The Development and Implementation of a Jail-Based Substance Abuse Treatment Program

Formerly incarcerated military veterans—comprising approximately 8% of the prison population—experience significant barriers to reentry including homelessness, mental illness, and mortality. One of the most consequential barriers is relapsing into substance use. Most justice-involved veterans (JIV) possess histories of substance abuse before imprisonment, and this rate continues upon release. Mental illness—depression in particular—is often comorbid with substance abuse. With high rates of depression and substance use in a JIV population, it is important to determine to what extent release from prison contributes to predicting substance use and negative clinical outcomes. This study compares rates of substance use and negative outcomes between two matched samples of JIV and general veterans, both with depression and a substance use disorder. It is hypothesized that JIV will have a higher rate of substance use and that use will be associated with higher negative outcomes in the JIV condition. Rates of use of veterans released from prison and general veterans were collected during six-year follow-up periods. Use was defined as the use of an illicit substance or alcohol, if an alcohol use disorder was present, and determined by urine drug tests or self-report recorded in medical notes. Results indicate that JIV used substances at a higher rate compared to those not recently incarcerated, and that such use is predictive of several other negative outcomes including homelessness, use of inpatient substance treatment, and reincarceration. Structured drug treatment programs and other interventions should cater to veterans recently released from prison to offer help in these areas.

IntroductionSubstance abuse, defined here as the abuse of alcohol, cannabis, cocaine and heroin, in older adults is often neglected, both in science and in practice.Substance abuse is a serious public health issue as it not only affects physical and mental health of the abusers, it also leads to increased costs for society (Adams et al., 1993).Older adults with addiction problems deserve special attention.Compared to younger people, smaller amounts of substance may lead to intoxication and organ damage because of greater use of contraindicated medications, less efficient liver metabolism and decreases in lean body mass and total body water (Dufour & Fuller, 1995).Substance use and abuse among people aged 50 and over is rapidly increasing in Europe and the United States (Beynon, 2009).For Europe, the number of older people with substance use problems is estimated to more than double between 2001 and 2020 (Gossop, 2008).This is partly due to the size of the baby-boom cohort (born between 1946 and 1964) and the higher rate of substance use among this group (Gfroerer et al., 2003).Estimates from the United States suggest that the number of adults aged 50 and over will double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020 (Han et al., 2009).To reduce the negative trend in substance abuse, effective prevention is required.Cuijpers and Willemse (2005) distinguish four types of prevention in this context; universal prevention, selective prevention, indicated prevention and care based prevention.For each level of prevention, specific knowledge is needed.For universal prevention, targeted at the entire population regardless of the risk of addiction, knowledge about the prevalence, causes and adverse consequences of risk-full use are important.In selective prevention, aimed at groups at risk of becoming addicted, knowledge of risk factors is essential to identify the groups.For indicated prevention, aimed at people with limited symptoms, it is important to recognize signs of addiction and have knowledge of appropriate treatments.Finally, care based prevention, referring to people with an addiction according to DSM criteria, it is important to have insight into factors that influence the course of the disease.Insufficient knowledge of one or more levels of prevention can lead to under-recognition of addiction problems by social workers (Adams et al., 1992), lack of agreement between doctors on the causes and treatment of addiction (Brown, 1982), and people are still insufficiently aware of the importance and effects of proper treatment (McInnes & Powell, 1994). www.intechopen.comPsychiatric Disorders -Trends and Developments 390In this chapter, an overview is given of what is known about the prevalence and the biopsycho-social characteristics of older people who abuse substances.In addition, we will describe the known risk factors for the development and course of substance abuse. Methods ReviewIn addressing the aim of this chapter, three databases (PubMed, PsychINFO, and Socindex) were investigated for potentially relevant studies using the following keywords: "Alcohol", "drug abuse", "heroin", "cocaine", "cannabis", "substance abuse" each combined with AND (elderly OR older adults).Based on the title and abstract of each retrieved article the potential relevance for the current study was investigated.We selected only articles that were written in English, have appeared in peer-reviewed journals, were based on original quantitative empirical research, aiming at the older population (aged 50 years or older).Relevant information for answering the research questions was extracted from each selected article.For information on the prevalence and the bio-psycho-social characteristics of older people who abuse substances, studies containing information on one or more of the following characteristics were selected: prevalence, trends in use with age, bio-psycho-social characteristics of users, and risk-full use or addiction.For information on risk factors for the development and course of substance abuse, only longitudinal studies or case-control studies were selected.

American Indian and Alaska Native (AIAN) communities have higher rates of substance use than other racial and ethnic groups. Substance use disorder (SUD) is tied to the increased risk of experiencing homelessness. National policies have also led to the disproportionate rates of homelessness among AIAN communities. However, specific experiences related to the occurrence of SUD and homelessness among AIAN in California, as well as seeking and accessing SUD treatment, are not well understood. This study explored potential SUD risk and resilience factors for AIANs experiencing homelessness and their experiences when seeking services for SUD. Nineteen interviews were conducted in northern, central, and southern California. Thematic analysis was used for these data. The five primary codes were: (1) risk factors for SUD, (2) resilience related to SUD service seeking, (3) services available, (4) barriers accessing services, and (5) services needed. Based on the results, themes for risk were trauma, mental health, and community conditions. Themes for resilience were identified at individual and community levels and included personal motivation and community support and inclusiveness. Themes for services available were limited knowledge about service types and services’ location. The themes for barriers accessing services were identified at internal and external levels, and included lack of readiness and transportation challenges, respectively. Themes for services needed included continuum of care, integrated care, and culturally sensitive services. Findings highlight the importance of addressing the potential risk factors and service needs of AIANs experiencing homelessness to provide comprehensive and culturally sensitive services to reduce substance use.

