Biomedical subjects

Stephen Magura

Publications and source records attributed to Stephen Magura.

At least 19 recordsLinked to original sources

PubMed2007

Effects of "dual focus" mutual aid on self-efficacy for recovery and quality of life.

Four million adults in the U.S. have co-occurring serious mental illness and a substance use disorder. Mutual aid can usefully complement treatment, but people with co-occurring disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons with dual diagnoses. Three hundred and ten persons attending 24 DTR groups in New York City during 1998 were interviewed and followed-up for two years. A mediational model was specified and results across time were summarized with generalized estimating equations (GEE). Degree of DTR Affiliation (attendance and involvement) was significantly associated with Self-efficacy for Recovery and three quality of life measures: Leisure Time Activities, Feelings of Well-Being and Social Relationships. Self-efficacy fully mediated the effects of DTR Affiliation on Leisure Time and Feelings and partially mediated DTR's effect on Social Relationships. The association of DTR involvement with self-efficacy is consistent with the processes inherent in mutual aid, although the observational nature of these data preclude causal inference. To improve outcomes, clinicians should facilitate affiliation with dual focus groups among persons with dual diagnoses as part of a comprehensive treatment approach.

Adult↗

PubMed2006

Predictors of engagement in vocational counseling for methadone treatment patients.

Employment enhances the outcomes of substance dependency treatment. Unfortunately, although unemployed methadone treatment patients frequently state they are interested in a job, many fail to participate in vocational services when available. Unless patients become engaged, vocational services do not have an opportunity to be effective. This is the first study to explore a broad array of factors that may be associated with differential engagement in vocational services among methadone patients. The study was conducted in two methadone programs in New York City during 2001-2004. Unemployed methadone patients (n = 211) were voluntarily randomly assigned to either of two vocational counseling programs (standard vs. experimental) and followed for 6 months. The sample was 59% male, 75% minority group, aged 45 years on average, and in methadone treatment for 5 years on average. Being engaged in the vocational counseling programs was defined as five or more sessions with the counselor in the first 6 months after study entry. In multivariate analysis, the factors associated with higher engagement in vocational counseling were being non-Hispanic, having more education, a drug injection history, a crack use history, having chronic emotional/mental problems, better work attitudes, and assignment to the experimental vocational program. The results indicate that it is often the most "needy" unemployed methadone patients who become more engaged in vocational counseling. A vocational counseling model which emphasizes assertive outreach and attends to nonvocational clinical issues as well is more likely to engage patients.

Adult↗

PubMed2005

Factor structure of the Conners Adult ADHD Rating Scale (CAARS) for substance users.

Adult substance users are known to have above average rates of Attention Deficit-Hyperactivity Disorder (ADHD), but the psychometric properties of self-report measures of ADHD symptoms for adult substance users are unknown. Subjects (206 adults with a DSM-IV substance abuse disorder) were administered the Conners Adult ADHD Rating Scales (CAARS) upon enrolling in outpatient treatment. A factor structure similar to that reported for other populations was obtained and internal consistency reliabilities for the subscales and the overall index were high. Compared with CAARS norms, substance users scored significantly above average on all subscales as well as on the overall index. The CAARS may prove useful for measuring ADHD symptomatology among substance users, but additional reliability and validity evidence is needed. The CAARS should not be used by itself to diagnose individuals for ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Motivationally enhanced group counseling for substance users in a soup kitchen: a randomized clinical trial.

