Magdalena Kulesza

Help-seeking Stigma and Mental Health Treatment Seeking Among Young Adult Veterans

Veterans underutilize mental health services. We investigated the association between treatment-seeking stigma and utilization of mental health services in a sample of 812 young adult veterans. Higher perceived public stigma of treatment seeking was significantly related to lower treatment utilization. Although many veterans were concerned about negative perceptions if they were to seek treatment, a much smaller number of them endorsed that they would judge a fellow veteran negatively in similar situation. Targeting perceived public stigma of treatment seeking, through perceived norms interventions, might help narrow the gap between the need and receipt of help among veterans.

Reviewing and interpreting the effects of brief alcohol interventions: comment on a Cochrane review about motivational interviewing for young adults

Abstract Background Cochrane recently published a systematic review on motivational interviewing (MI) for alcohol misuse in young adults. The review authors concluded that ‘there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol misuse’ (p. 2), as effect sizes were ‘small and unlikely to be of any meaningful benefit in practice’ (p. 27). As most of these interventions were quite brief, we wish to open a dialogue about interpreting effect sizes in this review and of (brief) alcohol interventions more generally. Analysis We analyze four methodological aspects of the review that likely influenced the authors conclusions about intervention effects: (1) risk of bias assessments, (2) search strategies, (3) assessing the quality of the body of evidence and (4) definitions of sustainability and clinical significance. Conclusions We interpret the effect sizes found in this review to indicate modest yet beneficial and potentially meaningful effects of these interventions, given their brevity and low cost. This interpretation is consistent with other reviews on brief, MI‐based interventions and brief interventions more generally. We therefore encourage the field to re‐open dialogue about the clinical importance of the effects of MI on alcohol misuse by young adults. Rather than dismissing interventions with small effects, we believe a more fruitful way forward for the field would be to catalogue effect sizes for various alcohol interventions. Such a catalogue would help stakeholders themselves to choose which interventions meet their minimum desired impact, and thus may be suitable given their targeted populations, setting and resources.

Developing a research agenda for understanding the stigma of addictions Part I: Lessons from the Mental Health Stigma Literature

BACKGROUND AND OBJECTIVES Although advocates and providers identify stigma as a major factor in confounding the recovery of people with SUDs, research on addiction stigma is lacking, especially when compared to the substantive literature examining the stigma of mental illness. METHODS A review of key studies from the stigma literature that yielded empirically supported concepts and methods from the mental health arena was contrasted with the much smaller and mostly descriptive findings from the addiction field. RESULTS Integration of this information led to Part I of this two part paper, development of a research paradigm seeking to understand phenomena of addiction stigma (eg, stereotypes, prejudice, and discrimination) and its different types (public, self, and label avoidance). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE In Part II paper (American Journal of Addictions, Vol 26, pages 67-74, this issue), we address how this literature informs a research program meant to develop and evaluate and stigma strategies (eg, education, contact, and protest). Both papers end with recommendations for next steps to jumpstart the addiction stigma portfolio. Here in Part I, we offer one possible list of key research issues for studies attempting to describe or explain addiction stigma. (Am J Addict 2017;26:59-66).

Developing a research agenda for reducing the stigma of addictions, part II: Lessons from the mental health stigma literature: Reducing The Stigma of Addiction

BACKGROUND AND OBJECTIVES Although advocates and providers identify stigma as a major factor in confounding the recovery of people with SUDs, research on addiction stigma is lacking, especially when compared to the substantive literature examining the stigma of mental illness. METHODS A comprehensive review of the stigma literature that yielded empirically supported concepts and methods from the mental health arena was contrasted with the much smaller and mostly descriptive findings from the addiction field. In Part I of this two part paper (American Journal of Addictions, Vol 26, pages 59-66, this issue), constructs and methods from the mental health stigma literature were used to summarize research that seeks to understand the phenomena of addiction stigma. RESULTS In Paper II, we use this summary, as well as the extensive literature on mental illness stigma change, to outline a research program to develop and evaluate strategies meant to diminish impact on public and self-stigma (eg, education and contact). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The paper ends with recommendations for next steps in addiction stigma research. (Am J Addict 2017;26:67-74).

