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1.
Am J Drug Alcohol Abuse ; 49(6): 756-765, 2023 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-37737714

RESUMO

Background: Currently, the capacity to provide buprenorphine treatment (BT) is not sufficient to treat the growing number of people in the United States with opioid use disorder (OUD). We sought to examine participant retention in care rates of primary care delivered BT programs and to describe factors associated with retention/attrition for participants receiving BT in this setting.Objectives: A PRISMA-guided search of various databases was performed to identify the articles focusing on efficacy of BT treatment and OUD.Method: A systematic literature search identified 15 studies examining retention in care in the primary care setting between 2002 and 2020. Random effects meta-regression were used to identify retention rates across studies.Results: Retention rates decreased across time with a mean 0.52 rate at one year. Several factors were found to be related to retention, including: race, use of other drugs, receipt of counseling, and previous treatment with buprenorphine.Conclusions: While we only investigate BT through primary care, our findings indicate retention rates are equivalent to the rates reported in the specialty care literature. More work is needed to examine factors that may impact primary care delivered BT specifically and differentiate participants that may benefit from care delivered in specialty over primary care as well as the converse.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos , Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/complicações , Resultado do Tratamento , Atenção Primária à Saúde , Analgésicos Opioides/uso terapêutico
2.
J Prim Care Community Health ; 14: 21501319221147246, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36625264

RESUMO

BACKGROUND: Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. METHODS: A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths. RESULTS: The presence of an NAL had a significant (univariate P-value = .013; multivariable p-value = .010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P-value < .001), MOUD (univariate P-value < .001; multivariable P-value = .009), and Good Samaritan Law (univariate P-value = .033; multivariable P-value = .018). CONCLUSION: Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Naloxona/uso terapêutico , Analgésicos Opioides/uso terapêutico , Overdose de Opiáceos/tratamento farmacológico , Overdose de Opiáceos/epidemiologia , Overdose de Drogas/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
3.
Inquiry ; 58: 469580211017666, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34027712

RESUMO

There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Médicos , Profilaxia Pré-Exposição , Estudantes de Medicina , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Estados Unidos
4.
Prev Med Rep ; 20: 101184, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32995141

RESUMO

Opioid overdose fatalities include deaths from natural opioids (morphine and codeine), semi-synthetic opioids (oxycodone, hydrocodone), synthetic opioids (prescription and illicit fentanyl, tramadol), methadone, and heroin. From 1999 to 2017, there were 702,568 drug overdose deaths in the U.S., with 399,230 attributed to opioids. This study aimed to assess the dynamics of opioid related fatalities throughout the U.S. from 2006-2016. This study is a secondary analysis of data obtained through the Kaiser Family Foundation's analysis of Centers for Disease Control and Prevention data, 1999-2016. The data obtained were from all 50 states and the District of Columbia. A total of 272,130 individuals were included in the analysis. This represents the number of opioid overdose deaths in the United States from 2006-2016. Descriptive analysis of overall rates was conducted and mapped for visualization. Novel predictive models of increase for each drug overdose category were developed and used to calculate rate changes. Finally, the elasticity of change in rate for each drug category was calculated annually for the past 11 years. The highest rate of opioid overdose-related death occurred in West Virginia (40.03 per 100,000). In our secondary analysis, we explored the change in the rate of opioid-related deaths from 2015 to 2016. The changing dynamics of fatal opioid overdose at the state level is critical to guiding policy makers in addressing this crisis. Rates of fatal opioid overdose vary across the states, but we identify some trends. Regional differences are identified in states with the highest overdose rates from all opioids combined.

