Dr. Heather J. Gotham is a Clinical Associate Professor in the Department of Psychiatry & Behavioral Sciences, and member of the Center for Behavioral Health Services and Implementation Research in the Division of Public Mental Health & Population Sciences.
She is the Director of the Network Coordinating Office of the Mental Health Technology Transfer Center (MHTTC) Network funded by SAMHSA. The MHTTC Network consists of 10 regional centers, a National American Indian & Alaska Native Center, and a National Hispanic & Latino Center. The overarching goal of this network is the implementation and sustainment of evidence-based mental health prevention, treatment, and recovery support practices across US states and territories. She is also a co-investigator on a National Institute on Drug Abuse (NIDA) funded project studying the implementation of substance use disorder treatments in HIV care settings.
Dr. Gotham has served as principal investigator, co-investigator or evaluator on SAMHSA, NIH, HRSA, and CDC grants. Her research focuses on implementation science, including factors affecting implementation, training and education of health care providers, and longitudinal course of implementation. Topics include substance use and mental health treatments for adolescents and adults, co-occurring mental health and substance use disorders, and screening, brief intervention, and referral to treatment (SBIRT).
Dr. Gotham assisted in the development of the Dual Diagnosis Capability in Addiction Treatment (DDCAT) index with Mark McGovern, and led the development of the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) index. She co-authored practice guidelines for co-occurring disorders treatment in the State of Missouri, and led the evaluation for Missouri’s COSIG (Co-occurring State Infrastructure Grant) grant as well as another foundation-funded multi-site co-occurring disorders initiative. She has served on several national and state-level expert panels, and provided training and technical assistance on co-occurring disorders at the national, state, and local levels.
Paired with her work in assisting providers to implement clinical protocols, Dr. Gotham has significant experience in clinical teaching and training behavioral health and health care students and professionals. This work includes serving as the supervisor of a clinical research rotation in an APA-approved psychology internship, and designing curricula and providing training and technical assistance to behavioral health and health professionals on treatments for adult and adolescent substance use disorders (including opioid use disorder), implementing EBPs into behavioral health settings, co-occurring mental health and substance use disorders and treatment, integrating behavioral and primary health, and SBIRT. Dr. Gotham led two SAMHSA-funded SBIRT health professions training grants, developing didactic, role play, standardized patient scenarios, and training vignettes for SBIRT, and teaching medical students and residents; baccalaureate and advanced practice nursing, dental, dental hygiene, master’s level social work, and clinical psychology PhD students; medical, dental, nursing, and behavioral health faculty; clinical preceptors; and community healthcare providers. She also has experience developing interactive online training.
Clinical Associate Professor, Psychiatry and Behavioral Sciences
Psychological Resident, St. Louis VA Medical Center, Medical/Health Psychology (2000)
PhD, University of Missouri-Columbia, Clinical Psychology (1999)
Internship, St. Louis VA Medical Center, Clinical Psychology (1999)
MA, New School for Social Research, General Psychology (1993)
BA, University of Wisconsin-Stevens Point, Psychology (1991)
Current Research and Scholarly Interests
Dr. Gotham’s research focuses on implementation science, including factors affecting implementation, and training and education of health care providers, across a range of evidence-based practices for adolescent and adult substance use and mental health disorders, co-occurring mental health and substance use disorders, and screening, brief intervention, and referral to treatment (SBIRT).
Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Stanford University School of Medicine (8/15/2018 - 8/14/2023)
The SAMHSA-funded MHTTC Network, with 10 Regional Centers, 2 National Focus Area Centers, and a Network Coordinating Office, develops and disseminates resources, and provides training and technical assistance, to accelerate the implementation of mental health related evidence-based practices. Stanford University School of Medicine’s Center for Behavioral Health Services and Implementation Research houses the Network Coordinating Office, which serves as the focal point and provides leadership, infrastructure, and support to the MHTTC Network.
1520 Page Mill Rd, Palo Alto
- Mark McGovern, Professor, Stanford University School of Medicine
- Steven Adelsheim, Psychiatry and Behavioral Sciences
- Kate Hardy, Clinical Professor, Psychiatry and Behavioral Sciences
- Shannon Wiltsey Stirman, Associate Professor of Psychiatry and Behavioral Sciences (Public Mental Health and Population Sciences) at the Palo Alto Veterans Affairs Health Care System, Stanford
HD2A Research Adoption Support Center (RASC), Stanford University School of Medicine
The HEAL Datat2Action Research Adoption Support Center (RASC) aims to stem the tide of overdose death in the US by assembling a uniquely qualified team with expertise in dissemination and implementation (D&I) science and leading a scientifically-driven support endeavor designed to effectively translate evidence based interventions for substance use disorders and pain.
Improving alcohol and substance use care access, outcomes, and equity during the reproductive years: A Type 1 Hybrid Trial in Family Planning Clinics, Columbia University/Emory University
This implementation trial will evaluate family planning clinics as a novel setting in which to simultaneously test the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) for alcohol and drug use. Coupled with an evidence-based Implementation and Sustainment Facilitation implementation strategy, our findings will ultimately support adoption and scale-up of substance-related care across a premier national sexual and reproductive healthcare organization and its expansive network of FP
clinics serving millions of women in the U.S. every year.
