Biomedical subjects

Thomas J McMahon

Publications and source records attributed to Thomas J McMahon.

12 recordsLinked to original sources

PubMed2006

Does assigning a representative payee reduce substance abuse?

BACKGROUND: Approximately 700,000 Social Security beneficiaries in the U.S. with psychiatric disabilities have been assigned a representative payee to manage their funds but it is unclear how those judged to need a payee differ from others and whether payee assignment improves clinical outcomes, especially substance abuse. METHODS: Participants in this observational 12-month cohort study (n=1457) received SSI or SSDI and had serious mental illness. They were subsequently enrolled at eighteen community-based sites that provided Assertive Community Treatment. Social Security administrative records were used to determine whether a payee had been assigned. RESULTS: At baseline, participants who were assigned a payee were more likely to have schizophrenia and had more severe clinician-rated drug and alcohol use than those not assigned a payee. In GEE models that adjusted for these and other potentially confounding covariates, participants assigned a payee between 4 and 12 months after program entry subsequently used significantly more psychiatric services than participants not assigned payees but showed no greater reduction in substance use. CONCLUSIONS: Although substance use is associated with being assigned a payee, substance use does not decline substantially following payee assignment. Participants assigned payees made greater subsequent use of psychiatric services, suggesting the potential for benefit from payee assignment.

Adult↗

PubMed2006

Substance-abusing mothers and disruptions in child custody: an attachment perspective.

Using an attachment framework, we examined (1) whether substance-abusing mothers' perceptions of how they were parented were related to the severity of their substance abuse and psychological maladjustment and (2) whether these two factors mediated the association between mothers' perceptions of how they were parented and their children's placement out of home. There were 108 mothers of 248 children who completed interviews upon admission to a methadone maintenance program for women. Measures included lifetime risk composite scores derived from the Addiction Severity Index, the Parental Bonding Instrument, and a demographics questionnaire. A multilevel modeling approach was used to model effects of the hierarchically organized data (e.g., children nested within families). Findings are consistent with an attachment perspective on parenting suggesting that the internal psychological processes of a parent play a critical role in the continuity of parenting.

Adjustment Disorders↗

PubMed2006

Contingency management for smoking cessation in adolescent smokers.

This pilot study evaluated the use of contingency management (CM) procedures in combination with cognitive-behavioral therapy (CBT) for smoking cessation in adolescents. Twenty-eight treatment-seeking adolescent smokers participated in a 1-month, school-based smoking cessation program and were randomly assigned to receive either CM with weekly CBT or CBT alone. In the CM+CBT group, biochemical verification of abstinence was obtained twice daily during the first 2 weeks, followed by daily appointments during the 3rd week and once every other day during the 4th week. Participants were monetarily reinforced for abstinence on an escalating magnitude schedule with a reset contingency. At the end of 1 week and 1 month of treatment, abstinence verified using quantitative urine cotinine levels was higher in participants in the CM+CBT group (1 week: 76.7%; 1 month: 53.0%) when compared with the CBT-alone group (1 week: 7.2%; 4 weeks: 0%). These preliminary results provide a strong initial signal supporting the utility of CM techniques for smoking cessation in adolescents and demonstrate the feasibility of implementing such a program in a school setting.

Adolescent↗

PubMed2006

Effect of Social Security payments on substance abuse in a homeless mentally ill cohort.

