Sally J. Stevens

Traumatic stress and gender differences in relationship to substance abuse mental health physical health and HIV risk behavior in a sample of adolescents enrolled in drug treatment.

Research on traumatic stress (TS) among adolescent substance users is limited, with research indicating that not all adolescents who experience trauma are substance users and not all adolescent substance users report symptoms of TS. In the general adolescent population, research on TS symptoms indicates gender differences, with more females reporting traumatic life events and more symptoms associated with traumatic stress. A gap in research exists, however, with regard to gender differences among adolescent substance users who report low versus acute levels of TS symptoms. This study included 274 male and 104 female adolescents enrolled in four drug treatment programs in Arizona. Comparisons between males and females and those with low versus acute levels of TS symptoms were examined with regard to substance use, mental health, physical health, and HIV risk-taking behavior. Results indicate significant differences between males and females and between those reporting low versus acute TS. In general, females and those with acute levels of TS symptoms had higher levels of substance use, mental health, and physical health problems as well as greater HIV risk behaviors when compared to males and those with low levels of TS symptoms. Results of this study indicate the need to assess adolescents for TS, including victimization and maltreatment histories, when entering substance abuse treatment and the need to simultaneously address issues of substance use, TS, and related mental health, physical health, and HIV sex risk behavior while in treatment.

Imaging of the Ovary

Epithelial ovarian cancer has the highest mortality rate among the gynecologic cancers and spreads beyond the ovary in 90% of the women diagnosed with ovarian cancer. Detection before the disease has spread beyond the ovary would significantly improve the survival from ovarian cancer, which is currently only 30% over 5 years, despite extensive efforts to improve the survival. This study describes initial investigation of the use of optical technologies to improve the outcome for this disease by detecting cancers at an earlier and more treatable stage. Women undergoing oophorectomy were recruited for this study. Ovaries were harvested for fluorescence spectroscopy, confocal microscopy, and optical coherence tomography. Fluorescence spectroscopy showed large diagnostic differences between normal and abnormal tissue at 270 and 340 nm excitation. Optical coherence tomography was able to image up to 2mm deep into the ovary with particular patterns of backscattered intensity observed in normal versus abnormal tissue. Fluorescence confocal microscopy was able to visualize sub-cellular structures of the surface epithelium and underlying cell layers. Optical imaging and/or spectroscopy has the potential to improve the diagnostic capability in the ovary, but extended systematic investigations are needed to identify the unique signatures of disease. The combination of optical technologies supported by modern molecular biology may lead to an instrument that can accurately detect early carcinogenesis.

A Therapeutic Community for Substance-Abusing Pregnant Women and Women with Children: Process and Outcome

The fact that women of childbearing age make up a large proportion of the alcohol and other drug using population has gained national attention. Since treatment for addicted pregnant women and women with children has become a federal priority, treatment programs of various modalities have opened their doors to this population. One promising treatment modality is the therapeutic community (TC). This article briefly describes Amity, a TC for women and children that provides long-term residential TC treatment for addicted pregnant women and women with children. Amity currently has 65 women and 50 children living together in treatment on a 23-acre ranch. Descriptive data including demographic information and data on violence are presented. Preliminary outcome data are detailed, comparing drop out and treatment completion on such variables as alcohol and other drug use, rearrest, employment, child custody, and involvement in support groups. A pattern of behavior involving experiences in violent episodes and alcohol and other drug use is illuminated and discussed. Ideas for further research are suggested.

Chasing Sexual Orientation: A Comparison of Commonly Used Single-Indicator Measures of Sexual Orientation

This research investigated the utility of single-indicator measures of sexual orientation in examining group differences. Adolescents and young adults reported their sexual orientations, preferences, and partners. Results indicate that, (a) depending on the measure of sexual orientation, 10% to 22% cannot be categorized into a sexual orientation group using a single-indicator measure; (b) self-identified sexual orientation is often incongruent with preference and behavior; (c) incongruity differs by gender and self-identified sexual orientation; and (d) detected differences in gay/lesbian, bisexual, and straight individuals vary by measure of sexual orientation. These results indicate that classification of sexual orientation by single-indicator measures can lead to inconsistent conclusions across studies.

Gender differences in substance use, mental health, and criminal justice involvement of adolescents at treatment entry and at three, six, twelve and thirty month follow-up

Abstract Many adolescents entering substance abuse treatment have coexisting mental health problems and are criminally involved. Examination of the complexities of substance use, mental health, and criminal justice involvement along with changes in these issues following treatment is needed. This study includes 941 males and 266 females enrolled in seven drug treatment programs located in geographically diverse areas of the United States. Comparisons between males and females at treatment entry and three. six, 12 and 30 months later were examined with regard to substance use, mental health, and criminal justice involvement. Results indicate that females showed significantly greater severity in substance use, problems associated with use, and mental health related variables at intake while males had significantly more days on probation /parole. With respect to change over time, the rate of change in mental health and days on probation/parole differed between the sexes. Results indicate that while rate of change is different for males and females on most variables, there was positive change following treatment for both groups with regard to substance use, mental health, and probation/parole status. The high severity levels of females at intake calls for gender-specific outreach and identification along with gender-specific treatments.

