Return to Work for Healthcare Professionals with Substance Use Disorders: Clinical, Legal, and Ethical Challenges

Occupational health providers (OHPs) and other clinicians who assess readiness to work have a difficult task in assessing return to work for healthcare professionals (HCPs) with substance use disorders (SUDs). About 10 to 15 % of HCPs will misuse drugs or alcohol at some time in their career, yet they are often reluctant to seek help. This paper reviews the clinical challenges of assessing SUDs in HCPs, including risk factors, prognosis, and limited evidence base for work restrictions. Furthermore, ethical and legal challenges throughout the return to work process are reviewed for stakeholders such as HCPs with SUDs, OHPs, other providers, employers, and the public at large. Suggestions are made for stakeholders, particularly for OHPs and other providers, who are navigating this complex environment.     

Distress Tolerance and Intimate Partner Violence among Men in Substance Use Treatment

Intimate partner violence (IPV) is overrepresented among men in substance use treatment. Individuals who relapse following substance use treatment report greater IPV perpetration relative to individuals who remain remitted. In addition, distress tolerance has been shown to be an important treatment target in substance use treatment, with distress tolerance predicting relapse following treatment. However, we are unaware of any research that has examined the relationship between distress tolerance and IPV among men in substance use treatment, which may hold important treatment implications. The current study therefore examined this relationship in a sample of men in substance use treatment (N = 138). Results demonstrated that distress tolerance was negatively associated with physical and psychological IPV perpetration. After controlling for age and substance use and problems, distress tolerance remained associated with psychological, but not physical, IPV perpetration. These findings suggest that distress tolerance may be an important component of treatments for IPV, particularly for psychological aggression. Substance use treatment programs that target distress tolerance may concurrently reduce the risk for relapse to substance use and IPV perpetration.     

Patterns of Violence Exposure and Substance Use among Child Welfare Involved Youth

Journal of Family Violence - Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW)...     

Naturally Occurring Social Support in Interventions for Former Prisoners with Substance Use Disorders: Conceptual Framework and Program Model

Purpose

Naturally-occurring social support is underutilized in interventions with former prisoners with substance use disorders. This paper proposes a conceptual framework followed by a program model to inform the development of naturally-occurring social support interventions with former prisoners with substance use disorders.

Methods

We reviewed all published social support interventions designed for former prisoners and people with substance use disorders over a ten year period. Building on the implications of this review, empirical literature, professional experience, and theory, we propose a conceptual framework for naturally-occurring social support programs.

Results

Few published programs exist that actively incorporate social support providers into the program model. Of these, even fewer use naturally-occurring support. Expanding on gaps in theory and program approaches, the conceptual model posits that it is the appropriate match of support needs and provision that reinforces emotions, cognitions, and behaviors, that in turn, promote adaptive outcomes.

Conclusions

With mounting pressure to identify interventions that will reduce high re-incarceration rates, this paper draws attention to a neglected, potentially effective, and low cost resource - naturally-occurring social support. The described program, Support Matters, illustrates how social support interventions can be used with former prisoners to promote reduced relapse to substance misuse and crime.     

Female Perpetrated Dyadic Psychological Aggression Predicts Relapse in a Treatment Sample of Men with Substance Use Disorders

This study examined whether female-to-male (FTM) psychological aggression predicted men’s relapse of substance use disorder (SUD) 6 months following substance use treatment. Men diagnosed with either a substance abuse or dependence disorder who had recently begun an SUD treatment program participated in the study with their female relationship partners (N = 173). Logistic regression was used to examine the relationship between baseline FTM psychological aggression and SUD relapse when controlling for baseline demographic, dyadic, substance abuse- and treatment-related variables, as well as frequencies of other male- and female-perpetrated aggressive dyadic behaviors. Higher frequencies of severe, but not minor, forms of FTM psychological aggression uniquely predicted an increased risk of relapse at 6 months follow-up. These data add to the developing research program highlighting the negative sequelae of female-perpetrated psychological aggression and also provide an empirical basis for targeting specific dyadic behaviors in the context of SUD treatment and relapse prevention.     

Substance Use and Intimate Violence Among Incarcerated Males

The purpose of this study was to examine substance use patterns among a sample of incarcerated males who report engaging in levels of intimate violence, as well as identifying similarities and differences in demographic, economic status, mental health, criminal justice involvement, relationships, and treatment factors for three groups of incarcerated males - those who report perpetrating low intimate violence, those who report perpetrating moderate intimate violence, and those who report perpetrating extreme intimate violence the year preceding their current incarceration. Findings indicated that low intimate violence group's perpetration consisted almost exclusively of emotional abuse. Moderately intimate violent males and extremely intimate violent males, however, report not only high rates of emotional abuse but physical abuse as well. The distinction between moderate and extremely violent groups was substantial. Findings also indicated that perpetrators at different levels of violence in this study did not vary significantly in age, employment history, marital status, or race. However, the three groups showed significant differences in three main areas: (1) cocaine and alcohol use patterns, (2) stranger violence perpetration and victimization experiences, and (3) emotional discomfort. Implications for substance abuse and mental health treatment interventions and for future research are discussed.     

