Blake Barrett

Recovery orientation of treatment, consumer empowerment, and satisfaction with services: a mediational model.

OBJECTIVE This study explores the relationship between the recovery orientation of treatment and subjective experiences of consumer empowerment and satisfaction with services for individuals with severe and persistent mental illness. METHODS Instruments measuring perceptions of empowerment, recovery orientation of treatment, and satisfaction with services were administered to 45 participants enrolled in two demographically similar mental health treatment programs in Tampa, Florida - a community mental health center and an Assertive Community Treatment team. Analyses were conducted according to traditional mediation models. Empowerment was expected to mediate the relationship between the recovery orientation of treatment and consumer satisfaction with services. RESULTS A recovery-based treatment orientation significantly predicted both consumer empowerment and satisfaction with services. Empowerment mediated the relationship between treatment orientation and consumer satisfaction. CONCLUSIONS These preliminary findings highlight the impact of the recovery orientation of treatment on empowerment and satisfaction with services among individuals with severe and persistent mental illness.

The Role of Positive Alcohol Expectancies in Underage Binge Drinking among College Students.

Abstract Objective: This study explored associations between positive alcohol expectancies, and demographics, as well as academic status and binge drinking among underage college students. Participants: A sample of 1,553 underage college students at 3 public universities and 1 college in the Southeast who completed the Core Alcohol and Drug Survey in the Spring 2013 semester. Methods: A series of bivariate analyses and logistic regression models were used to examine associations between demographic and academic status variables as well as positive alcohol expectancies with self-reported binge drinking. Positive alcohol expectancies were examined in multivariable models via 2 factors derived from principal component analyses. Results: Students who endorsed higher agreement of these 2 emergent factors (sociability, sexuality) were more likely to report an occurrence of binge drinking in the past 2 weeks. Conclusions: Study results document associations between positive alcohol expectancies and binge drinking among underage students; implications for prevention and treatment are discussed.

Clinical History and Characteristics of Persons with Oxycodone-Related Deaths in Hillsborough County, Florida in 2009

AIMS To analyze toxicological findings of accidental deaths involving oxycodone to determine demographic characteristics and clinical histories. METHODS Accidental deaths in which oxycodone was mentioned as a cause of death were analyzed. The sample included all persons deceased in Hillsborough County in 2009 where oxycodone was present. The entire sample was divided into two subgroups listing oxycodone as the primary/contributory cause of death (n=117) or oxycodone as the incidental cause of death (n=38). Differences between the two groups in demographic and clinical history variables as well as the presence and concentration of drugs were examined. RESULTS The majority of decedents within the entire sample (N=155) were Caucasian males (58.1%) aged 50 or older. More than half of the population (52.9%) did not hold prescriptions for oxycodone. Those who died with a primary/contributory cause of death were younger, more likely to have a history of substance abuse, and more likely to have alprazalom (Xanax) present in their system. Across the entire sample, the mean oxycodone concentration level was 0.40 mg/L, with a range from 0.02 to 3.70 mg/L. Those who died with a primary/contributory cause of death had a significantly higher level of mean oxycodone concentration than those with an incidental cause of death, 0.48 mg/L compared to 0.16 mg/L. CONCLUSIONS Results suggest that the demographic findings mirror statewide and national trends. In general, mean oxycodone concentration levels were shown to be lower than those previously reported in literature. Overlap and range of concentrations between those with a primary/contributory and incidental cause of death demonstrates the significance of individual case history and tolerance in the interpretation of postmortem drug concentrations when determining cause and manner of death.

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.

College students who endorse a sub-threshold number of DSM-5 alcohol use disorder criteria: Alcohol, tobacco, and illicit drug use in DSM-5 diagnostic orphans

OBJECTIVES Diagnostic orphans (DOs) represent a group of individuals with no formal diagnosis, despite endorsing some criteria of an alcohol use disorder (AUD). Prior research has indicated that rates of DSM-IV DOs in college are high and closely resemble those with an alcohol abuse diagnosis across pertinent alcohol use risk factors. However, significant changes to the DSM-IV AUD criteria have been made for the current DSM-5 manual, which may impact how DOs are classified. This study examined the unique alcohol and illicit drug use characteristics of a group of 2,620 DSM-5 DOs in college and tested whether DOs differed from those with and without a DSM-5 AUD across pertinent alcohol and drug use risk factors. METHODS Participants were 2,620 DSM-5 DO undergraduate college students, between the ages of 18 and 30, recruited from three public universities in the Southeastern, United States. RESULTS Diagnostic orphans represented 19.6% (n = 506) of the sample; with the most frequently endorsed criteria being tolerance and consuming alcohol in hazardous situations. DOs reported significantly greater alcohol consumption, alcohol and drug related problems, and illicit drug use compared to those with no DSM-5 AUD diagnosis. Alternatively, DOs reported significantly lower alcohol use and illicit drug use compared to those with a DSM-5 AUD. CONCLUSION The present findings indicate that DSM-5 DOs in college represent a distinct group of drinkers relative to those with and without a DSM-5 AUD. Current screening initiatives should target this group to prevent future escalation of problem drinking.

Relationship between Trauma and Risky Behavior in Substance-Abusing Parents Involved in a Family Dependency Treatment Court

This exploratory study examined participants in a Family Dependency Treatment Court (FDTC), designed for substance-abusing parents whose children were removed from the home. Twenty-five participants were interviewed one year after FDTC enrollment to assess retrospectively the relationship between trauma history and risky behaviors. Treatment compliance rates were found to be high, and most participants had negative urinalysis results. Qualitative analyses revealed that approximately half of the participants attributed decreases in risky behaviors to the FDTC program. This study increases understanding of the effect of substance abuse and trauma on high-risk behaviors and might help to improve services for substance-abusing parents involved in the child welfare system. Finally, the future success of reducing child abuse and neglect and parental substance use could hinge on the partnership between judicial and substance abuse treatment through FDTCs. Findings from this exploratory pilot study should be replicated with more representative and larger samples.

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.

Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies

Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH), and the second program was based out of a substance abuse treatment agency and used the CCISC model of care in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews at baseline before being admitted to the programs and then 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilization, and levels of unmet needs; and a tool assessing employment, housing, and past-month substance use. Results indicated that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT program was associated with slightly greater reductions in mental health symptoms. Both programs were also associated with significant improvements in residential stability, although participants in the ACT-SH program were more likely to own or rent their own residence 6 months following program enrollment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve homeless individuals with behavioral health needs. Although the CCISC-RT program was based in a residential treatment facility and delivered a greater intensity of behavioral health services than the ACT-SH program, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of needed services, reducing their substance use and mental health symptoms, and attaining a stable residence.

Six-Month Behavioral Health Outcomes Among Family Dependency Treatment Court Participants

Significant substance abuse problems are prevalent in families involved with the child welfare system. Family Dependency Treatment Courts (FDTCs) are partnerships among the child welfare, court, and treatment systems designed for substance-abusing parents whose children are removed from the home primarily due to abuse and/or neglect. FDTCs enable the court to mandate treatment and make child reunification dependent on treatment compliance. This study evaluated 83 individuals during the first 6 months of their participation in a FDTC program. Participants included substance-abusing parents involved in the child welfare system who were referred to FDTC. Results indicated statistically significant reductions in past-month substance use, anxiety, and depression as well as high rates of therapeutic alliance. These findings, indicating significant reductions in the frequency of parental drug and alcohol use, replicate earlier FDTC evaluations. Assuming continuing evidence of cost savings, this unique judicial and treatment approach will likely continue to spread across the United States.