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The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …

Objective: This study tested a motivational intervention designed to enhance the likelihood that detoxified alcohol users will seek and participate in any form of aftercare. Method: After a baseline interview, 96 clients (76 men and 20 women) in a hospital inpatient detoxification unit were randomly assigned to either a standard care condition or a motivational interviewing condition, consisting of three motivational sessions conducted by master’s-level therapists. Results: Two months after discharge, participants in the motivational condition did not differ from controls in the areas of sustained abstinence, typical drinking, or entry into formal treatment. However, clients receiving motivational interviewing were more likely to participate in 12-step groups. Conclusions: Motivational interviewing is a potentially useful strategy to encourage detoxification clients to initiate participation in self-help and may show promise as a strategy for helping alcohol users remain abstinent during the critical initial period following discharge from detoxification.

This study examined the relationship between sex trading and psychological distress among a nonrandom sample of women recruited from 3 methadone maintenance clinics in New York City. Face-to-face interviews with 280 women (M age = 40.7) revealed that 32% had traded sex for money or drugs in the previous year. Compared to other participants, these women reported less education and higher rates of incarceration in the past year, sexually transmitted diseases, childhood sexual abuse, partner abuse, and current regular crack/cocaine and alcohol use. Hierarchical multiple regression analysis indicated that sex traders scored 0.41 units higher than non-sex traders on the General Severity Index of the Brief Symptom Inventory after controlling for all relevant covariates. The findings emphasize the need to consider the interrelation of psychological distress, abuse, and addiction in designing public health interventions addressing methadone maintained women.

The challenging context of social work interventions require that most intervention studies will be derived from nonexperimental research designs. Two evaluation studies in this special issue employed nonrandomized designs to examine the efficacy of two programs—a police crisis intervention team designed to enhance officers’ responses to mental health crisis and a program for pregnant incarcerated women. Each is a laudable effort to examine important intervention outcomes in insular settings. The design and execution problems explicated in both studies are familiar to researchers who venture into such practice arenas. Disappointing outcomes, as in these two studies, can sometimes be attributed to the problems of nonequivalent comparison designs or to unanticipated events. Intervention researchers must also recognize that programs often fail to demonstrate differences and can even result in adverse outcomes.

This article examines the relationship between sex trading and psychological distress and assesses sexual human immunodeficiency virus (HIV) risk behaviors and HIV seroprevalence in a sample of young men recruited from the streets of Harlem. The authors interviewed 477 men, aged 18 to 29 years, of whom 43 (9.0%) had received money or drugs in exchange for sex in the preceding 30 days and were categorized as sex traders. Psychological distress was measured by using the Brief Symptom Inventory (BSI). Sex traders scored significantly higher than non-sex traders on the General Severity Index and on all nine subscales of the BSI. According to multivariate analysis after adjusting for perceived HIV risk, current regular crack cocaine use and homelessness, sex traders scored 0.173 units higher on the General Severity Index than non-sex traders (p.001). More of the sex traders tested positive for HIV (41% versus 19%, p.001). The alarmingly high HIV seroprevalence rate in sex traders in this sample underscores the need to redouble HIV prevention efforts for this population. The high levels of psychological distress and crack cocaine dependence among sex traders may undermine their ability to adopt safer sex behaviors and should be considered in intervention designs.

This study investigated the utility and psychometric properties of the University of Rhode Island Change Assessment Scale (URICA) in a sample of 257 female inmates from a large urban prison. It addressed three major issues: (a) whether URICA captures stages of change among female offenders with a recent history of drug abuse; (b) whether distinct, reliable subgroup profiles would emerge from a cluster analysis of the URICA scale; and (c) whether women in these clusters would differ in their demographic characteristics, drug-use patterns, or psychological symptoms. Results indicate that the URICA is a useful, reliable, and valid tool to assess stages of change in drug-using incarcerated women. Consistent with other studies conducted with different populations, the scale yielded five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Cluster analysis using the hierarchical agglomerate method classified the subjects into five clusters, which correlated with subjects' psychological symptoms. Intervention implications of URICA are discussed.

