Substance Abuse 2003 (Fall 2003)


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  • Substance Abuse 2003 (Fall 2003)

    1. 1. Psychological Treatment of Substance Use: 2003 Findings
    2. 2. Suggested Citation <ul><li>American Psychological Association Practice Directorate. (2004). PracticeNet survey: Psychological treatment of substance use. Retrieved Month, Day, Year from: </li></ul><ul><li>Copyright 2004 American Psychological Association </li></ul>
    3. 3. PracticeNet Methodology <ul><li>PracticeNet uses real time behavior sampling (RTBS), an internet survey system designed to capture “in the moment” clinician behavior </li></ul><ul><li>Responses from survey administered October 23-November 14, 2003 (approximately 59% response rate) </li></ul><ul><li>Additional survey data compiled from survey conducted in Sept-Oct 2002 </li></ul>
    4. 4. Psychologist Demographics (n=238) <ul><li>55% female </li></ul><ul><li>96% White </li></ul><ul><ul><li>3 Hispanic/Latino, 2 Asians, 2 Blacks, 3 multiracial </li></ul></ul><ul><li>81.5% PhD, 12.6% PsyD, 2% EdD </li></ul><ul><ul><li>6 students </li></ul></ul><ul><li>Average age 51 years, range 25-79 </li></ul><ul><li>Average years of service post degree: 17 </li></ul><ul><ul><li>Range 0-50 years </li></ul></ul>
    5. 5. Primary Practice Settings and Hours Worked (n=238) <ul><li>Average 25 hours of direct clinical hours per week, range 3-55 </li></ul><ul><li>Average of 39.5 hours worked in clinical settings, range 4-65 </li></ul><ul><li>110 individuals (46%) work only in private practice </li></ul><ul><li>49 individuals (21%) work only in organizational settings </li></ul><ul><li>78 individuals (33%) work in both settings </li></ul>
    6. 6. Treatment Setting and Clinical Services <ul><li>Clinical interactions occurred in… </li></ul><ul><li>72% private practice (1/3 solo, 2/3 group practice) </li></ul><ul><li>18% organizational setting </li></ul><ul><li>8% university/college counseling center </li></ul><ul><li>2 people seen in prison/jail, 1 in community outreach, 3 in school </li></ul><ul><li>Clinical services provided (not mutually exclusive)… </li></ul><ul><li>Individual treatment (82%), assessment or evaluation (20.5%), education (16%), medication evaluation/ management (6%), other (7.8%) </li></ul>
    7. 7. Client Demographics (n=205) <ul><li>57.6% female </li></ul><ul><li>Average age 37 years, range 6-82, 15% less than 18 years of age </li></ul><ul><li>80% white, 6% Hispanic/ Latino, 5.4% African American or Black, 4.4% Asian American or Asian, 2.5% multiracial </li></ul><ul><li>89% born in the United States, 2 Canadians seen in Canada, 15 immigrants to the US </li></ul><ul><ul><li>Immigrants’ average number of years in US: 22.6 years, range 5-58 years </li></ul></ul>
    8. 8. Client Diagnoses (n=205) <ul><li>88% have been assigned a diagnosis, 5.4% do not have a DSM diagnosis, 6% are still in an assessment phase </li></ul><ul><li>Of those diagnosed, the primary diagnosis is… </li></ul><ul><li>Major depression (23%) </li></ul><ul><li>Adjustment disorder (20%) </li></ul><ul><li>Anxiety disorder (17%) </li></ul><ul><li>Dysthymia (8%) </li></ul><ul><li>Substance use disorder (4%) </li></ul><ul><li>Bipolar disorder (4%) </li></ul><ul><li>20% with additional Axis 1 diagnoses </li></ul>
    9. 9. Substance Use Problems (n=205) <ul><li>25% of clients are known to have a current or past substance use problem </li></ul><ul><li>24 individuals (12%) reported to have a “current substance use problem” BUT only 7 individuals with a primary substance use diagnosis and 9 individuals with a secondary substance use diagnosis </li></ul><ul><li>13 individuals (6%) are in recovery and have reduced substance use </li></ul><ul><li>14 individuals (7%) are in recovery and abstinent </li></ul><ul><li>111 (54%) have never had a substance use problem </li></ul><ul><li>43 (21%) individuals have not discussed substance use with their psychologist </li></ul>
