Aims and objectives Substance misuse is a chronic relapsing condition associated with high morbidity and mortality. Treatment attempts to reduce harms associated with drug use and to promote recovery and has developed considerably in the last 30 years. Opioid substitution therapy using methadone (OST-M) is an effective treatment for opioid dependency. Though the effectiveness of OST-M in delivering harm-reduction is well evidenced, evidence demonstrating recovery is limited as is understanding of those factors influencing progress. In this context, national policy makers and stakeholders have repeatedly questioned the value of OST-M as a substance misuse treatment and, at times, have sought to limit its use. Rigorous, long term outcome studies of UK subjects are required to improve clinical outcomes in OST-M subjects and to ensure ongoing availability of evidence-based treatments. In this context, the study had two main objectives: to demonstrate that standard clinical information systems can deliver rich, valid datasets to support outcome research; to use these data to explore the relationships between a selection of baseline variables (patient characteristics, comorbid conditions, the nature of substance misuse and the treatment received), the clinical process and long term outcomes achieved in a large cohort of OST-M patients in a standard NHS treatment setting. Methods and materials Standard clinical information, collected over 7 years, was linked with validated data from a range of databases. A large representative sample (76% of the OST-M treatment population in a region) was described in detail. Follow-up data were retrieved from clinical casenotes (4 years) and linked datasets (4-7 years) and collated to create a database for analysis. Variables for analysis were selected following a review of the published literature. Univariate analyses were undertaken to demonstrate statistically significant associations between baseline and follow-up variables. Significant variables were then entered into multiple regression analyses to develop predictive models for selected outcomes. Any predictive models were then subjected to cross-validation to determine their predictive power in novel datasets. Key results Many highly significant associations were shown. Significant personal (demographic) factors included: age, gender, having children, having conflict in personal relationships, educational level achieved and being in employment. It was notable that the area lived in (of three districts) was strongly associated with a wide variation in clinical process and outcomes achieved. Whether treated in primary care or specialist services, the medical treatments received, the level of non-NHS support and patient satisfaction showed strong associations with outcome. Baseline illicit drug use was also strongly associated with outcome. Multiple regression analyses found that despite these highly significant associations, strong predictive models of long terms outcome could not be demonstrated. Where weak models were created - predicting drug use (by self - report); drug use (positive tests); family stability - cross validation showed these had no predictive value in novel datasets. Conclusions Standard clinical information, linked with relevant NHS datasets can give rich and comprehensive data suitable for research of large representative samples over long time periods. This study represents one of the largest OST-M populations ever described in the UK with longer follow-up periods than most of the published literature. In this study strong associations were found between a range of independent and dependent variables over 4-7 years. These findings broadly reflected the evidence base. However, the associated variables could not generate strong useful predictive models of long term outcome. This could reflect issues of study design or data quality. This type of approach should be further developed in the field of substance misuse research. Issues of data quality would require to be addressed to maximize the value of these datasets. Further research is required to develop better understanding into key factors influencing long term outcomes of treatment in substance misuse.

