RESUMEN
Three models of adolescent substance use, the deviance-prone, affect-regulation, and normative development models, were assessed regarding their ability to predict the substance use of a high-risk homeless adolescent sample with high rates of deviance, depression, and substance use. Hierarchical multiple regression analyses that included tests for curvilinear and gender interaction effects were performed. Results supported the deviance-prone model most strongly, with delinquency but not aggressive behavior predicting substance use. The affect-regulation model received support for females but not for males. With respect to the normative development model, results did not indicate that moderate substance users were better off than abstainers in terms of negative affect or interpersonal relationships.
Asunto(s)
Adaptación Psicológica , Jóvenes sin Hogar/psicología , Trastornos Relacionados con Sustancias/psicología , Adolescente , Depresión/psicología , Femenino , Identidad de Género , Humanos , Delincuencia Juvenil/psicología , Masculino , Modelos PsicológicosRESUMEN
Assessment of therapeutic orientation is a significant problem in substance abuse program evaluation. This study reports the initial results of a new approach to measuring treatment orientation through a self-report survey that focuses on distinctive features of substance abuse treatment orientations. The Drug and Alcohol Program Treatment Inventory (DAPTI) assesses treatment goals and activities specific to eight orientations: AA/12 Step, Therapeutic Community, Cognitive-Behavioral, Insight/Psychodynamic, Rehabilitation, Dual Diagnosis, Medical and Marital/Family Systems. We present findings from a nationwide assessment of 327 Veterans Administration (VA) Substance Abuse treatment programs that demonstrate promising subscale internal consistency, discriminant validity, and concurrent validity. In addition, the DAPTI distinguishes between programs with independently verified orientations and between inpatient, extended care, outpatient, and methadone maintenance programs. The DAPTI may be helpful in systematically assessing differences in treatment orientations between different types of programs, such as inpatient, community residential, and outpatient care.
Asunto(s)
Alcoholismo/rehabilitación , Política de Salud/tendencias , Investigación sobre Servicios de Salud/tendencias , Drogas Ilícitas , Psicotrópicos , Trastornos Relacionados con Sustancias/rehabilitación , Alcoholismo/psicología , Atención Ambulatoria/tendencias , Terapia Combinada , Predicción , Humanos , Metadona/uso terapéutico , Evaluación de Procesos y Resultados en Atención de Salud , Admisión del Paciente/tendencias , Grupo de Atención al Paciente/tendencias , Trastornos Relacionados con Sustancias/psicología , Estados UnidosRESUMEN
This study examined the patient case mix and program determinants of 6-month readmission rates and early treatment dropout for 7,711 VA inpatients with both substance abuse and major psychiatric disorders treated in one of 104 substance abuse programs. Patients were treated in one of three types of inpatient programs: explicitly designed dual diagnosis specialty programs, substance abuse programs with a dual diagnosis psychotherapy group or standard substance abuse programs. Dual diagnosis specialty programs differed from regular substance abuse programs in that they had a more severe case mix, a higher 180-day readmission rate, greater dual diagnosis treatment orientation, used more psychotropic medication, had longer lengths of stay, had greater tolerance of relapse and medication noncompliance, and a higher rate of psychiatric aftercare in the 30 days after discharged. Programs with less severe case mix, longer intended and actual length of stay, lower 7-day dropout rates, greater tolerance of problem behavior, 12-step groups, and higher immediate postdischarge utilization of outpatient mental health treatment lower 180-day readmission rates. Programs with less severe patient case mix, more use of psychotropic medications but less of methadone and antabuse, less varied and diverse treatment activities, and low use of patient-led groups had lower dropout rates.