This chapter reviews the literature on factors related to quality of self-report data on drug use and discusses two series of empirical studies investigating the quality of those data. One set of analyses examined the quality of the longitudinal retrospective self-report from narcotics addicts, including validity of recent narcotics use, reliability of various measures, stability of relationships among these measures, and pattern reliability among latent constructs. Results contribute strongly to confidence in the validity of the relationships among these data derived from addicts' self-report. The second set of analyses focused on validity of self-reported drug use among high-risk groups, including samples from sexually transmitted disease (STD) clinics, hospital emergency rooms (ERs), and jails. Results suggest that the accuracy of self-report of recent drug use varies by the sample sources, drug types, and subject characteristics. Targeting these high-risk groups may improve prevalence estimation. The chapter concludes that empirical validation of self-report is always necessary to enhance the utility of collected self-report data and provide means of controlling for potential biases.
{"title":"Self-reported drug use: results of selected empirical investigations of validity.","authors":"Y I Hser","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This chapter reviews the literature on factors related to quality of self-report data on drug use and discusses two series of empirical studies investigating the quality of those data. One set of analyses examined the quality of the longitudinal retrospective self-report from narcotics addicts, including validity of recent narcotics use, reliability of various measures, stability of relationships among these measures, and pattern reliability among latent constructs. Results contribute strongly to confidence in the validity of the relationships among these data derived from addicts' self-report. The second set of analyses focused on validity of self-reported drug use among high-risk groups, including samples from sexually transmitted disease (STD) clinics, hospital emergency rooms (ERs), and jails. Results suggest that the accuracy of self-report of recent drug use varies by the sample sources, drug types, and subject characteristics. Targeting these high-risk groups may improve prevalence estimation. The chapter concludes that empirical validation of self-report is always necessary to enhance the utility of collected self-report data and provide means of controlling for potential biases.</p>","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"167 ","pages":"320-43"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20188262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Metabolic bioactivation reactions potentially related to drug toxicities.","authors":"N Castagnoli, K P Castagnoli","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"173 ","pages":"85-105"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20202246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L M Sayre, D A Engelhart, D V Nadkarni, M K Manoj Babu, A M Flammang, G D McCoy
{"title":"The role of iminium-enamine species in the toxication and detoxication of cyclic tertiary amines.","authors":"L M Sayre, D A Engelhart, D V Nadkarni, M K Manoj Babu, A M Flammang, G D McCoy","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"173 ","pages":"106-27"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20202247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J W Gibb, M Johnson, I Elayan, H K Lim, L Matsuda, G R Hanson
{"title":"Neurotoxicity of amphetamines and their metabolites.","authors":"J W Gibb, M Johnson, I Elayan, H K Lim, L Matsuda, G R Hanson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"173 ","pages":"128-45"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20202248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacokinetics of cocaine: considerations when assessing cocaine use by urinalysis.","authors":"R T Jones","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"175 ","pages":"221-34"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20396161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Six questions are presented to systematically guide investigators’ decisions on outcome assessment for randomized clinical trials of pharmacological agents for substance-related disorders (American Psychiatric Association 1994). Use of the questions is illustrated by applying them to cocaine dependence. The questions were distilled from four sources: the author’s experience conducting psychiatric treatment outcome research, the extensive literature on treatment outcome methodology (Kazdin 1994), a recent comprehensive text on the clinical evaluation of psychotropic drugs (Prien and Robinson 1994), and Kraemer and Telch’s (1992) paper on outcome measurement for clinical trials.
