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Martin, Toby C.The Effect of Social Networks and Co-occurring Mental Disorders on Barriers to Treatment and Treatment Motivation among Women with Substance Use Disorders
Doctor of Philosophy, Case Western Reserve University, 2007, Social Welfare
This study examined the predictive role of social networks and substance use and mental health disorders on perceived barriers to treatment services and treatment motivation. The research objectives of this study were to identify and to gain a further understanding of the barriers and motivators women experience in accessing services in substance abuse treatment and/or mental health disorders treatment programs. The sample consisted of 245 women: 86 recruited from community based substance abuse treatment facilities and 159 recruited from an ongoing study of cocaine exposed infants and their mothers. The measures included: the Diagnostic Interview Schedule to determine substance use and mental health disorders, Allen Barriers Scale to measure perceived barriers to substance use and mental health disorders treatment, Treatment Motivation Scale to measure Problem Recognition, Desire for Help and Treatment Readiness and Social Network Map to collect information on the composition of and support provided by the social network. Multiple regressions examined the contributions of social network characteristics, substance use and mental health disorders, current participation in treatment, age of women, and the number of children to barriers to treatment and treatment motivation. Overall, few social network variables accounted for barriers to treatment. Informational support and lack of sobriety support from friends were statistically significant predictors of treatment barriers. Several social network variables were found to be predictive of treatment motivation, although not always in the direction expected. Informational support was the only positive support predictive in the expected direction. Dual disorder status was a significant predictor of both treatment barriers and treatment motivation. The study did not show the age of the woman as a significant predictor of barriers but did show age as a significant predictor for treatment motivation. The number of children was not found to be a significant predictor for barriers; however, it was a significant predictor for Desire for Help. The treatment status of the women proved to be a significant predictor of barriers as well as for Problem Recognition and Desire for Help. Clinicians should attend to the personal social networks of clients to help address barriers to treatment and treatment motivation.

Committee:

Elizabeth Tracy (Advisor)

Subjects:

Social Work

Keywords:

substance use disorders; social networks; barriers to treatment; treatment motivation; women with substance use disorders

McCurdy, Anne ShickThe Effects of Client and Respondent Variables on Addiction Professionals' Decision Making: A Factorial Survey
PHD, Kent State University, 2016, College and Graduate School of Education, Health and Human Services / School of Lifespan Development and Educational Sciences
The purpose of the current study was to investigate the effects of 4 client variables and 10 respondent (i.e., participant) variables on two measures of addiction professionals’ decision making. Data were collected using Rossi and Nock’s (1982) factorial survey approach. This approach uses randomly constructed vignettes intended to represent hypothetical and life-like scenarios. Respondents are randomly assigned a predetermined number of vignettes and are then asked to make decisions about those vignettes. The factorial survey approach is inherently hierarchical, meaning that data are simultaneously collected at two levels: (a) the vignette level, and (b) the respondent level. Chi-square and hierarchical regression analyses were performed on factorial survey data collected from a sample of 124 members of the Association for Addiction Professionals (NAADAC). Results of the current study suggest that particular client and respondent variables influence addiction professionals’ decision making. Notable client variables include the client’s drug of choice, previous treatment experience, understanding of substance use, and preferred treatment goal. Notable respondent variables include level of education and addiction-specific training. Results also identified inconsistencies between select client variables and addiction professionals’ decision making. This study highlights the need for increased exposure to, and training in, addiction theories and individualized treatment approaches among addiction professionals.

Committee:

Cynthia Osborn (Committee Co-Chair); Betsy Page (Committee Co-Chair); Michael Ensley (Committee Member)

Subjects:

Counseling Education

Keywords:

Substance Use Disorders; Addiction; Theory; Treatment; Factorial Survey Approach

Baum, David E.The Effects of a Brief Motivational Enhancement Targeting Parents of Adolescent Substance Users
Doctor of Psychology (Psy.D.), Xavier University, 2016, Psychology
Adolescent substance misuse is a public health problem that results in substantial costs to society. Teenagers who move beyond normative use and require treatment often do not improve due to poor treatment initiation, retention, and completion. As such, efforts are needed to improve adolescent-focused substance use treatment. One potential avenue for strengthening outcomes is increasing parental engagement, as parents are central for adolescent treatment progress. The present study sought to increase treatment initiation, adherence and completion by targeting parental ambivalence about treatment using a brief motivational enhancement (ME) intervention. Using random assignment, the ME was compared to a time-matched psychoeducation (PE) control intervention and a standard care control (SCC) condition. Results from the study indicated no differences in outcome across conditions. Participants who received the ME were not significantly more likely to follow through with treatment recommendations, attend more sessions of treatment, or complete the program with greater frequency. Overall findings suggest that motivational enhancement does not provide added value to a private-pay, traditional adolescent substance use assessment. The present findings underscore the need to consider context when using motivational interviewing as extant findings may inflate its relative efficacy.

