Substance use, need, and demand for substance user treatment services in patients treated for sexually transmitted diseases in michigan.

The association between substance use and communicable diseases, and the need for substance user treatment services for patients treated for communicable diseases, is well documented. This study builds upon this knowledge in that it quantifies the need and demand for substance user treatment services in a large population of patients treated for communicable diseases, specifically, sexually transmitted diseases (STDs), an area in which there is insufficient research published in the literature, but which is essential for policy development. More than 1700 patients treated for STDs in publicly funded clinics in Michigan between 1994-1995 were interviewed about their substance use, consequences of use and demand for substance user treatment services. Results indicated that the rates of substance use and demand for substance user treatment services were significantly higher among persons encountered in the STD clinics compared to the Michigan general adult population; however, a large proportion of STD patients determined to need substance user treatment services according to DSM-III-R criteria for "substance dependence" and "abuse" did not report ever receiving it. These results are followed by a discussion of possible policy implications for planning for substance user treatment services for patients treated for STDs in publicly funded clinics and suggestions for further research.

Test-retest reliability of psychoactive substance abuse and dependence diagnoses in telephone interviews using a modified Diagnostic Interview Schedule-Substance Abuse Module.

The test-retest reliability of lifetime substance abuse and dependence diagnoses obtained by telephone interviewers was investigated. Trained personnel administered two identical interviews based on a modified Diagnostic Interview Schedule-Substance Abuse Module (DISSAM) approximately a week apart for 100 respondents, of whom 55 were receiving alcohol or other drug treatment and 45 and randomly selected from residential households in one Michigan county. The uncorrected agreement for all lifetime dependence diagnoses exceeded 93% for all six categories assessed and the more conservative chance corrected agreement (Cohen's Kappa coefficient kappa) was .92 (alcohol),.76 (marijuana),.87 (cocaine), and .71 (other opiates). Kappa coefficients for hallucinogens and heroin dependence could not be calculated due to low (i.e., 5% or less) base rates. Likewise, kappa was calculated only for a single abuse diagnosis, alcohol, with kappa = .42 and 95% agreement. In the interpretation of kappa, the standard applied was: kappa ranging from .41 to .60 represented moderate agreement, kappa ranging from .61 to .80 represented substantial agreement, and kappa ranging from .81 to 1.00 represented excellent agreement. Thus, test-retest reliability was excellent for lifetime alcohol and cocaine dependence and was substantial for lifetime marijuana and other opiates dependence. These results indicate that lifetime psychoactive substance abuse diagnoses can be obtained fairly reliably over the telephone using trained lay interviewers.

Effectiveness of a family skills training program for substance use prevention with inner city African-American families.

The effectiveness of the Safe Haven Program for the prevention of substance use, a family skills training program for African-American families, was evaluated through a nonequivalent comparison, repeated measures, quasi-experimental design which included pre- and posttest parent and child interviews, including the Moos Family Environment Scale and the Achenbock and Edelbrock Child Behavior Checklist. The results indicate that the Safe Haven Program is effective in increasing parenting efficacy and behaviors toward children, improving the childrens' risk and protective factors and behaviors, and supporting treatment reductions in the parent and family illegal substance use.

Organizational frameworks of a substance use prevention program.

Failures to implement substance use prevention programs preclude success in program effectiveness and sustantation. Failures to initiate substance use prevention programs can result from the failure of program managers to meet the challenges which occur in the creation and management of program organizations. Attention to the program organization from a variety of frameworks is useful in the implementation process. Based on divergent organizational theories, four approaches utilized in the implementation of a substance use prevention program are presented.