Soup kitchens tend to serve residentially unstable adults characterized by a high prevalence of substance abuse. In this study, 289 soup kitchen guests who reported drug or alcohol problems were randomly assigned to information and referral (I&R) plus peer advocacy (peers encouraging subjects to participate in other services) (N = 139) or to an experimental 12-session motivational group (three sessions per week for 4 weeks) followed by a 36-session cognitive-behavioral group (three sessions per week for 12 weeks), plus I&R and peer advocacy. Mean age was 42; 82% male; 68% African-American; 81% unstable residence; 14% HIV+. Experimentals were significantly more likely than the controls to have increased their participation in some type of substance abuse intervention during the follow-up period. In addition, experimentals were significantly more likely than controls to have reduced both drinking and heavy drinking at follow-up (there was no difference between groups in reduction of cocaine use). Interaction analysis indicated that the experimental intervention was more effective for participants with higher rather than lower substance abuse severity at baseline. These results support the concept that motivationally enhanced group counseling, provided as a low-threshold outreach intervention, can help to increase participation in formal treatment and 12-step groups and to reduce substance abuse, particularly for those starting with high severity of use.

Adult↗

PubMed2005

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users.

OBJECTIVE: To determine the psychometric properties of the Toronto Alexithymia Scale (TAS-20), an established self-report measure of alexithymia, for a substance user sample participating in a clinical trial of outpatient cognitive-behavioral therapies (N=230). METHODS: Confirmatory and exploratory factor analyses were used to determine the number and nature of the factors underlying the TAS-20 in a sample of substance users. Structural equation modeling was used to determine the predictive validity of the TAS-20. RESULTS: A factor structure comparable, but not identical, with TAS-20 psychometric results with other populations was found; alpha coefficients were .88 for the feelings factor, .62 for the external thinking factor, and .87 for the total score. Although, on average, the substance users did not appear to have elevated alexithymia scores compared with the undergraduate students, alexithymia predicted less treatment engagement, i.e., fewer sessions attended and weaker helping alliance. Alexithymia also predicted alcohol use outcomes but not drug use outcomes. The relation between alexithymia and drinking outcome was conditional on whether the patient was using solely alcohol at baseline. CONCLUSION: The TAS-20 has reasonably good psychometric properties in this sample, which might be improved by dropping several marginal questionnaire items. Alexithymia appears to attenuate substance abuse treatment engagement. More clinical and research experience with this construct and specific instrument in substance user samples is needed.

Adult↗

PubMed2005

The combined effects of treatment intensity, self-help groups and patient attributes on drinking outcomes.

Better understanding of the diverse factors that predict alcoholism treatment outcomes is essential to improving treatment strategies. Patients accepted for treatment at a multimodality program were interviewed and followed-up at three months and one year after admission. The study tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, modality matching, treatment retention, aftercare, self-help group participation and patient attributes at admission. Drinking frequency diminished substantially between baseline and the two follow-ups. Outcomes for inpatient were better than for outpatient treatment in bivariate analysis, but outcomes for these modalities were equal after adjusting for the effect of patient-treatment mismatching. Aftercare treatment, time in treatment for outpatients, community 12-Step group participation, and several patient attributes such as motivation for change and psychiatric severity significantly predicted drinking outcomes at one or both follow-ups. Clinical implications of the results are discussed.

Adult↗

PubMed2005

Substance use among young adolescents in HIV-affected families: resiliency, peer deviance, and family functioning.

This study examines the association of risk and protective factors with substance use among 77 early adolescents (11-15 years old) with an HIV-infected parent who were interviewed in 2000-2001 in the South Bronx, a HIV high-prevalence area of New York City. The subjects were 49%female, 53% African American, and 30% Hispanic; mean age was 13 years old. A face-to-face interview was used to administer a battery of instruments representing community, family, peer, and resiliency factors. Forty percent reported ever using tobacco, alcohol or drugs; 71% were aware of their parent's HIV seropositivity. An age-adjusted path analytic model was constructed which showed: 1) family functioning predicted resiliency (a composite measure of psychological adjustment and personal competencies); 2)positive community factors and resiliency predicted less affiliation with deviant peers; and 3) poorer family functioning and affiliation with deviant peers predicted substance use. These results underscore the need for interventions that address social influence factors among vulnerable early adolescents with HIV-positive parents.