: Identifying and Disseminating Substance, Treatment, Strategy (STS) recommendations to AIDS Service Organizations, The Ohio State University
Substance use disorders among individuals living with HIV/AIDS are highly prevalent and problematic, leading to decreased retention in care, medication adherence, and viral suppression and significantly increasing the risk of new HIV infections. However, despite more than a decade of calls to improve SUDSI within AIDS Service Organizations (ASOs), this remains an urgent need. This project seeks to identify stakeholder-driven Substance-Treatment-Strategy (STS) recommendations for improving SUDSI within ASOs across the nation, and then test the effectiveness of external facilitation as a strategy for implementing an identified evidence-based SUD practice in HIV care settings.
Learning Collaboratives: a Strategy for Quality Improvement and Implementation in Behavioral Health.
The journal of behavioral health services & research
Learning collaboratives are increasingly used in behavioral health. They generally involve bringing together teams from different organizations and using experts to educate and coach the teams in quality improvement, implementing evidence-based practices, and measuring the effects. Although learning collaboratives have demonstrated some effectiveness in general health care, the evidence is less clear in behavioral health and more rigorous studies are needed. Learning collaboratives may contain a range of elements, and which elements are included in any one learning collaborative varies widely; the unique contribution of each element has not been established. This commentary seeks to clarify the concept of a learning collaborative, highlight its common elements, review evidence of its effectiveness, identify its application in behavioral health, and highlight recommendations to guide technical assistance purveyors and behavioral health providers as they employ learning collaboratives to improve behavioral health access and quality.
View details for DOI 10.1007/s11414-022-09826-z
View details for PubMedID 36539679
Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions.
BMC medical education
2022; 22 (1): 575
To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision.Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training.Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic.Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.
View details for DOI 10.1186/s12909-022-03598-y
View details for PubMedID 35897014
The Setting-Intervention Fit of Nine Evidence-Based Interventions for Substance Use Disorders Within HIV Service Organizations Across the United States: Results of a National Stakeholder-Engaged Real-Time Delphi Study.
Journal of acquired immune deficiency syndromes (1999)
2022; 90 (S1): S206-S214
BACKGROUND: Given substance use disorders (SUDs) among people with HIV are highly prevalent, integrating SUD services within HIV service settings is needed to help end the HIV epidemic. In this study, we assessed the setting-intervention fit (SIF) of 9 evidence-based SUD interventions: acamprosate, disulfiram, oral naltrexone, injectable naltrexone, oral buprenorphine, injectable buprenorphine, contingency management, motivational interviewing, and cognitive behavioral therapy (CBT).SETTING: Clinical and nonclinical HIV service organizations (HSOs) in the United States.METHODS: In May 2020, a stakeholder-engaged real-time Delphi was completed with 202 HSOs. HSO respondents rated the extent to which each SUD intervention was fundable, implementable, retainable, sustainable, scalable, and timely for their HSO, and these 6 items were summed into an SIF score (possible range of 0-18).RESULTS: Motivational interviewing had the highest average SIF score (11.42), with SIF scores above the midpoint (9.5) for clinical (11.51) and nonclinical HSOs (11.36). For nonclinical HSOs, none of the other interventions were above the midpoint. For clinical HSOs, the average SIF scores were above the midpoint for CBT (10.97) and oral buprenorphine (9.51). Multivariate regression analyses, which controlled for characteristics of the HSO respondent, revealed geographic region of the United States and whether the HSO currently offered any substance use services as 2 of the best predictors of SIF scores.CONCLUSIONS: Notwithstanding the need to improve the SIF for the other evidence-based SUD interventions, motivational interviewing, CBT, and oral buprenorphine are currently the evidence-based SUD interventions with greatest perceived fit for integration within HSOs in the United States.
View details for DOI 10.1097/QAI.0000000000002981
View details for PubMedID 35703773
Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network.
General hospital psychiatry
1800; 75: 1-9
OBJECTIVE: Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change.METHOD: Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development.RESULTS: From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation.CONCLUSIONS: The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.
View details for DOI 10.1016/j.genhosppsych.2022.01.004
View details for PubMedID 35078020
Health Facts Medication Adherence in Transplantation (H-MAT) Study: A Secondary Analysis of Determinants and Outcomes of Medication Nonadherence in Adult Kidney Transplant Recipients.
International journal of nephrology
2022; 2022: 9653847
Aims: To explore the relationship between determinants and posttransplant medication nonadherence (MNA) in adult kidney transplant recipients, and to examine the relationship between posttransplant MNA and clinical outcomes.Methods: Using the World Health Organization's model, this retrospective, multicenter, correlational study examined the relationship between determinants, posttransplant MNA, and clinical outcomes in 16,671 adult kidney transplant recipients from the Cerner Health Facts national data warehouse.Results: With 12% MNA, those who were nonadherent were more likely to have the social/economic factors of being younger, single, Caucasian versus Hispanic race, have the condition-related factor of mental health/substance use disorder, and have the healthcare system-related factor of government/health maintenance organization/managed care insurance (p's < 0.05). Bivariate correlations indicated both age (OR=1.006, p=0.01) and mental health or substance use disorder diagnosis (OR=1.26, p=0.04) were significant predictors of MNA. Patients were 0.6% more likely to be medication adherent for each year they increased in age and 26% more likely to be MNA if they were diagnosed with a mental health/substance use disorder. Nonadherent patients were less likely to be readmitted, but more likely to have complications after transplant and medication side effects (p's < 0.01).Conclusions: Using one of the largest samples of adult kidney transplant patients, our findings support the WHO model and move the body of medication adherence intervention research forward by clarifying the importance of focusing interventions not only on the patient but on multilevel determinants. Consistent with previous studies, MNA negatively impacts transplant outcomes.
