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Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse treatment provision among individuals of varying socioeconomic and racial/ethnic backgrounds. This study investigates that achievement by analyzing the relationship between community socioeconomic and racial/ethnic disadvantage and organizational provision of substance abuse treatment, treatment need and utilization across United States counties, 2000, 2002 and 2003. Results confirm equity in service provision in poorer communities and those with higher concentrations of African Americans. Significant disparities remain, however, in communities with higher concentrations of Hispanics, youth and female-headed households. Limitations and implications for future studies of health care provision are discussed.

This paper's aim is to examine the relationship between intimate partner violence, childhood abuse and psychiatric disorders among 118 female drug users in treatment in Barcelona, Spain.

Secondary analysis of a cross‐sectional study of the psychiatric, behavioural and social risk factors for HIV. DSM‐IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders; the Composite Abuse Scale assessed intimate partner violence and the Child Maltreatment History Self‐Report assessed childhood physical and sexual abuse.

The odds of experiencing intimate partner violence were 2.42 times greater among those with any depressive disorder (95 per cent CI 1.13, 5.20), over three times greater for those who reported ever attempting suicide (OR 3.20; 95 per cent CI 1.29, 7.94), met criteria for borderline personality disorder (OR 3.05; 95 per cent CI 1.31, 7.11), had been abused in childhood (OR 3.38; 95 per cent CI 1.45, 7.85) or currently lived with a substance user (OR 3.74; 95 per cent CI 1.29, 10.84). In multiple logistic regression, only living with a substance user (OR 3.42; 95 per cent CI 1.08, 10.86) and a history of childhood abuse (OR 2.87; 95 per cent CI 1.05, 7.86) remained significant in the model examining intimate partner violence victimisation.

The small sample size, together with the fact that the study was not originally powered to examine differences in intimate partner violence may have increased the possibility of type II errors.

Histories of psychiatric disorders, intimate partner violence and childhood abuse are common in female substance users in treatment. Research suggests that such histories result in poorer treatment outcomes. Histories of intimate partner violence and childhood abuse should be identified and addressed in substance abuse treatment to enhance treatment outcomes.

There have been few studies about the prevalence of substance abuse and links to offending behaviour among those with intellectual disabilities. This paper aims to address this issue.

This baseline audit describes: the prevalence of alcohol and substance misuse in patients within a forensic intellectual disability service; and the introduction of a Drug and Alcohol Awareness Course. In total, 74 patients were included in the audit.

Roughly half of the patients audited had co‐morbid harmful use or dependence with the problem being equally prevalent in men and women. Whilst alcohol and cannabis were the commonest drugs of abuse, cocaine, stimulants and opiates were abused by a small but significant number. Of those with harmful use or dependence, 35 per cent had used the drug in the immediate lead up to their index offence. A diagnosis of personality disorder and past history of convictions for violent offences was significantly more likely to be present in the group with harmful use or dependence. There were no differences on major mental illnesses or pervasive developmental disorders.

The high prevalence of substance abuse makes it an important risk factor that could determine treatment outcomes. Forensic intellectual disability units need replicable substance abuse targeted treatment programmes that can be formally audited and evaluated.

Findings are discussed in relation to service planning and treatment outcomes from forensic intellectual disability services.

The purpose of this qualitative case study was to explore perceptions of the impact of program participation on parenting styles and behavioral changes using observations and in-depth semi-structured interviews with Black and Coloured staff and mothers at a community-based organization (CBO) in the Western Cape Province (WCP) in South Africa (SA). Purposive sampling was utilized in this research via the CBO and narratives from a total of twenty-three (twelve mothers and eleven staff) interviews form the basis of this manuscript. Data was collected between January – February 2017 and was analyzed through the phenomenological and inductive thematic analysis approach. The staff interviews revealed that child abandonment and neglect and the abuse of women are the two main environmental contextual factors that impact program participation. According to staff, improved self-esteem and positive life changes were identified as successful outcomes of participant involvement. The parent interviews provided examples of emotional issues such as domestic abuse and personal issues with alcohol and drugs as individual factors that impact their program participation. Changes in parenting styles was identified as successful outcomes among parent participants. The goal of this study was to provide much-needed insight into this community by presenting a variety of voices, specifically Black and Coloured men and women, that are underreported in the literature. Findings from this research adds to the knowledge of community-based parenting programs (CBPPs) for low-income and underserved populations in SA and internationally.

The purpose of this paper is to address a possible interaction of cognitive distortions associated with substance dependency and intimate partner violence (IPV), and the effects on subsequent behavior. The primary focus was to investigate the relationship between offender perception (i.e. perception of family problems (FP) and perception of need for treatment for family problems (FPTx)) and treatment outcome (i.e. substance use and violence), among a unique sample of substance dependent male offenders of IPV. An additional investigation included the change in perception from baseline to the end of treatment.

In total, 63 participants were randomly assigned to one of two treatment conditions and assessed across 12 weeks of treatment.

Participants in the (FP+) (i.e. those who perceived family problems at baseline) and (FPTx+) (i.e. those who perceived a need for treatment for family problems at baseline) conditions reported a significantly greater change in the number of days of violence from baseline to the end of treatment, compared to participants in the (FP−) (i.e. those who did not perceive family problems at baseline) and (FPTx−) (i.e. participants who perceived no need for treatment at baseline) conditions. (FP+) and (FPTx+) participants had significant decreases in any violent behavior from pre- to post-treatment.

The results of this study highlight the importance of techniques aimed at improving clients’ ability to recognize and admit to problem behaviors, a critical component of cognitive-behavioral therapy, in an effort to increase their motivation for treatment, thus leading to greater treatment success.

