Biomedical subjects

Mark P McGovern

Publications and source records attributed to Mark P McGovern.

9 recordsLinked to original sources

PubMed2006

Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers.

As the model for treating co-occurring disorders in addiction treatment settings becomes articulated, service systems need data on prevalence, current practice, and barriers to the implementation of evidence-based practices. A self-report survey was administered to 453 addiction treatment providers (43 agency directors, 110 clinical supervisors, and 300 clinicians) from a single state system of care. Data on prevalence estimates, treatment practices, and barriers to implementing services for co-occurring disorders were obtained. The three groups estimated that several co-occurring disorders were extremely common: mood disorders (40%-42%), anxiety disorders (24%-27%), posttraumatic stress disorder (24%-27%), severe mental illnesses (16%-21%), antisocial personality disorder (18%-20%), and borderline personality disorder (17%-18%). Practice patterns for patients with these co-occurring disorders differed widely, from referral to mental health programs to provision of integrated treatment. Common barriers to providing services to persons with co-occurring disorders were lack of psychiatric personnel and resources. Comprehensive surveys of an addiction treatment service system can rapidly and economically produce estimates of prevalence, current practices, and barriers to evidence-based practices. This objective information is critical for systems intending to enhance services to persons with co-occurring disorders.

Administrative Personnel↗

PubMed2005

Relapse of substance use disorder and its prevention among persons with co-occurring disorders.

This article summarizes the scientific literature on the relapse process, describes the basic principles of relapse prevention treatment, highlights the major empirical studies, and offers suggestions for future research and application, especially in terms of ongoing care for persons with co-occurring disorders. Relapse prevention treatments have a well-established efficacy and effectiveness for persons with substance use disorders. Key ingredients include reducing exposure to substances, fostering motivation for abstinence, self-monitoring, recognizing and coping with cravings and negative affect, identifying thought processes with relapse potential, and deploying, if necessary, a crisis plan. Relapse prevention approaches may be best suited for persons in the action of maintenance stages of treatment or recovery. Further research is needed to examine relapse prevention therapies as a key component to continuing care for persons with co-occurring substance use and psychiatric disorders.

Adaptation, Psychological↗

PubMed2005

Future directions in preventing relapse to substance abuse among clients with severe mental illnesses.

The authors review the literature on substance use disorders among persons with severe mental illnesses, including the other papers in this special section on relapse prevention, and suggest future directions. Although prevention of relapse to substance abuse has a well-developed theoretical and empirical base, this perspective has rarely been applied to persons with co-occurring severe mental illness. Research indicates that clients with co-occurring disorders are highly prone to relapse to substance abuse, even after they have attained full remission. Their risk factors include exacerbations of mental illness, social pressures within drug-using networks, lack of meaningful activities and social supports for recovery, independent housing in high-risk neighborhoods, and lack of substance abuse or dual diagnosis treatments. The evidence in hand suggests several steps: developing healthy and protective environments that are experienced as nurturing of recovery; helping people make fundamental changes in their lives, such as finding satisfying jobs, abstinent friends, networks of people who are in the process of recovery, and a sense of meaning; providing specific and individualized treatments for mental illnesses, substance use disorders, and other co-occurring problems; and developing longitudinal research on understanding and preventing relapse that addresses social context as well as biological vulnerabilities and cognitive strategies.

Diagnosis, Dual (Psychiatry)↗

PubMed2004

A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system.

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n = 21) and clinicians (n = 89) from 24 public addiction treatment programs in New Hampshire (USA). Clinicians are more motivated to adopt some evidence-based practices (twelve-step facilitation, cognitive behavioral therapy, motivational interviewing, relapse prevention therapy) than others (contingency management, behavioral couples therapy, pharmacotherapies). Translational strategies for treatment development and research dissemination are discussed.

Adult↗

PubMed2004

Physicians and nurses with substance use disorders.

