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Bone marrow biopsy is common in patients suspected of having systemic AL amyloidosis. However, little is known about the incidence, morphology and clinical phenotype of non-AL amyloid types in bone marrow.We retrospectively identifiedThe amyloid types were: AL (ATTR amyloid is common in bone marrow and its morphologic distribution overlaps with AL. Amyloid typing is critical as over 10% of patients with bone marrow amyloid, cardiac amyloidosis, and an M-spike have ATTR amyloidosis.

Substance use disorders (SUDs) are a pervasive public health problem with deleterious consequences for individuals, families, and society. Furthermore, SUD intervention is complicated by the continuous possibility of relapse. Despite decades of research, SUD relapse rates remain high, underscoring the need for more effective treatments. Scientific findings indicate that SUDs are driven by dysregulation of neural processes underlying reward learning and executive functioning. Emerging evidence suggests that mindfulness training can target these neurocognitive mechanisms to produce significant therapeutic effects on SUDs and prevent relapse. The purpose of this manuscript is to review the cognitive, affective, and neural mechanisms underlying the effects of mindfulness-based interventions (MBIs) on SUDs. We discuss the etiology of addiction and neurocognitive processes related to the development and maintenance of SUDs. We then explore evidence supporting use of MBIs for intervening in SUDs and preventing relapse. Finally, we provide clinical recommendations about how these therapeutic mechanisms might be applied to intervening in SUDs and preventing relapse.

Scientific and professional developments in the coming decade will have profound implications for social work doctoral education and the research and academic careers doctoral students are preparing for. These developments include the knowledge explosion, corporatization of the university and related effects, and the emergence of the Grand Challenges for Social Work initiative delimiting key directions for social work research and practice. We consider potential effects of these developments on doctoral social work education and proffer curricular, pedagogic, and programmatic recommendations for improving doctoral education in the coming decade.

Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.

Background: A subset of chronic pain patients misuse prescription opioids as a means of regulating negative emotions. However, opioid misuse may result in deficits in emotion regulation strategies ...

Background: Internet gaming disorder (IGD) is characterized by signs and symptoms similar to substance use and gambling disorders, and associated with psychosocial impairments. Research suggests th...

This mixed methods study explores college students' readiness-to-change and receptivity to treatment for problem Internet overuse behaviors. Focus groups were conducted with 27 college students who self-identified as Internet over-users, and had experienced biopsychosocial problems related to Internet overuse. Participants completed standardized questionnaires assessing their Internet use and sociodemographic forms. Focus groups explored readiness to change problem Internet overuse behaviors and receptivity to treatment. Similar to college students with other addictive behaviors, students with problem Internet overuse fall along a continuum vis-à-vis readiness-to-change their behaviors. Over half of the participants were receptive to treatment for their problem Internet overuse behaviors.

Objective: Self-medication with alcohol has been documented among individuals exposed to chronic trauma who may be unable to resist urges to drink in high-risk situations. Persistent alcohol use ca...

In everyday conversation, viewing a talker's face can provide information about the timing and content of an upcoming speech signal, resulting in improved intelligibility. Using electrocorticography, we tested whether human auditory cortex in Heschl's gyrus (HG) and on superior temporal gyrus (STG) and motor cortex on precentral gyrus (PreC) were responsive to visual/gestural information prior to the onset of sound and whether early stages of auditory processing were sensitive to the visual content (speech syllable versus non-speech motion). Event-related band power (ERBP) in the high gamma band was content-specific prior to acoustic onset on STG and PreC, and ERBP in the beta band differed in all three areas. Following sound onset, we found with no evidence for content-specificity in HG, evidence for visual specificity in PreC, and specificity for both modalities in STG. These results support models of audio-visual processing in which sensory information is integrated in non-primary cortical areas.

Administrators of schools of social work are paying more attention to the changing roles and types of faculty in their institutions, particularly given the surge of non-tenure-track faculty in academia. This topic is timely as social work grapples with the divergent roles, structure, and demographic characteristics of non-tenure-track faculty compared to their tenured or tenure-track counterparts. This exploratory study presents data from non-tenure-track women faculty (N = 10) on how they experience professional development. In-depth, qualitative data was collected to answer the research question, What do faculty identify as the barriers, supports, and opportunities for professional development and job satisfaction? Results indicate that organizational climate and mentoring are barriers and facilitators of faculty development, and the subjective definition of faculty development varies.