5.
Soc Work Public Health ; 31(7): 678-687, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27366988

RESUMO

The past decade has seen a marked increase in the illicit use of opioids, as well as a doubling of the percentage of individuals seeking treatment for opioid use disorders. However, little is known about the differences between opioid users and nonopioid users in residential treatment. Further, no studies have been published that compare opioid users and nonopioid users in treatment for co-occurring substance use and mental disorders. To address this gap, this study examined differences between opioid and nonopioid substance users in residential treatment for co-occurring disorders. Data was drawn from 1,972 individuals treated between 2009 and 2011 at one of three private residential treatment centers that provide integrated treatment for co-occurring substance use and mental disorders. Data was collected at program intake, and 1- and 6-month postdischarge using the Addiction Severity Index and the University of Rhode Island Change Assessment. To examine within-group changes in substance use, addiction severity, and mental health across time, linear mixed-model analyses were conducted with facility, year, age, gender, and race included as covariates. The authors found more similarities than differences between the two groups on baseline characteristics, treatment motivation, length of stay, and outcomes on measures of substance use, addiction severity, and mental health. The results demonstrate that though opioid users entered treatment with higher levels of substance use-related impairment, they were just as successful in treatment outcomes as their non-opioid-using peers.


Assuntos
Comorbidade , Transtornos Mentais , Transtornos Relacionados ao Uso de Opioides , Tratamento Domiciliar , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
J Dual Diagn ; 11(1): 75-82, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25531670

RESUMO

OBJECTIVE: The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment. METHODS: This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay. RESULTS: Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change. CONCLUSIONS: The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Fatores Etários , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento Domiciliar/estatística & dados numéricos , Resultado do Tratamento
7.
J Addict Nurs ; 25(4): 204-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25514691

RESUMO

An increasing number of Americans are experiencing sleep problems. There is evidence of a complex, bidirectional relationship between sleep disorders, substance abuse, and mental health symptoms. Institutional settings have been shown to elicit sleep problems as well. This pilot study was conducted with 28 patients in private, residential, dual-diagnosis treatment for addiction and mental health disorders. Upon admission, consenting patients were administered the Addiction Severity Index to assess pretreatment substance use and mental health symptoms. Patients followed a normal course of treatment as well as participated in a nightly sleep hygiene group that included relaxation suggestions. Evaluations with the Addiction Severity Index were completed again 30 days after discharge from treatment. Significant improvements in some substance use patterns as well as mental health symptoms were noted. Although results cannot be directly attributed to the use of a sleep hygiene group, this pilot study lays the foundation for future investigations of interventions supporting sleep in the dual-diagnosis population.


Assuntos
Pacientes Internados , Transtornos Mentais/reabilitação , Sono , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/enfermagem , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Resultado do Tratamento
8.
J Psychoactive Drugs ; 45(2): 122-31, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23909000

RESUMO

A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.


Assuntos
Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Pacientes Desistentes do Tratamento/psicologia , Instituições Residenciais , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Fatores Etários , Comorbidade , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Prática Privada , Instituições Residenciais/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
9.
Soc Work Public Health ; 28(2): 109-18, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23461346

RESUMO

Active substance users have been characterized as ambivalent about accessing treatment services. Few studies have addressed the social context and related barriers that individuals experience in addressing substance abuse problems. These barriers appear to be heightened for female methamphetamine users living in rural areas of Appalachia. The purpose of this study is to document the willingness of active female methamphetamine users to access substance abuse treatment services, their ability to access substance abuse treatment services, and the barriers they experienced in accessing substance abuse treatment services. Findings from a sample of 153 rural female methamphetamine users revealed the majority of respondents met the criteria for substance dependence (99.3%), believed they had a drug problem (84.9%), believed they needed treatment services (62.9%), and wanted to go to treatment "now" (51.4%). However, only one fourth (26.8%) had accessed treatment, and many had experienced barriers in attempting to enter treatment services.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Região dos Apalaches , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/normas , Humanos , Entrevistas como Assunto , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Distribuição por Sexo , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Tennessee/epidemiologia
10.
J Assoc Nurses AIDS Care ; 24(5): 438-48, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23340238

RESUMO

This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.


