Biomedical subjects

J W Finney

Publications and source records attributed to J W Finney.

At least 19 recordsLinked to original sources

PubMed2001

Predictors of deterioration among patients with substance-use disorders.

The purpose of this study was to identify patients with substance-use disorders who deteriorate during treatment, and to examine baseline predictors of deterioration. Three groups of 872 patients each, matched on number of problems at baseline, were selected from a larger sample based on their treatment outcome (improved, nonresponsive, deteriorated). Deterioration was predicted by younger age and African-American race; four aspects of patients' history (psychiatric symptoms, arrests, prior drug treatment, and recent inpatient or residential care); and having no close friends. Patients who had both an alcohol and a drug diagnosis, a personality-disorder diagnosis, and those who had a shorter episode of care and fewer outpatient-mental-health visits, also were more likely to deteriorate.

Adolescent↗

PubMed2001

A comparative, process-effectiveness evaluation of VA substance abuse treatment.

Over 3,000 patients from 15 VA inpatient, substance abuse treatment programs showed considerable improvement from intake to a one-year follow-up. Patients in 12-step programs, as opposed to cognitive-behavioral (CB) or eclectic programs, and those with more extended continuing outpatient mental health care and 12-step self-help group involvement, were more likely to be abstinent and free of substance use problems at follow-up. Consistent with their better one-year outcomes, patients in 12-step programs improved more between intake and discharge than CB patients on proximal outcomes assumed to be specific to 12-step treatment (e.g., disease model beliefs) and as much or more on CB proximal outcomes. Proximal outcomes assessed at treatment discharge and follow-up were, at best, modestly related to one-year substance use and other outcomes. No evidence was found that CB or 12-step treatment is more beneficial for certain types of patients.

Adult↗

PubMed2001

Self-help group participation among substance use disorder patients with posttraumatic stress disorder.

Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participation was similar for SUD patients with and without PTSD. PTSD patients with worldviews (e.g., holding disease model beliefs) that more closely matched 12-step philosophy participated more in 12-step activities. Although greater participation was associated with better concurrent functioning, participation did not prospectively predict outcomes after case mix adjustment. An exception was that greater participation predicted decreased distress among PTSD patients whose identity was more consistent with 12-step philosophy. In summary, PTSD patients participate in and benefit from 12-step participation; continuing involvement may be necessary to maintain positive benefits.

Adult↗

PubMed2001

Children's health care use: a prospective investigation of factors related to care-seeking.

OBJECTIVES: To determine the best predictors of the amount of children's health care use. RESEARCH DESIGN: Child health, psychosocial, and family status variables were collected. Families were then followed prospectively for 2 years to gather health care use data. Multivariate regression analysis was used to determine factors related to volume of child health care use. SUBJECTS: 367 mothers and children ages 5 to 11 years continuously enrolled in a staff model HMO. MEASURES: Child health care visits obtained from a computerized database comprised the dependent variable. Independent variables were organized into a 5-component framework including: Demographic Characteristics; Family Characteristics; Child Health and Prior Health Care Use; Child Behavior and Mental Health; and Mothers' Mental Health and Health Care Use. RESULTS: The volume of a child's past health care use was the best predictor of future health care use, with the presence of past acute recurring illnesses, child pain and mother's retrospective health care use also serving as significant predictors in the model. Analysis of a second model was conducted omitting children's past use of health care. In this model the mother's worry about child health was the best predictor of use, with child health and child and maternal psychosocial variables significantly contributing to explained variance in the model. CONCLUSIONS: This study supports prior research indicating past use is the best predictor of future health care use. In addition, the study suggests that maternal perceptions of child health and maternal emotional functioning influence the decision-making process involved in seeking health care on behalf of children. Effective management of pediatric health care use needs to address broader needs of the child and family beyond solely the child's health, most notably maternal functioning.

Child↗

PubMed2001

Can methodological features account for patient-treatment matching findings in the alcohol field?

OBJECTIVE: Despite enthusiasm for the potential of matching patients to alcohol treatments to improve outcomes, consistent findings have not emerged. This review considers the extent to which methodological factors may account for the pattern of findings from research on Patient x Alcohol Treatment interactions. METHOD: We focused on 55 studies that compared more than one type of alcohol treatment and included formal statistical tests for interactions. We examined four predictors of the number of significant interactions found in the 55 studies: (1) the number of statistical tests for interactions conducted, (2) the average number of participants, (3) whether or not participants were randomized to treatment and (4) the proportion of tested interactions that were hypothesis- or rationale-driven, as opposed to exploratory. RESULTS: Only the number of statistical tests for interactions predicted the number of patient-treatment interactions identified per study (zero-order r = 0.47; r2 = 0.22). A substantial number of tests for interactions (43) was conducted, on average, per study. Only a minority of the studies (33%) included enough participants to have a reasonable probability (0.80) of identifying a medium-sized matching effect. CONCLUSIONS: Drawing general conclusions regarding matching patients to alcohol treatments is hampered because Type I error has contributed to the matches identified, studies in this area are often underpowered, and the combinations of patient and treatment variables that have been tested are few relative to the numerous possible combinations. To be productive, future research will need to focus on patients at the extremes of matching dimensions and on distinct treatments. (J Stud. Alcohol 62: 62-73, 2001)

Alcoholism↗

PubMed2000

Intervention models for mothers and children at risk for injuries.

