Marcia Andersen

Substance abuse in women: relationship between chemical dependency of women and past reports of physical and/or sexual abuse

The purpose of this research was to describe a group of chemically dependent females who were involved with the criminal justice system and note if they reported histories of physical/sexual abuse. Data for this study were obtained from Andersens 1986 research project funded by the Michigan Department of Corrections and Wayne State University. The findings showed that 19.7% reported histories of sexual abuse and that 27% reported histories of physical/sexual abuse prior to incarceration. These findings suggest a need for a sexual assessment tool and for further research on the relationships of sexual/physical abuse and chemical dependency.

Reliability and Validity of Not-in-Treatment Drug Users' Follow-Up Self-Reports

Based on a sample of 259 drug users not in treatment from five different sites, we examined the reliability of self-reported demographic and behavioral information and the validity of self-reported drug use. Data were collected twice with a 48-hr interval, using the Risk Behavior Follow-Up Assessment (RBFA; National Institute for Drug Abuse, 1992), a structured interview. We examined internal consistency and test–retest reliability and found that, overall, drug users were generally reliable reporters of information regarding their demographics, drug use, sexual behavior, work and income, and criminal behavior. Exceptions to these findings of reliability were noted for items that were phrased too broadly. Comparison of self-report data and urinalysis results indicates that drug users accurately report cocaine and opiate use, although reports of cocaine use were somewhat more valid. These findings indicate that self-report data from drug users, when collected by trained interviewers, can be considered reliable and valid.

Integrating medical and substance abuse treatment for addicts living with HIV/AIDS: evidence-based nursing practice model.

Forty‐five active substance abusers with HIV/AIDS voluntarily participated in a substance abuse treatment research study with interviews at intake, 6 months and 12 months. These participants were engaged in treatment for a minimum of 45 days and a maximum of 90 days. The study used a nursing model of care, The Personalized Nursing LIGHT model, to integrate treatment for HIV/AIDS with substance abuse treatment. The LIGHT model seeks to enhance patient well being directly and thereby to support interventions that decrease substance use and improve management of chronic disease. The substance abuse treatment team included a nurse who used the LIGHT model and coordinated an integrated care protocol. The nurse accompanied clients on visits to their physicians for HIV treatment and facilitated the integration of medical recommendations with the substance abuse treatment. Six‐month posttest data were gathered on all 45 participants and 12‐month posttest interviews were accomplished with 29 of them. At 6 months, 78% of the respondents (35/45) reported no drug use in the past 30 days, and, at 12 months, 79% (23/29) were drug free for the past month. Significant decreases from intake to 6 months were detected on Addiction Severity Index (ASI) composite scores for drug use (p < 0.01), alcohol use (p < 0.04), medical severity (p < 0.02), psychiatric severity (p < 0.01), legal problems (p < 0.04), and employment difficulty (p < 0.01). Improvement of 6‐month drug use composite scores was related significantly to treatment duration (R = 0.42; p < 0.01). Significant decreases in ASI measures of drug use (p < 0.01), alcohol use (p < 0.01), employment difficulty (p < 0.01), and family/social problems (p < 0.01) also occurred at 12 months. Well being, as measured by a Global Well Being Index, was found to improve significantly at 6 months (p < 0.02) and 12 months (p < 0.07). Concurrently, significant improvement was observed on Medical Outcomes Study‐36‐Item Short‐Form Health Survey (SF‐36) measures of general health and health functioning. These changes were noted at 6 months in the general health (p < 0.02), mental health (p < 0.01), social functioning (p < 0.01), role/emotional status (p < 0.04), and vitality (p < 0.01) subscales. At 12 months, the social functioning (p < 0.01) subscale responses were further decreased.