Assuntos
Negro ou Afro-Americano , Criminosos , Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/prevenção & controle , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Continuidade da Assistência ao Paciente , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/reabilitação , Transtornos Mentais/terapia , Saúde Mental , Pessoa de Meia-Idade , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Psicoterapia , Qualidade de Vida , Assunção de Riscos , Apoio Social , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Transtornos Relacionados ao Uso de Substâncias/terapia , Tennessee , Resultado do Tratamento
12.
J Evid Based Soc Work ; 7(1): 41-57, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20178024

RESUMO

In the United States, the threat of HIV/AIDS to African American women's health has become the focus of much concern. This paper describes a federally funded community-based program that provides services to African American women at risk for HIV/AIDS in Nashville, Tennessee. The program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important for the continued development of culturally relevant interventions aimed at reducing the disproportionate rates of HIV/AIDS within the African American community by ensuring treatment access to all populations.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/métodos , Promoção da Saúde/métodos , Acessibilidade aos Serviços de Saúde , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Transtornos Relacionados ao Uso de Cocaína , Cocaína Crack , Feminino , Infecções por HIV/prevenção & controle , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tennessee/epidemiologia , Adulto Jovem
13.
Health Soc Work ; 34(4): 283-91, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19927477

RESUMO

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville,Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV.


Assuntos
Negro ou Afro-Americano , Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína Crack , Infecções por HIV/etnologia , Infecções por HIV/etiologia , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Tennessee/epidemiologia
14.
J Ethn Subst Abuse ; 7(1): 115-30, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19842304

RESUMO

Like many areas of the country, the state of Tennessee is experiencing a recent and growing rise in the rate of methamphetamine use, particularly in rural areas of the state. While substance use is a known risk factor for contracting HIV/AIDS, there is limited information regarding the risk behaviors of rural methamphetamine users. This paper seeks to document the existence of known HIV risk behaviors as they relate to rural southern methamphetamine use. Qualitative interviews with ninety-seven current and former methamphetamine users from the Cumberland Plateau area, a rural mountainous region in the state of Tennessee, suggest that methamphetamine users are putting themselves at risk for contracting HIV/AIDS and other blood-borne diseases through high-risk injection and sexual behaviors. Additionally, the results present the perceptions of respondents regarding the impact of methamphetamine use on rural communities and related service needs.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/etnologia , Atitude Frente a Saúde , População Negra/psicologia , Infecções por HIV/etnologia , Necessidades e Demandas de Serviços de Saúde , Indígenas Norte-Americanos/psicologia , Metanfetamina , População Rural , Abuso de Substâncias por Via Intravenosa/etnologia , Sexo sem Proteção , População Branca/psicologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/reabilitação , Região dos Apalaches/epidemiologia , Região dos Apalaches/etnologia , População Negra/estatística & dados numéricos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Inquéritos Epidemiológicos , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Masculino , Metanfetamina/síntese química , População Rural/estatística & dados numéricos , Facilitação Social , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Tennessee , População Branca/estatística & dados numéricos , Adulto Jovem
16.
Am J Drug Alcohol Abuse ; 31(4): 669-84, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16318040

RESUMO

Despite increasing attention directed to conceptual and methodological issues surrounding spirituality and despite the centrality of "spiritual transformation" in the recovery literature, there is little systematic evidence to support the role of spiritual change as a necessary condition for substance abuse behavior change. As an explicit conceptualization of mechanisms underlying behavior change is fundamental to effective interventions, this article: 1) briefly reviews relevant behavior change theories to identify key variables underlying change; 2) presents an integrative conceptual framework articulating linkages between program components, behavior change processes, spiritual change mechanisms and substance abuse outcomes; and 3) presents a discussion of how the mechanisms identified in our model can be seen in commonly used substance abuse interventions. Overall, we argue that spiritual transformation at an individual level takes place in a social context involving peer influence, role modeling, and social reinforcement.