Objective. To examine associations among attention-deficit/hyperactivity disorder (ADHD) symptom dimensions (hyperactivity, impulsivity, inattention, and sluggish cognitive tempo [SCT]) and functional impairment among adults. The potential influence of co-occurring internalizing and externalizing difficulties, as well as self-reported executive functioning deficits, on these associations was also evaluated. Methods. One thousand eight hundred and ninety-four adults (58.8% female; 75.9% Caucasian; age: M = 36.24 [SD = 11.65] years) recruited from Amazon’s Mechanical Turk (MTurk) completed extensive questionnaire batteries assessing ADHD symptoms, co-occurring internalizing and externalizing difficulties, executive functioning deficits, and functional impairment across a range of domains. First, factor analyses were completed to identify empirically-derived functional impairment factors for use in subsequent analyses. Second, associations between ADHD symptom dimensions and functional impairment factors were examined via a path model. Third, multiple mediation analyses were conducted to evaluate the impact of ADHD symptom dimensions on functional impairment domains via internalizing and externalizing difficulties. Finally, additional multiple mediation analyses were completed to examine to influence of ADHD symptom dimensions on functional impairment via self-reported executive functioning deficits. Results. Factor analyses identified four overlapping but distinct functional impairment factors indexing general impairment, quality of life, romantic relationship functioning, and social support. Path analyses revealed significant associations between increased ADHD symptoms and higher general impairment, lower quality of life, reduced romantic relationship functioning, and decrements in perceived social support. Multiple mediation analyses indicated that ADHD symptom dimensions influence functional impairment domains via specific internalizing, externalizing, and executive functioning difficulties. Conclusions. The pattern of findings provides further support for associations between ADHD symptom dimensions and a range of functional impairments, as well as highlighting potential exacerbation of these effects in the presence of co-occurring mental health and executive functioning difficulties. Current findings may help to clarify the complex phenomenology of ADHD in adults, and carry implications for improving extant treatment approaches.

Health care systems still focus on single disease management and ignore the complexities of multiple conditions management. Though self-management is the focus of chronic disease management, patients with comorbidities face challenges in meeting their self-management goals. The purpose of this study was to explore the perspectives of patients with comorbid conditions on the use of eHealth technology to promote self-management. The research was grounded on the technology acceptance model. I sought to explore the participants' understanding of self-management, the challenges to self-management and their perspectives on the use of eHealth for self-management. In this phenomenological study, 10 interviews were conducted from a purposeful sample of those with two or more comorbid conditions. The collected data were audio recorded and transcribed verbatim. Prolonged engagement, member checks, and triangulation were used to ensure trustworthiness. Self-reports and observation augmented the interviews. Data collection continued until saturation was reached, then analyzed iteratively and organized according to themes. The results showed that the participants managed their conditions at home by taking prescribed drugs, attending clinics, and following a special diet. However, they faced financial constraints, struggled with symptom control, and took too many drugs. The results also showed that technology could be used for people living with comorbidity as a source of information, to remind patients to take drugs or attend clinics, to increase awareness of symptoms, and to assist in the management of the disease. This study is expected to help in understanding (a) the challenges faced by patients with comorbidities, and (b) how the use of technology promotes self-management in this growing group.

The purpose of this dissertation study was to investigate the direct and interactive relationships between depression and conduct problems and substance abuse treatment outcomes in a national sample of adolescents participating in substance abuse treatment. This study involved a secondary analysis of data from the National Institute on Drug Abuse's- Drug Abuse Treatment Outcome Study for Adolescence (DATOS-A), a multi-site, longitudinal study of substance abusing adolescents seeking treatment. Participants completed a battery of self-report and interview measures at treatment intake including the Diagnostic Interview Schedule for Children Revised (DISC-R), which assessed depression and conduct problems. Adolescents also completed structured interviews relating to substance use at intake and 12 months after treatment. Results from the multiple regression analyses supported hypotheses relating to greater conduct problems predicting greater post-treatment substance use. Results from the multiple regression analyses failed to support study hypotheses relating to depression and the interaction of conduct problems and depression predicting post-treatment substance use. Significant control variables included age, length of treatment, and intake level of substance use. Results are discussed within the context of the relevant literature.

Thesis (Ph. D.)--University of Rhode Island, 2005. / Typescript. Includes bibliographical references (leaves 83-93).

Thesis (Ph. D.)--University of Oregon, 2001. / "Based on data collected from the Oregon Adolescent Depresssion Project (OADP)."--Abstract. Typescript. Includes vita and abstract. Includes bibliographical references (leaves 73-84). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 105-124). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 105-124). Also available on the Internet.

Source: Masters Abstracts International, Volume: 47-06, page: 3549. Adviser: Alfred L. Mcalister. Includes bibliographical references.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb 18, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Thesis advisor: Dr. Stephen Whitney. Includes bibliographical references.