Committee:

Susan Kenford, Ph.D. (Committee Chair); Kathleen Hart, Ph.D. (Committee Member); Gibson Jennifer, Ph.D. (Committee Member)

Subjects:

Psychology

Keywords:

Adolescent, Parental Motivation, Motivational Interviewing, Motivational Enhancement, Substance Use Disorders, Treatment Adherence, Parental Engagement

Hruska, BryceEXAMINING THE RELATIONSHIPS BETWEEN POSTTRAUMATIC STRESS DISORDER SYMPTOMS, POSITIVE SMOKING OUTCOME EXPECTANCIES, AND CIGARETTE SMOKING IN PEOPLE WITH SUBSTANCE USE DISORDERS: A MULTIPLE MEDIATOR MODEL
PHD, Kent State University, 2014, College of Arts and Sciences / Department of Psychology
Posttraumatic stress disorder (PTSD) is highly comorbid with cigarette smoking and substance use disorders (SUDs) and may serve as a smoking cessation barrier in people with SUDs. Positive smoking outcome expectancies (i.e., beliefs that cigarette smoking will result in positive outcomes) are associated with PTSD, and may represent intervening variables that can be targeted in smoking cessation treatments in people with SUDs experiencing PTSD symptoms. Despite these relationships, no research to date has considered (a) whether PTSD symptoms are related to cigarette smoking in people with an SUD and (b) whether positive smoking outcome expectancies may serve as mechanisms for this relationship. The present study will address these limitations by examining the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of people with SUDs seeking detoxification treatment services. In addition, the mediating effects of a number of different types of positive smoking outcome expectancies on these relationships will be tested to determine the contributions of different types of positive smoking outcome expectancies in explaining the relationship between PTSD symptoms and cigarette consumption/cigarette dependence symptoms. These aims will be tested using an existing cross-sectional data set containing data from 227 trauma exposed, current smokers with SUDs (59.9% male, 89.4% Caucasian) self-identifying as current smokers who completed questionnaires asking about PTSD symptoms, typical daily cigarette consumption, positive smoking outcome expectancies, and cigarette dependence symptoms.

Committee:

Douglas Delahanty, PHD (Committee Chair); David Ricco, PHD (Committee Member); Deric Kenne, PHD (Committee Member); Jeffrey Ciesla, PHD (Committee Member); John Johnson, PHD (Committee Member)

Subjects:

Psychology

Keywords:

Posttraumatic stress disorder; substance use disorders; cigarette smoking; nicotine dependence

Leslie, Mykal JPatterns in Allegations of Workplace Discrimination Filed by Americans with Substance Use Disorders under Title I of the Americans with Disabilities Act
PHD, Kent State University, 2018, College and Graduate School of Education, Health and Human Services / School of Lifespan Development and Educational Sciences
The purpose of this study was to investigate the patterns in allegations of workplace discrimination by individuals with substance use disorders (SUDs). The goal of the research was to describe the discrimination, both actual and perceived, that has occurred against individuals with SUDs through analysis of the United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database in comparison to a group of individuals with other physical disabilities (GENDIS) as defined by the Americans with Disabilities Act (ADA). An ex post facto, causal comparative quantitative design was used with the EEOC IMS database to examine the ADA Title I complaints received by the EEOC from people with SUDs from 1992 through 2011 (n = 8,432) in comparison to the GENDIS group over the same time period (n = 82,618). Results revealed statistically significant differences in the pattern of issues alleged by the two groups. The SUD group was, on average, significantly younger, had a significantly higher proportion of males, had proportionally more individuals who identified as Caucasian and as Other, and proportionally fewer individuals who identified as Hispanic/Mexican and Asian than did the GENDIS comparison group. People with SUDs were significantly less likely than the GENDIS group to have their allegations result in a merit-based case resolution. Implications for counseling practice as well as counselor education and supervision are discussed.