This is the second in a series of papers focused on alcohol and substance abuse rehabilitation centers. Centers face the ongoing challenge of validating outcomes to meet the burden of evidence for insurance companies. In the first paper, data mining was used to establish baseline patterns in treatment success rates, for the Futures: Palm Beach Rehabilitation Center, that have a direct impact on a client’s ability to receive insurance coverage for treatment programs. In this paper, we examine 2016 outcomes and report on facility efficacy, alumni progression and sobriety, and forecast treatment success rates (short and long term) in support of client insurability. Data collection has been standardized and includes admissions data, electronic medical records data, satisfaction survey data, post-discharge survey data, Centers for Disease Control (CDC) data, and demographic data. Clustering, partitioning, ANOVA, stepwise regression and stepwise Logistic regression are applied to the data to determine statistically significant drivers of treatment success.

Roughly half a million persons in the USA are homeless on any given night and over a third of those individuals have significant alcohol/other drug (AOD) problems. Many are chronically homeless and in need of assistance for a variety of problems. However, the literature on housing services for this population has paid limited attention to comparative analyses contrasting different approaches. The paper aims to discuss these issues.

The authors examined the literature on housing models for homeless persons with AOD problems and critically analyzed how service settings and operations aligned with service goals.

The authors found two predominant housing models that reflect different service goals: sober living houses (SLHs) and housing first (HF). SLHs are communally based living arrangements that draw on the principles of Alcoholics Anonymous. They emphasize a living environment that promotes abstinence and peer support for recovery. HF is based on the premise that many homeless persons with substance abuse problems will reject abstinence as a goal. Therefore, the HF focus is providing subsidized or free housing and optional professional services for substance abuse, psychiatric disorders, and other problems.

If homeless service providers are to develop comprehensive systems for homeless persons with AOD problems, they need to consider important contrasts in housing models, including definitions of “recovery,” roles of peer support, facility management, roles for professional service, and the architectural designs that support the mission of each type of housing.

This paper is the first to consider distinct consumer choices within homeless service systems and provide recommendations to improve each based upon architecture and community planning principles.

Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis.

A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis.

The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis.

This study adds to the growing body of literature showing that patient-centered care allows for more effective treatment and ultimately, improved health outcomes.

Persons in the USA who are incarcerated for drug offenses are increasingly being released into the community as a way to decrease prison and jail overcrowding. One challenge is finding housing that supports compliance with probation and parole requirements, which often includes abstinence from drugs and alcohol. Sober living houses (SLHs) are alcohol- and drug-free living environments that are increasingly being used as housing options for probationers and parolees. Although a few studies have reported favorable outcomes for residents of SLHs, little is known about resident experiences or the factors that are experienced as helpful or counterproductive. The paper aims to discuss this issue.

This study conducted qualitative interviews with 28 SLH residents on probation or parole to understand their experiences living in the houses, aspects of the houses that facilitated recovery, ways residence in an SLH affected compliance with probation and parole, and ways the houses addressed HIV risk, a widespread problem among this population. Interviews were audiotaped and coded for dominant themes.

Study participants identified housing as a critically important need after incarceration. For residents nearing the end of their stay in the SLHs, there was significant concern about where they might live after they left. Residents emphasized that shared experiences and goals, consistent enforcement of rules (especially the requirement of abstinence) and encouragement from probation and parole officers as particularly helpful. There was very little focus in HIV issues, even though risk behaviors were fairly common. For some residents, inconsistent enforcement of house rules was experienced as highly problematic. Research is needed to identify the organizational and operational procedures that enhance factors experienced as helpful.

Data for this study are self-reported views and experiences. Therefore, the study may not tap into a variety of reasons for resident experiences. In addition, the data set was small (n=28) and limited to one city in the USA (Los Angeles), so generalization of results might be limited. However, SLHs represent an important housing option for criminal justice involved persons and knowledge about resident experiences can help guide organization and operation of houses and identify areas for further research.

This paper is the first to document the views and experiences of persons on probation or parole who reside in sober living recovery houses. These data can be used by SLH operators to develop houses that are responsive to factors experienced as helpful and counterproductive. The significance of this paper is evident in the trend toward decreasing incarceration in the USA of persons convicted of drug offenses and the need for alcohol- and drug-free alternative living environments.

Retrospective studies of therapeutic community (TC) treatment for drug abuse found reductions in drug use, criminality, and increased work participation after treatment completion. These studies have also shown treatment benefits, even without completion, are correlated with days of stay in residential treatment. However, others have found that high rates of early leaving from TC treatment reduce the proportion of clients with positive outcomes, raise the total cost per treated client, and lower the treatment benefit-to-costs ratio. The purpose of this paper is to describe an experimental approach to raising the days in residential treatment using earlier vocational access for clients.

The current study used a random assignment design to compare earlier integration of on-site vocational training in a vocationally integrated therapeutic community to off-site vocational training initiated after one year of residence in a traditional therapeutic community.

The resulting data support the hypotheses that client expectations and early training in job skills increase rate of treatment affiliation, the proportion of clients having effective lengths of stay, and the rate of treatment completion.

Research limitations/implications include the difficulty of assuring unbiased selection and controlling treatment assignment and conditions.

Practical implications of this research project are to support practitioners striving for longer, more effective lengths of stay, while at the same time attempting to reduce treatment time and increase effectiveness.

Social Implications of this project are to encourage social support for addiction treatment and emphasize the value of paired residential treatment and vocational education.

The originality and value of this research project lies in the adoption of a working model at Phoenix House TC (in-house vocational preparation), which utilizes early in-house vocational education as a means to increase residential program participation, increase employment skills and prospects, and decrease overall length of treatment.