Stepfamily scholars have emphasized the importance of including stepchildren in the analysis and discussion of stepfamily life. This systematic review synthesized recent research examining predictors/correlates of stepparent–child relationship quality from the viewpoint of stepchildren in the United States. Five bibliographic databases were searched, resulting in 631 potentially relevant studies for review. Manual searches of three prominent family studies journals were also conducted. Screening and eligibility assessment based on a priori inclusion criteria yielded a final sample of 23 studies, including published studies and reports found in the “gray” literature. Significant predictors/correlates associated with stepchildren's perceptions of stepparent–child relationship quality were grouped into the following conceptual domains: individual characteristics, family characteristics, features of (step)parent–child interactions, and stepcouple dynamics. Limitations, implications, and future research direct...

Prior research has focused primarily on the educational benefits of high socioeconomic status (SES). Little is known about educationally successful youth from low-SES backgrounds, and no published review has systematically evaluated the methodological characteristics of research in this area. The primary aim of this report was to systematically review methodological characteristics of research identifying parenting factors conducive to the educational success of low-SES youth. A secondary aim was to briefly summarize the substantive findings of research in this area. A bibliographic search of 11 electronic databases, a manual search of two journals, and reference harvesting yielded 30 English-language studies published between 1994 and 2014 employing quantitative, qualitative, and mixed-method designs that met a-priori study eligibility criteria. Studies of parent–school involvement, parental expectations for current and long-term academic performance, and warm, responsive, and consistent parenting styles...

Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic neoplasm that typically presents with B symptoms, anemia, and lymphadenopathy. Its overall prognosis is poor, with a 5-year survival rate of 30%. We present a case of AITL that went into spontaneous remission, an uncommon occurrence.

The authors are developing a novel type of spinal cord stimulator, designed to be placed directly on the pial surface of the spinal cord, for more selective activation of target tissues within the dorsal columns. For pre-clinical testing of the device components, an ovine model has been implemented which utilizes the agility and flexibility of a sheep's cervical and upper thoracic regions, thus providing an optimal environment of accelerated stress-cycling on small gauge lead wires implanted along the dorsal spinal columns. The results are presented of representative biomechanical measurements of the angles of rotation and the angular velocities and accelerations associated with the relevant head, neck and upper back motions, and these findings are interpreted in terms of their impact on assessing the robustness of the stimulator implant systems.

This study develops a means of delivering electrical stimuli directly to the pial surface of the spinal cord for treatment of intractable pain. This intradural implant must remain in direct contact with the cord as it moves within the spinal canal. Therefore, magnetic resonance imaging was used to measure the movement of the spinal cord between neutral and flexed-back positions in a series of volunteers (n = 16). Following flexion of the back, the mean change in the pedicle-to-spinal cord dorsal root entry zone distance at the T10-11 level was (8.5 ± 6.0) mm, i.e. a 71% variation in the range of rostral-caudal movement of the spinal cord across all patients. There will be a large spectrum of spinal cord strains associated with this observed range of rostral-caudal motions, thus calling for suitable axial compliance within the electrode bearing portion of the intradural implant.

Eighty-two hospitalized alcoholics receiving pharmacological aversion therapy (PAT) over a 10-day treatment interval completed cognitive, behavioral, and psychophysiological measures evaluating conditioned aversion to alcohol. Pre-post assessments provided convergent support for the efficacy of PAT vis-à-vis production of conditioned aversion to alcohol. Positive alcohol-related outcome expectancies were significantly reduced, whereas confidence that drinking could be avoided in various high-risk situations for consumption was increased following PAT. Behavioral and cardiac rate assessments revealed significant changes following PAT that were specific to alcoholic beverages and potentially reflective of conditioned alcohol aversion. Patients with more extensive pretreatment experiences with alcohol-associated nausea and greater involvement in antisocial conduct appeared to be less susceptible to the PAT conditioning protocol.

Although helium-related fatalities and concerns about potentially harmful effects of helium use have increased in recent years, virtually nothing is known about the epidemiology of helium inhalation in adolescents. This exploratory investigation examined the prevalence and correlates of helium inhalation in a large sample of at-risk youth. Study participants were 723 Missouri adolescents (M age = 15.5, SD = 1.2) in residential treatment for delinquent behavior. More than one-in-nine (N = 81, 11.5%) adolescents had inhaled helium with the intention of getting high, and one-third (N = 27, 34.2%) of helium users reported they actually did get high when they inhaled helium. Helium users were significantly more likely to be Caucasian, to live in rural/small town areas, and to have histories of mental illness, auditory hallucinations, and alcohol and marijuana use than nonusers. Helium users also reported significantly more current psychiatric distress, suicidality, traumatic life experiences, and antisocial attitudes, traits, and behaviors than nonusers. Helium inhalation was prevalent in this sample and many such users reported getting high while using helium. Helium users had psychosocial profiles similar to those of volatile solvent users, suggesting that they may be at substantial risk for a variety of adverse health outcomes.

