Patricia A. Harrison

Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation.

Objectives This study examines alcohol and nonmedical drug use before and during pregnancy and identifies the predictors of use cessation before the first prenatal visit. Methods Data analyses were based on the Prenatal Risk Overview (PRO), a structured interview that screens for psychosocial risk factors associated with poor birth outcomes. The study sample includes 1,492 consecutive prenatal care patients from four urban clinics between November 2005 and June 2007. Results Reported alcohol and drug use pre-pregnancy was much higher among U.S.-born women than immigrants, and among unmarried women than married women. American Indians had the highest rates among racial/ethnic groups. Since learning of their pregnancy, 5.6% of patients reported alcohol use and 10.7% reported drug use, reflecting cessation rates of 87.0% for alcohol and 55.6% for drugs. In logistic regression analyses, older age, current smoking, and lack of transportation predicted both alcohol and drug use continuation. Alcohol use continuation was also predicted by pre-pregnancy alcohol use frequency, depression, and physical/sexual abuse by someone other than an intimate partner. Drug use continuation was also predicted by race (higher for American Indians and African Americans), and pre-pregnancy drug use frequency. Conclusions Women who continued to use alcohol or drugs after learning they were pregnant were more frequent users than spontaneous quitters, more likely to smoke cigarettes, and had more psychosocial stressors. Achieving higher rates of cessation may require approaches that simultaneously address substance use and impediments to quitting. Higher continuation rates among some cultural groups require further investigation.

Differential drug use patterns among sexually abused adolescent girls in treatment for chemical dependency.

A sample of 444 girls admitted to adolescent chemical dependency treatment was divided into four groups based on sexual abuse experiences. Girls who reported intrafamilial abuse, extrafamilial abuse, or both, were compared with nonvictims in terms of alcohol and drug use histories. Prevalence and frequency of alcohol, marijuana, and cocaine did not differ significantly among the groups. However, all sexual abuse victims were significantly more likely to regularly use stimulants, sedatives, tranquilizers, and hallucinogens. Sexual abuse victims also reported earlier onset of alcohol and drug use, more self-medication, and more use to escape family problems.

Alcoholics Anonymous after Treatment: Attendance and Abstinence

Follow-up data on 900 inpatients at eight hospital-based chemical dependency treatment centers demonstrate a high correlation between total abstinence 6 months after discharge and weekly attendance at Alcoholics Anonymous during this period. Almost three-fourths (73%) of the regular attendees remained chemically free, compared with one-third (33%) of the nonattendees. These data suggest that Alcoholics Anonymous is an appropriate and beneficial aftercare for the majority of treatment inpatients.

Sexual abuse correlates: Similarities between male and female adolescents in chemical dependency treatment.

A history of sexual abuse was examined for its relationship to signs ofpsychosocial dysfunction among an aggregated adolescent chemical dependency treatment sample. Chemical Abuse Treatment Outcome Registries (CATOR) collected and analyzed data on adolescents admitted to nine private treatment centers from 1984 to 1986; 210 self-reported female victims were compared with 234 nonvictims, 81 male victims with 890 nonvictims. Both male and female victims used a wider variety of drugs than did nonvictims and more used alcohol and drugs to self-medicate. More victims were troubled by nervousness, sleep problems, sexual problems, and suicidal thoughts. Twice as many victims as nonvictims had attempted suicide during the previous year. More victims were arrested at a young age, and more had suffered serious legal consequences. These findings have important implications for the evaluation and treatment of adolescents in clinical and correctional settings, as well as for rethinking priorities and strategies for prevention of substance abuse among the young.

Systematic Prenatal Screening for Psychosocial Risks

The Prenatal Risk Overview (PRO) was designed to screen for 13 psychosocial risk factors associated with poor birth outcomes. This study describes the development and implementation of the PRO in 4 community health centers. The study also examines the prevalence, co-occurrence, and inter-correlations of psychosocial risks in their prenatal populations. The study sample included 1,386 prenatal patients screened between November 2005 and April 2007; 95% were women of color; 77% were not married. The PRO classified 48% at moderate or high risk for housing instability; 32% for food insecurity; 75% for lack of social support; 7% for intimate partner violence; 9% for other physical/sexual abuse; 18% for depression; 23% for cigarette use, 23% for alcohol use, and 25% for drug use. Systematically assessing and quantifying psychosocial risks are essential activities for evaluating the extent to which appropriate and timely responses to identified risks reduce infant mortality, preterm births, and low birth weights.