OBJECTIVES: To determine whether receipt of social supplemental security income (SSI) or Social Security disability income (SSDI) disability payments is associated with increased drug and alcohol use. DATA SOURCES/STUDY SETTING: Secondary analysis of data from 6,199 participants in the Access to Community Care and Effective Social Supports and Services demonstration for the homeless mentally ill. DESIGN: Observational, 12-month, cohort study completed over 4 years. Substance abuse and other outcomes were compared between the participants who did not receive SSI or SSDI during the 12-month study, those newly awarded benefits, and those without benefits throughout the 12 months. DATA COLLECTION METHODS: Social Security administrative records were used to corroborate Social Security benefit status. Drug and alcohol use were measured by self-report and clinician ratings. PRINCIPAL FINDINGS: Participants who did not receive benefits significantly reduced their substance use over time. In generalized estimating equations models that adjusted for potentially confounding covariates, participants who newly received Social Security benefits showed no greater drug use than those without benefits but had significantly more days housed and fewer days employed. Participants whose benefits antedated the demonstration and continued during the 12 months had more clinician-rated drug use over time than those without benefits. CONCLUSIONS: In this vulnerable population, participants with newly awarded benefits did not have any different drug use changes than those without benefits, and had relatively more days housed. The hypothesis that Social Security benefits facilitate drug use was not supported by longitudinal data in this high-risk population.

Adult↗

PubMed2006

Patterns and correlates of substance use among affluent, suburban high school students.

Despite ongoing concern about substance use during adolescence, very little is known about alcohol and drug use among teens living in affluent social settings. In this longitudinal study, cluster analysis was used to characterize patterns of substance use and change in other dimensions of psychosocial adjustment within a cohort of 292 high school students (54% girls) living in an affluent, suburban community. When compared with a cluster of students reporting minimal use, clusters reporting escalating, declining, and persistently high use consistently demonstrated relatively poorer psychosocial adjustment. Moreover, other dimensions of psychosocial adjustment remained relatively stable despite changes in substance use, and there were relations involving substance use and other aspects of psychosocial adjustment that may be specific to this social setting. The findings highlight the need for preventive intervention grounded in a clear understanding of developmental process occurring within populations of affluent, suburban teens.

Achievement↗

PubMed2005

How early bonding, depression, illicit drug use, and perceived support work together to influence drug-dependent mothers' caregiving.

In this study, the authors used an attachment framework to examine how drug-dependent mothers' early bonding experience, depression, illicit drug use, and perceived support work together to influence the family environment. The authors hypothesized that (a) depression and drug use function as proxies for a stronger risk factor, the perceived absence of support available in everyday life, and (b) associations between mothers' early bonding experience and family environment are mediated by perceptions of support and nurture available in everyday life. The authors used a "building block" analytic approach and data collected from 125 mothers enrolled in methadone maintenance to test hypotheses. Both hypotheses were confirmed for 1 outcome, family adaptability. For the 2nd outcome, family cohesion, only perceived support was a significant predictor. Although preliminary, the findings suggest that perceptions of relationships in everyday life play a critical role in the etiology of drug-dependent mothers' parenting.

Adolescent↗

PubMed2005

Looking for poppa: parenting status of men versus women seeking drug abuse treatment.

This survey of individuals seeking methadone maintenance treatment was pursued to document the parenting status of drug-dependent men and clarify ways their status as parents differs from that of drug-dependent women. Data concerning demographic characteristics, drug abuse history, and parenting status were systematically coded from the medical records of 362 men and 162 women seeking methadone maintenance treatment during a 12-month period. Analysis of parenting status by gender indicated that, although a greater proportion of women were the parent of at least one biological child, there were actually more fathers than mothers within the cohort. Among the parents, fathers were more likely to have been abusing opioids when they first became a parent, and they were more likely to be living away from their children. There were no significant gender differences in the number of children or the average age of children. The results suggested that fathering may be an important, but largely neglected, treatment issue for drug-abusing men.

Adult↗

PubMed2004

Interpersonal maladjustment as predictor of mothers' response to a relational parenting intervention.