Adolescent↗

PubMed2005

Moderators of effects of motivational enhancements to cognitive behavioral therapy.

Patient treatment matching hypotheses were tested for substance users randomly assigned to a group cognitive behavioral therapy (CBT; n= 114) or a group motivational intervention (GMI; n= 116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15-week follow-up, the study predicted that alexithymia, antisocial personality disorder (ASPD), and network support for alcohol and drug use would be associated with less substance use for CBT subjects and that hostility and lower treatment motivation would be associated with less substance use for GMI subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and ASPD. Results indicate the use of assessing specific patient attributes to better inform treatment recommendations.

Adult↗

PubMed2004

Social support mediates the effects of dual-focus mutual aid groups on abstinence from substance use.

BACKGROUND: Specialized 12-step based groups have emerged to address the needs of persons recovering from both substance abuse and psychiatric illness. OBJECTIVE: This study investigates the role of social support in mediating the association between mutual aid participation and subsequent substance use for dually diagnosed persons. METHOD: A cohort of Double Trouble in Recovery (DTR) members in New York City were studied prospectively over a two-year period. FINDINGS: Longer DTR participation during the first year of the study was associated with lower substance use in the second year; that effect was partially explained by the maintenance of high level of social support. CONCLUSION: These findings speak of the enduring influence of 12-step attendance on reducing substance use, and underline the importance of both 12-step attendance and supportive networks for dually diagnosed persons.

Adult↗

PubMed2004

Linking female sex workers with substance abuse treatment.

We evaluated mobile street-based outreach as a modality for linking street-walking female sex workers with substance abuse treatment in New York City. Sex workers (N = 179) approaching an existing outreach facility were randomly assigned to receive usually provided services, or to receive an enhanced version of these services. Among the 144 women successfully followed for 6 months, 35.0% were detoxified; 43.1% of the 78 current heroin users received methadone maintenance; and 35.4% of the followed-up clients received some other type of treatment. Intervention group differences in these outcomes were not significant. Detoxification during followup was associated with heroin dependence and lifetime detoxification. Methadone maintenance (among heroin users) was associated with Hispanic ethnicity and legally mandated treatment. Other types of treatments were negatively associated with the degree of involvement in the sex trade. We conclude that a variety of factors affect motivation for substance abuse treatment among female sex workers, and that street-based outreach is a highly effective modality for linking this population with much needed treatment.

Adolescent↗

PubMed2004

Perceived reasons for substance misuse among persons with a psychiatric disorder.

The etiology of substance use among persons with severe mental illness remains unclear. This study investigates stated reasons for substance use among persons in recovery from co-occurring disorders of serious mental illness and substance abuse and dependence. The desire to fit in with peers played a key role in the initiation of substance use; boredom, loneliness, temptations to use, and stress were cited most as relapse triggers. The authors discuss the need for dually diagnosed persons to develop sobriety-supporting peer networks to help them learn adaptive strategies to deal with the stress of recovery; further, treatment programs should instill hope for recovery and provide opportunities for meaningful activities and relationships.

Adult↗

PubMed2004

The effect of 12-step based fellowship participation on abstinence among dually diagnosed persons: a two-year longitudinal study.

A large percentage of individuals are dually-diagnosed with a psychiatric disorder and a substance use disorder. Such persons typically face more difficulties and have poorer outcomes than do single disorder substance users. Among noncomorbid substance users, treatment and participation in 12-Step groups have been shown to enhance the likelihood of abstinence from substance misuse. Specialized 12-Step based fellowships have recently emerged to address the recovery needs of dually-diagnosed persons. The present study is a longitudinal investigation of the effect of such 12-Step based groups on abstinence among dually-diagnosed persons. Participants were members of Double Trouble in Recovery (DTR) who were recruited at community-based meetings in New York City and reinterviewed twice at yearly intervals. Generalized estimating equation analysis indicated that, over the two-year study period, ongoing DTR attendance was significantly associated with a greater likelihood of abstinence after controlling for other pertinent variables, such as mental health symptoms. For clinicians, these findings underline the importance of fostering stable affiliation with specialized 12-Step based groups among their clients.