Effect of a Nursing Outreach Intervention to Drug Users in Detroit, Michigan

The aim of the National Institute on Drug Abuse Cooperative Agreement Projects Detroit site was to compare the effectiveness of two outreach interventions in decreasing the AIDS-related high-risk behaviors of active, injecting drug users and crack cocaine users not in treatment programs. A sample of 539 drug users, 70% males and 30% females, was selected from two high-risk neighborhoods. All subjects participated in two standard AIDS educational and counseling sessions. Half of the subjects then participated in an enhanced intervention—a nursing intervention called Personalized Nursing LIGHT Model. A regression model was used to compare the effects within the two study groups on: (a) number of times injecting heroin, (b) crack cocaine usage, and (c) number of episodes of unprotected sex during the preceding 30 days. The differences between the enhanced groups actual post-test behavior and the behavior predicted by standard treatment alone may be attributable to the addition of the enhanced treatment. The results show the differences are in the expected direction during year two of the study when program conditions were at their maximum, staff were on board and trained, and clients participated actively. Significant decreases were obtained for all three risky behaviors; for heroin, for crack, and for unprotected sex. A dosage measure, participation in addiction treatment (“Tuesday group”), was also significant. These results show that enhanced treatment adds to behavior improvement beyond the contribution of the standard intervention—when the treatment conditions are operating as planned.

LIGHT model: an effective intervention model to change high-risk AIDS behaviors among hard-to-reach urban drug users.

Two thousand thirty-three hospital emergency room (ER) patients who were current, active injecting drug users (IDUs) were voluntary participants in a pretest, posttest research project which utilized a nursing model, the Personalized Nursing LIGHT Model, as a counseling approach to decrease high-risk AIDS behaviors. The LIGHT Model works by directly improving well-being and thereby indirectly decreasing high-risk behaviors associated with AIDS. Addicts from an urban ER in each of three cities (Detroit, Michigan; Brooklyn, New York; and Baltimore, Maryland) were treated with teams consisting of nurses and indigenous outreach workers. Posttest data were gathered on 995 of the clients who received the Personalized Nursing LIGHT Model teaching and counseling intervention. In a posttest at least 3 months after the initial interview, these IDUs reported a significant increase in well-being, t(530) = -11.77; p < .001, and significant reductions in frequency of IV heroin use, z = -18.4; p < .001, IV cocaine use, z = -16.0; p < .001, and IV speedball use, z = -14.3; p < .001, as well as significant decreases in sharing of cookers (a type of drug-using equipment), z = -13.8; p < .001, and other high-risk behaviors associated with AIDS acquisition and transmission. At a second posttest, at least 6 months after the initial interview, these results were unchanged.

From Theory to Practice: The Planned Treatment of Drug Users

ACKNOWLEDGMENTS: This interview is part of a project supported by Sandoz, Inc. Without the belief and support of Dr. Craig Burrell, the project would never have been initiated or completed.

Integrating Health Care for Women Diagnosed with HIV Infection, Substance Abuse, and Mental Illness in Detroit, Michigan

This article describes the evolution of Personalized Nursing, a comprehensive nursing practice model of care. Findings from several nursing research studies contributed to the development of Personalized Nursing. The model includes a practice model of the art of nursing care based on nursing theory and a specific nursing process that directs nursing care delivery. The process of care delivery includes location of hard-to-reach clients; linkage to health care providers; integration of care among providers for clients diagnosed with HIV, mental illness, and substance abuse; and strategies to promote retention in health care. Use of Personalized Nursing is designed to assist clients to improve their well-being and increase positive health-related behaviors. Personalized Nursing has been used in urban landscapes to serve multiply diagnosed clients at risk for HIV infection. The model is currently being used in a study targeting multiply diagnosed women who are lost to follow-up from medical care.

Community Outreach with Active Drug Users: The Detroit Experience

Out-of-treatment drug users are hard to reach. Outreach using indigenous outreach workers introduces appropriate and targeted interventions in an effort to slow the spread of HIV within drug-using networks. A project in Detroit, Michigan, part of the National Institute on Drug Abuse (NIDA) Cooperative Agreement (CA) Project, demonstrated some innovative strategies to reach, recruit, retain, and follow up active drug-using participants in a randomized clinical trial research project.

The Impact of an Intervention Program for HIV-Positive Women on Well-Being, Substance Use, Physical Symptoms, and Depression

SUMMARY The Womens Intervention Program of the Well-Being Institute (WBI) in Detroit, Michigan, was designed to assist HIV-positive women with a history of substance abuse to access primary medical care. The program, based on The Personalized Nursing LIGHT Model, postulates that improved well-being precedes positive change in important areas such as substance use and coping with chronic disease. This evaluative study of 55 participants from intake to first follow-up after six months in the program shows that well-being significantly improved, that substance use declined as well-being improved, that well-being was a significant predictor of ability to cope with living with HIV, and that depression was correlated with physical condition with respect to both status and change.