In previous work, Luthar and Suchman (2000, Development & Psychopathology, 12, 235) reported results of a randomized clinical trial testing the efficacy of the Relational Psychotherapy Mothers' Group (RPMG) for methadone-maintained mothers. In this extension, we examined maternal interpersonal maladjustment as a predictor of differential response to RPMG versus standard drug counseling (DC). We predicted that RPMG mothers with high levels of interpersonal maladjustment would improve on parent-child relationship indices, whereas DC mothers with high levels of interpersonal maladjustment would show no improvement. Fifty-two mothers enrolled in the study completed baseline, post-treatment and 6-month followup assessments and a subset of 24 "target" children between the ages of 7 and 16 completed measures on mothers' parenting. As predicted, results of hierarchical regression analyses indicated moderate interpersonal maladjustment x treatment interaction effects for all parenting outcomes at post-treatment and for a subset of outcomes at followup. Plotted interactions confirmed predictions that, as maternal interpersonal maladjustment increased, parenting problems improved for RPMG mothers and remained the same or worsened for DC mothers. Results indicate the potential value of interpersonally oriented interventions for substance-abusing mothers and their children.

Adjustment Disorders↗

PubMed2003

Initial appointment nonattendance in child and family mental health clinics.

Current medical, psychiatric, and nursing sources were examined for literature concerning the problem of initial appointment non attendance at child and family mental health clinics. The factors proposed to underlie missed initial appointments were reviewed and found to be both contradictory and inconsistent. Interventions designed to increase attendance were considered. These interventions were found to significantly increase attendance consistently. However, it is noted that the research on underlying factors is not utilized in structuring these interventions. Suggestions for future research to address this problem are offered.

Adolescent↗

PubMed2002

Drug dependence, parenting responsibilities, and treatment history: why doesn't mom go for help?

Despite longstanding concern that the presence of children deters drug-dependent women from entering treatment, there have been few empirical tests of the relationship between parenting responsibilities and treatment-seeking behavior. In this study, the relationship between number of biological children and treatment history was examined in a cohort of 153 women seeking methadone maintenance treatment. In a standard multiple regression analysis that also allowed for the potential influence of (a) age, (b) education, (c) ethnic minority status, (d) cohabitation with a sexual partner, (e) chronicity of opioid use, and (f) knowledge of HIV infection, there was a significant, negative relationship between number of children and number of earlier contacts for drug abuse treatment. Ethnic minority status and cohabitation with a sexual partner were also associated with fewer earlier contacts; greater chronicity and knowledge of HIV infection were associated with more earlier contacts. Moreover, there was significant moderation of the negative relationship between parenting responsibilities and treatment history by (a) ethnic minority status, (b) cohabitation, and (c) chronicity of use. Within a cross-sectional research design, the findings highlight ways parenting responsibilities may interact with other factors over time to influence the treatment-seeking behavior of drug-dependent women.

Adult↗

PubMed2002

Fathers with serious mental illnesses: a neglected group.

In recent years, policy makers, researchers, and practitioners alike have come to recognize how the traditional emphasis on mothers has overshadowed the equally critical contribution of fathers to child development and family life. In spite of this growing recognition of the importance of fathers, the need to better understand and support fathers with serious mental illnesses (SMI) has received little attention within mental health, public welfare, child protection, or criminal justice systems. In an effort to counter the continuing neglect of fathers with SMI, this paper provides an overview of the scant existing research focusing on fathers with SMI and sets forth a series of recommendations highlighting the need for greater inclusion of fathers in future research and ways to support men with SMI in their role as parents.

Child↗

PubMed2002

Substance abuse and fathering: adding poppa to the research agenda.

Although a number of socioeconomic forces have converged across cultures to make fathering one of the more prominent social issues of the new millennium, the status of substance-abusing men as fathers is rarely acknowledged in the conceptualization of public policy, service delivery or research focusing on the adverse consequences of drug and alcohol abuse. In this commentary, the authors call for the substance abuse research community to expand understanding of fathering occurring across cultures in the context of chronic substance abuse. Building upon research being undertaken with other populations of fathers, the authors argue there is need to clarify (a) the number of substance-abusing fathers, (b) patterns of reproduction among substance-abusing men, (c) ways in which substance abuse contributes to compromise of fathering, (d) ways in which compromise of fathering contributes to psychological distress in substance-abusing men, (e) ways in which compromise of fathering affects developmental outcomes for children, and (f) ways in which clinical and preventive intervention might be used to minimize the harm associated with paternal substance abuse.

Family Health↗