Committee:

Steve Rainey (Committee Co-Chair); Martin Jencius (Committee Co-Chair); Phillip Rumrill (Committee Member)

Subjects:

Counseling Education

Keywords:

Substance use disorders; workplace discrimination; employment; Americans with Disabilities Act; EEOC; stigma; people with disabilities

Stevenson, Lauren DeMarcoThe Influence of Treatment Motivation, Treatment Status and Social Networks on Perceived Social Support of Women with Substance Use or Co-Occurring Disorders
Doctor of Philosophy, Case Western Reserve University, 2009, Social Welfare

This study examined predictors of perceived social support and support forrecovery of women with substance use disorders or co-occurring substance use and mental disorders. The sample consisted of 136 adult women; 86 women were engaged in inpatient and outpatient substance abuse treatment programs, and 50 women were recruited from a study of mothers with cocaine exposed infants.

The women in the study were predominantly African American (82.4%) and of low income status with 80% of the women reporting an annual family income below $15,000. All of the women had a current substance use disorder and 77 (56.6%) of the women also had a co-occurring mental disorder including: Major Depression, Post Traumatic Stress Disorder, Mania, Generalized Anxiety Disorder, Hypomania, and Dysthymia. On average, women reported having a social network comprised of 10.73 members.

A significant relationship was found between critical members (those who provide negative support) within women’s social networks and perceived social support, with a higher percent of critical network members predicting lower perceived social support. Perceived social support scores were also significantly lower for women with a co-occurring mental disorder. Indirect relationships were found for women’s perceived social support. The percent of professionals within women’s social networks moderated the relationships between women’s treatment motivation and treatment status with perceived social support. The percent of substance users in women’s networks moderated the relationship between treatment motivation and perceived social support.

A sub sample analysis of 86 women in substance abuse treatment explored predictors of support for recovery. A significant relationship was found between the percent of members who support sobriety and support for recovery. This finding provides construct validity for the support for recovery measure.

Practice implications as well as directions for future research are included in this study. Findings suggest that clinicians should work with social network members and clients on improving communication and eliminating critical support to improve social support. Future research should focus on the impact of social relationships on treatment outcomes.

Committee:

Elizabeth Tracy, PhD (Committee Chair); David Biegel, PhD (Committee Member); Kathryn Adams, PhD (Committee Member); Sonia Minnes, PhD (Committee Member)

Subjects:

Social Research; Social Work

Keywords:

Social Support Networks; Social Support; Substance Use Disorders; Dual Disorders; Co-Occurring Disorders; Treatment Motivation; Social Networks; Substance Abuse; Women

Mermelstein, Liza C.Family Functioning and Substance Use Severity among Adolescents upon Admission to Residential Substance Use Treatment
Master of Science (MS), Ohio University, 2011, Clinical Psychology (Arts and Sciences)
Using the Circumplex Model of Family Systems (Olson, 1989; 2000; Olson & Gorall, 2006), this study sought to conceptualize family functioning patterns and examine the relationship between family functioning and substance use severity in adolescents admitted to a residential substance use treatment center. More problematic family functioning (i.e., greater family disengagement, rigidly, enmeshment and chaos) and less healthy family functioning (i.e., lower balanced cohesion and lower balanced flexibility) was observed in the current sample compared to a non-clinical comparison sample. Substance use severity was operationalized using the Substance Abuse Subtle Screening Inventory-Adolescent-2 (SASSI-A2) and three groups of substance users were established (Low Severity, Moderate Severity, and High Severity; Miller & Lazowski, 2001). After controlling for family member substance abuse, peer substance use and the impact of trauma, family cohesion level was significantly related to substance use severity group. Study findings suggest that family based interventions need to incorporate a wide range of problematic patterns and family cohesion, in particular, is an important family functioning pattern that should be addressed in interventions for adolescents in residential substance use treatment settings.

Committee:

Bernadette Heckman, Ph.D. (Committee Chair); John Garske, Ph.D. (Committee Member); Julie Owens, Ph.D. (Committee Member)

Subjects:

Clinical Psychology

Keywords:

Substance use disorders; FACES-IV; Circumplex Model; Adolescents; Family Functioning; Substance use treatment;