View details for DOI 10.1155/2022/9653847
View details for PubMedID 35721370
Rural mental health care during a global health pandemic: Addressing and supporting the rapid transition to tele-mental health
Journal of Rural Mental Health
2021; 45 (1): 1-13
View details for DOI 10.1037/rmh0000169
Resilience-Focused HIV Care to Promote Psychological Well-Being During COVID-19 and Other Catastrophes.
Frontiers in public health
2021; 9: 705573
The COVID-19 pandemic has adversely affected people with HIV due to disruptions in prevention and care services, economic impacts, and social isolation. These stressors have contributed to worse physical health, HIV treatment outcomes, and psychological wellness. Psychological sequelae associated with COVID-19 threaten the overall well-being of people with HIV and efforts to end the HIV epidemic. Resilience is a known mediator of health disparities and can improve psychological wellness and behavioral health outcomes along the HIV Continuum of Care. Though resilience is often organically developed in individuals as a result of overcoming adversity, it may be fostered through multi-level internal and external resourcing (at psychological, interpersonal, spiritual, and community/neighborhood levels). In this Perspective, resilience-focused HIV care is defined as a model of care in which providers promote optimum health for people with HIV by facilitating multi-level resourcing to buffer the effects of adversity and foster well-being. Adoption of resilience-focused HIV care may help providers better promote well-being among people living with HIV during this time of increased psychological stress and help prepare systems of care for future catastrophes. Informed by the literature, we constructed a set of core principles and considerations for successful adoption and sustainability of resilience-focused HIV care. Our definition of resilience-focused HIV care marks a novel contribution to the knowledge base and responds to the call for a multidimensional definition of resilience as part of HIV research.
View details for DOI 10.3389/fpubh.2021.705573
View details for PubMedID 34422749
View details for PubMedCentralID PMC8371444
The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders.
AIDS and behavior
Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD's individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0-24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.
View details for DOI 10.1007/s10461-021-03473-9
View details for PubMedID 34586532
Barriers and Challenges to Making Referrals for Treatment and Services for Opioid Misuse in Family Planning Settings.
Journal of women's health (2002)
Background: In this opioid overdose epidemic, women are an overlooked group seeing increasing rates of overdose death. Implementation challenges have prevented evidence-based interventions from effectively reaching women who misuse opioids, with gaps in access to effective treatment and services. Family planning clinics could serve as important points of contact for referral to needed treatments and services. The study explores how family planning staff knowledge and attitudes related to opioid misuse serve as potential barriers and challenges in making referrals for evidence-based services and treatments. Methods: In 2018, we conducted a national online survey of family planning staff, assessing knowledge and attitudes of treatments and services for opioid misuse. Results: A total of 691 family planning staff completed the survey. Most respondents agreed that opioid misuse was a major problem in their community (86.0%) and identified challenges in responding to it, including a lack of treatment access (70.3%), the absence of in-house behavioral health staff (67.2%), and unfamiliarity with local treatment providers (54.1%). Respondents reported low levels of acceptability for syringe services programs (46.0%), medications such as methadone and buprenorphine (55.4%), and naloxone to reverse opioid overdose (60.1%). Controlling for other factors, race/ethnicity, urbanicity, workplace role, and substance use training were associated with differences in acceptability. Conclusions: Family planning settings could play a critical role in connecting women who misuse opioids to treatment and services. Strategies are needed to increase the acceptability of evidence-based interventions and the feasibility of having family planning staff play a linkage role.
View details for DOI 10.1089/jwh.2020.8761
View details for PubMedID 33844948
Main findings from the substance abuse treatment to HIV care (SAT2HIV) project: a type 2 effectiveness-implementation hybrid trial
View details for Web of Science ID 000576910000034
The implementation and sustainment facilitation strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized, type 2 hybrid trial.
