A specialized system of care for co-occurring clients can be an asset to this population, if the services offered deliver adequate results that contribute to the overall wellbeing of this community. Therefore, providers, including social workers and other professionals to determine the effectiveness of these programs, should routinely assess established programs that are design to meet the most basic needs of co-occurring populations. This will permit an increase the knowledge and understanding of outcomes and perhaps develop alternative resources to connect gaps in the delivery of services. This research evaluated the effectiveness of services that co-occurring clients received from Cedar House Life Change Center. It attempted to understand the correlation between graduation success and other variables, such as length in treatment, mental health and substance use diagnosis, types and frequency of services, and the effects of diverse populations on the treatment outcomes.

Purpose. The purpose of this study was to evaluate whether severe victimization experiences, and psychological and social resources were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. Method. Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. Results. Longer duration/frequent victimization, more than one type of victimization, recent victimization, low self-efficacy beliefs and available sources of emotional support were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. Conclusion. The findings show that some indicators of severe victimization experiences, psychological and social resources are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs. Particular emphasis may be placed on enhancing self-efficacy and social skills, so that adolescents may benefit from their available sources of support.

Substance use disorders (SUD) and mental health disorders are often thought of as completely separate problems even though these disorders commonly co-occur. Among adolescents who seek treatment for substance use problems, co-occurring mental health problems (MHP) are common. This is concerning because co-occurring disorders among adults have been associated with more severe MHPs, relapsing to substance use sooner, being less likely to maintain abstinence, and other problems. Despite the awareness that co-occurring disorders are problematic for adolescents, few studies have been conducted to understand these problems with an adolescent sample. The purpose of this study was to understand if factors commonly related to co-occurring disorders among adults were the same for adolescents and to examine two measurement models for the dependent variable, substance use. This secondary analysis of data first examined characteristics that are related to MHPs among a sample of adolescents (N=801) who use substances. Factors in three domains were examined: demographics, substance use, social factors. The results indicated that among these adolescents, MHPs were common. Two key factors related to having a MHP were gender and the severity of the SUD. Females and adolescents with more severe SUDs, like dependence, were more likely to have MHPs. Furthermore, severity of the SUD partially mediated the relationship between several of the other factors and MHPs. The type of substance an adolescent reported using was also important. In addition, adolescents who had more peers and more family members who participated in deviant activities had more severe substance use problems and were more likely to have a MHP. In addition to examining the factors related to mental health problems among a substance using population, this study modeled the dependent variable in two different ways which had not been done before and allowed for variance in the measure to be accounted for in the model. MHPs were measured both continuously and categorically. The results of the comparison indicated that there were not major differences between the two models. Implications for social work practice, policy and research are discussed.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support. / October 2007

Past research has highlighted the importance of better understanding the high rate of smoking among individuals exposed to trauma. However, few studies have investigated the cognitive mechanisms that may contribute to the smoking-trauma relationship. The primary goal of the present study was to examine the associative relationship between smoking and trauma at a cognitive level, by examining the extent to which trauma-relevant pictures primed attentional biases to smoking-related words on a modified Stroop task. Eighty trauma-exposed smokers (classified as having low, medium, or high levels of post trauma symptomatology) ink-named smoking-related and neutral words after being primed with trauma-related, positive, or neutral picture cues. Although participants did not display an overall significant difference in reaction time between smoking words and neutral words, we found a significant prime x word type interaction, with slower reaction time to smoking words after being primed by trauma-related pictures. In addition, we found a significant 3-way interaction between symptom severity level, prime category, and target type. Further analyses revealed that the prime x word type interaction was significant only among individuals with the lowest and highest levels of PTSD symptomatology. A secondary aim of the study was to evaluate the relationship between smoking-related variables and posttraumatic stress disorder symptoms on a dimensional range. We found that participants who were more severely impaired at the time of the study were more likely to report strong cravings to smoke. Overall, findings suggest that smokers who have experienced trauma exhibit an attentional bias to smoking words when primed with trauma-related picture, and that post-trauma symptoms are related to smoking motivation. Implications for treatment are discussed.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.

