Diane M. Herbeck

Empirically supported substance abuse treatment approaches: A survey of treatment providers’ perspectives and practices

To better understand the extent that empirically supported and promising substance abuse treatment approaches are implemented in community settings, treatment providers were surveyed regarding their perceptions and use of several psychosocial and pharmacological treatment interventions. Program directors (n=30) and staff members (n=331) from diverse community settings rated the effectiveness and extent of use of various treatment interventions, and provided information on program and workforce characteristics via self-administered questionnaires. On average, program directors and staff rated the psychosocial treatment interventions as effective, with the exception of vouchers/motivational incentives. About half of the treatment providers did not know the effectiveness of certain pharmacological treatments, including buprenorphine and naltrexone. Respondents from the majority of programs (55%-80%) reported using Motivational Enhancement Therapy, Community Reinforcement Approach, and Supportive Expressive Psychotherapy. The extent that programs used several of the treatment interventions was related to organizational training and information resources. The study findings provide important information regarding training and research dissemination efforts.

Pilot Trial of a Disclosure Intervention for HIV+ Mothers: The TRACK Program.

OBJECTIVE The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLHs) to disclose their serostatus to their young children (age 6-12 years). METHOD MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had 3 individual sessions and 1 follow-up phone call. The sessions focused on preparing MLHs for disclosure through behavioral exercises using Derlegas model (V. J. Derlega, B. A. Winstead, K. Greene, J. Serovich, & W. N. Elwood, 2004) of HIV disclosure. Both MLHs and their child were assessed across multiple time points (baseline, 3, 6, and 9 months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mothers health, childs mental health, and family outcomes). RESULTS MLHs in the intervention group were 6 times more likely to disclose their HIV status than those in the control group (OR = 6.33, 95% CI [1.64, 24.45]), with 33% disclosing in the intervention group compared with 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness. CONCLUSIONS TRACK was found to be successful in helping MLHs disclose their HIV status to their children, with positive outcomes noted for both MLHs and their children.

Anxiety/stress among mothers living with HIV: effects on parenting skills and child outcomes

Abstract Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between six and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure of HIV status. Respondents were assessed using multiple measures of stress/anxiety, parenting skills, and child outcomes, including the Parenting Stress Index, the RAND Mental Health Inventory, the Family Routines Questionnaire, and the Child Behavior Checklist. Covariance structural modeling was used to assess the variable relationships, with latent constructs created for maternal anxiety/stress, parenting skills, and child problem behaviors (both direct and indirect effects were evaluated, with a model-based bootstrap used to verify model stability). Results demonstrated that maternal stress was negatively associated with a broad range of parenting skills, and that parenting skills were negatively associated with child problem behaviors. Mothers living with HIV who are anxious about their own health and functioning, and who were more stressed in their parental role, were more likely to exhibit poorer parenting skills – specifically to engage children less frequently in family routines (e.g., eating meals together, having a bedtime routine), poorer parent–child communication, and poorer and less consistent parenting discipline. Not uncommonly, mothers living with HIV experience a range of stressors above and beyond those related to their illness (e.g., poverty, residence in high risk and low resource communities, discrimination). Results demonstrate the need for interventions designed to decrease maternal stress and enhance parenting skills for families affected by HIV.

Self-report of Longitudinal Substance Use: A Comparison of the UCLA Natural History Interview and the Addiction Severity Index.

Reliance on self-report of alcohol and drug use behavior is typical among studies of substance abusers. Few studies have compared different instruments assessing frequency of drug use over long periods of time to determine if the pattern of use is shown to be similar across measures. In this study, the UCLA Natural History Interview (NHI) and the Addiction Severity Index (ASI) were administered at three annual follow-up periods (N = 301). The temporal pattern of the trajectories of days of use assessed by the ASI and NHI are comparable (in terms of both slope and intercept) for alcohol, heroin, cocaine, methamphetamine, and marijuana use. Some discrepancies appear to arise from differences in terminology among the instruments. However, the patterns of drug use were consistent across instruments, supporting their reliability for longitudinal examination of self-reported drug use.

HIV-Positive Mothers’ Communication About Safer Sex and STD Prevention With Their Children:

Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and sexually transmitted disease (STD) prevention, including at what age they began such discussions and what messages they gave to their children. The majority of mothers (95%) had talked with their child about safer sex; some began such discussions when the children were as young as 6 years old, but most began when the children were around 12 years old. Mothers’ messages fell into the following areas: (a) protecting oneself from STDs; (b) giving factual information regarding STDs, including HIV; (c) avoiding pregnancy; (d) empowering and respecting oneself; and (e) communicating with sexual partners. The mothers’ own HIV status affected the discussions with their children. Content of mothers’ messages, child reactions, and child outcomes are discussed.

