The purpose of this study was to explore beliefs about what works in substance abuse treatment among adolescents. This was a qualitative study that was comprised of fourteen counselors who were interviewed regarding what works in substance treatment with adolescents. The study identified four themes that contribute to our knowledge about what works in substance abuse treatment among adolescents. The study recommends that future research explore further what works with adolescents in substance abuse treatment, including collaborating with family members, identifying strengths in adolescents, building an authentic rapport with adolescents, and using the latest evidence-based practices.

Prescription pain medication abuse is a developing social problem in the United States. This quantitative study, grounded in attachment theory, examined relationships between attachment, perceived social support, and relapse. It was hypothesized that significant relationships existed between (a) attachment dimensions and relapse and (b) perceived social support and relapse. A further hypothesis was that perceived social support was a mediator in the relationship between attachment and relapse. Participants were 69 adult females, each of whom completed a demographic questionnaire; the Advanced Warning of Relapse (AWARE) Questionnaire; the Experiences in Close Relationships, Revised (ECR-R); and the Personal Resource Questionnaire (PRQ). A multiple linear regression was conducted to determine relationships between attachment and perceived social support on relapse. A mediation analysis was conducted to determine whether perceived social support was a mediator between attachment and relapse. Results identified that women with anxious styles of attachment have higher relapse potential and that women with higher levels of perceived social support appeared to have decreased attachment anxiety. Results indicated that women with increased attachment anxiety who also reported higher levels of perceived social support showed a reduced potential to relapse. This research contributes to positive social change by confirming the importance for health professionals to incorporate both attachment theory and the role of social support into treatment modalities to prevent relapse and to increase public awareness about these psychological factors of prescription pain medication addiction.

The purpose of this research was to identify risk factors for future substance abuse (SA) and/or substance dependence (SD) among young boys with attention deficit/hyperactivity disorder (ADHD). The prevalence of childhood ADHD among adult substance abusers has been well documented and stimulant medication therapy is considered to be a protective factor. However, this population remains at high risk for developing SA disorder in adulthood. Thus, since stimulant therapy alone does not eliminate the risk of future SA, it is important to determine other factors that contribute to this problem in this population. The specific questions addressed in this research were 1) What risk factors predict SA problems in later life for adolescent boys who were diagnosed with ADHD? ; 2) Do boys diagnosed with ADHD and receiving stimulant medication have the same risk factors for SA as undiagnosed/unmedicated (normal) boys? and 3) Is the medication effect at reducing SA in later years dependent or independent of the response to the pharmacological treatment for behavioral symptoms of ADHD? This study evaluated data collected in a longitudinal study (1968 to present) of boys diagnosed with ADHD at the University of Iowa Hospital outpatient psychiatric clinic. Longitudinal regression and odds-ratios were used to measure the strength of correlation of risk factors to adult SD outcomes in three groups: diagnosed medicated boys, diagnosed unmedicated boys and a comparison group of undiagnosed, unmedicated (normal) boys. It was hypothesized that specific risk factors could be identified in the two groups of diagnosed boys (medicated and unmedicated). It was further hypothesized that poor response to medication would predict higher rates of adult substance abuse. and thus be an indicator for early prevention/intervention need for the poor responders. Results indicated that few of the evidence-based risk factors identified for the general adolescent population were significant predictors of adult SD for these adolescents diagnosed with ADHD. Other identified risk factors did not appear to be influenced by the effects of the medication. Response to stimulant medication was not related to the outcome of adult substance dependence, indicating that the protective factor exists regardless of medication response.

Many adolescents with substance use disorders have ongoing problems with abuse and/or dependence throughout their lives. Little research has been conducted examining the differences among adolescents who do and do not continue to have difficulties. This study compared adolescents who recidivate versus those who do not recidivate after receiving treatment for substance abuse. Adolescents were compared on four categories of variables: (a) demographic variables, (c) delinquency /substance use history, ( c) social/educational support, and ( d) treatment history. It was found that the most powerful predictors of recidivism within these categories were criminal history severity, age at intake, and treatment completion. The implication of this finding is discussed. It may be possible in the future for treatment providers to identify adolescents most at risk for recidivism, as these teens should perhaps receive more intensive treatment, a different type of treatment, and/or more intensive monitoring during and after treatment.