Implementation research and practice
Substance use disorders (SUDs) among people with HIV are both prevalent and problematic. The Substance Abuse Treatment to HIV care project was funded to test the Implementation and Sustainment Facilitation (ISF) strategy as an adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for SUDs within HIV community-based organizations.Using a cluster-randomized, type 2 hybrid trial design, 39 HIV organizations were randomized to either (1) ATTC (n = 19) or (2) ATTC + ISF (n = 20). Each HIV organization identified two staff members to be prepared to implement the MIBI (N = 78). Subsequently, during the implementation phase, HIV organizations in each condition randomized client participants (N = 824) to one of the two intervention conditions: usual care (UC; n = 415) or UC + MIBI (n = 409). Both staff-level outcomes and client-level outcomes were examined.The ISF strategy had a significant impact on the implementation effectiveness (i.e., the consistency and the quality of implementation; β = .65, p = .01) but not on time-to-proficiency (β = -.02) or level-of-sustainment (β = .09). In addition, the ISF strategy was found to have a significant impact on the intervention effectiveness (the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up.The ISF strategy was found to be an effective adjunct to the ATTC strategy in terms of implementation effectiveness and intervention effectiveness. It is recommended that future efforts to integrate the project's MIBI for SUD within HIV organizations use the ATTC + ISF strategy. However, given the ISF strategy did not have a significant impact on level-of-sustainment, implementation research testing the extent to which the ATTC + ISF strategy can be significantly enhanced through effective sustainment strategies is warranted.Substance use among people living with HIV is associated with increased mental health problems, worse medication adherence, and worse HIV viral suppression. Increasing substance use-related services in HIV community-based organizations is an important public health need. The Substance Abuse Treatment to HIV care project tested two strategies for helping HIV organizations implement a brief intervention (BI) designed to motivate clients to decrease their substance use. The project also tested if receiving a BI improved clients' outcome. Two staff from each of the 39 participating organizations were taught how to deliver the BI using the Addiction Technology Transfer Center (ATTC) training strategy (online and in-person training, monthly feedback, and coaching). Half of the organizations also received the Implementation and Sustainment Facilitation (ISF) strategy, which included monthly meetings with an ISF coach for the two BI staff and one or more leadership staff from the organization. Organizations that received both the ATTC and ISF strategies delivered more BIs and higher quality BIs than organizations that only received the ATTC strategy. In addition, clients receiving BIs at organizations that received both strategies were more likely to decrease their substance use. However, receiving both strategies did not improve how quickly staff learned to deliver the BI or improve the number of BIs delivered during the project's 6-month sustainment phase. Future research focused on implementing BIs within HIV organizations should consider using the ATTC and ISF strategies while also seeking to enhance the strategies to improve sustainment.
View details for DOI 10.1177/2633489520948073
View details for PubMedID 36189179
View details for PubMedCentralID PMC9523796
INTEGRATED BEHAVIORAL HEALTH: PATIENT AND PROVIDER PERSPECTIVES FROM TWO PRIMARY CARE CLINICS
OXFORD UNIV PRESS INC. 2020: S599
View details for Web of Science ID 000546262401421
- Implementing Substance Use Screening in Family Planning JNP-JOURNAL FOR NURSE PRACTITIONERS 2019; 15 (4): 306–10
Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education
JOURNAL OF ADDICTIONS NURSING
2018; 29 (4): E1–E8
Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use.A nonrandomized two-group pretest-posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training.Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students' skills assessed through standardized patient interactions were significantly better.Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.
View details for PubMedID 30507825
Comparison of Instructional Methods for Screening, Brief Intervention, and Referral to Treatment for Substance Use in Nursing Education
2018; 43 (3): 123–27
Most nursing programs lack curriculum on substance use. This project evaluated 3 didactic instructional methods for teaching baccalaureate nursing students about screening, brief intervention, and referral to treatment for substance use. In-person, asynchronous narrated slides and interactive online instructional methods were all effective in developing students' competency; however, active learning methods (in-person and interactive online course) were more effective in changing students' attitudes about their role in screening and intervening for drug use.
View details for PubMedID 28817479
The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity
BIOMED CENTRAL LTD. 2018
View details for Web of Science ID 000428649900021
Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial
ADDICTION SCIENCE & CLINICAL PRACTICE
2017; 12: 31
In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA) funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment.As part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs' usual care (control condition) or usual care plus a MIBI for substance use (experimental condition) delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines.If successfully able to implement MIBI as an effective adjunct to usual care, the current trial may have a significant impact on increasing the capacity of ASOs to address problematic substance use among individuals living with HIV/AIDS. Reducing the prevalence of problematic substance use among individuals living with HIV/AIDS within the United States may lead to significant improvements on key performance measures (i.e., the HIV Care Continuum and the 90-90-90 target). Trial registration ClinicalTrials.gov: NCT02495402.
View details for PubMedID 29149914
Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial
ADDICTION SCIENCE & CLINICAL PRACTICE
2017; 12: 32
Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment.Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome).Although not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO's capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.
View details for PubMedID 29149909
Reflecting on care: Using reflective journaling to evaluate interprofessional education and clinical practicum experiences in two urban primary care clinics
Journal of Interprofessional Education & Practice
2017; 8: 6-9
View details for DOI 10.1016/j.xjep.2017.04.003
Consider the setting: Challenges in integrating Screening, Brief Intervention, and Referral to Treatment into nursing and social work students’ clinical practice
Journal of Addictive Behaviors, Therapy & Rehabilitation
View details for DOI 10.4172/2324-9005.1000160
Evoking a reciprocity of caring: Integration of a humanities-based content into an interprofessional education immersion course for advanced practice nursing and health professions students
Journal of Nursing Education and Practice
2016; 6: 10-121
View details for DOI 10.5430/jnep.v6n9p110
Integrating substance use disorder and health care services in an era of health reform: Models, interventions, and implementation strategies
American Journal of Medical Research
2016; 3: 75-124
View details for DOI 10.22381/AJMR3120163
Nursing Students' Experiences With Screening, Brief Intervention, and Referral to Treatment for Substance Use in the Clinical/Hospital Setting
JOURNAL OF ADDICTIONS NURSING
2014; 25 (3): 122–29
Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings.
View details for PubMedID 25202808
Dual Diagnosis Capability in Mental Health and Addiction Treatment Services: An Assessment of Programs Across Multiple State Systems
ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
2014; 41 (2): 205-214
Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the dual diagnosis capability in addiction treatment and dual diagnosis capability in mental health treatment indexes, and sampled 256 programs across the United States. Approximately 18 % of addiction treatment and 9 % of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures.
