M. Scott Young

Assessing illicit drug use among adults with schizophrenia

Accurate drug use assessment is vital to understanding the prevalence, course, treatment needs, and outcomes among individuals with schizophrenia because they are thought to remain at long-term risk for negative drug use outcomes, even in the absence of drug use disorder. This study evaluated self-report and biological measures for assessing illicit drug use in the Clinical Antipsychotic Trials of Intervention Effectiveness study (N=1460). Performance was good across assessment methods, but differed as a function of drug type, measure, and race. With the Structured Clinical Interview for DSM-III-R as the criterion, self-report evidenced greater concordance, accuracy and agreement overall, and for marijuana, cocaine, and stimulants specifically, than did urinalysis and hair assays, whereas biological measures outperformed self-report for detection of opiates. Performance of the biological measures was better when self-report was the criterion, but poorer for black compared white participants. Overall, findings suggest that self-report is able to garner accurate information regarding illicit drug use among adults with schizophrenia. Further work is needed to understand the differential performance of assessment approaches by drug type, overall and as a function of race, in this population.

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.

Consumer Perceptions of Integrated Trauma-Informed Services among Women with Co-Occurring Disorders

As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers’ perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers’ perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers’ perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.

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.

Changes in sources and perceived quality of social supports among formerly homeless persons receiving assertive community treatment services.

We recruited a sample of individuals who were formerly homeless that received assertive community treatment (ACT) services to assess differences in their sources and perceived quality of social support related to changes in their residence status. Standardized questionnaires were administered to 22 participants via face-to-face interviews, including various measures of social support and relationship quality. Results indicated that participants mentioned ACT staff members significantly more often than any other relationship category (e.g., friends or family) as sources of social support. Participants also indicated that the quality of their relationships with ACT staff members was significantly better than relationships maintained before and during their homelessness. These findings indicate that ACT staff can serve as social supports for clients on their caseloads, and they further suggest that clients perceive these worker-consumer relationships to be of high quality. Implications related to community integration are discussed.

The Relationship between Outpatient Mental Health Treatment and Subsequent Mental Health Symptoms and Disorders in Young Adults

The objective of this study was to evaluate community-based outpatient mental health services for young adults. Participants were interviewed at ages 21, 24, 27, and 30. Outcomes included: (1) symptoms of depression, generalized anxiety, social phobia, dysthymia and post traumatic stress individually and as a global scale; and (2) a dichotomous diagnosis variable inclusive of all above disorders. Treatment was indicated by an outpatient visit to a psychiatrist or other professional. Treatment did not reduce mental disorder or symptoms. Substance use, violence, poverty, community disorganization, and family history of antisocial behavior increased risks for negative outcomes, while social support was protective. The absence of positive findings associated with outpatient treatment is troubling given the empirically supported interventions for the conditions examined. Practitioners, agencies, and managed care organizations share a responsibility to implement effective and comprehensive interventions.

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.

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders

Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related symptoms, and substance use outcomes. Women did better with integrated treatment and with mandated treatment regardless of treatment condition for psychiatric, trauma, and substance use outcomes at both follow-ups. Further research clarifying unintended side effects and change mechanisms of mandated treatment is needed to inform policy decisions.

Implementing Assertive Community Treatment in Diverse Settings for People Who Are Homeless With Co-Occurring Mental and Addictive Disorders: A Series of Case Studies

The Assertive Community Treatment model (ACT) was developed more than 30 years ago to treat individuals with serious and persistent mental illness. This qualitative study highlights practical challenges encountered when establishing ACT teams in diverse settings serving people who are homeless with co-occurring mental and addictive disorders (COD). Program administrators and evaluators from nine programs located in seven states completed a survey on implementation challenges, fidelity, modifications to the ACT model, and program successes. Challenges encountered related largely to staffing and funding limitations as well as to difficulties with implementing the ACT model without modifications. Several modifications to the model were believed beneficial to recruiting and retaining consumers. These included emphasizing housing, adding staff positions not prescribed by ACT, implementing mini-teams within the program, delivering in-office services in a group format, and placing time-limited services by transitioning consumers to less intensive settings. Successes included reduction in hospitalizations, psychiatric symptoms, and substance abuse. Stabilization of consumers was attributed largely to housing assistance and maintenance; medication adherence; and delivery of intensive, multidisciplinary services including substance abuse treatment. Implications of this study suggest the need to adapt the ACT model for people who are homeless with COD by tailoring program staffing and service delivery. Furthermore, there is a need for a measure capable of assessing ACT fidelity in the context of both housing models and integrated treatment for the homeless population.