Ellen Tuchman

Women and Addiction: The Importance of Gender Issues in Substance Abuse Research

ABSTRACT Substance use was considered to be primarily a male problem, and many substance abuse studies are conducted with a predominance of male participants. However, recent substance abuse research indicates significant gender differences in the substance-related epidemiology, social factors and characteristics, biological responses, progressions to dependence, medical consequences, co-occurring psychiatric disorders, and barriers to treatment entry, retention, and completion. The epidemiology of womens drug use presents challenges separate from those raised by mens drug use. A convergence of evidence suggests that women with substance use disorders are more likely than men to face multiple barriers affecting access and entry to substance abuse treatment. Gender-specific medical problems as a result of the interplay of gender-specific drug use patterns and sex-related risk behaviors create an environment in which women are more vulnerable than men to human immunodeficiency virus. Individual characteristics and treatment approaches can differentially affect outcomes by gender. All of these differences have important clinical, treatment, and research implications.

Exploring the Prevalence of Menopause Symptoms in Midlife Women in Methadone Maintenance Treatment

Abstract Menopause is a natural process that occurs in womens lives as part of normal aging. Many women go through the menopausal transition with few or no symptoms, while some have significant or even disabling symptoms. The purpose of this paper is to describe the menopausal symptom experience of 135 urban methadone-maintained midlife women between the ages of 40 and 55 years. A cross-sectional survey comprising sample characteristic questions and a 14-item menopause symptom checklist was administered. Ninety-six percent reported one or more symptoms with a mean of 6.2 symptoms. Symptom reporting was found to be relatively high, with more than half of the sample reporting hot flashes, night sweats, sleep disturbances, joint pains, and fatigue in the two weeks preceding the survey. However, the psychological symptoms (irritability and depression) were the two most common symptoms in this sample. This study documents a relatively heavy burden of symptoms in an aging cohort of methadone-maintained women. The physical and psychological impact of aging and, in particular, the experience of menopause in these women is rarely studied and poorly understood. This gap in critical knowledge is further complicated by the remarkable similarity of many symptoms associated with menopause and opiate withdrawal. Aging, drug-related health problems, and poor access to health care further complicate the picture and underscore the importance of better integration of health care with social work intervention.

Evidence-Based Practice: Integrating Classroom Curriculum and Field Education

This article describes the use of problem-based learning to teach the scope and consequences of evidence-based practices in mental health through an innovative assignment that integrates classroom and field learning. The authors illustrate the planning and implementation of the Evidence-Based Practice: Integrating Classroom Curriculum and Field Education Assignment designed to promote a deeper, more comprehensive and critical understanding of the multiple and interacting factors that may prevent a social work student from providing the best possible services to clients with severe mental illness and co-occurring substance abuse. The authors discuss the challenges in and implications of developing and implementing a problem-based assignment that integrates evidence-based practice material from class and field. Implications of using problem-based learning in social work education are then discussed.

Implementation of an evidence-based modified therapeutic community: Staff and resident perspectives

The widespread successful implementation of evidence-based practices (EBPs) into community substance abuse settings require a thorough understanding of practitioner and client attitudes toward these approaches. This paper presents the first that we know of a qualitative study that explores staff and resident experience of the change process of a therapeutic community to an evidence-based modified therapeutic community for homeless individuals with co-occurring substance abuse and mental illness disorders. The sample consists of 20 participants; 10 staff and 10 residents. Interviews were conducted at the agency, recorded and transcribed verbatim. Transcripts were organized and coded from a grounded theory perspective. Themes and patterns of staff and resident experience were identified. The change in program structure from TC to MTC were perceived by staff as efforts to accommodate the particular needs of the homeless individuals with mental and substance abuse disorders and feeling they were inadequately prepared with inadequate resources to facilitate a successful transition. Participant descriptions were described in terms of loss of structure, loss of peers and being helped. Findings have potential to shape implementation of evidence-based practices in community substance abuse treatment.

A model-guided process evaluation: Office-based prescribing and pharmacy dispensing of methadone

This article presents an exemplar of a model-guided process evaluation that specifies the treatment model, assesses its implementation, monitors the fidelity of the model throughout the project, assesses model exposure and absorption, and helps understand the programs intermediate effects (proximal outcomes) as well as final effects (distal outcomes). The New Mexico study on office-based prescribing and community pharmacy dispensing of methadone is a research demonstration project that phases a small group of female methadone maintenance patients out of methadone clinics and into a program where they will obtain their scheduled doses of methadone at pharmacies that work in collaboration with physicians and a social worker.The patients methadone treatment will in this way become part of their overall health care. Early detection of problems of implementation (e.g., the omission of program content or the delivery of inaccurate information) enables the researcher to make adjustments before the problems become unmanageable and the integrity of the original research design is compromised. A model-guided process evaluation can critically inform health services research demonstrations designed for enabling continuous, ongoing feedback and improvement of client-related services.