We have designed, built and tested an anthropomorphic-scale surrogate spinal canal, for use in preliminary evaluations of the performance characteristics of a novel intradural spinal cord stimulator. The surrogate employs a silicone mock spinal cord with semi-major and semi-minor diameters of 10 and 6 mm, respectively, commensurate with those of actual thoracic-level spinal cord. The axial restoring force provided by the 300 µm thick silicone denticulate ligament constructs on the mock cord is ~ 0.32 N mm(-1) over a 1.5 mm range of displacement, which is within a factor of 2 of that measured by others in human cadaver specimens. Examples of testing protocols of prototype intradural stimulators that employ this device are discussed.

We have designed, built and tested a novel device for placing intradural neurmodulator implants directly on the pial surface of the spinal cord. This applier tool is designed for ergonomic handling of delicate electro-mechanical devices such as the Iowa-Patch™ spinal cord stimulator implant, which is aimed at overcoming certain shortcomings in the performance of standard epidural stimulator devices. The applier is approximately 14 cm long, 6 mm in diameter, made of stainless steel components, and has simple and reliable mechanisms for the attachment and release of the implant from it. We describe the design of the device, details of its construction, and its performance during in vivo testing of somatosensory evoked potentials in an ovine model of intradural spinal cord stimulation.

Objective: Gasoline inhalation to achieve intoxication is a problem of global significance; however, few studies have examined the prevalence, correlates, and characteristics of gasoline abuse in adolescents. This study examined gasoline abuse in a sample of adolescents in residential treatment for delinquent conduct.Methods: Standardized psychosocial instruments were administered via a structured interview to 723 adolescents (97.7% of the study population).Results: More than one-in-five (21.9%) adolescents reported lifetime gasoline abuse. Gasoline users were disproportionately white, poor, and from rural areas. Gasoline abusers were more likely to have received a formal psychiatric diagnosis, evidenced greater current psychiatric distress and suicidal ideation, had higher levels of past trauma, were more likely to use inhalants for self-medication purposes, and exhibited more severe antisocial traits and behaviors than users of inhalants other than gasoline and inhalant non-users. In multivariat...

Volatile substance misuse (VSM) is prevalent in the United States and associated with manifold deleterious outcomes. This review summarizes research on: (1) the prevalence of VSM in the United States and its trends since 1975, (2) population subgroups at an elevated risk for VSM, (3) key correlates of VSM, (4) psychosocial consequences of VSM, including emerging public health threats, and (5) etiological and contextual considerations of VSM use. Implications for future research and practice with volatile substance misusers in the United States are identified.

Inhalant use is a serious global problem with consequences equal to or surpassing those of other drugs, Regrettably, few prior studies have examined inhalant users’ patterns of service and treatment utilization, The purpose of this study is to identity factors associated with service use and barriers to treatment among a nationally representative sample of inhalant users. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) reveal that among inhalant users problem severity and substance use disorder comorbidity were associated with substance abuse treatment barriers and service usage. These findings can help improve the service delivery system to provide effective treatments and reduce the risk of emergency department usage, which is among the most expensive and least effective ways to deal with substance abuse.

Anecdotal reports and recent medical examiner and poison control center studies suggest that computer duster spray (CDS) inhalation is an emerging public health threat. However, there is a current dearth of empirical data on CDS use.Study aims were to examine the prevalence, frequency, correlates, and modalities of CDS use among a treatment sample of antisocial youth.A battery of standardized psychosocial instruments was administered via interview of 723 Missouri adolescents in residential care for antisocial behavior.Lifetime CDS use was prevalent (14.7%) in this young service population (97.7% of whom participated). CDS users were significantly more likely to report histories of perinatal injuries or illness, traumatic experiences, suicidality and physician-diagnosed mental illness, and evidenced higher levels of psychiatric symptoms, antisocial attitudes and behaviors, and polydrug use than CDS nonusers.CDS use was endemic in this treatment sample of adolescents and associated with a range of clinically significant comorbidities. Current findings describe an underrecognized and potentially dangerous form of substance misuse that has rarely been studied but that may be of growing importance.