Adult↗

PubMed2004

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives.

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.

Humans↗

PubMed2004

The effectiveness of vocational services for substance users in treatment.

Employment appears frequently in the literature as an outcome criterion for substance users in treatment, and most clinicians subscribe to the belief that work plays an important role in recovery from addiction. Despite the importance attached to employment, the major standard treatment modalities have not been shown as effective in increasing client employment after treatment. The article presents a critical review and synthesis of three decades of research on the effectiveness of specialized vocational intervention for addiction treatment clients.

Employment↗

PubMed2004

A new work placement model for unemployed methadone maintenance patients.

Traditionally, methadone-maintained patients have made only limited progress in vocational rehabilitation programs, largely because they encounter multiple individual-level barriers to their employment. The Customized Employment Supports (CES) model is designed to help patients overcome these employment barriers and attain paid work as soon as possible. To facilitate this transition, the model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients in a working alliance and enhance patients' self-efficacy. Methods used to help patients increase their self-efficacy are derived from social psychological literature and include role modeling, persuasion, and minimizing emotional arousal. Because the transition to competitive work is a major change, many patients initially take smaller steps such as entering training programs and accepting informal employment. The CES model is being evaluated in a randomized clinical trial.

Employment↗

PubMed2004

Better definition of vocational services is critical within substance user treatment programs.

Vocational rehabilitation in substance user treatment programs is often poorly defined; programs rarely provide adequate descriptions of the vocational services they offer. There is no standardization in the content of vocational counseling, in the format of its delivery, or in the qualifications of staff that deliver it. Thus, the type, intensity, and quality of vocational services can vary widely among programs, as well as over time within a given program due to vocational staff turnover. However, current demands for greater accountability in social services pose a challenge to this state of affairs. There is no evidence that vocational services as currently delivered in treatment programs are either effective or even reasonably efficient. Note that "programs are increasingly called on to justify their existence, their expenditure of funds and their achievement of objectives. Behind the call for accountability is an awareness of the gap between almost unlimited social need and limited resources" (Weiss, 2004). It is difficult to achieve accountability for ill-defined and variable vocational services.

Counseling↗

PubMed2004

Efficacy of the customized employment supports (CES) model of vocational rehabilitation for unemployed methadone patients: preliminary results.

This article presents initial efficacy data for an innovative vocational rehabilitation model designed for methadone-maintained patients--the Customized Employment Supports (CES) model. In this model, a CES counselor works intensively with a small caseload of patients in order to overcome the vocational as well as nonvocational barriers that hinder their employment, with the goal of attaining rapid placement in competitive employment. The CES model was implemented at two Manhattan methadone treatment programs as part of a randomized clinical trial comparing the model's employment outcomes with those of standard vocational counseling. The study tested the hypothesis that patients in the experimental group will have better employment outcomes than those in the comparison group. The data were collected from May 2001 through September 2003. The sample consisted of the first 121 patients who had completed their 6-month follow-up interviews. The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. The clinical trial is continuing.

Adult↗

PubMed2004

The impact of welfare reform on methadone treatment: policy lessons from service providers in New York city.

This article explores the impact of recent changes in welfare policy on public assistance recipients who are in methadone maintenance treatment, from the perspective of methadone service providers. Data were collected between late 2000 and early 2002, and included in-depth interviews with 11 providers from three methadone treatment programs in New York city, contextual interviews with three welfare agency personnel and three patient advocates, and participant-observation in trainings and clinical meetings related to vocational services and public assistance for methadone patients. Because service providers are front-line implementers of new welfare regulations, their experiences, and insights should be consulted by policymakers as welfare policy continues to evolve.

Attitude of Health Personnel↗