    10. 10. Substance Use Problem Client Characteristics 23% married 38% married 33% married 8% married Marital Status* 35 38 40 32 (4 adolscnt) Age in years 81% White 84% White 81% White 62.5% White Race* 53% female 66% female 48% female 37.5% female Gender* Never discussed (n=43) Never a problem (n=111) In recovery (n=27) Current problem (n=24)
    11. 11. Substance Use Problem Client Characteristics <ul><li>50% of individuals with current substance use problems smoke, 33% of those in recovery smoke and 13% of those for whom substances have never been a problem smoke cigarettes </li></ul><ul><li>29% of individuals with current substance use problems have a chronic health condition, 59% of those in recovery have a chronic health condition, 39% with no substance use problem have a chronic health condition </li></ul><ul><li>54% of substance users seen in private practice, 74% of those in recovery and 76% of “never a problem” seen in private practice </li></ul>
    12. 12. Diagnoses of Individuals with Substance Use Problems (n=24) <ul><li>54% of individuals identified to have a substance use problem were assigned a primary or secondary substance use diagnosis </li></ul><ul><li>21% (5) have a primary substance use disorder </li></ul><ul><li>33% (8) have a secondary substance use disorder </li></ul><ul><li>Individuals with a secondary substance use disorder diagnosis had primary diagnoses of a mood disorder (7) or PTSD (1) </li></ul><ul><li>Primary diagnoses of individuals without a substance use diagnosis include… </li></ul><ul><li>5 (21%) individuals not assigned diagnoses </li></ul><ul><li>2 MDD, 1 PTSD, 2 anxiety disorder, 1 ADHD </li></ul>
    13. 13. Substance Distribution Most Reported Substances Among Clients Known to have a Substance Use Problem
    14. 14. Clinical Interventions Employed with Individuals with Substance Use Problems (Not Mutually Exclusive) 21% 5 Other 33% 8 *Harm reduction 42% 10 *Relapse prevention 42% 10 *Motivational interviewing 46% 11 *Cognitive behavioral therapy % n= *Often cited in clinical and scientific literature
    15. 15. Substance Use Problems in Social Network <ul><li>All psychologists were asked whether they had inquired about substance use within the client’s social network. </li></ul><ul><li>112 psychologists (54.6%) have discussed substance use in client’s social network (19% of psychologists discussed it in the current session) </li></ul><ul><li>54 clients (48% of those with whom it has been discussed) have at least one person in their social network with a substance use problem </li></ul><ul><ul><li>Parent is most commonly the person with the problem (10 clients), followed by partner/spouse and friend (9 clients each) </li></ul></ul><ul><li>9 individuals have more than one person within their social network with a substance use problem </li></ul>
    16. 16. Substance Use Problems in Social Network, cont. <ul><li>Clients are mildly to moderately impacted by substance use problems in social network </li></ul><ul><ul><li>For those clients for whom the problem was discussed in the most current session, the impact was higher </li></ul></ul><ul><li>Psychologists discussed substance use within the social networks of 17 of 31 child and adolescent clients </li></ul><ul><ul><li>5 child and adolescent clients had one person within their social networks with a substance use problem (either a parent or a friend) </li></ul></ul>
    17. 17. Children/Adolescents and Substance Use Problems (n=31) <ul><li>4 adolescents have substance use problems (ages 13-17) </li></ul><ul><ul><li>2 males, 2 females </li></ul></ul><ul><ul><li>Problematic substances- marijuana (all), alcohol (2), inhalants (1) </li></ul></ul><ul><ul><li>2 of these adolescents also smoke cigarettes </li></ul></ul><ul><li>5 adolescents smoke cigarettes (ages 13-17), 2 of whom have substance use problems </li></ul><ul><ul><li>4 females, 1 male </li></ul></ul><ul><ul><li>2 teen smokers are receiving smoking cessation interventions, neither of whom has other substance use problems </li></ul></ul>
    18. 18.