We review risk factors commonly associated with childhood unintentional injuries and highlight adolescent mothers and their young children as a high risk group. Several intervention models of injury, including the epidemiological model, Peterson and Brown's "working model," and the socioecological model have been proposed to explain the events that lead to injuries. Discussion of these models is provided and a synthesis of the adolescent parenting model and the socioecological model of injury is suggested as way to address the complex variables that lead to an injury causing event for adolescent mothers and their young children. Finally, we suggest areas of future investigation and their implications for prevention and treatment.

Accident Prevention↗

PubMed2000

Limitations in using existing alcohol treatment trials to develop practice guidelines.

In recent years, substantial efforts have been made to identify "best practices" and develop comprehensive practice guidelines for the treatment of various psychiatric disorders and medical conditions, based on systematic, often quantitative reviews of the existing intervention research. There probably are more than 300 comparative treatment trials that have been conducted in the alcohol field. With this large body of research, one might think the development of alcohol treatment guidelines would be a straightforward task. Unfortunately, that is not the case. Four problems are discussed with the "box-score" reviews that have been conducted thus far to identify effective alcohol treatment modalities. At least two of these problems are fundamental barriers to determining the relative efficacy or effectiveness of alcohol treatment modalities even in "meta-analyses" with "effect sizes". These impediments are discussed, as is how future alcohol treatment trials could be conducted so that their findings would more readily inform practice guidelines.

Alcohol-Related Disorders↗

PubMed2000

Consistency of self-administered and interview-based Addiction Severity Index composite scores.

AIMS: This study assesses the viability of a self-administered version of the Addiction Severity Index for monitoring substance abuse patients' functioning. DESIGN AND MEASUREMENTS: Patients completed the ASI interview and a self-administered questionnaire containing ASI composite items an average of 4 days apart. Composite scores from both formats were compared using correlations and mean differences. PARTICIPANTS AND SETTING: Participants were 316 veterans entering substance abuse treatment in a US Department of Veterans Affairs medical center. FINDINGS: Composite scores for alcohol, drug, psychiatric, family, legal and employment problems correlated 0.59-0.87 across formats. Patients endorsed more drug use and psychiatric symptoms by questionnaire than by interview. Medical composite scores correlated only 0.47 across formats. CONCLUSIONS: This study and previous research suggest that a self-administered questionnaire can be a feasible alternative to ASI interviews for monitoring substance abuse patients' treatment outcomes.

Female↗

PubMed2000

Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care.

AIM: To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care. DESIGN: Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up. FINDINGS: Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up. CONCLUSIONS: Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care.

Adult↗

PubMed2000

Improving the quality of VA care for patients with substance-use disorders: the Quality Enhancement Research Initiative (QUERI) substance abuse module.

Substance-use disorders are costly in both human and economic terms and are highly prevalent among patients in the VA Health Care System. The Quality Enhancement Research Initiative (QUERI) Substance Abuse Module (SAM) seeks to enhance identification and management of patients with substance-use disorders seen in primary care and other medical settings; bolster specialized substance-abuse treatment practices; improve care for patients with multiple comorbidities; and strengthen treatment for high-risk and underserved substance-abuse patient subgroups. This article describes how the SAM will achieve these aims by following the QUERI process steps and conducting an integrated set of research projects that incorporates literature reviews and meta-analyses, naturalistic and randomized controlled trials of promising treatments, studies of barriers to guideline implementation, and outcome-oriented evaluations of the implementation of practice guidelines.

Benchmarking↗

PubMed2000

Six- and ten-item indexes of psychological distress based on the Symptom Checklist-90.

Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6- and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.

Adult↗

PubMed2000

Two-year mental health service use and course of remission in patients with substance use and posttraumatic stress disorders.

OBJECTIVE: Comorbid diagnoses of substance abuse/dependence and posttraumatic stress disorder (SUD-PTSD) adversely affect substance abuse patients' treatment outcomes. Recently, several practices have been recommended for the treatment of SUD-PTSD patients based on empirical findings, including providing PTSD-specific care. Accordingly, this study examines the association between outpatient PTSD treatment and the long-term course of SUD-PTSD patients. METHOD: Male substance abuse/dependence patients (N = 125) with a comorbid diagnosis of PTSD completed 1-and 2-year follow-ups. Based on these reports, 26 patients were stably remitted from substance abuse, 39 were partially remitted and 60 were not remitted at either follow-up. These three groups were compared on mental health service use indices gathered from patients' self-reports of inpatient treatment and nationwide Veterans Affairs (VA) databases abstracting outpatient visits. RESULTS: SUD-PTSD patients who attended more outpatient substance abuse, psychiatric and PTSD services in the first year following treatment (and cumulatively over the 2-year follow-up) were more likely to maintain a stable course of remission from substance use in the 2 years following inpatient SUD treatment. When the three types of sessions were examined in regression analyses, PTSD sessions in the second year and the total number of PTSD sessions over the 2 years following the index treatment episode emerged as the most significant predictors of remission. Self-help group participation was also associated with a remitted course for SUD-PTSD patients. CONCLUSIONS: These data suggest that PTSD-focused treatment services are an essential treatment component for substance abuse/dependence patients with PTSD.