The Alcohol Use Disorder Identification Test (AUDIT), developed by the World Health Organization, was administered to 400 incarcerated, drug-using women in order to assess its utility, validity, and reliability. Principal component factor analysis and reliability tests were conducted. Sensitivity and specificity for all possible AUDIT cutoff points were computed, and a Receiver Operating Characteristics (ROC) curve was plotted to suggest an AUDIT cutoff point for identifying problem drinkers. This cutoff point was then assessed as to its concurrent and discriminant validity. Principal component factor analysis identified one factor that accounted for a substantial portion (67.3%) of the total variance of the AUDIT, a result that indicated that the AUDIT could be used as a consistent and summated screening tool for identifying problem drinkers. Internal consistency was high (Alpha = 0.94). The ROC curve, sensitivity, and specificity tests suggest that a total AUDIT score of 10 or more is a reliabl...

Despite the scope of the HIV/AIDS epidemic among female offenders, little is known about the risk behaviors of these women and even less about ways in which to reduce HIV/AIDS among this population. This article describes the development of an eight-session group cognitive-behavioral and social support enhancement intervention that aims to reduce HIV risk among drug-using female offenders. The intervention is based on social-cognitive theory and informed by other skills-training approaches with demonstrated efficacy at reducing HIV risk. Both current and former offenders were involved in the development of this intervention. Help-seeking and social support skills are unique to this intervention, as is an eight-session booster conducted after release from jail to enhance transfer of skills to the community.

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

This study identified predictors of reported sexual risk reduction among 109 female injection drug users enrolled in methadone clinics. Univariate analyses were used to examine the individual effects of each variable on the outcome of sexual behavior change over the past 6 months. Multiple logistic regression was then used to identify which of these variables were independently associated with such a change. Women with more than one sexual partner were more likely than women with one or no sexual partner to report changing their sexual behavior. African-American women were less likely than White Anglo or Latina women to report changing their sexual behavior. Women who held stronger beliefs that luck plays the largest role in getting AIDS were less likely to report changing their sexual behavior. Change in sexual behavior was associated with feeling comfortable asking partners to use condoms, higher depression scores, and loss of friends or family to AIDS. The observed relationship between personal susceptibility and depression suggests that risk reduction interventions should also address the depressive symptomatology associated with feelings of vulnerability.

Guided by theory, empirical research, and clinical experience, this demonstration tested a 12-session group intervention for 38 inner-city children who had lost a caregiver. The design of the group intervention was guided by the psychodynamic tradition of the sponsoring agency, themes from the bereavement literature, and findings from intervention research on bereaved children and adults. Attendance for the group intervention was high among those 29 children who completed posttests. The loss of the parent figure often had an impact on caregiving and living arrangements. Children rated themselves as significantly more depressed at pretest than their caregivers rated them, but at posttest this difference diminished. However, the majority of children remained depressed throughout the study. Pretest and posttest comparisons suggest that the treatment intervention may have enabled children to develop a more mature concept of death. Mixed outcomes and the methodological limitations of the study allow for multiple interpretations. Nevertheless, modest results reported here may encourage other clinical researchers to build on this early effort. Better understanding of how to treat bereaved children must await controlled, longitudinal research.

The University of Wisconsin Medical School established an alternative Independent Study Program (ISP) in the basic medical sciences in 1972. This program enabled class size to be increased without increasing laboratory teaching space, provided better education for students with diverse educational backgrounds, permitted individual progress, and promoted independent study. When compared to the most receptive oriented regular curriculum students (RCR) and those most discovery oriented (RCD), the preferred learning style of self-selected ISP students was more discovery or self-directed. They retained that style after graduation, while RCD students frequently became less discovery oriented. The ISP group was older, had more females, and had more advanced degrees. Although they had lower undergraduate grade point averages, they did well on the Verbal, General Information, Problem-Solving, and Quantitative sections of the MCAT. They also did well scholastically in Medical School, scored well on the National Boards Medical Examination, had the same distribution of residencies, and obtained the same quality of residency placement for medicine, surgery, and pediatrics. They have been very supportive of the program and feel that it was valuable in developing their abilities for continued self education.