View details for DOI 10.1007/s10488-012-0449-1
View details for Web of Science ID 000331200300006
View details for PubMedID 23183873
View details for PubMedCentralID PMC3594447
Screening, Brief Intervention, and Referral to Treatment Overview of and Student Satisfaction with an Undergraduate Addiction Training Program for Nurses
JOURNAL OF PSYCHOSOCIAL NURSING AND MENTAL HEALTH SERVICES
2013; 51 (10): 29–37
Preparing nursing students to apply an evidence-based screening and brief intervention approach with patients has the potential to reduce patients' risky alcohol and drug use. Responding to Mollica, Hyman, and Mann's article published in 2011, the current article describes implementation results of an Addiction Training for Nurses program of Screening, Brief Intervention, and Referral to Treatment (SBIRT) embedded within an undergraduate nursing curriculum. Results reveal that students in other schools of nursing would benefit from similar, significant training on substance use disorders and SBIRT. Training satisfaction surveys (N = 488) indicate students were satisfied with the quality of the training experience. More than 90% of students strongly agreed or agreed that the training was relevant to their nursing careers and would help their patients. Additional clinical practice and skill development may increase students' reported effectiveness in working with the topic area of substance use and SBIRT.
View details for DOI 10.3928/02793695-20130628-01
View details for Web of Science ID 000327138200012
View details for PubMedID 23855435
Confirming the factor structure of the alcohol and alcohol problems questionnaire (AAPPQ) in a sample of baccalaureate nursing students
RESEARCH IN NURSING & HEALTH
2013; 36 (4): 412–22
The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) is a multi-dimensional measure of clinicians' attitudes toward working with patients with alcohol problems. In the past 35 years, five- and six-subscale versions and a short version of the AAPPQ have been published. While the reliability of the AAPPQ subscales has remained acceptable, the factor structure has not been verified using confirmatory techniques. In the current study, we split a sample of 299 baccalaureate nursing students to use exploratory (EFA) and confirmatory factor analyses (CFA). When compared to the original six-factor solution and an imposed six-factor structure in CFA, the EFA seven-factor solution with three original items (19, 20, and 25) removed had the best model fit.
View details for DOI 10.1002/nur.21537
View details for Web of Science ID 000322003900009
View details for PubMedID 23633092
Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training on Nursing Students' Attitudes Toward Working With Patients Who Use Alcohol and Drugs
2013; 34 (2): 122–28
Screening, Brief Intervention, and Referral to Treatment (SBIRT) can reduce alcohol use and negative health outcomes in patients with risky substance use. However, negative attitudes that some health care professionals have toward patients who use substances are a barrier to implementing SBIRT.The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addictions (IRETA), developed a curriculum to train baccalaureate student nurses to deliver SBIRT.Following SBIRT education and training, students' perceived attitudes toward patients who use alcohol became more positive. Less robust changes were found for attitudes related to patients who use drugs.Nurses composing the largest group of healthcare workers are in key positions to screen, intervene, and provide education about substance use.
View details for DOI 10.1080/08897077.2012.715621
View details for Web of Science ID 000317742700009
View details for PubMedID 23577905
Assessing the Co-occurring Capability of Mental Health Treatment Programs: the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index
JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH
2013; 40 (2): 234-241
The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index was developed to assess the capability of mental health programs to provide substance abuse and co-occurring treatment services. The DDCMHT is an objective scale rated following a site visit that includes semi-structured interviews with staff at all levels, review of program documents and client charts, and ethnographic observation of the milieu and setting. Using data from 67 mental health programs across six states, this study found that the DDCMHT had excellent total score reliability, variable subscale reliability, high inter-rater reliability (n = 18), and moderate construct validity (n = 22). Results also suggest that many mental health programs are at a relatively low level of capability for the delivery of care to individuals with co-occurring disorders. Results from this important new benchmark measure, the DDCMHT, can be used with programs in implementation planning and with treatment systems, states, or national organizations to guide policy change.
View details for DOI 10.1007/s11414-012-9317-8
View details for Web of Science ID 000318518100009
View details for PubMedID 23334656
Curriculum Infusion of SBIRT into a Baccalaureate Nursing School
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. 2012: 218
View details for Web of Science ID 000306464200063
Addiction training for undergraduate nurses using screening, brief intervention, and referral to treatment
Journal of Nursing Education and Practice
2012; 2 (4): 167-177
View details for DOI 10.5430/jnep.v2n4p167
Research to practice in addiction treatment: key terms and a field-driven model of technology transfer.
Journal of substance abuse treatment
2011; 41 (2): 169–78
The transfer of new technologies (e.g., evidence-based practices) into substance abuse treatment organizations often occurs long after they have been developed and shown to be effective. Transfer is slowed, in part, due to a lack of clear understanding about all that is needed to achieve full implementation of these technologies. Such misunderstanding is exacerbated by inconsistent terminology and overlapping models of an innovation, including its development and validation, dissemination to the public, and implementation or use in the field. For this reason, a workgroup of the Addiction Technology Transfer Center (ATTC) Network developed a field-driven conceptual model of the innovation process that more precisely defines relevant terms and concepts and integrates them into a comprehensive taxonomy. The proposed definitions and conceptual framework will allow for improved understanding and consensus regarding the distinct meaning and conceptual relationships between dimensions of the technology transfer process and accelerate the use of evidence-based practices.