Trajectories of delinquency from age 14 to 23 in the National Longitudinal Survey of Youth sample

This study utilised data from the National Longitudinal Survey of Youth to investigate risk trajectories for delinquency and factors associated with different trajectories, particularly substance use. The sample (n = 8984) was 49% female. A group-based trajectory model was applied, which identified four distinct trajectories for both males and females: a High group with delinquency rates consistently higher than other groups, with some decrease across the age range; a Decreased group, beginning at high levels with substantial decrease to near zero; a Moderate group, experiencing some decline but remaining at moderate rates of delinquency through most of the age range; and a consistently Low group, having low rates of delinquency declining to near zero by mid-teens to late-teens. The Low group was distinguished by several protective factors, including higher rates of maternal authoritative parenting style, possible lower acculturation (higher rates of non-English spoken at home), higher rates of religious activity, later substance use initiation, lower rates of early delinquent activity, less early experience with neighbourhood or personal violence, and higher rates of perceiving penalty for wrongdoing. Conversely, the High group was characterised by several vulnerability factors – essentially the converse of the protective factors above.

Methamphetamine Use and Violent Behavior: User Perceptions and Predictors

This study describes the extent to which methamphetamine users perceive that their methamphetamine use has resulted in violent behavior, and describes the level of self-reported prevalence of specific violent criminal behaviors irrespective of methamphetamine use. Predictors of these two violence-related indicators, in terms of potential correlates from substance use history, criminal history, and health risk domains, are examined. Data were collected from extensive interviews of 350 methamphetamine users who received substance use treatment in a large California county. A majority (56%) perceived that their methamphetamine use resulted in violent behavior; 59% reported specific violent criminal behaviors. For more than half of those reporting violent criminal behavior, this behavior pattern began before methamphetamine initiation. Thus, for a subsample of methamphetamine users, violence may be related to factors other than methamphetamine use. Users’ perceptions that their methamphetamine use resulted in violence appears strongest for those with the most severe methamphetamine-related problems, particularly paranoia.

Using Facebook to Maximize Follow-Up Response Rates in a Longitudinal Study of Adults Who Use Methamphetamine

This study examines the process and effects of using facebook (FB) to locate and re-contact study participants targeted for follow up in a longitudinal study of adult methamphetamine users (N = 649). A follow-up interview was conducted in 2009–11 approximately 8 years after previous study participation. Our paper describes re-contact efforts involving FB, including IRB regulatory issues and the effectiveness of using FB compared to mailings and phone calls. A total of 48 of the 551 surviving non-incarcerated participants who agreed to be contacted for follow up studies were contacted via FB, of whom 11 completed the follow-up interview. Those contacted through FB were more likely to be younger, female, relocated out-of-state, and reported somewhat higher rates of anxiety and cognitive problems compared to those not located on FB. Although participants contacted through FB are likely to differ demographically from those contacted by phone or mail, FB provides a potentially effective means to expand conventional methods of correspondence for contacting hard to reach participants.

Impact of Maternal HIV Health: A 12-year Study of Children in the Parents And children Coping Together Project

PURPOSE The purpose of this 12-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent well-being and behavioral outcomes, extending an earlier published account. METHODS Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS, who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning, and depression) and child/adolescent outcomes (e.g., depression, anxiety/worry, aggression, and self-concept) were assessed over 16 time points. RESULTS Using growth curve modeling, results show a negative effect of maternal health status on child/adolescent outcomes, including child/adolescent depression, anxiety/worry, aggression, and self-concept. Interaction effects within the growth models suggest younger children are more impacted by poor maternal health than are older children/adolescents. CONCLUSIONS This is the first study to follow a cohort of children of mothers living with HIV/AIDS over such an extended age range, through late adolescence/early adulthood, to determine the impact of maternal health status throughout the entire developmental period.

Mortality, causes of death, and health status among methamphetamine users.

This study examines causes of death, years of life lost, and health and drug use characteristics associated with mortality over an 8 to 10 year period in a sample of methamphetamine users who had and had not received substance use disorder treatment (N = 563). Decedents reported initiating their methamphetamine use for different reasons than surviving methamphetamine users, and some of these differences varied by treatment status. Study findings provide additional detail on long-term health and mortality outcomes in a diverse sample of methamphetamine users, which may inform public health strategies targeting the comparable and divergent needs of treated and untreated populations.