The economic burden of prescription opioid abuse is believed to be substantial, however it is not known whether total and per-event hospital (ED and inpatient) costs associated with opioid abuse or misuse differ by insurance status. We also wanted identify predictors of charges. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the sampling design of the NEDS, we estimated national total and mean charges -- overall and by insurance status (Medicare, Medicaid, private insurance, or self-payment). Charges were adjusted using the 2010 Medical Consumer Price Hospital Services index. We used a log-linked gamma regression model to assess potential predictors of charges. The number of opioid abuse-related events was 515,896; 506,837; and 564,559 for 2006, 2007, and 2008, respectively. Approximately 55% visits in each year resulted in inpatient admissions. Total charges billed for opioid abuse-related events were US$9.8; 9.6; and 9.5 billion for 2006, 2007, and 2008, respectively. Medicaid patients had the highest charges in each years followed by Medicare patients. Approximately 93% of total charges were due to subsequent inpatient admission. Overall unadjusted mean charges were $20,651; $20,373; and $18,384 for 2006, 2007, and 2008, respectively. Compared to events paid for by private insurance, Medicaid-covered events had significantly higher mean charges, and self-paid events had significantly lower charges (p < 0.001 for each year). Inpatient admissions resulted in significantly higher mean charges compared to treat-and-release ED visits (p < 0.001 for each year). We found similar results after adjusting for clinical and demographic factors. Age, number of diagnoses, inpatient admission, presence of cardiac tissue disorders, respiratory infections or failure, gastrointestinal hemorrhage, and acute pancreatitis were significantly positively associated with total charges billed (p < 0.001 for all). This study helps in determining differences in hospital costs of opioid abusers by insurance status and in identifying potential predictors of such costs, resulting in better understanding the economic burden of opioid abuse on the healthcare system. / text

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Not available / text

This thesis investigates the phenomenological task of asking what the lived experience of the wounded healer is like for ex-drink/drug-addict Counselling Psychologists working in addiction. The wounded healer is a term that has been circulating in medical and psychotherapy circles for the past 150 years and has been associated with the helping professions and in particular addiction.

The purpose of the study was to evaluate the construct validity of the Substance Abuse Subtle Screening Inventory (SASSI) as a screening test for alcoholism. The study sample consisted of 238 participants. These included 50 alcoholics, 50 normals, 50 psychiatric outpatients, 50 co-dependent family members and 38 drug addicts, so classified by clinician diagnosis.All participants were administered the SASSI and also the Michigan Alcoholism Screening Test (MAST) and the MacAndrew Alcoholism-Screening Scale (AMAC). Correct classification rates for all three tests were determined using both a five-group criterion of classifying as an alcoholic, normal, psychiatric outpatient, co-dependent or drug addict, and a simpler two-group criterion of classifying as a substance abuser or non-abuser. Five null hypotheses were tested using Chi-square (alpha = .01) tests for equal proportions of classification accuracy. A sixth null hypothesis was tested using linear discriminant function analyses.Results Five-group criterion:1. The three tests differed in correctly classifying alcoholics, with the MAST statistically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the MAST and the AMAC statistically significantly superior to the SASSI.3. The three tests differed in correctly classifying psychiatric outpatients, with the AMAC statistically significantly superior to the SASSI.4. The three tests differed in correctly classifying drug addicts, with the AMAC and the SASSI statistically significantly superior to the MAST.5. The three tests did not differ to a statistically significant degree in classifying codependents.Two-group criterion (abuser/non-abuser):1. The three tests differed in correctly classifying alcoholics, with the MAST statitically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the SASSI statistically significantly superior to the AMAC and the MAST.3. The three tests differed in correctly classifying psychiatric outpatients, with the SASSI and the AMAC statistically significantly superior to the MAST.4. The three tests differed in correctly classifying drug addicts, with the MAST statistically significantly superior to the AMAC and the SASSI.5. The three tests differed in correctly classifying co-dependents, with the SASSI statistically significantly superior to the AMAC and the MAST.Employing the two-group criterion, all tests vastly improved their performance with the SASSI significantly superior to the MAST and the AMAC at author-recommended cutting scores. Increasing the cutting score for the MAST improved classification accuracy even further. Employing the linear discriminant function, the three tests differed significantly, with the MAST statistically significantly superior to all other scales.ConclusionsNone of the three scales performed adequately with the five-group criterion. The simpler two-group criterion produced an 87% classification accuracy rate for the SASSI with the study sample at author-recommended cutting scores, which was statistically significantly superior to the MAST and the AMAC. The highest classification accuracy rates of 90.3% and 91.2% respectively were produced by the MAST at elevated cutting scores of 10 and 12 in the two-group criterion. These parallelled linear discriminant function results for the MAST. / Department of Counseling Psychology and Guidance Services