View details for DOI 10.1016/j.jsat.2011.02.006
View details for PubMedID 21466943
Increasing program capability to provide treatment for co-occurring substance use and mental disorders: Organizational characteristics
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2010; 38 (2): 160–69
The Dual Diagnosis Capability in Addiction Treatment and the Dual Diagnosis Capability in Mental Health Treatment indexes were used to document change in the capability of 14 substance abuse and mental health agencies to provide services to clients with co-occurring substance use and mental disorders (COD). COD capability significantly increased over 2 years, with the largest improvements seen in client assessment and staff training for COD. The role of agency structural characteristics and organizational readiness for change was also investigated. The study found modest evidence that some structural characteristics (e.g., agency size) and organizational readiness for change were related to increased COD capability. Further study is needed of how these factors affect implementation and fidelity to evidence-based practices, including how programs might compensate for or modify the effects of organizational factors to enhance implementation efforts.
View details for PubMedID 19717273
Victimization among African-American adolescents in substance abuse treatment
JOURNAL OF PSYCHOACTIVE DRUGS
2008; 40 (1): 67–75
Victimization is regarded as a significant public health issue, especially among adolescents in urban areas. Although victimization is linked to substance use, the research on victimization among adolescents in treatment is underdeveloped. Given the high rate of victimization among African-American adolescents, further research on the prevalence and correlates of victimization for this population is needed. This knowledge can guide the development of effective treatment and prevention strategies. This study contributed to the research by examining the rate and different types of victimization among a sample of African-American adolescents in an urban substance abuse treatment program, testing whether victimization is associated with increased levels of psychopathology and high-risk behaviors; and comparing the rates and associations with existing studies of adolescent victimization. It reports on a sample of 259 African-American adolescents receiving substance abuse treatment in an inner-city program. Fifty-four percent of the subjects reported lifetime victimization. Severity of victimization was associated with depression, generalized anxiety disorder, traumatic stress disorder, and conduct disorder, although the effect sizes were relatively small. Lifetime victimization exhibited a relationship of small to moderate strength with high-risk behaviors (i.e., illegal activity, gang membership, multiple sex partners and unprotected sex). Service implications and recommendations for future research are provided.
View details for DOI 10.1080/02791072.2008.10399762
View details for Web of Science ID 000254845500008
View details for PubMedID 18472666
View details for PubMedCentralID PMC4112386
An implementation story: Moving the GAIN from pilot project to statewide use
JOURNAL OF PSYCHOACTIVE DRUGS
2008; 40 (1): 97–107
Similar to implementing an evidence-based practice (EPB), implementing an evidence-based assessment (EBA) is a long, complex process that can take several years to complete. Between 2002 and 2007, the state of Missouri first piloted the Global Appraisal of Individual Needs-Initial (GAIN-I; Dennis et al. 2006) assessment at one state-contracted adolescent substance abuse treatment program and then implemented the GAIN statewide. This case study documents the implementation process through Fixsen and colleagues' (2005) six stages of implementation, from exploration and adoption through sustainability, and outlines challenges and solutions encountered at the external, organizational, and individual staff level. Strengths of this project included recognition that implementation is an ongoing multistep process, strong support by state-level staff, contracting with an external purveyor for ongoing technical assistance at the agency level as well as training of front-line clinicians, and an implementation team comprised of stakeholders at multiple levels.
View details for PubMedID 18472669
- Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here? PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2006; 37 (6): 606–13
Trajectories of dynamic predictors of disorder: Their meanings and implications
CAMBRIDGE UNIV PRESS. 2004: 825–56
Developmental psychopathologists are increasingly focused on characterizing heterogeneity of trajectories of psychological disorders across the life course (e.g., developmentally limited vs. chronic forms of disorder). Although the developmental significance of trajectories has been highlighted, there has been little attention to relations between trajectories and their etiologically and clinically relevant time-varying covariates (dynamic predictors). Depending upon the functional relation between a disorder and a dynamic predictor, we expect to see different trajectories of dynamic predictors. Thus, we propose a taxonomy of trajectories of dynamic predictors of course of disorder and provide an initial investigation into its validity. Using a mixed-gender, high-risk sample of young adults followed over 7 years, we identified dynamic predictors that covary with the course of alcohol use disorder (AUD). Based on a logically derived classification to facilitate interpretation of findings, three comparison groups were examined: persons whose AUD "remitted" (n = 33), those with a chronic AUD (n = 29), and nondiagnosers (n = 274). We hypothesized seven patterns of dynamic prediction (stable vulnerability indicators, course trackers, deterioration markers, developmentally specific variables, developmental lag markers, course-referenced variables, and recovery behaviors) and found evidence for five of them. The interpretation of markers of risk for development and course of AUDs and their implications for prevention, early intervention and formal/self-change treatments are discussed.
View details for PubMedID 15704817
- Diffusion of mental health and substance abuse treatments: Development, dissemination, and implementation CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2004; 11 (2): 160–76
Alcohol involvement and developmental task completion during young adulthood.