Trauma,Psychiatric, Substance Use,and Thought Disorders Among Youth in the Juvenile Justice System and How to Deal with Them

The personal stories that youth in juvenile facilities report to their counselors are heartbreaking because they are filled with accounts of excessive trauma resulting from neglect, physical, sexual, and emotional violence perpetrated on these children. Perry found that trauma develops from severe neglect, abuse, and living in terrorizing environments. Trauma changes the neural processing ability within the child's developing brain which can lead to hypervigilance and dysfunctional behavior. ¹ Widom found that children who had been abused or neglected as children have 30% higher arrests as a juvenile and as an adult for a violent offense. ²      

Co-occurring Psychiatric and Substance Dependence Disorders as Predictors of Parolee Time to Rearrest

An estimated 500,000-plus people are on parole each year, many with serious co-occurring psychiatric and substance use disorders. Using cross sectional, self-report data this study examined the relationships between parolee time to rearrest, serious mental illnesses, and substance dependency (n = 1,121). Regression analyses indicated that after controlling for demographic and criminal justice variables, parolees with serious psychiatric and substance dependence disorders were rearrested faster than non-dually diagnosed parolees (p < .05). An explanation is that compared with parolees without dual diagnoses, parole violations by dually diagnosed parolees are detected and punished more quickly because of closer parole supervision.     

Substance Use and Abused Women's Utilization of the Police

There is extensive research that addresses the role of police in responding to domestic violence calls. However, there has been relatively little attention to the factors that impel women to call the police during an incident of abuse. This paper investigates the role of alcohol and drugs in influencing women's utilization of the police for misdemeanor-level incidents of abuse, and is based on interview data from 419 abused women. Results indicate that women are significantly more likely to call the police when male partners use both alcohol and drugs, and when they are frequently drunk. Offender drunkenness, rather than the quantity or frequency of alcohol consumption, has a significant escalation effect on police utilization by victims of abuse.     

The Effects of Mental Health and Substance Abuse Disorders on Institutional Misconduct Among Female Inmates

The US Sentencing Guidelines are among the most ambitious attempts in history to control sentencing discretion. However, a major sea change occurred in January of 2005, when the US Supreme Court ruled in United States v. Booker and Fanfan, that in order to be constitutional, the federal guidelines must be advisory rather than presumptive. The impact of the Booker/Fanfan decisions on interjurisdictional variation and sentencing disparity is an opportunity to examine the issue of whether the increased opportunity to sentence according to substantively rational criteria entails increased extralegal disparity. We draw on a conceptualization of courts as communities and a focal concerns model of sentencing decisions to frame expectations about federal sentencing in the wake of Booker/Fanfan. We test these expectations using USSC data on federal sentencing outcomes from four time periods: prior to the 2003 PROTECT Act, the period governed by the PROTECT Act, post-Booker/Fanfan, and post-Gall v US. In general, we find that extralegal disparity and between-district variation in the effects of extralegal factors on sentencing have not increased post-Booker and Gall. We conclude that allowing judges greater freedom to exercise substantive rationality does not necessarily result in increased extralegal disparity.     

Intergenerational Transmission of Violence: the Influence of Self-Appraisals,Mental Disorders and Substance Abuse

Although research has demonstrated connections between experiencing abuse as a child and being in a violent relationship as an adult, the specific mechanisms through which this transmission occurs are unclear. The purpose of this study was to identify the relationship between certain personal factors (self-appraisals and mental/substance use disorders) and experiencing violence as an adult. Data from the National Comorbidity Survey (NCS) 1990–1992 were utilized. Respondents who reported experiencing childhood abuse or victimization and were in a current intimate partnership (N = 590) were selected for analysis. Multivariate logistic regression indicated that low self-esteem, past year PTSD, and past year alcohol dependence were significantly associated with intimate partner violence after controlling for other self-appraisals and mental disorders.     

Patterns of Crime and Substance Abuse among Israeli Ex-Addict Female Inmates

The current study examined the relationship between drug addiction and crime involvement among Israeli female prisoners, and further examined the differential contribution of early onset of drug, sexual abuse and poly drug use, to predict involvement in offenses against person. Fifty-four ex-addict female inmates participated in this study. Research findings indicated that a majority began using drugs prior to their involvement in crime and most were convicted of drug-related crimes. In addition, almost half had a history of sexual abuse. Female inmates who were sexually abused were characterized by an early onset of drug and poly drug use. A relationship was observed between poly drug use and offenses against person. Also, the duration of drug abstinence corresponded to a lower sense of coherence and higher level of trait anxiety among female inmates. The implications of these findings for substance abuse treatment are discussed. Gila Chen, PhD, is a lecturer in the Criminology Department at Ashkelon Academic College and Bar-Ilan University. Her academic interests include youth at risk, female offenders, self-help groups, and drug addiction.     