The question of whether crack cocaine use is associated with increased violence compared to powdered cocaine use has not been adequately explored in large nationally representative general population samples.This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to 1) determine the comparative prevalences of violent behaviors among crack cocaine users and powdered cocaine users, 2) examine these differences while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders (a majority of cocaine users use other substances), and levels of crack cocaine and powdered cocaine use.The likelihood of violence associated with crack cocaine users was greater compared to powdered cocaine users at the bivariate level. However, these differences were almost uniformly statistically nonsignificant when demographic, mood and non-cocaine substance use disorders were controlled for.The substantial attenuation of the association of crack cocaine use with violence after adjustment suggests that the sociodemographic characteristics, psychiatric variables, and non-cocaine substance use disorders that make some individuals more likely to use crack cocaine than powder cocaine are responsible for the increased prevalence of violence observed among crack users, rather than crack itself.

Practice guidelines are important tools for improving the delivery of evidence-based practices and reducing inappropriate variation in current treatment approaches. This study examined the degree to which guidelines targeted to the treatment of substance use disorders or serious mental illness address treatment of co-occurring disorders. Guidelines archived by the National Guideline Clearinghouse (NGC) were retrieved in December 2007 and content analyzed. Nineteen pertinent guidelines were identified, and 11 included recommendations regarding the assessment and/or treatment of co-occurring disorders. None of the guidelines making recommendations for treatment of co-occurring disorders included outcomes that clearly targeted both substance use and mental health disorders. Limitations and implications of this study are noted.

This study describes the number and characteristics of accidental deaths associated with recreational inhalant misuse in North Carolina from 2000 to 2008. Inhalant-related deaths were identified via an electronic search of records of the North Carolina Office of the Chief Medical Examiner. Thirty deaths were attributed to recreational inhalant use, and nearly a third involved the inhalation of compressed-air products. Polydrug use and comorbid psychiatric disorders were common among decedents. The types of inhalants most often resulting in death differed from previous studies, as did the somewhat older mean age of decedents. Further research on inhalant-related mortality is warranted.

An evidence-based practice (EBP) movement is underway in social work that promises to change the very nature and methods of clinical education and practice. Growing demands for accountability, increasingly sophisticated clients, heightened threats of malpractice liability, and a host of additional factors arising within and external to the profession have contributed to the growth of EBP. This review examines indices of the growing influence of EBP, reasons for the emergence of EBP, misgivings about and potentially positive features of EBP, and examines one school of social work's efforts to implement an evidence-based clinical practice curriculum. It is important that clinicians be aware of current developments in relation to evidence-based clinical education and practice as these will likely significantly shape the face of social work direct practice in the coming years.

The purpose of this study was to examine the prevalence, patterns, and predictors of nitrite inhalant use in antisocial adolescents. Face-to-face interviews were conducted with 723 Missouri youth (M age = 15.5, SD = 1.2) in residential care for antisocial behavior. The lifetime prevalence of nitrite inhalant use was 1.7% (1.3% for boys; 4.3% for girls, p = .06), a figure somewhat higher than comparable estimates from the MTF and NSDUH national surveys. Most lifetime users reported nitrite use in the prior year (92%) and experienced intoxication (83%) during periods of nitrite inhalation. Nitrite users had significantly higher scores on measures of somatization, obsessive-compulsive traits, interpersonal sensitivity, impulsivity, fearlessness, suicidality, and polydrug use and were significantly more likely to have suffered a serious head injury and to be White than their non-nitrite-using counterparts. Nitrite users also reported significantly higher levels of current psychiatric distress related to periods of faintness or dizziness, hot or cold spells, difficulty making decisions, and their "mind going blank" than did non-nitrite users. Antisocial adolescent nitrite users are at substantially elevated risk for serious functional impairments given their high rates of lifetime head injury, comparatively more varied and intensive levels of involvement with psychoactive drugs, and symptom reports suggestive of psychiatric and cognitive dysfunction.

SUMMARY We explored the presence of relatively discrete subgroups of adolescent females in a statewide sample (N = 94) using latent class statistical methodology. Specifically, we hypothesized that, rather than being a homogenous group, the girls in the sample would separate into clusters with both crossover and distinguishing characteristics. Results showed confirmation of our hypothesis with a best-fit three cluster solution consisting of a low violence cluster, a moderately violent cluster, and a high-rate violent cluster of girls. Findings provide a more precise identification and description of subgroups of female juvenile offenders to inform treatment efforts and provide a preliminary typology/cluster profile to build upon in future research addressing this population.