Journal of studies on alcohol
2003; 64 (1): 32–42
Relations among young adult alcohol use disorders (AUDs), preadulthood variables (gender, family history of alcoholism, childhood stressors, high-school class rank, religious involvement, neuroticism, extraversion, psychoticism) and young adult developmental tasks (baccalaureate degree completion, full-time employment, marriage) were evaluated.Participants were 424 first-time college students (228 women) who were 18-20 years old; approximately half had a history of paternal alcoholism. Participants were assessed on five occasions over 7 years (Years 1, 2, 3, 4 and 7).Structural equation modeling results suggest preadulthood variables were more salient predictors of developmental tasks than AUD diagnoses, with the majority of effects due to apparent selection processes. In addition, marriage protected against later AUD diagnosis at Year 7.Findings highlight the importance of prospective multivariate models that specify potential selection, causation, socialization and reciprocal effects in order to fully examine complex relations among variables, including alcohol involvement, during major life-transition periods.
View details for PubMedID 12608481
- Older adults, substance use, and HIV/AIDS: Preparing for a future crisis Journal of Mental Health and Aging 2002; 8: 349-363
The problem of college drinking: insights from a developmental perspective.
Alcoholism, clinical and experimental research
2001; 25 (3): 473–77
This article represents the proceedings of a symposium at the 2000 RSA Meeting in Denver, Colorado. John Schulenberg and Jennifer L. Maggs were Organizers. Stephen W. Long was Chair and provided opening remarks. The presentations were: (1) I'm not a drunk, just a college student: Binge drinking during college as a developmental disturbance, by John Schulenberg; (2) Course of alcohol use disorders during college, by Kenneth J. Sher; (3) How do students experience alcohol and its effects? Positive versus negative expectancies and consequences, by Jennifer L. Maggs; and (4) Brief intervention in the context of developmental trends in college drinking, by G. Alan Marlatt. Critique and commentary were provided by Robert A. Zucker.
View details for PubMedID 11290861
Transitioning into and out of large-effect drinking in young adulthood.
Journal of abnormal psychology
2001; 110 (3): 378–91
As individuals age beyond the college years into young adulthood, many exhibit a tendency to moderate or "mature out of" alcohol involvement. The current study classified effect-drinking statuses in young adults and examined transitions among statuses using latent transition analysis, a latent variable state-sequential model for longitudinal data. At 3 occasions over 7 years (Years 1, 4, and 7), 443 men (47%) and women (mean age of both at baseline = 18.5 years; 51% with family history of alcoholism) responded to 3 past-30-day items assessing drinking and subjective effects of drinking: whether the respondent drank alcohol, felt high, and felt drunk. Latent statuses included abstainers (14% at Year 1), limited-effect drinkers (8%), moderate-effect drinkers (23%), and large-effect drinkers (54%). Respondents with family history of alcoholism were less likely to transition out of large-effect drinking than those without family history. Men exhibited more severe initial effect-drinking statuses and lower transition probabilities into less severe effect-drinking statuses than women.
View details for PubMedID 11502081
Pathological alcohol involvement: a developmental disorder of young adulthood.
Development and psychopathology
1999; 11 (4): 933–56
In 1987, we began a longitudinal study of the offspring of alcoholic parents and have been following this group of young adults from their freshman year in college throughout their transition into later young adulthood. The goal of this review is to highlight some of the findings we consider most important and relevant to the development of pathological alcohol involvement in young adulthood. Courses of pathological alcohol involvement in young adulthood are outlined. Predictors of both the development and course of pathological alcohol use in young adulthood are also addressed, including family history of alcoholism, personality, alcohol use motivations, and role transitions. While certainly a problem in its own right, pathological alcohol involvement can also affect the attainment of important life tasks and success in various life roles. Consequently, we also examine the effects of pathological alcohol involvement on later role transitions and role attainment. Finally, prevention, policy, and treatment issues surrounding this stage of life are discussed.
View details for PubMedID 10624733
Determinants of exercise among children. II. A longitudinal analysis
1998; 27 (3): 470–77
Research has demonstrated that physical activity serves an important preventive function against the development of cardiovascular disease. The recognition that U.S. children are often sedentary, coupled with the observation that physical activity habits tend to persist into adulthood, has prompted the investigation of exercise determinants consistent with social learning theory. The purposes of the present study were to identify social learning variables relevant to children's exercise and to explore the longitudinal predictive value of the determinants.Data were collected from 111 families (N = 54 girls, N = 57 boys) who were interviewed in both Phase 1 (fifth and sixth grades) and Phase 2 (eight and ninth grades) of this study. Data from mothers (N = 111) were collected during both phases; data from 80 fathers were collected at Phase 2 only.The results of simultaneous stepwise regression analyses indicated that child's enjoyment of physical activity was the only consistent predictor of physical activity during Phase 1. At Phase 2, child's exercise knowledge, mother's physical activity, and child's and mother's friend modeling/support emerged as predictors for girls. For boys, child's self-efficacy for physical activity, exercise knowledge, parental modeling, and interest in sports media were important. Longitudinally, mother's self-efficacy, barriers to exercise, enjoyment of physical activity, and child's self-efficacy for physical activity were important for girls. Only child's exercise knowledge predicted boys' physical activity. The addition of information from fathers nearly doubled the explanatory power of the predictors for both genders.Socialization in the family unit exerts a tremendous influence on health-related behaviors such as exercise. The relative importance of determinants seems to differ for girls and boys and the pattern of these determinants appears to change over time.