This paper describes a life skills training intervention with 230 mothers of children with a variety of developmental disabilities. The study's design evaluated the effects of a skills-building method developed to improve coping and social support networks of mothers of handicapped children. In groups of 10-12, mothers of handicapped children participated in one of two intervention groups: a skills-building intervention or a comparison treatment intervention using traditional counseling methods. At posttest assessment participants in the skills-building sessions demonstrated improved coping and communication skills, greater satisfaction with social support networks, and a reduction in depression and stress levels.

Despite a slowing of the rates of human immunodeficiency virus (HIV) infection among intravenous drug users, this group remains at high risk for contracting acquired immune deficiency syndrome (AIDS). Promising reports of safer drug use patterns among addicts notwithstanding (Coleman, Lodico, Evans, & DiClemente, 1992; Sorensen, Batki, Coates, & Gibson, 1988; Watters et al., 1988), untreated drug users continue to share needles (Neaigus et al., 1992; Ortiz et al., 1992; Robles, Matos, Cancel, & Colon, 1992). Moreover, there is as yet little evidence of sustained safer sexual practices among drug users and their partners (Abdul-Quader et al., 1992; El-Bassel et al., 1992). In an ongoing series of studies, the authors are testing a small-group skills-training approach to reducing HIV-risk behavior among methadone patients. Earlier reports of these investigations have described the study methodology and preliminary outcomes (El-Bassel & Schilling, 1992; Schilling, El-Bassel, Schinke, Gordon, & Nichols, 1991). This article describes the conceptual components and strategies of a skills-building intervention model consisting of 13 weekly sessions followed by six monthly booster sessions. Social workers, many trained in group work and cognitive-behavioral approaches, would be positioned to initiate, and possibly carry out, such groups in chemical dependency treatment settings. Methadone Maintenance Methadone maintenance has been shown to be an effective approach to treating large numbers of heroin addicts, thereby reducing the risk of HIV infection associated with the sharing of intravenous drug paraphernalia (Ball & Ross, 1991; Murphy & Rosenbaum, 1988; Sorensen et al., 1988). Paradoxically, studies in the past several years have at once revealed both the protective effects and critical shortcomings of methadone maintenance treatment programs (MMTPs). Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to such programs (Obuchowsky & Zweben, 1987; Roszell, Calsyn, & Chaney, 1986; Schilling, El-Bassel, Gilbert, & Schinke, 1991). These challenges underscore the need for enhancing the nonpharmacological services of methadone clinics (Rounsaville & Kleber, 1985; Sorensen, 1991; Weddington, 1991). Most methadone patients receive medication several times per week. Their attendance is usually predictable. Counseling services would seem to be a natural extension of MMTP programs, and indeed federal regulations require programs to provide supportive services along with medication. Unfortunately, MMTPs have always had limited counseling components, and resources for supportive programs, including social work services, have eroded in recent years (Ball & Corty, 1988; Hubbard et al., 1989). Even if AIDS were not a consideration, MMTPs might benefit from sociobehavioral interventions that help clients to anticipate relapse, avoid high-risk situations, and recover from temporary lapses (Stark, 1989; Weddington, 1991). The AIDS crisis brings the need for MMTP program enhancements to the foreground. In response to this need, we developed and tested a set of theoretically and empirically derived intervention strategies designed to reduce drug use and high-risk sexual behavior among MMTP patients. Theoretical and Empirical Foundations of Training The underpinnings of the intervention are drawn from social learning theory (Bandura, 1977), health behavior models (Bandura, 1977; Cronkite & Moos, 1984; Wesson, Havassy, & Smith, 1986), theories of expectancy (Christiansen & Goldman, 1983; Marlatt & Roshenow, 1980) and self-efficacy (Baer, Holt, & Lichtenstein, 1986; Bandura, 1977; Donovan & Chaney, 1985; Heather, Rollnick, & Winton, 1983), relapse prevention (Marlatt & Gordon, 1985; Nurco, Stephenson, & Hanlon, 1991; Wesson et al., 1986), problem solving (Larson & Heppner, 1989; Nezu & D'Zurilla, 1981; Platt, Taube, Metzger, & Duome, 1988), skills training (Hawkins, Catalano, Gilmore, & Wells, 1989; Zackon, McAuliffe, & Ch'ien, 1985), self-regulation (Rehm & Rokke, 1988), social support (Fraser & Hawkins, 1984; Wesson et al. …