The social work academic community is currently considering and critiquing the idea of evidence-based practice (EBP). Given the vital part that practicum education plays in the social work profession, understanding the views of field instructors on this subject is essential. The George Warren Brown School of Social Work at Washington University surveyed 283 field instructors within 180 agencies and found that the majority (87%, N=235) viewed it as a useful practice idea. However, most of the indicators employed to assess use of scientific evidence in social work practice revealed that it occurs too infrequently. A lack of time was reported as the greatest obstacle.

Adolescent ecstasy (MDMA) use in the U.S. has increased more than 230 percent over the past decade. Results from animal studies indicating that ecstasy is damaging to serotonin-releasing neurons and anecdotal reports describing persistent anxiety among heavy adult ecstasy users have led to growing concerns about the role ecstasy use may play in adolescent anxiety and depressive disorders. This study examined the prevalence of ecstasy use among 104 incarcerated youth and the associations of lifetime frequency of ecstasy use with various measures of current psychopathology. A total of 43 (41.3%) youth reported lifetime ecstasy use. Lifetime frequency of ecstasy use was significantly positively (r = .25, p < .05) associated with current severity of anxiety symptoms. Multiple linear regression models controlling for polydrug use revealed that ecstasy use might not be as uniquely harmful as initial animal, case, and media reports have suggested. Study limitations, practice implications, and future res...

Three hypotheses concerning associations between neuroanatomical abnormalities, neuropsychological impairments, and the behavioural manifestations of autism were investigated. The primary hypothesis was that the social interaction impairments diagnostic of autism are associated with deficits of socioemotional perception and abnormalities of the amygdala. One subsidiary hypothesis was that the learning and language impairments that occur in less able individuals with autism are associated with impaired memory, and with abnormalities of hippocampal regions. A second subsidiary hypothesis was that the repetitive behaviour diagnostic of autism is associated with executive deficits and with abnormalities of the prefrontal cortex. Associations between the neuroanatomical regions investigated were also examined.Ten adult males with high functioning autism (HFA) were compared with 10 healthy controls matched for age, sex, verbal and nonverbal ability. Hypothesis-driven structural MRI and neuropsychological tests were used to collect neuroanatomical and neuropsychological data on all subjects. A version of the Wing Autism Diagnostic Interview Checklist was used to collect clinical data on the HFA subjects.Strong convergent evidence in support of the amygdala hypothesis was obtained, and preliminary support for the hippocampal/parahippocampal hypothesis. No clear evidence was obtained in support of the prefrontal hypothesis. Patterns of associations amongst volume measures within and between medial temporal and prefrontal regions suggest stronger within-region and weaker between-region associations in the HFA group compared with controls.These findings are discussed in terms of a model of autism in which selective abnormalities of the amygdala and hippocampus (in all cases) and of the parahippocampal gyrus (in lower functioning cases) are implicated, and in which a disruption of coordinated limbic and prefrontal activity may be critical.

The Porters Pass Fault comprises a series of discontinuous Holocene active traces which extend for c. 40 km between the Rakaia and Waimakariri Rivers in the foothills of the Southern Alps. There have been no historical earthquakes on the Porters Pass Fault (i.e., within the last 150 yr), and the purpose of this paper is to establish the timing and magnitudes of displacements on the fault at the ground surface during Holocene paleoearthquakes. Displaced geomorphic features (e.g., relict streams, stream channels, and ridge crests), measured using either tape measure (n = 20) or surveying equipment (n = 5), range from 5.5 to 33 m right lateral strike slip and are consistent with six earthquakes characterised by slip per event of c. 5–7 m. The timing of these earthquakes is constrained by radiocarbon dates from four trenches excavated across the fault and two auger sites from within swamps produced by ponding of drainage along the fault scarp. These data indicate markedly different Holocene earthquak...