Park, HyunyongPatterns of Personal networks and their relationships to treatment outcomes among women with substance use disorders
Doctor of Philosophy, Case Western Reserve University, 2016, Social Welfare
Substance use disorders (SUDs) and their related negative impacts on individuals, families, and communities have become one of the more significant social welfare issues facing our society. In 2013, approximately 5.8% of adult women aged 18 or older in the United States were diagnosed with at least one SUD. Although substance use disorders are challenging for both men and women, research has shown that women are more vulnerable than men when they develop SUDs in terms of physical, mental health, and other treatment outcomes. Relational theory, Stress-Coping theory, and empirical literature consider that personal networks are an important factor influencing women’s treatment outcomes. Compared to previous studies that used variable-centered approaches, the present study utilized a person-centered approach to examine patterns of personal networks. The aims of this study are: (a) to identify the underlying subgroups of women with SUDs who had similar patterns of personal networks, (b) to examine socio-demographic and clinical characteristics associated with the underlying subgroups, and (c) to examine the relationships between the underlying subgroups and treatment outcomes post treatment intake. This study is a secondary data analysis with 272 women who received treatment and completed a personal network questionnaire at 6 month and treatment outcomes questionnaire at 12 months post treatment intake. This study employed Latent Class Analysis in order to address research questions. The findings show three distinctive subgroups of women who had similar patterns of personal networks: (a) family-centered supportive networks (36.4%), (b) treatment-centered supportive networks (23.2%), and (c) substance using negative networks (40.4%). Several socio-demographic (e.g., African American, age) and clinical characteristics (e.g., abstinence self-efficacy, trauma symptoms) were associated with the patterns of personal networks. Compared to women with either family-centered supportive networks or treatment-centered supportive networks, women with substance using negative networks were more likely to have poorer treatment outcomes after controlling for socio-demographic and clinical characteristics. The findings highlight three distinctive patterns of personal networks among women with SUDs and their relationships to treatment outcomes. The findings can be useful for practitioners to make tailored intervention because the study shows multiple pathways to improve women’s treatment outcomes.

Committee:

Elizabeth Tracy, PhD (Committee Chair); Kathleen Farkas, PhD (Committee Member); Meeyoung Min, PhD (Committee Member); Christopher McCarty, PhD (Committee Member)

Subjects:

Social Work

Keywords:

Personal networks; Substance use disorders; Patterns of personal networks; Treatment outcomes

Smith, StephanieExamining the Influence of Peritraumatic Dissociation on Treatment Outcomes and Symptom Severity Among Women Substance Users
PhD, University of Cincinnati, 2014, Arts and Sciences: Psychology
Substance use disorders (SUDs) continue to be associated with significant mental health problems (Brady & Randall, 1999; Finney, Moos, &Timko, 1999; Schukit, 2006). SUDs are commonly associated with other psychological disorders, thus complicating treatment for these populations and influencing treatment outcomes (Najt, Fusar-Poli, & Brambilla, 2011; Compton, Cottler, Abdallah, & Spitznagel, 2003). Women with substance use disorders (SUDs) have co-occurring disorders (Mangrum, Spence, & Steinley-Bumgarner, 2006), more impaired psychological and occupational functioning and often have difficulty adhering to treatment regimens (Mangrum, Spence, & Steinley-Bumgarner, 2006). Exposure to trauma is often related to the onset of several psychological disorders and has been shown to significantly predict substance use (Dansky, Brady, Saladin, Killeen, Becker, & Roitzsch, 1996). Peritraumatic dissociation (PD) is a specific symptom cluster associated with trauma exposure. It is defined as emotional numbing, detachment, and memory impairments shortly after a traumatic experience (van der Velden & Wittmann, 2008). PD has been found to significantly predict PTSD among college students (Bernat, Ronfeldt, Calhoun, & Arias, 1998) and women with histories of trauma (Olde, van der Hart, Kleber, van Son, Wijen, & Pop, 2005). However, neither of these studies examined the influence of PD symptoms among women with histories of SUDs who have been shown to be at higher risk for long term psychological dysfunction and poorer treatment outcomes (Levin, Ilgen, & Moos, 2007). It is unclear how PD influences psychological symptoms, making it difficult to determine what (if any) influence PD symptoms have on treatment outcomes or psychological functioning. Procedures: In the original study (Hien et al., 2005), interested women were asked to consent on IRB approved written consent forms. Next, the participants were screened to ensure they met the inclusion criteria for substance abuse or dependence and PTSD or subthreshold PTSD. Once the baseline assessment was completed, each site randomly assigned participants into the trauma or WHE group. Data on treatment service utilization, abstinence, PTSD symptom severity, global psychiatric symptoms, and substance use severity were collected across four time intervals. Results and Discussion The findings did not support hypothesis one. Specifically. PD did not predict days of substance abuse or treatment utilization at 6 months. The results did support hypothesis two baseline as PD symptom severity was significantly associated with greater psychiatric symptom severity and more PTSD symptoms at all four time intervals. The findings did not support the hypothesis that PD symptoms were associated with greater substance use severity. The results also revealed that relationship between PD and PTSD is weaker among African Americans than Whites. This study clearly demonstrates the relation of PD to psychiatric symptoms among substance using women with trauma histories. The findings suggest that addressing trauma generally and PD specifically may be essential to psychological functioning among women with histories of trauma and SUDs. These findings have been consistent in the literature and suggest that PD symptoms are associated with greater psychological impairments (Sibranji, et.al, 2012; Breh & Seidler, 2007).