{"title":"Outcome measurement considerations: pharmacological treatments for substance abuse.","authors":"Karla Moras","doi":"10.1037/e495552006-006","DOIUrl":"https://doi.org/10.1037/e495552006-006","url":null,"abstract":"Six questions are presented to systematically guide investigators’ decisions on outcome assessment for randomized clinical trials of pharmacological agents for substance-related disorders (American Psychiatric Association 1994). Use of the questions is illustrated by applying them to cocaine dependence. The questions were distilled from four sources: the author’s experience conducting psychiatric treatment outcome research, the extensive literature on treatment outcome methodology (Kazdin 1994), a recent comprehensive text on the clinical evaluation of psychotropic drugs (Prien and Robinson 1994), and Kraemer and Telch’s (1992) paper on outcome measurement for clinical trials.","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"175 1","pages":"118-36"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57799123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the event that methamphetamine evokes HO. formation within serotonergic axon terminals, the resultant oxidation of 5-HT would be expected to generate not only 5,6-DHT but also T-4,5-D, 7-S-Glu-T-4,5-D, 6, 8, and 7,7'-D (figure 1), at least three of which (T-4,5-D, 7-S-Glu-T-4,5-D, and 6) are lethal in mouse brain. Furthermore, several intermediates/products formed in the in vitro oxidation of 5-HT by HO. are readily autoxidized (4,5-DHT, 5,6-DHT, 5, 7, and 9) or redox cycled (T-4,5-D, 6, 8, 7,7'-D, 7-S-Glu-T-4,5-D) in reactions that would be expected to yield O2-. and/or H2O2 as byproducts. These byproducts, in the presence of trace levels of transition metal ion catalysts, would be readily converted into HO. (Walling 1975; Halliwell and Gutteridge 1984). Together these putative aberrant oxidative metabolites of 5-HT and HO.-forming reactions might contribute to the degeneration of serotonergic nerve terminals. Similarly, the methamphetamine-induced intraneuronal formation of HO. in dopaminergic terminals might be expected to generate not only 6-OHDA (and 2-OHDA and 5-OHDA, figure 3) but also 5,-S-CyS-DA and 5-S-Glu-DA, precursors of DHBT 17 and other more complex dihydrobenzothiazines (figure 4). DHBTs 17 to 19 are lethal in mouse brain, although at this time the biochemical/chemical mechanisms underlying this toxicity and specific neuronal systems affected are unknown. However, 5-S-CyS-DA and 17 to 19 are much more easily oxidized than DA, and the latter DHBTs appear to be capable of redox cycling reactions (Zhang and Dryhurst 1994). Thus, the HO.-mediated oxidation of DA in dopaminergic nerve terminals induced by methamphetamine might be expected to generate aberrant oxidative metabolites that (as a result of autoxidation and redox cycling reactions) potentiate formation of O2-. and/or H2O2, and then HO. and neuronal damage. A number of lines of evidence, discussed previously, suggest that aberrant metabolite(s) of DA (other than or in addition to 6-OHDA) might contribute to the methamphetamine-induced degeneration of not only dopaminergic terminals but also serotonergic terminals. Similarly, aberrant metabolite(s) of 5-HT (other than or in addition to 5,6-DHT) might be involved in the