This study examines the predictors of alcoholism among 201 patients from three methadone maintenance treatment programs (MMTPs) in New York City. Using the Michigan Alcohol Screening Test, one-fifth of the sample met criteria for alcohol dependence. Few subjects were currently enrolled in any form of chemical dependency treatment other than MMTP. Alcoholics started to use alcohol at an early age, and almost every alcoholic subject admitted to alcohol abuse before entering MMTPs. More alcoholics than nonalcoholics reported symptoms of somatization, obsessive-compulsive behavior, depression, phobic anxiety, and psychosis. Logistic regression indicated that alcoholism among MMTP patients was associated with years drinking, years of sharing needles, utilization of drug abuse detoxification but not alcohol detoxification, smaller increases in methadone dosage over time, and psychiatric symptomatology. Findings are discussed in terms of their implications for designing more efficacious treatment approaches for dually addicted patients in MMTPs.

African Americans and Latinos, respectively, account for 29% and 16% of persons with the acquired immunodeficiency syndrome, yet collectively represent less than 20% of the US population (Centers for Disease Control 1990) Although rates of human immunodeficiency virus (HIV) transmission have slowed among gay Anglo men there is less evidence to indicate that patterns of transmission have been altered among Black and Hispanic intravenous drug users. In this article, risk factors for HIV transmission among drug users are described, and sociocultural aspects of these risk behaviors are discussed Next, the advantages and disadvantages of various approaches to reducing the spread of HIV among drug users and their associates are considered, particularly as they apply to ethnic-racial minorities Finally, brief examples are provided of how existing theories of behavior change can be applied in Hispanic and African-American communities and suggestions are offered for further research

The AIDS crisis, the increase in other sexually transmitted diseases (STDs), and the continuing problem of unwanted pregnancies, necessitate new methods of barrier protection. In 1988, Wisconsin Pharmacal began testing the safety and efficacy of a new female condom (Reality), a disposable, prelubricated, polyurethane device that is both a contraceptive and a barrier against STDs. The product requires no professional fitting and is inserted by the woman. Preliminary data from clinical and laboratory studies indicate that the female condom may be an effective barrier against STDs. A widespread use of the female condom, however, will depend on women's and men's initial attitudes, including culturally determined barriers to acceptance.

This study examined the relationship among cognitive functioning, social support networks, and risk for child abuse in a sample of 92 mothers of developmentally disabled children. Mothers found to be at highest risk for child abuse potential tended to score low on cognitive skills, social support networks, and life satisfaction. Beck Depression Inventory scores were found to explain 57% of the variance in the Child Abuse Potential Scores. Single mothers differed significantly from married mothers on child abuse potential, relationship satisfaction, community involvement, and loneliness. The authors discuss implications of the study and the need for future research with families of handicapped children.

This paper reports an outcome study of coping skills intervention to help adolescents manage stress associated with the transition from elementary school to junior high. In a randomized design, sixth grade students from four elementary schools were pretested, then two schools each were assigned to an intervention condition and to a control condition. Intervention condition subjects received eight sessions of instruction and practice in coping skills intervention. Following intervention, all subjects were posttested. At posttest and relative to control condition subjects, intervention condition subjects scored more positively on measures of problem solving, assertive direct refusals, adequacy of information about junior high school, ability to handle stress, ability to deal with peer pressure, and general readiness for junior high school.

This paper considers coping styles of mothers and fathers of handicapped children. Cautioning against stereotyping, the authors find that mothers and fathers differ in how they appraise and cope with the stress of rearing a developmentally disabled child. The need for systematic investigation of gender-related coping styles in families with handicapped children is discussed.

