Maryann Amodeo

Racial and ethnic differences in drug treatment entry of injection drug users in Massachusetts

This article examines patterns of drug treatment entry among 28,000 adult injection drug users (IDUs), with special attention to racial and ethnic differences. The data analyzed originates from a statewide drug-treatment database covering four years. Through the use of logistic regression analysis, the study identified significant population differences between those who used detoxification only, those who used residential treatment and those who used methadone maintenance. Latino IDUs were approximately a third less likely than Caucasian IDUs to enter residential treatment and African American IDUs were half as likely as Caucasian IDUs to enter methadone maintenance treatment. This article discusses specific programmatic and research implications including the need to determine whether differential entry rates are due to access, client awareness, cultural, referral or other factors.

Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy.

PURPOSE This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). METHODS The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). RESULTS Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. DISCUSSION EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.

The Therapeutic Attitudes and Behavior of Social Work Clinicians With and Without Substance Abuse Training

This study examines the influence of substance abuse training on social workers in nonaddiction treatment settings. Eighty-one Masters level social workers who completed a 9-month training program were compared with a matched sample of 78 Masters level social workers who did not enroll, with supervisors as collateral informants. Subjects and supervisors were blind to the purpose of the study. Measures included behavior, clinical skills, and self-rated attitudes. After training, trainees were significantly more likely than comparisons to 1) work with substance-abusing clients, 2) have “substance abuse”-related roles, 3) seek jobs that increased their opportunities to work with substance-abusing clients, 4) assess and intervene with substance abuse, and 5) obtain high ratings of optimism, confidence, and competence.

Modifications of evidence-based practices in community-based addiction treatment organizations: A qualitative research study

This qualitative research effort explored implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study describes CBO program director attitudes on: (1) satisfaction with EBPs they were mandated to implement; (2) the extent to which their organization modified the EBPs; (3) reasons for modifications; and, (4) the standards they used for modifications. Findings indicate that program directors were highly positive both about EBPs implemented and the modifications made to those EBPs. A broad range of modifications were identified; most common were adding or deleting intervention sessions in efforts to serve the needs of a specific client population. Given the addiction treatment fields lack of standards for modifying EBPs, it is not surprising that little consistency occurred in modification efforts. As government funders of addiction treatments require that CBOs implement EBPs, standards need to be created for modifying and adapting the EBPs while maintaining their fidelity.

Racial differences in social support: Kin versus friends.

Social support was examined among 290 Black and White women recruited from the community. We hypothesized that (1) social support, adjusted for social class, would not vary by race and (2) social support would be related to well-being. Standardized measures were administered, examining support provided by friends versus kin separately. Multivariate models showed that Black women reported similar numbers of kin and fewer friends than Whites, while satisfaction with support did not vary by race. Measures of social support were generally associated with well-being. These findings question earlier reports that Black women have stronger kin support than White women, suggesting that clinicians should not assume that Blacks can rely on kin for social support.

Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.

Parental Status of Women Injection Drug Users and Entry to Methadone Maintenance

This article examines patterns of methadone maintenance treatment entry among 9018 adult women injection drug users (IDUs), with special attention to parental-status differences. The data originate from a statewide drug-treatment database covering all women IDUs who entered drug treatment in the State of Massachusetts over a four-year period. Through the use of logistic regression analysis, the study found that among these women IDUs, those who resided with their children were significantly more likely to enter methadone maintenance than women who were mothers but did not reside with their children. Mothers residing with their children were 73% more likely to enter methadone maintenance than mothers who do not reside with their children. The authors discuss specific programmatic and policy implications including the need to determine whether methadone maintenance should be promoted as an alternative drug treatment option in order to preserve family unification or promote family reunification.

Using a Positive Youth Development Approach in Addressing Problem-Oriented Youth Behavior

Interest has grown in the positive youth development (PYD) approach and its application to youth in a variety of settings. When using the PYD approach, workers focus on youth assets rather than deficits, collaborate with youth in planning the youths future, build youth competencies rather than doing tasks for the youth, adopt a holistic perspective of healthy personal growth, and engage in long-range planning rather than short-term solutions. This approach has not typically been applied to youth who demonstrate problem behavior such as substance abuse or psychiatric symptoms. Building on three theories–-strengths, coping, and stages of change–- we offer practice guidelines for applying the PYD approach to problem-oriented youth behavior, with substance abuse as an example.

Childhood Sexual Abuse Among Black Women and White Women From Two-Parent Families:

Differences in childhood sexual abuse (CSA) between Black women and White women are explored in a community sample of 290 women raised in two-parent families.A selfadministered questionnaire and a face-to-face interview assessed CSA characteristics, aftermath, and prevalence as well as family structure and other childhood variables. Siblings served as collateral informants for the occurrence of CSA. Overall, comparisons of the nature, severity, and aftermath of CSA showed similarities by race; some differences, for example, in age of onset, are potentially relevant for the planning of prevention programs. Logistic regression models examined effects of childhood variables on CSA prevalence. Initial analyses showed a higher CSA prevalence among Black women (34.1% [45] of Black women vs. 22.8% [36] of White women) that was attenuated when family structure (e.g., living with two biological parents throughout childhood or not) and social class were considered. Of interest, differences in family structure remained important even among these two-parent families. Understanding the dynamics of abuse by race and family structure will facilitate the design of more targeted CSA prevention programs.

Addiction Training in Social Work Schools: A Nationwide Analysis

Social workers are needed to implement science-based treatments for alcohol and other drug (AOD) problems. Changes in insurance coverage through the Affordable Care Act will increase the demand for licensed Master of Social Work (MSW) clinicians. This national study of MSW programs (N = 210) examines prevalence of addiction courses and specializations. Web-based analyses showed that only 14.3% of accredited schools offered specialization; only 4.7% of accredited schools had one or more required courses. Social work education has not met addiction workforce development needs; there is no evidence this pattern will change.