degeneration of serotonergic and dopaminergic terminals and a subpopulation of cell bodies in the somatosensory cortex. Experimental evidence indicates that some of the neurodegenerative effects evoked by methamphetamine are mediated by NMDA and GABA receptors. Thus, it will be of considerable interest to investigate the neurotoxicity of putative aberrant oxidative metabolites of 5-HT (figures 1 and 2) and DA (figures 4 and 5) towards serotonergic, dopaminergic, and other neuronal systems and their interactions with NMDA, GABA, and other brain receptors. A central question relates to mechanisms by which methamphetamine might evoke the intraneuronal formation of oxygen radicals that appear to play important roles in the overall neurodegenerative processes evok
万一甲基苯丙胺引起HO。在5-羟色胺能轴突末端形成，由此产生的5-羟色胺氧化不仅会产生5,6- dht，还会产生t -4,5-D, 7- s - glu - t -4,5-D, 6,8和7,7'-D(图1)，其中至少有三种(t -4,5-D, 7- s - glu - t -4,5-D, 5-D和6)在小鼠脑中是致命的。此外，HO在体外氧化5-HT过程中形成了几种中间体/产物。很容易被氧化(4,5- dht, 5,6- dht, 5,7，和9)或氧化还原循环(t -4,5- d, 6,8,7,7 '- d,7 - s - glu - t -4,5- d)，这些反应预计会产生O2-。和/或H2O2作为副产物。在存在痕量过渡金属离子催化剂的情况下，这些副产物很容易转化为HO。(墙体1975;哈利威尔和古特里奇1984)。这些被认为是异常的5-羟色胺和HO的氧化代谢物。-形成反应可能导致血清素能神经末梢的退化。同样，甲基苯丙胺诱导HO在神经元内形成。多巴胺能末端可能不仅会产生6-OHDA(以及2-OHDA和5- ohda，图3)，还会产生5，-S-CyS-DA和5- s - glu - da, DHBT 17和其他更复杂的二氢苯并噻嗪的前体(图4)。DHBT 17至19在小鼠大脑中是致命的，尽管此时这种毒性的生化/化学机制和受影响的特定神经系统尚不清楚。然而，5-S-CyS-DA和17 - 19比DA更容易被氧化，而后者的dhbt似乎能够进行氧化还原循环反应(Zhang和Dryhurst 1994)。因此，HO。甲基苯丙胺诱导多巴胺能神经末梢DA -介导的氧化可能会产生异常的氧化代谢物，这些代谢物(作为自氧化和氧化还原循环反应的结果)增强了O2-的形成。或者H2O2，然后是HO。还有神经元损伤。前面讨论过的一些证据表明，DA的异常代谢物(除了6-羟色胺之外或除了6-羟色胺之外)可能导致甲基苯丙胺诱导的多巴胺能末端和5 -羟色胺能末端的退化。同样，5-羟色胺的异常代谢物(除了5,6- dht之外)可能参与了体感觉皮层中5-羟色胺和多巴胺末端以及细胞体亚群的退化。实验证据表明，甲基苯丙胺引起的一些神经退行性作用是由NMDA和GABA受体介导的。因此，研究假定的5-羟色胺(图1和2)和DA(图4和5)的异常氧化代谢物对血清素能、多巴胺能和其他神经元系统的神经毒性及其与NMDA、GABA和其他脑受体的相互作用将是相当有趣的。一个核心问题涉及甲基苯丙胺可能引起神经内氧自由基形成的机制，氧自由基似乎在该药物引起的整个神经退行性过程中起重要作用(DeVito和Wagner 1989;Cadet et al. 1994)。一旦假设的5-羟色胺氧化代谢物如t -4,5- d、7- s - glu - t -4,5- d、5,6- dht、6,8和7,7'- d(图1)在神经内形成，原则上自氧化/氧化还原循环反应应该能够产生O2-。和/或H2O2, HO的前体。同样，神经元内6-OHDA、5-S-CyS-DA和DHBTs 17至19和22的形成也可能增强O2-通量的升高。H2O2和HO。由于这些假定的异常代谢物容易发生自氧化/氧化还原循环反应。在人类和其他哺乳动物大脑中富含da的区域存在极低浓度的5-S-CyS-DA，这表明自氧化作用(Rosengren et al. 1985;Fornstedt et al. 1986, 1989, 1990)或其他形式的DA氧化在体内是正常的反应。此外，现有证据表明，是细胞质DA被氧化生成5-S-CyS-DA (Fornstedt et al. 1989;Fornstedt和
{"title":"Potential new insights into the molecular mechanisms of methamphetamine-induced neurodegeneration.","authors":"M. Wrona, Zhaoliang Yang, Fa Zhang, G. Dryhurst","doi":"10.1037/e495572006-011","DOIUrl":"https://doi.org/10.1037/e495572006-011","url":null,"abstract":"In the event that methamphetamine evokes HO. formation within serotonergic axon terminals, the resultant oxidation of 5-HT would be expected to generate not only 5,6-DHT but also T-4,5-D, 7-S-Glu-T-4,5-D, 6, 8, and 7,7'-D (figure 1), at least three of which (T-4,5-D, 7-S-Glu-T-4,5-D, and 6) are lethal in mouse brain. Furthermore, several intermediates/products formed in the in vitro oxidation of 5-HT by HO. are readily autoxidized (4,5-DHT, 5,6-DHT, 5, 7, and 9) or redox cycled (T-4,5-D, 6, 8, 7,7'-D, 7-S-Glu-T-4,5-D) in reactions that would be expected to yield O2-. and/or H2O2 as byproducts. These byproducts, in the presence of trace levels of transition metal ion catalysts, would be readily converted into HO. (Walling 1975; Halliwell and Gutteridge 1984). Together these putative aberrant oxidative metabolites of 5-HT and HO.