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

The purpose of this study is to describe endorsement rates of substance use criteria among homeless adolescents and to evaluate the reliability of diagnostic formulations among a group of adolescents who use more frequently and more heavily than other samples of adolescents. Substance use rates and DSM-IV abuse and dependence criteria were assessed among 198 (109 male) homeless youths between the ages of 13 and 19, as part of a larger study. Endorsement rates and reliability analyses were completed for diagnostic criteria assessed for alcohol, marijuana, amphetamines and heroin. Consistent with other studies of homeless youth, data revealed high rates of substance use and high rates of substance dependence. Both dependence and abuse diagnoses were associated with greater rates of use. DSM-IV criteria showed acceptable internal reliability, although variability was observed when applied to different substances. Of the drugs assessed, problems with heroin use appeared to be best, and marijuana use least, represented by dependence criteria. Criteria pertaining to continued use despite interference with role obligations and the experience of craving were consistently related to other dependence criteria. DSM-IV substance dependence criteria appear to have good internal reliability within a sample of adolescents who use at extremely high rates. Continued development of diagnostic systems for adolescent substance use should consider the social context of use, differential patterns of symptoms across different substances and the inclusion of additional criteria found reliable among adolescent samples.

Types of criminal legal system exposure and polysubstance use: Prevalence and correlates among U.S. adults in the National Survey on Drug Use and Health, 2015–2019

Cannabidiol (CBD) does not reduce cocaine reward or self-administration in a mouse model of schizophrenia genetic susceptibility.

American Indian/Alaska Native (Native) youth face high rates of substance use, teen pregnancy and sexually transmitted infections. In response to the COVID-19 pandemic, Respecting the Circle of Life (RCL), a sexual reproductive health and teen pregnancy prevention program for Native youth and their trusted adult, was adapted and delivered in a virtual format with Native youth in a rural, reservation-based Native community. This manuscript describes the adaptation process, feasibility, and acceptability of virtual program implementation. The manuscript describes the process of rapidly shifting the RCL program into a virtual format. In addition, a mixed-methods process evaluation of implementation forms, program feedback forms, in-depth interviews with participants, and staff debriefing sessions was completed. Results show virtual implementation of RCL is both feasible and acceptable for Native youth and their trusted adults. A key benefit of virtual implementation is the flexibility in scheduling and ability to have smaller groups of youth, which offers greater privacy for youth participants compared to in-person implementation with larger groups. However, internet connectivity did present a challenge for virtual implementation. Ultimately, sexual and reproductive health programs seeking to reach Native youth and families should consider virtual implementation methods, both during and outside of pandemic situations.

Geographic differences in substance use screening for justice-involved youth

The Evidence for SBIRT in Adolescents

Troubled parents, motivated adolescents: Predicting motivation to change substance use among runaways

Regrettably for African Americans, research has rarely addressed issues that affect their health and well-being. This lack of attention manifests itself in the dearth of literature available while doing literature reviews on prevention of comorbid mental illness and substance abuse (MISA) and substance use and abuse disorders in African Americans. However, there are a few studies on the prevention of substance use and abuse disorders alone and the prevention of relapse in African Americans with MISA problems. These articles form the basis of our proposal to prevent co-morbidity of mental and substance use and abuse disorders in African Americans.

Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work.

Substance use and substance use disorders as foster youth transition to adulthood

Objectives: Despite college students reporting high rates of substance use and adverse childhood experiences (ACE), few studies have examined ACE-related substance use patterns with diverse student samples. We estimated the prevalence of ACE and substance use and investigated ethnic differences in the relationship between ACE and substance use among college students from two states. Design: Data are responses (N = 7,148) on the National College Health Assessment (in California) and the College Student Health Survey (in Minnesota). Multivariable regression models assessed the associations between individual and accumulated ACE and alcohol, tobacco, marijuana, and illicit substance use and binge drinking (adjusting for age, gender, depression, and state) among non-Hispanic White, Hispanic, African American/Black, Asian Pacific Islanders, multiracial, and other students. Interaction terms were calculated to test for ethnic differences. Results: In the month preceding the survey, 22% of students used marijuana, 28% used tobacco, 75% drank alcohol; 6% used an illicit drug in the past year and 30% acknowledged past 2-week binge drinking. Although ACE were associated with all substance use behaviors (AORs ranged from 1.19 to 1.54, p < .001), there was significant ethnic variation in ACE exposure (40–52%) and the dose-response relationship between ACE and marijuana and tobacco use and binge drinking. Conclusions: The variability in ACE-related substance use patterns across ethnic groups highlights the need for research that advances our understanding of sociocultural influences in trauma response and the role that campus communities could have in the development of culturally sensitive services that address this issue.