Moderated mediation analysis: An illustration using the association of gender with delinquency and mental health.

PURPOSE When researchers find an association between two variables, it is useful to evaluate the role of other constructs in this association. While assessing these mediation effects, it is important to determine if results are equal for different groups. It is possible that the strength of a mediation effect may differ for males and females, for example - such an effect is known as moderated mediation. DESIGN Participants were 2532 adolescents from diverse ethnic/racial backgrounds and equally distributed across gender. The goal of this study was to investigate parental respect as a potential mediator of the relationship between gender and delinquency and mental health, and to determine whether observed mediation is moderated by gender. FINDINGS Parental respect mediated the association between gender and both delinquency and mental health. Specifically, parental respect was a protective factor against delinquency and mental health problems for both females and males. PRACTICAL IMPLICATIONS Demonstrated the process of estimating models in Lavaan, using two approaches (i.e. single group regression and multiple group regression model), and including covariates in both models.

Bringing Alcohol Treatment to Driving Under the Influence Programs: Perceptions from First-Time Offenders

ABSTRACT Alcohol use disorders (AUDs) are common among persons with a first-time driving under the influence (DUI) arrest. Individuals with a DUI arrest may attend a DUI alcohol education program for license reinstatement. The authors evaluated the acceptability of Cognitive Behavioral Therapy (CBT) for AUDs adapted for DUI programs. Participants (N = 35) were enrolled in one of two DUI programs in Los Angeles and were an average of age 34.5 (SD = 11.9) years, 66% male, 37.1% African American, 34.2% Hispanic/Latino(a), and 20% non-Hispanic White. The authors analyzed data from 10 focus groups and 35 self-report surveys that evaluated the nine-session CBT group protocol. Overall, participants stated that the CBT philosophy was acceptable and helpful in thinking about how to prevent future DUIs. They also found the coping skills in the sessions relevant to other life events and decisions. Participants valued the personal disclosure and interactive role-play and group exercises embedded within each session, stating that these exercises helped with group cohesion and self-disclosure. Data from satisfaction surveys showed that participants reported high satisfaction ratings on the overall session, session content, and session facilitator. Future studies are needed to evaluate whether evidence-based treatment within DUI programs may increase access to evidence-based care among individuals who are at risk and who may not otherwise seek treatment for their AUDs.

Evidence-Based Practices: Community-Based Interventions to Reduce Alcohol Use and Misuse

This chapter is a literature review highlighting effective community-based prevention initiatives for reducing and preventing adolescent substance use and misuse. Findings are presented from the research literature on multicomponent prevention initiatives and environmental strategies/policies implemented by communities that have a consistent evidence base of positive results. For these sections, the authors integrate findings from two recent publications, (1) Planning Alcohol Interventions Using NIAAA’s College AIM Alcohol Interventions Matrix (National Institute on Alcohol Abuse and Alcoholism (NIAAA). Planning alcohol interventions using NIAAA’s College AIM Alcohol Interventions Matrix (NIH Publication No. 15-AA-8017). Bethesda, MD: National Institutes of Health, 2015), and (2) Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (U.S. Department of Health and Human Services, Office of the Surgeon General. Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services, 2016). This update also includes a brief review of research literature on positive youth development (PYD), a holistic approach that focuses on developmental characteristics that can lead to positive outcomes including a reduction in negative behaviors among youth such as substance use. The chapter concludes by providing several recommendations to promote high-quality implementation to increase the likelihood of positive results. As funding for comprehensive evaluation efforts of community-based efforts becomes scarce, a communities’ capacity to ensure high-quality implementation should be prioritized.

Relationship between Provider Stigma and Predictors of Staff Turnover among Addiction Treatment Providers

ABSTRACT To further our knowledge about feasible targets for improving quality of addiction treatment services, the current study provides preliminary assessment of the relationship between provider stigma and indicators of staff turnover. As predicted, results suggest that higher provider stigma was significantly related to lower ratings of job satisfaction and workplace climate. However, provider stigma was not significantly related to burnout. Our preliminary findings, if replicated, suggest the importance of considering provider stigma as a risk factor for future staff turnover and job dissatisfaction. Promising provider stigma interventions do exist and offer viable opportunity for improving quality of addiction treatment.