-forming reactions might contribute to the degeneration of serotonergic nerve terminals. Similarly, the methamphetamine-induced intraneuronal formation of HO. in dopaminergic terminals might be expected to generate not only 6-OHDA (and 2-OHDA and 5-OHDA, figure 3) but also 5,-S-CyS-DA and 5-S-Glu-DA, precursors of DHBT 17 and other more complex dihydrobenzothiazines (figure 4). DHBTs 17 to 19 are lethal in mouse brain, although at this time the biochemical/chemical mechanisms underlying this toxicity and specific neuronal systems affected are unknown. However, 5-S-CyS-DA and 17 to 19 are much more easily oxidized than DA, and the latter DHBTs appear to be capable of redox cycling reactions (Zhang and Dryhurst 1994). Thus, the HO.-mediated oxidation of DA in dopaminergic nerve terminals induced by methamphetamine might be expected to generate aberrant oxidative metabolites that (as a result of autoxidation and redox cycling reactions) potentiate formation of O2-. and/or H2O2, and then HO. and neuronal damage. A number of lines of evidence, discussed previously, suggest that aberrant metabolite(s) of DA (other than or in addition to 6-OHDA) might contribute to the methamphetamine-induced degeneration of not only dopaminergic terminals but also serotonergic terminals. Similarly, aberrant metabolite(s) of 5-HT (other than or in addition to 5,6-DHT) might be involved in the degeneration of serotonergic and dopaminergic terminals and a subpopulation of cell bodies in the somatosensory cortex. Experimental evidence indicates that some of the neurodegenerative effects evoked by methamphetamine are mediated by NMDA and GABA receptors. Thus, it will be of considerable interest to investigate the neurotoxicity of putative aberrant oxidative metabolites of 5-HT (figures 1 and 2) and DA (figures 4 and 5) towards serotonergic, dopaminergic, and other neuronal systems and their interactions with NMDA, GABA, and other brain receptors. A central question relates to mechanisms by which methamphetamine might evoke the intraneuronal formation of oxygen radicals that appear to play important roles in the overall neurodegenerative processes evok","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"173 1","pages":"146-74"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57800383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is now a widespread acceptance that persons with severe mental illness are at increased risk to develop substance use disorders (alcohol and drug abuse/dependence). Reviews of the prevalence of substance use disorders in clients with schizophrenia (Mueser et al. 1990), bipolar disorder (Goodwin and Jamison 1990), and the young, chronically mentally ill (Safer 1987) indicate a wide range of prevalence estimates, from as low as 10 percent to over 65 percent. Variability in prevalence rates can be attributed to differences across studies in factors such as the setting in which clients are sampled (e.g., community mental health center, acute inpatient, chronic inpatient), methods for assessing psychiatric and substance use disorders (e.g., structured clinical interview, chart review), and the demographic mix of the study sample (e.g., proportion of males) (Galanter et al. 1988; Mueser et al. 1995).