Committee:

Ann Kathleen Hoard Burlew, Ph.D. (Committee Chair); Laura Nabors, Ph.D. (Committee Member); Giao Tran, Ph.D. (Committee Member)

Subjects:

Psychology

Keywords:

peritraumatic dissociation;substance use disorders;PTSD;Gender differences;treatment outcomes

Beeman, AmandaThe Effectiveness of the Seven Challenges Program for Urban Adolescents At-Risk for Substance Use Disorder
Doctor of Psychology (Psy.D.), Xavier University, 2014, Psychology
Substantial evidence points to the importance of early substance use interventions for adolescents (Kessler et aI., 201]; Schwinn, Schinke, & Trent, 2010; Swendsen et aI., 2010). Previous research on the Seven Challenges (7C) as a substance use intervention for adolescents has demonstrated that it decreases co-occurring mental health problems (depression/anxiety), substance use frequency, and substance-related problems (Smith, Hall, Williams, An, & Gotman, 2006; Stevens, Schwebel, & Ruiz, 2007). However, these efficacy studies have only utilized problem-focused measures and have not included racially or socioeconomically diverse populations. The current effectiveness study incorporates measures of client functioning and strengths in an evaluation of the 7C program with adolescents in a community mental health setting. Archival data of ] 6 youth between the ages of] 3 and 16 were analyzed, including measures of problem severity, functioning, and strengths that were collected at baseline, three, and six-month intervals. Substance use frequency was collected at baseline and six-months, but missing data precluded mean difference analyses of these results. There was no change in youth strengths. Limitations of the study include a small sample size, the absence of a control group, and missing data. Although these limitations are commonly present in community mental health settings, future research should attempt to address these limitations.

Committee:

W. Michael Nelson III, Ph.D. (Committee Chair)

Subjects:

Psychology

Keywords:

at-risk;substance use disorders;

Lee, Tayla T.C.Examination of Elaborated Structural Models of Psychopathology to Understand the Comorbidity of Substance Use and Internalizing Disorders
PHD, Kent State University, 2013, College of Arts and Sciences / Department of Psychology
Substance use disorders (SUDs) are frequently comorbid with internalizing disorders, including unipolar mood and anxiety disorders (Grant et al., 2004a). A large body of previous evidence suggests that the development of comorbid SUDs and internalizing dysfunction is a result of several, non-mutually exclusive causal relations between liabilities for these types of difficulties (Mueser et al., 2006). Alternatively, in models of psychopathology where several disorders are considered collectively, comorbidity between SUDs and internalizing disorders is hypothesized to occur due to a relation between broad predispositions for internalizing and externalizing dysfunction (Krueger & Markon, 2006). The current study aimed to begin resolving the discrepancy between these two bodies of research. Three structural models were estimated and contrasted to investigate whether there were direct, positive associations between substance use and aspects of internalizing difficulties when these potential relations were considered in the context of other frequently occurring mental disorder symptoms. These models were calculated in three samples, including college men (N = 554), college women (N = 874), and correctional (N = 818) participants. Overall, results across samples did not support the hypothesis that there would be a direct, positive relation between the liabilities for using substances and internalizing problems. Instead, comorbidity between substance-related and internalizing difficulties appeared to be largely a result of an association between broad tendencies for externalizing and internalizing problems. Although the current study had some limitations, results do suggest that researchers and clinicians should not treat aspects of internalizing and externalizing dysfunction as extraneous information to be ignored as these general behavioral predispositions may have a greater impact on comorbidity than previously believed.

Committee:

John R. Graham, Ph.D. (Committee Chair); Yossef S. Ben-Porath, Ph.D. (Committee Member); Kristin D. Mickelson, Ph.D. (Committee Member); Sonia Alemagno, Ph.D. (Committee Member); Kristen Marcussen, Ph.D. (Committee Member)

Subjects:

Clinical Psychology

Keywords:

Substance Use Disorders; Internalizing Disorders; Comorbidity