This study examined the interrelations among sexual victimization, attachment style, interpersonal relationship satisfaction, and substance use. Sexual victimization (i.e., child sexual abuse and adult sexual assault; CSA and ASA) is a major social concern for which further research is needed. While it is difficult to determine which difficulties are direct outcomes of sexual victimization, both CSA and ASA have been found to be associated with a variety of mental health problems, along with numerous other adverse outcomes across the lifespan (e.g., depression, risk of suicide, attachment insecurity, interpersonal relationship problems, substance abuse). By further exploring these relations and identifying potential mediating variables, specific therapy techniques may be tailored in order to address these variables in treatment. Factors such as attachment and interpersonal relationships are particularly important to consider when examining sexual victimization, due to the intimate nature of this type of victimization. It was expected that sexual victimization in women (controlling for other forms of childhood maltreatment) would predict insecure adult attachment, greater levels of harmful substance use (i.e., drug and alcohol abuse), and lower reported relationship satisfaction. Results indicated that women who experienced more severe CSA and anxious attachment engaged in greater levels of drug abuse (i.e., anxious attachment moderated the relation between CSA and drug abuse). In addition, women who experienced more severe ASA and child psychological abuse reported greater attachment insecurity (both attachment avoidance and anxiety) in their relationships and engaged in greater levels of substance abuse (i.e., both drug and alcohol abuse). Furthermore, women with greater levels of anxious attachment reported lower levels of relationship satisfaction. These findings suggest that clinicians working with women survivors of sexual victimization should be aware of potential attachment-related difficulties, as well as an increased risk of developing substance use problems that may be stemming from victimization experiences. / Graduate / 0621

This study examined the interrelations among sexual victimization, attachment style, interpersonal relationship satisfaction, and substance use. Sexual victimization (i.e., child sexual abuse and adult sexual assault; CSA and ASA) is a major social concern for which further research is needed. While it is difficult to determine which difficulties are direct outcomes of sexual victimization, both CSA and ASA have been found to be associated with a variety of mental health problems, along with numerous other adverse outcomes across the lifespan (e.g., depression, risk of suicide, attachment insecurity, interpersonal relationship problems, substance abuse). By further exploring these relations and identifying potential mediating variables, specific therapy techniques may be tailored in order to address these variables in treatment. Factors such as attachment and interpersonal relationships are particularly important to consider when examining sexual victimization, due to the intimate nature of this type of victimization. It was expected that sexual victimization in women (controlling for other forms of childhood maltreatment) would predict insecure adult attachment, greater levels of harmful substance use (i.e., drug and alcohol abuse), and lower reported relationship satisfaction. Results indicated that women who experienced more severe CSA and anxious attachment engaged in greater levels of drug abuse (i.e., anxious attachment moderated the relation between CSA and drug abuse). In addition, women who experienced more severe ASA and child psychological abuse reported greater attachment insecurity (both attachment avoidance and anxiety) in their relationships and engaged in greater levels of substance abuse (i.e., both drug and alcohol abuse). Furthermore, women with greater levels of anxious attachment reported lower levels of relationship satisfaction. These findings suggest that clinicians working with women survivors of sexual victimization should be aware of potential attachment-related difficulties, as well as an increased risk of developing substance use problems that may be stemming from victimization experiences. / Graduate / 0621

The extremely high prevalence of substance abuse among young offenders and the significant personal harms associated with such use highlights the need for the development and delivery of effective intervention programs. This thesis explores the beliefs of young offenders about their substance use and offending behaviour in order to inform the development of more engaging and potentially more effective intervention approaches. A grounded theory methodology was used, involving interviews with fourteen young offenders. The beliefs of participants about themselves and their behaviour were understood in terms of basic human needs for relatedness, autonomy and competence. It is concluded that interventions with young offenders who abuse substances should be designed in ways that help to overcome the internal and environmental barriers that prevent these needs being met. / Thesis (MPsy(Forensic))--University of South Australia, 2005.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2007. / Title from title screen (site viewed Feb. 22, 2008). PDF text:123 p. : col. ill. ; 588 K. UMI publication number: AAT 3275070. Includes bibliographical references. Also available in microfilm and microfiche formats.

Thesis (M. Sc.)--University of Newcastle, 1977. / Department of Psychology. Includes bibliographical references (leaves 72-76). Also available online.