Assuntos
Terapia Comportamental , Tratamento Domiciliar , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Atitude Frente a Saúde , Humanos , Motivação , Religião
17.
J Health Soc Policy ; 20(3): 67-77, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16236679

RESUMO

This study explores the impact of managed care on the substance abuse service system by reviewing the current status of the programs that were among the elite service providers in 1988. A survey was conducted assessing the status of the one hundred centers touted as the 100 best treatment centers for alcoholism and drug abuse (Sunshine& Wright, 1988). Findings include the following: Almost a third of these centers (31%) are no longer providing services, the majority of the programs who reported data continue to provide services primarily at a residential level of care (92%); however occupancy rates have dropped, the number of annual inpatient admissions have risen, and the length of treatment episodes has significantly decreased. In 1988, almost all (97.5%) facilities adhered to the 28-day treatment regiment, as evidenced by average treatment episodes of 26 days or longer. However, in 2001, the majority of programs (57.5%) reported treatment episodes of 25 days or less. While these facilities represent a fraction of the number of facilities that provide substance abuse services, they do exemplify elite programs that should be insulated from economic troubles, and help to document the changes that have occurred in the delivery system. Awareness of these changes is important for every social worker that advocates for substance abuse services.


Assuntos
Alcoolismo , Documentação , Centros de Tratamento de Abuso de Substâncias/classificação , Transtornos Relacionados ao Uso de Substâncias , Alcoolismo/terapia , Coleta de Dados , Humanos , Programas de Assistência Gerenciada , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos
18.
J Ethn Subst Abuse ; 4(1): 53-75, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16870572

RESUMO

Significant health disparities in the rates of HIV infection exist that primarily impact African American women. While research has demonstrated that HIV is preventable through changes in high-risk behaviors facilitated by substance abuse treatment, an individual must first be able to access and engage with treatment to derive any benefit from these services. While there is some research that identifies barriers to treatment access and engagement for African American women who use crack cocaine, these barriers require further examination. Current literature has focused primarily on internal motivation and treatment readiness without placing these concepts within the unique environmental context of social stressors for crack cocaine-using African American women. This study presents the results of eleven focus groups with eighty-nine African American women in which respondents document the HIV risk behaviors of crack cocaine users, present their experiences in accessing substance abuse and HIV services, and documents their perceptions of barriers and services needs. The results of this study may further develop an understanding of the means by which individual service users experience their relationships with service providers and the factors that affect these relationships in order to better target potential interventions to reduce the spread of HIV.


Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano/psicologia , Transtornos Relacionados ao Uso de Cocaína/etnologia , Cocaína Crack , Infecções por HIV/etnologia , Infecções por HIV/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Medo , Feminino , Nível de Saúde , Humanos , Prevalência , Psicologia , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Saúde da Mulher
19.
J Addict Dis ; 23(4): 41-53, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15339713

RESUMO

A structured diagnostic interview (Practical Adolescent Diagnostic Interview) designed to gather basic information about substance use disorders, other mental health conditions, and related experiences was used in a variety of clinical settings. Anonymous data from 279 adolescents interviewed as part of routine clinical assessments in a variety of clinical programs were analyzed to assess the ability of the questions to identify potential problem areas and to provide a preliminary exploration of interrelationships between those problems. Results demonstrated that the vast majority of individuals manifested indications of multiple problems. For a given diagnostic condition, the trend is for those meeting at least the minimal DSM-IV criteria to exhibit substantially more than the minimum number of symptoms. Internal consistencies for item groups defining the various conditions range from more than .700 to over .900 indicating adequate to excellent internal consistency and reliability. Utility of the instrument for routine clinical use is also discussed.


Assuntos
Psiquiatria do Adolescente/métodos , Entrevista Psicológica , Adolescente , Comportamento do Adolescente , Criança , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Soc Work ; 49(3): 356-63, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15281690

RESUMO

This article provides information on harm reduction, a recent development in substance abuse services in response to the HIV/AIDS epidemic. The author outlines abstinence and harm reduction perspectives and the stages of change model and discusses how these perspectives can be integrated in social work practice. He proposes using harm reduction strategies for individuals for whom the abstinence perspective may not be appropriate. Together, the traditional abstinence and harm reduction perspectives provide a basis for a more comprehensive continuum of care for individuals experiencing problems related to their substance use.


Assuntos
Redução do Dano , Serviço Social , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados Unidos
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