Women in treatment: changing over time

The early 1970s marked the transition of experimentation with illicit drugs from a deviant behavior to a normative behavior among adolescents in the United States as well as the resurgence of the feminist movement in this country. A sample of 572 women from 21 treatment centers in 11 states was divided into two groups--age 35 and over, and under 35--to roughly correspond to whether they had reached adulthood before or after these cultural shifts. Younger and older women exhibit significant differences with respect to substance use patterns and prevalence of eating disorders, childhood antisocial behaviors, suicide attempts, and abuse by boyfriends and spouses.

Outcomes monitoring in Minnesota: treatment implications, practical limitations.

Minnesota developed its treatment outcomes monitoring system to evaluate its service delivery system and to identify specific ways to enhance treatment outcomes. Standardized patient and treatment data were collected for all outpatient and inpatient admissions, and an assessment interview and weekly treatment services records were completed for 4953 adults and 387 adolescents who consented to participate in the outcomes study. Six-month follow-up interviews were completed for 64.4% of these adults and 83.5% of these adolescents. The study identified predictors of treatment completion and outcome for adults and adolescents, and predictors of outcome by setting for adults. The study also examined results for programs designed especially for adolescents, women, and culturally specific populations, as well as the relationships to outcomes of ancillary services and continuing care activities. Anticipated policy and program design changes resulting from the findings are discussed, along with the practical limitations of conducting a state outcomes monitoring system.

The effects of data collection mode and disclosure on adolescent reporting of health behavior

This study examined how information obtained from an adolescent screening instrument administered in a medical clinic is affected by the method of data collection and knowledge that a summary report would be given to the provider. The Adolescent Health Review (AHR) was administered to 610 adolescent patients randomly assigned to 1 of 3 conditions to test the effect of mode of administration (paper vs. computer) and disclosure of results to the provider versus only to researchers (using the computer version). The AHR obtained information on mental health, sexual experiences, and use of psychoactive substances. Response patterns varied by mode of administration, with the paper version generally eliciting higher, and arguably more accurate, rates of disclosure. Knowing that the results would be provided to the doctor further attenuated disclosure. Results suggest that the paper versions higher rates of reporting must be weighed against the computer versions benefits of automated scoring and reporting.

Correlates of sexual abuse among boys in treatment for chemical dependency

Abstract Chemical dependency in adolescence is compounded frequently by environmental and developmental difficulties. Victims of child sexual abuse are believed to be at increased risk of psychological and behavioral problems, including alcohol and drug abuse. However, empirically derived evidence of correlates of sexual abuse victimization among boys is scarce. In a sample of 1,227 boys in adolescent chemical dependency treatment centers, only a small proportion (6.6%) disclosed a history of intrafamilial or extra‐familial sexual abuse. However, these boys can be distinguished from their counterparts by more serious psychopathology, behavior problems and environmental risk. Specifically they report more family violence and substance abuse, more agitation and suicidal behavior and earlier legal troubles. Even their histories of substance abuse set them apart: they started drinking and drug use earlier, were involved with more drugs and used drugs more frequently. Their symptoms patterns were more indicati...

Conjoint Treatment of Dual Disorders

Traditional, distinct models of treatment for psychiatric illness and substance abuse are no longer adequate to respond to the clinical reality of coexisting disorders (Ziegler-Driscoll, Sax, Deal, & Ostreicher, 1980). The body of evidence on the prevalence of dual disorders is increasing rapidly (Alterman, Erdlen, & Murphy, 1981; McLellan, Druley, & Carson, 1978; Pokorny, 1965; Powell, Penick, Othmer, Bingham, & Rice, 1982). Many authors agree that existing substance abuse rehabilitation concepts are outmoded for the emerging population and that more comprehensive and flexible services are needed to respond successfully to patients with chronic patterns of substance abuse and severe emotional dysfunction (Carroll, 1975; Dichter & Eusanio, 1978; Fine, 1980; McLellan, MacGahan, & Druley, 1978; Ziegler-Driscoll et al, 1980). Others emphasize that the successful assimilation of patients with a wide array of problem areas and range of dysfunction into an effective program will be determined not only by the severity of the patients’ disorders but by the training and experience of the staff (Fine, 1980; Zosa, 1978).