This thesis takes Discursive Psychology as its main theoretical influence. Drawing on the resources of Discursive Psychology and utilising analytic tools provided by Conversation Analysis, these principles are applied to the study of addiction, and specifically alcohol problems. The data explored are telephone calls to an alcohol helpline. Four analytic chapters are presented. The first focuses on the concept of loss of control over drinking, identifying features of how this concept is constructed in talk and suggests possible functions of control talk for both callers and Advice Workers. The second analytic chapter examines how Advice Workers respond to callers' professed impaired control over their drinking and I demonstrate that embedded in discursive sequences of problem formulation and advice giving are issues of agency, accountability and responsibility. The thesis moves on to explore the role of knowledge in calls to an alcohol helpline and the analysis reveals that both the expert status of the Advice Worker and the speciality of the topic are co-constructed between the speakers on the helpline. The final analytic chapter features just one telephone call and demonstrates the application of such an analysis for alcohol service providers. The thesis ends with a discussion of the main overall findings and the implications of the research for clinical practice. I close by arguing that initial agency contact is a very important site of study and recommend that this should be explored utilising naturally-occurring talk.

Arsenic (As) and nitrate (NO3) are common contaminants in groundwater that are introduced through a variety of natural and anthropogenic sources. In this study we investigated the sources and distribution of As and NO3 in Goshen Valley, Utah, USA. Goshen Valley is a semi-arid alluvial basin that is impacted by geothermal waters, agriculture, urban development, and legacy mining. In this study we sampled surface water, springs, and wells to analyze concentrations of major ions, trace elements (As, B, Ba, Ca, Fe, K, Li, Mg, Mn, Mo, Pb, Si, Sr, Zn), and stable isotopes in water (δ18O and δD). A subset of samples were also analyzed for 87Sr/86Sr, δ34S, and tritium (3H). Major ion concentrations showed high spatial variability ranging from freshwater to brines, with the highest concentrations found in springs discharging from playa sediments. Likewise, the highest trace element concentrations, including As, were found in the playa-impacted springs. Elevated NO3 concentrations were found in springs and wells in agricultural areas of the valley. δ18O and δD values range from -0.90238 to -17.6 and -37.0891 to -134.5 respectively and represent that the valley contains old groundwater, evaporative surface water, and mixed water signatures in multiple wells. Tritium values range from 0.5 to 7.8 and further show the diversity of water in the valley by indicating old, young, and mixtures of old and young waters. Variations in 87Sr/86Sr were used to evaluate flowpaths of waters with elevated As. 87Sr/86Sr ratios suggest that the groundwater has interacted with a mixture of lithologic units including Tertiary volcanics, Paleozoic carbonates, and Quaternary alluvial/lacustrine fill. Correlations with As and playa affected springs indicate playa sediments as a major As source. The As found in wells has no apparent elemental correlations or spatial patterns and is likely due to the naturally occurring As in the valley alluvium and carbonate units. NO3 in the valley is concentrated in agricultural areas and is likely due to fertilizers, livestock, and alfalfa crops. Of all the potential contaminant sources, the data suggests that the major source of As is the saline playa soils and the major source of NO3 is agricultural activities in the valley.

It is increasingly important to understand the factors associated with individuals struggling with addiction and their quality of life, especially with those struggling with co-occurring diagnoses (CODs). The purpose of this study was to explore the extent to which meaning, and CODs of anxiety and depression predict an individual's attitudes and beliefs about addiction among persons receiving treatment for substance use disorders (SUDs). The theoretical foundation used to guide this study was logotherapy, which emphasizes the importance of increasing meaning in life through choices, while also centering on being able to find meaning in all situations. A cross-sectional correlation design was employed, using a sample of patient admission records from a dual diagnosis treatment center in the western United States. The responses on 4 assessments related to meaning, symptoms of anxiety and depression, and attitudes about substances were analyzed using a multiple linear regression. There was no statistically significant relationship between an individual's attitudes and beliefs about addiction as predicted by that individual's meaning and CODs symptoms of anxiety and depression. A significant negative correlation existed between depression and meaning (p < .01), while a significant positive correlation existed between the depression and anxiety (p < .05) as well as the anxiety and attitudes about substances (p < .01). The findings from this study can assist counselor educators in understanding the correlation between SUD, increased depressive symptoms, and low personal meaning.