Kathleen A. Moore

Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months

Objective The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic e-ercise, sertraline therapy, or a combination of e-ercise and sertraline. Methods The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months). Results After 4 months patients in all three groups e-hibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the e-ercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one’s own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009). Conclusions Among individuals with MDD, e-ercise therapy is feasible and is associated with significant therapeutic benefit, especially if e-ercise is continued over time.

Characteristics of opinion leaders in substance abuse treatment agencies

Objective. This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence‐based treatment of co‐occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of “opinion leaders” as technology transfer agents. Method. A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co‐occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co‐occurring disorders. Results. The analyses demonstrate that opinion leaders differed from other counselors in competency‐related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co‐occurring disorders as well as a greater willingness and confidence in working with such clients. Conclusion. These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence‐based treatment practices in community treatment settings.

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.

NEW VERSION OF BRIEF DEPRESSION SCALE

(85 vs 58 days; P < .05), their emergency room attendance in the previous year was more frequent (25% vs 4.5%; P < .05), and a higher percentage were followed up by several clinics (56.5% vs 22.2%; P < .01). The distribution of chronic diseases, the number of drugs, and the functional status (Katz Index, Red Cross Index of Physical and Mental Incapacity) were similar in both Also, the number of patients living alone or needing hospital-paid transport for coming to the clinic was the same. Based on our results, we conclude that, in general, failed appointments were not related to medical problems, functional incapacity, or social problems; rather, they were caused by circumstantial factors such as forgetfulness or change of residence. The most effective way to prevent appointment failures could be reminding the patients about their appointments.6But phoning all patients before the day of their appointment would not be cost-effective if the percentage of failed appointments is low, as indicated in our study. A good alternative might be to phone the patients the day of the appointment if they fail to arrive. This would be useful for advising patients if they have medical problems and for setting up another appointment to assure follow-up.

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.

Implementing the Comprehensive, Continuous, Integrated System of Care Model for Individuals with Co-Occurring Disorders: Preliminary Findings from a Residential Facility Serving Homeless Individuals

ABSTRACT This study assessed the effectiveness of an evidence-based treatment model for homeless individuals with co-occurring diagnosed mental health and substance use disorders. The model, Comprehensive, Continuous, Integrated System of Care (CCISC), has been recognized by the Substance Abuse and Mental Health Services Administration as one of the best treatment protocols in the United States (Minkoff & Cline, 2004). During residential treatment, clients received medical care, counseling, psychiatric/psychological evaluation, recreational and vocational services, as well as comprehensive discharge planning. All 76 participants were administered measures assessing housing and employment status, as well as mental health symptomatology and levels of substance use at both baseline and six-month follow-up. Analyses revealed significant improvement in all assessment categories at six-month follow-up as well as client satisfaction with the program. The Comorbidity Program Audit and Self-Survey for Behavioral Health Services (COMPASS), a standardized measure to assess fidelity to the CCISC model, was utilized annually and indicated that the CCISC principles of care were being implemented as intended. These results underscore the effectiveness of an evidence-based model for treating clients with co-occurring mental health and substance use disorders.

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.