Maltreatment issues and outcomes of adolescents enrolled in substance abuse treatment

Although they are mandated reporters and work regularly with youth who have experienced abuse and trauma, many substance abuse treatment programs do not systematically screen for or address child maltreatment issues. This special issue provides a collection of articles that consistently demonstrate the feasibility of systematically screening for victimization among adolescents entering these programs and documents that multiple co-occurring types of victimization are actually the norm. Other articles in the section examine how levels of abuse and traumatic victimization are associated with aspects of adolescent substance use disorders, traumatic distress symptoms, co-occurring somatic and health problems, HIV risk behaviors, and a victim-to-abuser spiral. Finally, the articles address how this might affect treatment matching across levels of care. This introduction provides an overview of the articles and then highlights some of the key implications of this collective body of work for practice, policy, and future research.

Meeting the substance abuse treatment needs of lesbian, bisexual and transgender women: implications from research to practice.

Research on the incidence, etiology and substance abuse treatment needs of lesbian, bisexual and transgender (LBT) women is limited. Most research indicates higher levels of alcohol and drug abuse among these populations compared to their heterosexual counterparts, with recent research indicating that substance abuse is a particular concern for transgender individuals and an increasing problem among younger LBT individuals. Risk factors and reasons for substance abuse among sexual minority women are similar to those of heterosexual women, yet are substantially complicated by issues of family rejection and lack of social support, stigma and minority stress, as well as abuse and harassment. Historically, substance abuse prevention, early intervention, and clinical treatment programs were designed to meet the needs of the sexual majority population with relatively few programs designed to incorporate the specific needs of sexual minorities. This article reviews findings from previous studies and utilizes new data collected from community-based and residential substance abuse treatment programs to (1) examine issues relevant to LBT women and substance use, and (2) make recommendations for tailoring substance abuse treatment programs to meet the needs of these populations.

Sex partners of native American drug users

This study describes patterns of sexual behavior and condom use in a sample of Native American drug-using men and women (N = 114). Data are self-reports of sexual behavior in the last 30 days, including descriptions of the most recent sex partners up to five. These data provided information on 157 sex partner pairs, of which at least one partner was a drug user. Native American women (55%) were more likely than Native American men (23%) to report never using condoms for vaginal and anal sex in the last 30 days. Compared with other ethnic pair combinations, sex partner pairs composed of Native American women and white men (n = 18) were the least likely to use condoms (6% of pairs) and the most likely to report an injection drug user (IDU) sex partner (33% of pairs). These results suggest a potential vector of HIV and other sexually transmitted disease (STD) transmission between white male IDUs and Native American women and highlight the need for further qualitative and quantitative research to examine the factors underlying this pattern of sexual risk behavior.

A comparison of victimization and perpetration of intimate partner violence among drug abusing heterosexual and lesbian women

The study describes types and rates of intimate partner violence (IPV) reported by active drug using women enrolled in a street outreach HIV prevention research study located in Tucson, Arizona. IPV data were collected on 434 women at the baseline assessment who reported being in a current intimate partner relationship. The data collected included types of violence as well as rates of victimization and perpetration of IPV. Using profile analysis, we examined similarities and differences in patterns of incidence rates of both victimization and perpetration of IPV across different IPV behaviors experienced by heterosexual and lesbian women. Results indicate substantial rates of IPV among both heterosexual and lesbian women with both similarities and differences in IPV behaviors reported. Results suggest that type of relationship and type of IPV behavior are important factors in identifying and preventing IPV, and improving interventions aimed at addressing IPV.

Criminally Involved Drug-Using Mothers: The Need for System Change

Most criminally involved drug-using females are mothers and are a disenfranchised population; although, little data are available on the differences between female drug users with children and female drug users without children in their care with regard to income, stability, resources, and other economic and contextual variables. Given the lack of information on criminally involved drug-using women, this study examines differences between drug-using women with children and drug-using women without children in their care with regard to basic demographics, mobility, resources, drug use, and legal problems or involvement. Participants selected for this examination included 154 criminally involved female drug users who had given birth to at least one child and were selected from a larger sample of 214 women who were randomly assigned to participate in a legal session. Descriptive and inferential statistics were used to examine the differences and similarities of the two groups. An ethnic-racial disparity was evident when examining the differences of characteristics of women who have children in their care versus those who do not. Overall, data from this study suggest that both groups of women are on the edge in terms of poverty, addiction, and rearrest. These results indicate that proactive measures that address this high-risk group are required.