Characteristics of Abstainers from Substance Use and Antisocial in the United States

PURPOSE: Whether lifetime abstainer's antisocial behavior are maladjusted or well-adjusted is unresolved. The aim of this study was to compare abstainers (defined as persons with no lifetime use of alcohol and other drugs and non-engagement in antisocial or delinquent behavior) with non-abstainers across a range of sociodemographic and mental health characteristics in the United States. METHODS: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Structured psychiatric interviews (N = 43,093) using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV) were completed by trained lay interviewers between 2001 and 2002. RESULTS: The prevalence of abstaining was 11%. Abstainers were significantly more likely to be female, Asian and African-American, born outside the U.S., and less likely to be unemployed. Multivariate logistic regression analyses revealed that abstainers were significantly less likely to evidence lifetime mood, anxiety, or personality disorder compared to non-abstainers. CONCLUSIONS: Findings indicate that abstainers are not maladapted and are comparatively more functional than non-abstainers.     

Marijuana But Not Alcohol Use During Adolescence Mediates the Association Between Transmissible Risk for Substance Use Disorder and Number of Lifetime Violent Offenses

Aim

This study determined the extent to which alcohol and marijuana use during adolescence mediates the relation between transmissible risk for substance use disorder (SUD) and lifetime number of different types of violent offenses.

Methods

The transmissible liability index was administered to 359 10-12 year old youths who were tracked to 22 years of age. Past year frequency of alcohol and marijuana consumption was longitudinally tracked to age 22 at which time lifetime violent offenses was recorded.

Results

Rate of increase in marijuana use mediated the association between transmissible risk and lifetime number of different types of violent offenses. No association was found between past year frequency of alcohol use and violent offenses.

Conclusions

Prevention directed at lowering the psychological characteristics associated with transmissible risk for SUD may also reduce violent offending.     

Substance abuse among sexual offenders: review of research and clinical implications*

Substance abuse, and in particular alcohol abuse, has been linked to the aetiology and maintenance of violent offending generally and sexual offending specifically. The current paper reviews the literature pertaining to substance abuse among sexual offenders and highlights theoretical developments in the area. An emphasis on issues associated with the therapeutic alliance is stressed when working with high-risk clients who present with multiple needs, including alcohol abuse. The discussion concludes with some practical suggestions regarding assessment and treatment of groups of moderate- to high-risk offenders.     

Key Risk Factors for Relapse and Rearrest Among Substance Use Treatment Patients Involved in the Criminal Justice System

Substance use treatment programs for criminal justice populations have great potential for crime reduction, if they can effectively manage patients’ risk for relapse and rearrest. The current study used data drawn from the Comprehensive Assessment and Treatment Outcome Research (CATOR) system, a national registry of substance use treatment programs, which collected patient outcome data at 6- and 12-month intervals following discharge from treatment. The primary objective was to examine sets of factors that may compromise relapse and rearrest outcomes among patients who were court mandated to participate in treatment. Findings demonstrated that patients’ clinical severity of substance use was associated with relapse, which also significantly increased the probability of post-treatment arrest. Adolescent risk behaviors represented another set of risk factors, particularly among patients who experienced the most severe pattern of relapse and arrest outcomes. Additionally, demographic risk factors, including age, marital status (i.e., single or unmarried relative to married), employment (i.e., being unemployed compared to employed), and lower educational attainment were consistently linked to higher probabilities of relapse and rearrest. Treatment programs for criminal justice populations should consider incorporating appropriate clinical risk assessment measures, behavioral risk assessments, and appropriate employment interventions into standard treatment programming in an effort to improve outcomes.     

The Relationship Between Partner Abuse and Substance Use Among Women Mandated to Drug Treatment

This study investigates the relationship between substance use and partner abuse among women (N = 1,025) who entered drug-treatment programs through the criminal justice systems in New York City and Portland, Oregon. Self-report data on substance use and partner abuse indicate that although the rate of partner abuse in both cities is well above the national average, the less substance-involved women in Portland reported more abuse than their New York counterparts. Our analyses suggest that the relationship between partner abuse and substance use during conflicts varies within the population of women offenders who are heavily drug-involved, with women in Portland reporting a greater direct link between partner abuse and substance use. The findings indicate that there is a need for drug-treatment providers to understand their clients' victimization histories and the relationship between partner abuse and substance use in order to engage clients in the treatment process and help them learn how to avoid being victimized in the future.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.