Hispanic adolescents are the fastest growing ethnic-minority age group in America. They are also at high risk for drug, alcohol, and tobacco use. In this paper, the authors discuss the etiology of Hispanic adolescents' substance abuse, as explained in part by psychological stress. Based on the authors' research and on other data, a model for preventing substance abuse among Hispanic youths is presented. The model draws from coping, acculturation, social learning, and informal network theories. Concluding with a research agenda, the paper calls for descriptive, correlative, and intervention outcome studies to scientifically understand and prevent substance use among Hispanic adolescents.

Substance abuse is one of the worst problems experienced by American Indian people. In this article, methods to prevent substance abuse among Indian young people are described and the future implications of drug and alcohol abuse prevention efforts with Indian youth are discussed.

The entrance into junior high school is a critical but seldom studied event in the life of the adolescent. Little has been done to prepare youths for the transition. This study evaluated a skills building approach to prepare sixth graders for the entry to junior high. The curriculum was administered to two grade schools (n = 138) with two additional grade schools (n= 140) serving as controls. At the conclusion of post testing, youths in the skills training condition were more informed about junior high school, percieved themselves to be more prepared, and were better able to handle stress and peer pressure than the youths in the control condition. They used more direct refusals as a tactic in handling peer pressure, and were able to generate more options for dealing with tough situations. Generally, results of the study support claims of program effectiveness.

Normal sexual functioning has only recently become a prerogative of mentally retarded persons. More often, the sexuality of women and men with mental handicaps has been viewed as deviant and as cause for concern, restrictive policies, and clinical intervention. This paper critically evaluates scientific evidence for and against mentally retarded persons' increased risk of committing sexual offenses. Etiological theories of sexual offenses among the target population are discussed in detail. In addition, the authors describe treatment strategies for mentally retarded sexual offenders. Finally, the paper gives directions for future behavioral and social science research on issues concerning sexual offenses among mentally retarded persons.

Summary This paper describes an intervention programme, evaluation procedures, and results from a study of skills training for reducing stress with parents of handicapped children. Four mothers of developmentally disabled children participated in an 8-week training programme designed to teach parents ways to enhance their coping skills, increase their social support networks, and collectively make changes in their environment. Post-test data indicate that the programme shows promise for teaching coping and social support enhancement skills to parents.

Human services workers have long recognized that parents of handicapped children experience inordinate stresses. In recent years investigators have examined how such families deal with stress. This paper discusses stress in families of developmentally disabled children and how parents of special needs children draw on personal and social coping strategies to manage daily challenges. An overview of existing research is followed by a prescription for research on stress, personal coping, and social support. The authors call for prevention strategies to prevent stress-related maltreatment of special needs children.

Social support is receiving increasing attention as a concept valuable in understanding and improving client functioning. This review finds that social support is a complex phenomenon with potential drawbacks. Policymakers and practitioners are advised to use care in designing and implementing social support strategies and to consider both the benefits and the risks of social support interventions.

Research on single parents and on parents of handicapped children indicates that these groups experience extraordinary stress. The authors suggest that single and married parents of handicapped children have different available resources and therefore will appraise their circumstances differently. Questionnaires measuring parents' stress, life satisfaction, and perception of the child were administered to 33 single and 48 married mothers of handicapped children. No differences between these groups were found on total scores or on subscale scores. Differences between single and married mothers were found on 24 of 135 items. Most of the significant items related to family life in general rather than rearing a handicapped child. Findings are discussed in terms of social and economic supports, child rearing contributions of fathers, and implications for intervention.

Personal coping and social supports are presented as resources for parents of handicapped children. These closely linked concepts are viewed as increasingly of interest to practitioners and investigators who recognize that such parents encounter extraordinary stress. An overview of the difficulties faced by parents of handicapped children is followed by a review of several studies on coping among such parents. The authors describe a structured group approach to teach parents of handicapped children to use personal coping and social supports.