View details for PubMedID 9612838
Predicting stability and change in frequency of intoxication from the college years to beyond: Individual-difference and role transition variables
JOURNAL OF ABNORMAL PSYCHOLOGY
1997; 106 (4): 619–29
The authors examined whether individual-difference variables (e.g., family history of alcoholism, sex, personality traits, positive alcohol expectancies) and role transition-related variables (full-time work status, marital status, parenthood) moderate the "maturing-out" process whereby young adults who drink heavily during college decrease their drinking in the following years. Analyses were based on 288 young adults, assessed as full-time students (mostly college seniors, Year 4 of a larger study) and 3 years later (Year 7) when all had earned bachelor's degrees, and the analyses showed that frequency of intoxication (per week) decreased significantly (p < .0001). Entering the workforce full time, being male, and being less open to experience were associated with decreased postcollege drinking. Furthermore, relatively extraverted individuals were more likely to continue a pattern of frequent intoxication from Year 4 to year 7. The findings stress the importance of studying how individual-difference variables predict behavior across role transitions.
View details for PubMedID 9358692
Risperidone in the management of violent, treatment-resistant schizophrenics hospitalized in a maximum security forensic facility
JOURNAL OF THE AMERICAN ACADEMY OF PSYCHIATRY AND THE LAW
1997; 25 (4): 461–68
This study examines the effectiveness of risperidone compared with traditional neuroleptic medications in the areas of clinical functioning and aggressive behaviors in a sample of inpatients diagnosed with chronic schizophrenia. Similar to the methodology of Menditto et al. (Psychiatr Serv 47:46-51, 1996), two groups of 10 patients were selected from those being treated in a comprehensive psychosocial rehabilitation program. Group 1 subjects were placed on risperidone at various times during their treatment. Group 2 subjects, who were matched with Group 1 subjects on pre-study levels of clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC), remained on traditional neuroleptics throughout the study period. For each subject, scores on six TSBC subscales were examined at four time points; data were analyzed with repeated-measures multivariate analyses of variance and univariate analyses of variance. Frequency counts of aggressive behaviors (threats and assaults) were compiled into two six-month time periods and analyzed with nonparametric techniques. The risperidone group did not differ from the traditional neuroleptic group on measures of clinical functioning and aggressiveness measured over time. Both groups evidenced improvements in bizarre motor behaviors over the study period. The risperidone group evidenced some deterioration in measures of appropriate interpersonal interaction over time. No differences in aggressive behaviors were noted for either group. The study concludes that for forensic patients with chronic schizophrenia, risperidone failed to produce therapeutic effects in overall clinical functioning and aggressive behaviors that were significantly different from traditional neuroleptics. Descriptive comparisons are made between the receptor-binding profiles and clinical effectiveness of risperidone and clozapine in an attempt to explain these findings.
View details for PubMedID 9460034
A prospective, high-risk study of the relationship between tobacco dependence and alcohol use disorders
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1996; 20 (3): 485–92
This study examined the extent to which tobacco dependence (TD) and alcohol use disorders (AUDs) reciprocally influenced each other in a mixed-gender sample of 452 individuals (n = 232 biological family history of paternal alcoholism, n = 220 no first- or second-degree family history of alcoholism) who were assessed once early in their freshman year of college, approximately 3 years later when many were college seniors, and approximately 3 years later when many had entered or were entering the work force. AUDs were more prevalent in men than women, in individuals with a family history of alcoholism, and decreased overall with time. TD was more prevalent in those with a family history of alcoholism, showed increasing rates of use over time, and was less prevalent but more stable than AUDs. Transitional probabilities indicated that although a previous AUD or TD diagnosis increased the likelihood of being diagnosed with the other disorder at a later time, comorbid AUDs and TD did not significantly affect the likelihood of recovery from either disorder. Finally, path analysis revealed significant reciprocal relationships between AUDs and TD diagnoses (each predicting the other over time), and significant prediction of AUDs and TD by family history of alcoholism at the first and third times of assessment. Findings supported two general models of AUD/TD comorbidity: a shared vulnerability model and a reciprocal influence model.
View details for PubMedID 8727241
Do codependent traits involve more than basic dimensions of personality and psychopathology?
JOURNAL OF STUDIES ON ALCOHOL
1996; 57 (1): 34–39
Despite widespread use of the term codependency, empirical evidence regarding its construct validity is generally lacking. This study analyzed the construct validity of codependency as measured by Potter-Efron and Potter-Efron's Codependency Assessment Questionnaire (CAQ). It attempted to determine the CAQ's factor structure and whether there are any unique relations between symptoms of codependency and parental alcoholism after controlling for basic dimensions of personality and psychopathology.Participants were 467 (246 male, 221 female) young adult children of alcoholics and controls who contributed complete questionnaire data at the fourth wave of a longitudinal study of factors related to alcohol use and abuse.The CAQ showed reliability and basically a one dimensional structure, and CAQ scores were significantly related to family history. Although much of this relation between family history and codependency was accounted for by neuroticism and symptoms of general psychopathology, a small, but significant, association between family history and codependency remained even after statistically controlling for personality and psychopathology.We conclude that, although there may be unique aspects of the purported codependency syndrome that are related to a family history of alcoholism, most of the relation between codependency and family history appears to be "explained" by general negative affectivity.
View details for PubMedID 8747499
- The course of psychological distress in college: A prospective high-risk study Journal of College Student Development 1996; 37: 42-51