HIV and smoking: associated risks and prevention strategies

High rates of smoking among persons living with HIV (PLWH) may reduce the effectiveness of HIV treatment and contribute to significant morbidity and mortality. Factors associated with smoking in PLWH include mental health comorbidity, alcohol and drug use, health-related quality of life, smoking among social networks and supports, and lack of access to care. PLWH smokers are at a higher risk of numerous HIV-associated infections and non-HIV related morbidity, including a decreased response to antiretroviral treatment, impaired immune functioning, reduced cognitive functioning, decreased lung functioning, and cardiovascular disease. Seventeen smoking cessation interventions were identified, of which seven were randomized controlled trials. The most effective studies combined behavioral and pharmacotherapy treatments that incorporated comprehensive assessments, multiple sessions, and cognitive-behavioral and motivational strategies. Smoking cessation interventions that are tailored to the unique needs of diverse samples and incorporate strategies to reduce the risk of relapse are essential to advancing health outcomes in PLWH.

Relationship Between Menopause Symptoms and HIV Risk Among Midlife Women in Methadone Treatment: A Pilot Study

This pilot study explores somatic, psychological, and urogenital menopause symptoms associated with HIV drug and sexual risk among midlife women with substance abuse histories in methadone maintenance treatment. The Menopause Rating Scale (MRS) assessed menopause symptoms and severity. The Risk Behavior Assessment assessed demographic characteristics, drug, and sexual risk behaviors. Menopause symptom associations of HIV drug and sexual risk findings indicated that high school graduates and women not having sex with a regular partner scored significantly higher on the MRS somatic symptom subscale. HIV negative women had higher total MRS scores compared with HIV positive women. Forty-six percent of the sample was sexually active with almost half engaged in unprotected sex. Significant associations with sexual risk were high MRS somatic subscale scores with inconsistent condom use for vaginal sex, HIV negative with inconsistent protected vaginal sex, heroin use with having sex while high with HIV negative status. Preliminary data provide a basis for further exploration and designing intervention approaches to reduce HIV risk and further transmission among midlife women in methadone treatment.

A few thoughts on evidence in social work.

Social work practitioners must act every working day in the face of uncertainty. This uncertainty arises in part because knowledge is often difficult to locate or sometimes lacking regarding: the systems context the population being served; the particular client system; the set of problems the client system is experiencing; as well as the various interventions that could be selected. It seems reasonable to explore ways to reduce the experience of uncertainty, and narrow, if not eliminate, the knowledge gaps that arise in such situations. The generic idea of evidence-based practice has been advanced for some time as an approach to support practitioners in their day-to-day work. This article has two foci. First, it will briefly and selectively review attempts to make social work practice more evidence based. Second, it will describe one stage in the evolution of a Web-based service (Information for Practice [IP]). IP is a long-term project with the mission of keeping practitioners informed about news and new scholarship in the field, so that they can more easily make their practice more evidenced based.

Menopause symptom attribution among midlife women in methadone treatment.

This article describes menopause symptom attributions among 135 midlife methadone-maintained women between the ages of 40 and 55 years. A cross-sectional survey collected sample characteristics and a 14-item menopause symptom checklist. Following the checklist respondents were questioned regarding perceived symptom causality. For classic menopause symptoms (hot flashes, night sweats, and menstrual irregularities) a majority of women attributed menopause. For remaining symptoms, various attributions were reported or etiologies were unknown. How midlife women interpret their symptoms is important to understand since such appraisals may guide the type of health and treatment behaviors they choose. Education to promote understanding of the actual causes, diagnosis, and treatment of symptoms may encourage midlife women to seek appropriate intervention. Social workers treating midlife women must be aware of and understand the normal variations associated with menopause and the multifactor symptom etiology.

A CROSS-CURRICULAR, PROBLEM-BASED PROJECT TO PROMOTE UNDERSTANDING OF POVERTY IN URBAN COMMUNITIES

This article describes the use of problem-based learning to teach students about the scope and consequences of urban poverty through an innovative cross-curricular project. We illustrate the process, goals, and tasks of the Community Assessment Project, which incorporates community-level assessment, collection and analysis of public data, and social policy analysis and planning. Students in three masters classes (Social Work Research I, Ending Poverty: Models for Social Change and Social Action, and Advanced Social Policy in Aging) worked in self-directed groups to explore the impact of economic insecurity on our most vulnerable clients. The project engaged students, linked research and policy practice, and helped to educate the next generation of social workers about urban poverty and strategies for community-based research and practice.