Results of a statewide survey of adolescent substance use screening rates and practices in primary care.

Professional guidelines recommend annual screening, brief intervention, and referral to treatment (SBIRT) as part of health maintenance for all adolescents, but reported screening rates have been low and no report has documented the techniques being used. The objective of this study was to describe the results of a statewide questionnaire regarding adolescent substance use screening rates and techniques used by primary care physicians practicing in Massachusetts. A questionnaire was mailed to every licensed physician registered as practicing pediatrics (N = 2176), family medicine (N = 1335), or both (N = 8) in the Massachusetts Board of Medicine database. After eliminating physicians who did not provide care for adolescents, the survey response rate was 28% and the final analyzable sample consisted of 743 surveys. Less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use. Further physician training is recommended to encourage the use of developmentally appropriate screening tools and interventions for adolescents.

Improving the alcohol retail environment to reduce youth access: a randomized community trial of a best practices toolkit intervention.

Underage alcohol use remains a significant public health problem throughout the United States and has important consequences for the health of individuals and communities. The objective of this study was to assess the impact of distributing an alcohol retailer toolkit via direct mail on increasing positive alcohol retailer attitudes towards checking IDs, encouraging retail managers to formalize ID checking procedures with their employees, and promoting consumers to be prepared to show ID when purchasing alcohol. This community randomized study included five matched Massachusetts community pairs. Our analysis sample consisted of 209 retailers (77 intervention; 132 control). In models adjusted for baseline response and matching community and establishment characteristics, intervention communities reported posting, on average, one additional sign or wall decal in their establishments (ß = 0.937, P = 0.0069), and a twofold higher odds of handing out written materials on ID checking to staff (OR: 2.074, 95%CI: 1.003-4.288) compared to control establishments. However, the intervention was not found to have an effect on changing establishment policies, retailer attitudes, or other establishment practices. Intervention retailers perceived all components of the toolkit to be very useful for their establishments, and nearly all reported having shared materials with their employees and customers. These results suggest that some significant changes in alcohol retailer establishment practices can be achieved among motivated owners or managers through the distribution of a toolkit targeting best retailer practices. We do, however, recommend that future program planners consider alternative dissemination and marketing strategies beyond direct mail to encourage greater utilization.

Why the concept-based therapeutic community can no longer be called drug-free.

In the last two decades, a complex controversy has emerged in therapeutic community (TC) drug treatment programs, many of which are experiencing a marked increase in addicted clients with co-existing mental health disorders. This situation calls into question many theoretical and practical aspects of the TC approach to addiction recovery. Among the central issues: use of psychotropic medications for the increasing cases of comorbidity among substance abuse clients entering the TC, the influx of mental health professionals, and employment of a growing number of mental health interventions or services. The traditional drug-free self-help approach to drug treatment by the TC (with its own set of treatment interventions) and its historic dominance by ex-addicts or recovering persons as key staff are undergoing change. Integrating a biopsychosocial model into the traditional TC treatment modality requires a variety of adjustments that challenge the status quo in these programs. In particular, the use of psychotropic medications and mental health service providers in TC programs has improved the delivery of treatment to clients but at the same time it has created a cultural conflict for paraprofessional staff espousing the drug-free self-help philosophy. The clinical implications and organizational challenges of this predicament are described. Recommendations are provided on how to accept current health care realities without compromising the unique qualities of the TC approach.

The results of drug dependence treatment by therapeutic community in Thanyarak Institute on Drug Abuse.

A study of drug dependence treatment by therapeutic community (TC) in Thanyarak Institute on Drug Abuse from 1986 to 2000 was undertaken. 2,881 cases joined the TC program during this period (males 2,471 or 85.8%, females 410 or 14.2%). There were 278 cases who completed the TC program (males 261 or 93.9%, females 17 or 6.1%). The program course is at least one and a half year. The average duration of treatment in TC for the completion group was 27.6 +/- 7.1 months. The mean age was 30.9 +/- 6.4 years. About half of them had had a high school education. The majority (84.6%) of them were i.v. heroin addicts. The average drug-use duration was 9.8 +/- 5.7 years. After they completed the program, the clients were followed-up for five years. 203 cases (73.0%) were abstinent from drugs. Of this figure 21 cases (7.6%) had died during the follow-up from illness and accidents not directly related to relapsing to drugs. 75 cases (27.0%) relapsed to drugs. There were no significant differences between the abstinent and relapse cases in age, education, marital status, characteristic of addiction, previous treatment data and I.Q. Duration of treatment in the abstinent cases was longer (3.7 months) than the relapse cases. Significant differences (p < 0.05) were found in some personality characteristics. The relapse cases were neurotic-introversion personality type and had abnormal scores with low or high scores in hypersensitive character. They were likely to be easily stimulated to go back to using drugs. Although the TC program required much time and material resources to operate, the results of treatment were highly effective. The results of this study provide the rational to expand this TC program in order to provide more opportunities to the increasing demands for an effective treatment intervention for Thai addicts.