Bertram E. Stoffelmayr

The longitudinal stability of the Addiction Severity Index.

The Addiction Severity Index (ASI) is a structured interview widely used by substance abuse clinicians and researchers for client screening, determining treatment needs, and assessing treatment outcomes. Previous researchers have evaluated inter-rater agreement, test-retest reliability, and concurrent validity. The present report describes the stability of ASI scores in longitudinal work. In the context of an ongoing treatment outcome evaluation study involving seven assessors, inter-rater agreement, inter-rater reliability, as well as intra- and inter-rater accuracy were assessed repeatedly during a 2-year period. The results show the scores derived from the ASI to be stable across assessors and over time. The relationship between stable scores and resources required for training are discussed.

Residents' attitudes towards and skills in counseling: using undetected standardized patients.

Objective:To identify the frequency and quality of certain prevention-oriented counseling skills of resident physicians and to compare these skills with the residents’ attitudes towards and knowledge about primary prevention.Design:Longitudinal descriptive study.Patients/participants:54 PGY-1-3 internal medicine and family practice residents enrolled in three training programs affiliated with Michigan State University’s College of Human Medicine.Intervention:Trainees’ attitudes towards and knowledge about certain prevention activities were captured by an instrument designed for this study using 127 Likert scales. Counseling skills were assessed with one of two standardized patients. Residents were unaware of the simulation, which occurred in their routinely scheduled ambulatory care setting. Audiotapes of the interactions were rated by blinded, independent raters. Residents had strong positive beliefs about the role of primary care physicians in counseling patients, high levels of knowledge about what the counseling should entail, and high self-assessment about the frequency and quality of their own counseling interventions. Skill levles, however, were at or below a level defined as minimally acceptable.Conclusion:Resident physicians’ skill levels, as measured in this study, are inadequate to accomplish routine counseling interventions in the primary care setting. These results suggest that more reliance should be placed on direct observation of physicians, ideally in nonreactive settings, for purposes of drawing conclusions about physician performance. Further, these results have implications for the training of students and residents in the area of counseling for prevention.

Substance Abuse Prognosis with an Additional Psychiatric Diagnosis: Understanding the Relationship

Patients with alcohol and other substance abuse problems have poorer prognoses if there is a concomitant psychiatric diagnosis. However, because severity of psychiatric problems contributes more than the specific psychiatric diagnosis to prognosis, the nature of the interaction between substance abuse treatment outcome and an accompanying psychiatric diagnosis can be questioned. In this article an attempt is made to understand the poor-prognosis-with-psychiatric-diagnosis interaction through a literature review and an analysis of various problem areas that clients bring to substance abuse treatment. Problem areas were measured with a variety of instruments. The results show that groups that vary in severity of psychiatric problems also differ in severity of problems in other areas. As there is no doubt that such dual diagnosis patients pose a considerable treatment challenge, the implications of these findings for theoretical consideration and treatment planning are discussed.

Efficacy of a one-month training block in psychosocial medicine for residents : a controlled study

Study objective:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents.Design:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching.Setting:Community-based, primary care-oriented residency program at Michigan State University (MSU).Subjects:All 28 interns from the single-track MSU residency program during 1986/87–88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89.Teaching intervention:An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients.Measurements and main results:The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group×gender), the trainee group showed significantly greater gains (p<0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents’ acceptance of the program was high.Conclusions:Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training.

IMPROVING RESIDENTS CONFIDENCE IN USING PSYCHOSOCIAL SKILLS

OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive outcomes from, and personal commitment to psychosocial behaviors.DESIGN: Controlled randomized study.SETTING: A university- and community-based primary care residency training program.PARTICIPANTS: 26 first-year residents in internal medicine and family practice.INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills needed in primary care.MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from, and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization, and directive and nondirective facilitation of patient communication.RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization (p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine than did the untrained residents (p<0.001).CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and personal commitment to some, but not all, psychosocial skills.

Chapter 7. Are twelve step programs appropriate for disenfranchised groups? Evidence from a study of posttreatment mutual help involvement

Summary Conventional wisdom about 12 step mutual help programs for substance abusers holds that these organizations appeal primarily to white, middle class men. To investigate the validity of this claim, a sample of 558 persons who were followed up one year after their intake to substance abuse treatment was studied. Contrary to conventional wisdom, the 178 persons who were attending mutual help after treatment were not significantly different from the 380 who were not, on race, gender, education, employment pattern, or marital status. Supplemental analyses of the data suggested that women are more likely to drop out of 12 step groups than are men and that African Americans who attend self‐help after treatment have better outcomes on clinical and social measures than do African Americans who do not attend self‐help groups. Overall the findings suggest that 12 step programs both appeal to and benefit disenfranchised groups.

Exploratory and confirmatory factor analyses of the brief symptom inventory among substance abusers

The Brief Symptom Inventory (BSI) is a multidimensional measure of psychological and somatic distress that is used to obtain detailed symptom profiles. The BSI has been questioned regarding its ability to differentiate among its proposed nine dimensions, and the factor structure underlying the BSI has not been confirmed with substance abusers. Exploratory factor analyses were completed on substance abusers (ntotal = 453; nwomen = 121; nmen = 332); nine factors were not identified. Five models were then submitted to confirmatory factor analyses using an independent sample of substance abusers (ntotal = 456; nwomen = 127; nmen = 329). A one-factor model (i.e., global psychological distress) best represented the data. Implications for using the BSI in research and counseling are discussed.

Gender differences in depression and anxiety among alcoholics.

Recent research suggests that psychopathology, in particular depression and anxiety, differentially affects the substance abuse treatment response of men and women. This study explores the relationship between global psychopathology, depression, anxiety, and alcoholism treatment outcome. These variables were assessed in a sample of 507 (373 men; 134 women) substance abuse clients at intake and at a 6-month follow-up. With the exception of alcohol dependence, there were significant differences in the levels of alcohol problems, depression, anxiety, and global psychopathology for men and women at both intake and follow-up. For the whole sample and for men, initial levels of alcohol problems and alcohol dependence were the best predictors of alcohol problems at follow-up. For women, the initial levels of alcohol dependence and a global measure of psychological functioning were predictive of outcome at follow-up. These findings are compared with past research, and suggestions for further investigation are proposed.

Substance abuse treatment staff : Recovery status and approaches to treatment

Recovery status is an important characteristic of staff members working within substance abuse treatment Recovering and nonrecovering staff members were contrasted previously, however there is a third group: Individuals who are not recovering themselves but are part of families with recovering or addicted members. The purpose of the present study is to compare background, roles within program and approaches to treatment of these three groups. Six hundred and thirty-four staff members of fifty-one treatment programs completed questionnaires. Five hundred and seventy-five completed an item indicating their recovery status. Forty-four percent identified themselves as nonrecovering, 30 percent as recovering, and 26 percent as nonrecovering but part of families with an addicted or recovering member. Nonrecovering staff with addicted or recovering family members differed from the other two groups on gender, more of them were female, but were similar to nonrecovering staff in their approach to treatment but fell between recovering and nonrecovering staff on measures of roles within programs and background. Recovering counselors reported to pursue a wider range of treatment goals and to use more varied treatment techniques than nonrecovering counselors. The implication of these findings for training and licensure of paraprofessionals in the field of substance abuse treatment is discussed.

Issues related to participation in worksite health promotion: a preliminary study.

Purpose. The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities. Design. Follow-up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored. Setting. All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs. Subjects. A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed. Measures. The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities. Results. ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation. Conclusions. The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities.