terms of the outcome as well as the meaning to the adolescent itself. Parents of youths are frequently involved in the practical treatment, while friends rarely are, but they both form a central part regarding the process of change. The social capital is also of great importance since it is constructed within the different parts of the social network where the youth experiences support. Social capital can therefore be both constructive and destructive depending on the structure of those relationships.

The purpose of this study is to examine more closely those program components which facilitate dissonance, disharmony, and ambiguity among the keygroups of a residential substance abuse treatment program.