BACKGROUND: The literature addressing substance use patterns among medical professionals suggests that specialty, gender, age, familial substance abuse, and access/familiarity with prescription drugs are associated with particular chemical dependencies. These studies have rarely compared nurses and physicians directly, thereby making if difficult to tailor interventions to the potentially unique needs of each group. AIM: This paper reports a study to compare the initial clinical presentations, service utilization patterns, and post-treatment functioning of nurses and physicians who received services in an addiction treatment programme. METHOD: This exploratory study combined data collected through retrospective record reviews and prospective questionnaires. There were three types of dependent variables: initial clinical characteristics, treatment utilization patterns, and post-treatment functioning. The independent variable was membership of either professional group. Time both in treatment and between discharge and follow-up were covariates. RESULTS: Nurses and physicians showed comparable results in most domains. Among the statistically significant differences between groups, a subset was particularly noteworthy. Prior to participating in the programme nurses showed significantly less personality disturbance than physicians, although they tended to work and live in environments with more triggers to relapse, such as other substance users. After the index hospitalization, nurses received less primary treatment, worked longer hours, and were more symptomatic than physicians. Furthermore, nurses reported more frequent and severe work-related sanctions as a consequence of their behavioural disorders. CONCLUSION: In most areas of study, nurses and physicians demonstrated comparable results; however, a series of statistically significant differences suggest that these groups may have unique clinical needs. The policy implications of these findings are discussed.

Adult↗

PubMed2003

Evidence-based practices for substance use disorders.

There are inherent complexities in evaluating EBPs for substance use disorders: the heterogeneity of the disorder itself, the variability in people who suffer from them, the range of settings in which services are provided, and multiple lines of research development. This article outlined four models for evaluating the evidence for interventions for substance use disorders, and presented brief descriptions of pharmacological, behavioral/psychosocial, and treatment services that have a clearly defined intervention (chemical agent or manual-guided therapy) and a documented record of objective evaluation. Although substantial work is underway to evaluate effectiveness in the real world, clinicians and individuals with substance use disorders and their families should be cognizant of the burgeoning array of effective treatment alternatives that are available.

Cognitive Behavioral Therapy↗

PubMed2003

Gender of physicians with substance use disorders: clinical characteristics, treatment utilization, and post-treatment functioning.

Gender has emerged as an important variable in both the course and treatment of substance-use disorders. This study examines the role of gender in a sample of physicians (n = 73) treated for substance-use disorders. Pilot data gathered on physicians treated during 1995 to 1997, included initial pretreatment characteristics, service utilization, and posttreatment functioning. Although there were many similarities, important differences emerged among the groups. These differences have implications for physician education and training and warrant more systematic clinical research.

Adult↗

PubMed2003

Psychiatric comorbidity and physicians with substance use disorders: a comparison between the 1980s and 1990s.

The assessment and treatment of physicians with substance use disorders has been of considerable interest over the past twenty years. This study compares two cohorts of addicted physicians treated at a single program. Data from 101 physicians treated during 1985 to 1987 were compared with 73 physicians treated from 1995 to 1997. Although the cohorts were similar on demographic, physician specialty, and drug of choice variables, psychiatric comorbidity was significantly more prevalent in the later sample.

Adult↗

PubMedDate not supplied

A systematic analysis of college substance use policies.

College substance use policies provide guidelines for student behavior and influence campus culture. Although they are the primary environmental strategy to address campus substance use, policies have not been systematically compared and studied. We constructed a systematic review method to examine the accessibility, comprehensiveness, enforcement procedures, and clarity of college substance use policies. We developed an objective evaluation scheme for each of these 4 dimensions and then applied it to documented substance use policies from a sample of colleges and universities (N = 24). Policies were found to vary considerably but tended to specify compliance with local laws and emphasize student health and well-being. The next stage of campus policy review should examine actual implementation, evaluate potential differentiating factors among institutions, and assess the influence of policy on campus climate and student outcomes.

Administrative Personnel↗