Adult↗

PubMed2000

Long-term outcomes of alcohol use disorders: comparing untreated individuals with those in alcoholics anonymous and formal treatment.

OBJECTIVE: The aim of this study was to examine how the type and timing of help received over 8 years by previously untreated problem drinking individuals were linked to drinking and functioning outcomes. METHOD: At the time of the 8-year follow-up, individuals (N= 466, 51% male) had self-selected into four groups: no treatment (n = 78), Alcoholics Anonymous (AA) only (n = 66), formal treatment only (n = 74), or formal treatment plus AA (n = 248). RESULTS: Individuals who received some type of help--AA, formal treatment or both--were more likely to be abstinent at 8 years than were untreated individuals. Although the AA only group was better off than the formal treatment only group at 1 and 3 years, the informally and formally treated groups were equivalent on drinking outcomes at 8 years. Similarly, despite the formal treatment plus AA group having been better off at 1 and 3 years than the formal treatment only group, the two formal treatment groups were comparable on drinking at 8 years. Both helped and untreated individuals improved between baseline and 1 year on drinking outcomes, but only formally treated individuals showed continued improvement over 8 years on drinking indices. Participation in AA or formal treatment during Year 1 of follow-up was associated with better drinking outcomes at 8 years. CONCLUSIONS: Individuals who obtain help for a drinking problem, especially relatively quickly, do somewhat better on drinking outcomes over 8 years than those who do not receive help, but there is little difference between types of help on long-term drinking outcomes.

Adult↗

PubMed2000

Specialty mental health care improves patients' outcomes: findings from a nationwide program to monitor the quality of care for patients with substance use disorders.

OBJECTIVE: To describe the implementation of a nationwide program to monitor the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental health care, and the duration and intensity of care, relate to patients' outcomes. METHOD: Clinicians completed a baseline Addiction Severity Index (ASI) on more than 34,000 patients with substance use disorders; more than 21,000 (63%) were reassessed with the ASI an average of 12 months later. Nationwide health service utilization databases were used to obtain information about patients' diagnoses and their use of services during an index episode of care. RESULTS: On average, patients who received specialty outpatient mental health care experienced better risk-adjusted outcomes than did patients who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. There was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the intensity of care was more important for patients with both substance use and psychiatric disorders. CONCLUSIONS: The provision of specialty outpatient mental health care, and longer episodes of specialty care, were associated with better risk-adjusted substance use, symptom and social functioning outcomes for patients with substance use disorders. More emphasis should be placed on ensuring that these patients enter specialty care and on keeping them in treatment.

Adult↗

PubMed1999

Gender differences in problem drinking and depression: different "vulnerabilities?".

This study examines the relationship between stressors and resources and the functioning of a sample of 515 men and women who had a drinking problem. At a one-year follow-up, both women and men had improved on three functioning measures: alcohol consumption, days intoxicated, and depression. There were no gender differences at Time 2 on alcohol consumption, but men had more days intoxicated and women had more symptoms of depression. The impact of stressors and resources varied by life domain, functioning criterion, and gender. Although the predictors varied, the amount of variance in depression accounted for was the same for women and men. The most striking gender difference was the stronger impact of friendships for women on all aspects of functioning. This study provides support for reconsideration of the stress vulnerability of women and men.

Adult↗

PubMed1999

Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes.

AIMS: This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among dual diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders). DESIGN: In a prospective multi-site study, dual diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1-year follow-up. SETTING: Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System. PARTICIPANTS: A total of 981 male dual diagnosis patients participated in the study. MEASUREMENTS: Assessments included general and substance-specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms. FINDINGS: Dual diagnosis patients modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a 'dual diagnosis treatment climate' and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms. CONCLUSIONS: Enhancing general and substance-specific coping skills in substance abuse treatment may reduce dual diagnosis patients' post-treatment substance use and improve their psychological functioning.

Adaptation, Psychological↗

PubMed1999

Predictors of unintentional injuries to school-age children seen in pediatric primary care.

OBJECTIVE: To identify predictors of unintentional injury to school-age children seen in pediatric primary care. METHODS: Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. RESULTS: The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. CONCLUSIONS: We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury.

Child↗

PubMed1999

A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-step and cognitive-behavioral treatment to substance use outcomes.

This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment, traditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year follow-up. A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry, at or near discharge, and at a 1-year follow-up. Based on the results of factor analyses, composite proximal outcomes variables were constructed to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral beliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatment discharge were linked to 1-year outcomes, but the relationships were weak (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were stronger, but still modest in magnitude (r = .16 to .39). The weak predictive findings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved more frequently. In this regard, participation in continuing care was associated with enhanced maintenance of treatment gains on proximal outcomes. However, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficiently comprehensive.

Adaptation, Psychological↗