Language and ethnicity are parts of the interpersonal process that converge during psychiatric diagnosis, affecting diagnostic accuracy and concordance among clinicians. In this feasibility study, the authors videotaped two Hispanic psychiatrists conducting typical diagnostic interviews with first-time Hispanic patients (N = 10) in a community mental health clinic. Then, two non-Hispanic psychiatrists viewed the videotapes with translator assistance. All psychiatrists rendered DSM-IV diagnoses on the patients they interviewed or whose tapes they watched. On Axis I, psychiatrists did not differ, diagnosing mostly mood disorders. On Axis II, non-Hispanic psychiatrists diagnosed personality disorders more often. On Axis IV, Hispanic psychiatrists identified more psychosocial stressors, especially family-related ones. On Axis V, Hispanic psychiatrists rated patients more functionally impaired. Although limited, the findings raise several interesting questions that can be useful to clinicians and rese...

Alcohol use disorders are among the most prevalent and disabling conditions encountered by social work practitioners. Although a substantial body of research findings has accrued evaluating the effectiveness of available alcohol dependence treatments, few efforts have been made to assess the contribution that social work has made to this database. Thus, this study examined the contribution of social work to the alcohol dependence treatment outcome research literature over the past half-century. Controlled investigations of alcohol dependence treatments published between 1950 and 2000 were analyzed by publication outlet type and primary author's professional affiliation. Computerized bibliographic searches of medical and social science databases were conducted and a manual search of 13 core social work journals to identify controlled studies of alcohol dependence interventions. Results indicate that researchers affiliated with schools or departments of social work as well as studies contained with...

Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.

Children with disabilities, their families, and the social workers who provide services are faced with navigating complex social and institutional environments in their quest for developmental, educational and daily living supports. Models of disabilities provide conceptual frameworks for understanding and action that can inform the decision-making process of parents and social workers. A new ecological model of disability, the systems model, is proposed that integrates the medical model, focused on individual deficits, the social model, focused on disabling social environments, and the transactional model, focused on person-environment interactions. Diagnostic, institutional, and practice implications of the new model are discussed.

Although the strengths perspective is pop u lar in so cial work, it is un clear how it var ies from traditional social work practice approaches. Studies of the effeetiveness of strengths-based inter ventions are reviewed to as certain: (1) how the strengths perspective is operationalized and im pie mented, and (2) the empirical support for its effeetive ness. Few evaluations of strengths-based treatment have been published. In those studies reporting positive outcomes, it is not possible to determine whether out comes are due to the strengths perspective or to the delivery of additional services. Moreover, results indicate that the directives of the strengths perspective are not adequately operationalized or measured. The strengths per spec tive is a value stance, but there is littie support for it as a distinct and uniquely effective prac tice model.

Studies of nurses' attitude toward substance misusers, spanning three decades, are reviewed. Survey findings reflect greater acceptance of alcohol and drug misusers in recent years. However, significant minorities of nurses continue to regard substance users as immoral, characterologically defective, and unlikely to recover. Implications of these attitudes for treatment of substance misusers are discussed.

Experimental investigations of nurses consistently indicate that a patent labeled as a substance misuser is perceived far more negatively across a range of personal attributes than an identical patient who is not so labeled. Comparative evaluations suggest that nurses are less tolerant of social drinking and drug use and are more morally condemnatory of the chemically dependent than are other health-care professionals.

Treatment of adolescent substance abuse poses difficult challenges to social work practitioners. Effective intervention requires awareness of assessment and treatment approaches and knowledge of individual, peer, and family factors that contribute to alcohol or drug use. Social work's emphasis on contextual factors in the etiology and maintenance of addictive disorders is an important contribution to substance abuse treatment. Practitioners are in an excellent position to implement interventions addressing multiple causes of substance abuse. This paper discusses the prevalence of alcohol and drug use among adolescents in the United States. Assessment issues are identified and promising approaches to treating adolescents with substance use problems are noted. Implications for social work practice and research are delineated.

Until the, past decade, research related to women's patterns of substance abuse has rarely been reported. Although women's rates of substance use and abuse are generally lower than men's, the social, psychological, physiological and economic effects of substance abuse in women are particularly severe. This paper reviews patterns of substance abuse unique to women and examines their implications for treatment of women. Recommendations include revision of program and reimbursement policies and development of gender-sensitive assessment and intervention protocols. It is suggested that advocacy, parent training, and concrete, medical and vocational services be incorporated into treatment programming for female substance abusers.

The use of consistent contingent child rearing practices by parents has been shown to increase family attachment and cohesion, and decrease delinquent behaviors among children. Research indicates that these practices can be successfully taught through parent training. This paper describes the components of parent training, reviews implementation issues, and discusses research findings and implications. Practical problems associated with this approach that may limit its widespread use as a major delinquency prevention strategy are discussed. Areas for further research are identified.