Research into the comorbidity (or co-occurrence) of mental disorders is a relatively recent phenomenon. Much of this research has been conducted in clinical samples, which are prone to a range of biases that mean that the patterns observed are not representative of the general population. Although population-level research has previously been carried out, this thesis provides the first examination of comorbidity in the Australian population. This thesis examined the comorbidity of substance use and mental disorders among Australian adults. The major empirical work involved an examination of the patterns of homotypic comorbidity (other substance use disorders) and heterotypic comorbidity (mood disorders, anxiety disorders, and psychosis) of alcohol, tobacco and cannabis in the 1997 Australian National Survey of Mental Health and Well-Being (NSMHWB). These drugs were chosen as they are the most commonly used psychoactive substances in the Australian population. The NSMHWB involved a structured diagnostic interview of mental disorders with a representative sample of Australian adults. Three questions were addressed using this data: (1) What patterns of comorbidity exist between tobacco, alcohol and cannabis use, and other substance use and mental disorders?; (2) Are these patterns of comorbidity explained by common factors?; and (3) Does comorbidity affect the likelihood that mental health treatment has been sought? Similar patterns of homotypic comorbidity were observed for all three substances, and they were not explained by the other factors examined (gender, age, education, relationship status, employment and neuroticism). Cannabis dependence was the most strongly associated with other substance use disorders. Heterotypic comorbidity differed between alcohol, tobacco and cannabis use. Tobacco use predicted increased rates of all three groups of mental disorders (mood, anxiety and psychotic disorders). In the case of alcohol, only alcohol dependence was related to increased rates of all groups of mental disorders; alcohol use and abuse were not associated with heterotypic comorbidity. Any level of cannabis involvement was related to a similarly increased risk of mood and anxiety disorders. Cannabis use was linearly related to the risk of screening positively for psychosis. Common factors did not change the patterns of heterotypic comorbidity of tobacco and alcohol use. However, alcohol, tobacco and other drug use appeared to explain the higher rates of mood and anxiety disorders among cannabis users. Treatment seeking was much more likely among alcohol, tobacco and cannabis users when they had comorbid mental disorders. It was moderately increased when they had comorbid substance use disorders. The second piece of empirical work provided a more detailed examination of comorbid substance use problems among persons with psychosis. This topic was selected due to the limited epidemiological research on this issue, and the relatively large burden of disability that psychosis places upon the individual and the community. NSMHWB data were used to examine the prevalence of comorbid substance use disorders among persons who were likely to have met criteria for psychosis (as assessed by a screener used in the NSMHWB). Multiple regression analyses were used to test possible explanations for the higher rates of substance use disorders observed among persons reporting higher numbers of psychotic symptoms. The odds of alcohol dependence and regular tobacco use increased 1.5 times, and the odds of cannabis dependence increased twice, with each additional psychotic symptom reported, after adjusting for other substance use disorders, other mental disorders and demographic characteristics. Given the debate about the reasons for the association between cannabis use and psychosis, the final study used mathematical modelling to test four hypotheses about relationships between cannabis use and psychosis. Specifically, it examined trends in psychosis that would be predicted given the marked increases in the prevalence of cannabis use that have occurred in Australia over the past thirty years. The results suggested that a causal relationship - in which cannabis use caused psychosis among persons who would not otherwise have developed the disorder - is unlikely to explain the association. There was a better fit to the data provided by the other hypotheses examined, namely, that (a) cannabis use precipitates psychosis among vulnerable individuals; (b) cannabis use increases the risk of relapse among persons with psychosis; and (c) persons with psychosis are more likely to become regular cannabis users (without any effect upon the disorder). This thesis has demonstrated that in Australian adults there is significant comorbidity between alcohol, tobacco and cannabis use and other substance use and mental disorders. These patterns differ across the three substances. Some types of heterotypic comorbidity (e.g. between cannabis use and mood/anxiety disorders) are explained by common factors. The limited range of common factors tested here did not explain homotypic comorbidity. This thesis also suggested that mathematical modelling is a useful approach to consider when examining the plausibility of different relationships between risk factors and mental disorders. A number of hypotheses regarding comorbidity could not be tested using NSMHWB data, such as common genetic and other environmental factors. These can best be tested in research with samples of twins, and using longitudinal designs that assess a wide range of social and environmental factors. The findings of this thesis also have implications for treatment, because persons with comorbid disorders are more likely to seek treatment. There is an absence of validated treatments for persons with comorbid substance use and mental disorders, and more research is needed on this issue.

Thesis (M.A.)--University of Delaware, 2006. / Principal faculty advisor: Cynthia Robbins, Dept. of Sociology. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 2004. / Includes bibliographical references (p. 208-221). Also available on the Internet.

Thesis (M.S.)--University of Nevada, Reno, 2005. / "May 2005." Includes bibliographical references (leaves 55-61). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2005]. 1 microfilm reel ; 35 mm.

Hepatitis C is the most common blood-borne viral illness in the North America. Chronic hepatitis C infection may lead to cirrhosis of the liver, liver failure and liver cancer. In North America, injection drug use is the most important risk factor for infection and substance abusing populations are disproportionately affected by the disease. Antiviral therapy exists and approximately 50% of infected individuals can be cured. The aim of this thesis was to provide information to help clinicians and policy-makers minimize the impact of hepatitis C in substance abusers. The thesis is comprised of three studies. The first assessed the rate of progression to cirrhosis for those acquiring infection through injection drug use, using a meta-analysis of 44 studies from the published literature. We estimated that fibrosis progression occurs at a rate of 8.1 per 1000 person-years (95% Credible Region (CR), 3.9 to 14.7) corresponding to a 20-year cirrhosis prevalence of 14.8% (95% CR, 7.5 to 25.5). The second study measured the association between successful antiviral therapy and quality of life. We demonstrated that sustained responders to therapy had higher scores on the hepatitis-specific Medical Outcomes Survey Short-Form-36 (SF-36), Health Utilities Index Mark 2/3 (HUI2/3), and time-tradeoff (TTO) than treatment failures, an average of 3.7 years following antiviral therapy. The third study assessed rates of adherence to antiviral therapy and rates of sustained response in current or former iii substance abusers on methadone maintenance. We demonstrated that while use of illicit substances prior to therapy negatively affected adherence, rates of sustained response were comparable to non-substance abusing populations. Our work indicates the future burden of disease in current and former substance abusers, demonstrates that antiviral therapy can be successful in this population, and indicates that the benefits of successful therapy may extend beyond decreased disease burden to improved quality of life.

This descriptive study was designed to determine whether substance abusers could be differentially characterized by past involvement in crimes and, further, whether there is a relationship between the type of substance abused and the degree of violence of the crimes committed. By comparing the socio-demographic characteristics, substance-use, and strain-inducing events reported by 598 residential and outpatient treatment seekers in the Kentucky Treatment Outcome and Performance Pilot Studies Enhancement Project, this study provides further understanding of the crime-substance relationship. This study utilized Robert Agnew's 1992 general strain theory. Results suggest that substance addicts and substance users can be characterized in terms of their previous involvement in crime and their perceptions of personal strain. However, further differentiation between nonviolent and violent criminal offenders and type of substance used is not substantiated by findings presented in this study.