Jo Brocato

Exploring the Perspectives of Substance Abusing Black Men Who Have Sex With Men and Women in Addiction Treatment Programs A Need for a Human Sexuality Educational Model for Addiction Professionals

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as “barebacking.” These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.

The Impact of Acculturation, Motivation and the Therapeutic Alliance on Treatment Retention and Outcomes for Hispanic Drug Involved Probationers.

Factors associated with retention and outcomes for Hispanic offenders mandated to treatment for substance use disorders have been overlooked in the literature, resulting in an impediment to providing evidence-based, culturally relevant treatment services. This project examined the roles of motivational factors, the therapeutic relationship, and acculturation in predicting treatment retention and recidivism among Hispanic male probationers mandated to residential treatment. By following a treatment cohort over 120 days, this research identifies factors that may be targeted to improve interventions and policies. The following conclusion is supported: Among Hispanic offenders, the number of days in treatment is positively related to motivation to change and level of acculturation.

Enhancing Residential Treatment for Drug Court Participants.

In this study, the authors describe and evaluate the impact of increased access to residential treatment added to traditional drug court services in Orange County, California, with a goal of increasing program retention, successful completion, and graduation rates for a high-risk drug offender population participating in drug court between January 2004 and March 2005. Data were gathered from various sources, including the drug court management information system (MIS) and probation records, and the health care agency that provided case management services to drug court participants. The results suggest that increasing the drug courts capacity to adapt treatment for participants in need of a higher level of care was related to positive outcomes. Limitations of this study include the design that is susceptible to uncontrolled influences of extraneous variables such as changes in policy. This research encourages further examination of these variables in alternate settings to determine the extent to which these strong but preliminary results are generalizable.

Does Drug Testing Deter Drug Court Participants From Using Drugs or Alcohol

This study evaluates 3 drug-testing strategies implemented in 5 different jurisdictions with drug courts in Orange County, California. The purpose of the study was to determine whether the sweat patch acts as a deterrent and under what conditions it can be used to improve outcomes. Results indicated that although the use of the sweat patch did not result in statistically significant higher retention or graduation rates, it was perceived to be equal to the use of urine analysis in deterrent effect. The effectiveness of testing as a deterrent for drug use will likely depend on the scheduled administration of the tests and the immediacy of rewards and sanctions for participants.

Specialty Groups for Drug Court Participants

This study describes and evaluates specialty groups added to the traditional drug court services in Orange County, California, with a goal of increasing program retention and successful completion (graduation) rates for drug court participants. These enhanced treatment groups added an average of 90 minutes of specialty group therapy to traditional services offered to 139 drug court participants between January 2004 and March 2005. Data were gathered from various sources, including the drug court management information system (MIS) and probation records, as well as pre- and post-test surveys for each specialty group offered. The results suggest three specialty counseling groups (alcohol recovery, mask of addiction, and journaling) were related to positive outcomes in drug court. Limitations of this study include the small sample sizes in some of the specialty groups, as well as the typical enrollment/onset of group therapy that generally occurs as clients successfully progress toward graduation. This research further suggests an examination of these variables in alternate settings to determine the extent to which these strong but preliminary results are generalizable.

Drug Treatment Utilization Among Illicit Drug Users Receiving HIV Prevention Services in Los Angeles County

The aim of this project was to examine factors associated with substance use treatment participation among individuals using illicit drugs who were also receiving other health and social services. Data were collected from 1,189 respondents sampled in the Countywide Risk Assessment Survey in Los Angeles County, California. A binary logistic regression was used to examine behavioral model indicators and HIV risk behaviors associated with treatment use. Differences were found with regard to predisposing and need variables and to HIV risk behaviors between those who accessed treatment and those who did not. There are implications for targeted prevention strategies and triangulated service integration.

Stressful point-of-care rapid testing for human immunodeficiency virus, hepatitis C virus, and syphilis

Even with technological advances in point-of-care rapid testing for HIV, hepatitis, and syphilis, individuals may still find the experience of submitting to testing, and receiving results, to be stressful. Participants completed the rapid test experience questionnaires to assess stress both prior to and after the specimen collection. Participants completed the risk behavior assessment, the coping strategies indicator, and the Barratt impulsivity scale. Participants chose which rapid tests they wanted using a list administered via computer. Logistic regression analysis was used to model self-reported stress prior to testing and after testing. A total of 1097 individuals completed testing. Individuals who scored high on avoidance reported a stressful experience at pretest (OR = 1.15, CI = 1.04, 1.26) while higher educational attainment was associated with no stress at both time points. Injection drug users, avoidant, and impulsive individuals experience stress either before or after rapid testing. Education appears to be protective against stressful testing.

Sexual Practices and HIV Risk Behaviors Among African American Female Partners of Sex-Trading Men Who Have Sex With Men and Women: A Descriptive Analysis

African American women continue to be disproportionately burdened by HIV and AIDS. An important determinant of the risk of transmission lies in the characteristics of sexual partnerships. The current study explores the sexual risk behaviors of a vulnerable population subgroup of African American women who engage in sexual partnerships with men who are sex traders and have sex with both men and women. The sample was 106 adult African American women. Data regarding sociodemographics, drug-using behavior, sexual practices, HIV and sexually transmitted infections, and health-seeking behaviors were analyzed. Nearly 90% of participants reported unprotected vaginal sex and using crack cocaine in the previous 3 months. The recent use of heroin was significantly associated with diminished condom use. A clear majority of the participants did not know their HIV status. This study is the first to examine and document shared structural and behavioral risk profiles of this population.

Group Cognitive Therapy for Addictions, by Amy Wenzel, Bruce S. Liese, Aaron T. Beck, and Dara G. Friedman

reinforced each week, thus helping the client refocus onto healthy behaviors and thoughts when bipolar symptoms or cravings are resurfacing. A weakness is that the authors did not provide an in-depth literature review, perhaps because their target audience was not scholars. However, acknowledging references of Yalom’s Therapeutic Factors would have been important if readers wanted to learn more about classical group therapy. In summary, Integrated Group Therapy for Bipolar Disorder and Substance Abuse would be a helpful manual for any clinician who wants to provide the best clinical practices for persons with cooccurring bipolar illness and a substance use disorder. This is particularly important to social workers because we are the main providers of mental health services and often use group therapy to treat persons with cooccurring substance use problems and bipolar illness.

Measurement Tools Utilized to Assess Specialty Groups for Drug Court Participants

This article describes the initial construction of measurement instruments for use in an enhanced drug court program in Orange County, California. The evaluation instruments include pre- and post-test surveys that assess 11 specialty groups utilized in this drug court. The specialty groups offered to drug court participants were designed to increase program retention and successful completion of the drug court program. The survey instruments discussed herein measure clients’ knowledge gained during treatment, the extent to which group objectives were achieved, and overall participant satisfaction with the groups. The survey instruments are discussed in detail and are included as appendices, in hopes that they may provide other drug courts employing similar specialty groups with an evaluation tool that could be standardized and utilized for comparison across jurisdictions.