现在人们普遍认为，患有严重精神疾病的人患物质使用障碍(酒精和药物滥用/依赖)的风险更大。对精神分裂症(Mueser et al. 1990)、双相情感障碍(Goodwin and Jamison 1990)和年轻人慢性精神疾病(Safer 1987)患者中物质使用障碍患病率的回顾表明，患病率估计范围很广，从低至10%到65%以上。患病率的差异可归因于不同研究的不同因素，如取样对象的环境(例如，社区精神卫生中心、急性住院病人、慢性住院病人)、评估精神和物质使用障碍的方法(例如，结构化临床访谈、图表审查)和研究样本的人口结构(例如，男性比例)(Galanter等人，1988;Mueser et al. 1995)。
{"title":"The course and treatment of substance use disorder in persons with severe mental illness.","authors":"K. Mueser, R. Drake, K. Miles","doi":"10.1037/e495582006-002","DOIUrl":"https://doi.org/10.1037/e495582006-002","url":null,"abstract":"There is now a widespread acceptance that persons with severe mental illness are at increased risk to develop substance use disorders (alcohol and drug abuse/dependence). Reviews of the prevalence of substance use disorders in clients with schizophrenia (Mueser et al. 1990), bipolar disorder (Goodwin and Jamison 1990), and the young, chronically mentally ill (Safer 1987) indicate a wide range of prevalence estimates, from as low as 10 percent to over 65 percent. Variability in prevalence rates can be attributed to differences across studies in factors such as the setting in which clients are sampled (e.g., community mental health center, acute inpatient, chronic inpatient), methods for assessing psychiatric and substance use disorders (e.g., structured clinical interview, chart review), and the demographic mix of the study sample (e.g., proportion of males) (Galanter et al. 1988; Mueser et al. 1995).","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"172 1","pages":"86-109"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57800863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this chapter is to review the literature on drug and alcohol use among rural Mexican-Americans. Given the lack of empirical data on substance use among this population, the review was expanded to include adult alcohol use in rural areas of Mexico and the United States and in urban areas of the United States. This chapter focuses on sociocultural factors (gender, community norms, family traditionalism, and acculturation) associated with drug and alcohol use among rural Mexican-Americans by presenting an integrative analysis of factors related to the risks of drug use. The interrelationship between levels of acculturation and levels of family traditionalism as they relate to the risks of drug abuse is also examined. Finally, suggestions are offered for future research and for preventive interventions applicable to rural Mexican-American populations.
{"title":"Drug and alcohol use among rural Mexican-Americans.","authors":"F. Castro, S. E. Gutierres","doi":"10.1037/e495612006-023","DOIUrl":"https://doi.org/10.1037/e495612006-023","url":null,"abstract":"The purpose of this chapter is to review the literature on drug and alcohol use among rural Mexican-Americans. Given the lack of empirical data on substance use among this population, the review was expanded to include adult alcohol use in rural areas of Mexico and the United States and in urban areas of the United States. This chapter focuses on sociocultural factors (gender, community norms, family traditionalism, and acculturation) associated with drug and alcohol use among rural Mexican-Americans by presenting an integrative analysis of factors related to the risks of drug use. The interrelationship between levels of acculturation and levels of family traditionalism as they relate to the risks of drug abuse is also examined. Finally, suggestions are offered for future research and for preventive interventions applicable to rural Mexican-American populations.","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"168 1","pages":"498-530"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57802688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The mental health funding cuts and the block grant shift of the last decade have placed an increased emphasis on fee-generating services. In already underserved rural areas, this has generated immense challenges for mental health professionals on how to provide services to persons other than those with chronic mental illness. This chapter has discussed alternatives and innovations that have proven successful. Linkages with primary care physicians and indigenous residents who have been trained to provide basic mental health services under the supervision of mental health professionals are just two of the ways in which mental health professionals have risen to meet the challenges placed before them. A review of the literature produced few articles about rural programs addressing the issues of substance abuse, services to women, children, the elderly, those with severe mental illness or developmental disability, and the homeless, or crisis intervention programs. Much work needs to be done to provide adequate services to these special rural populations. It is hoped that the renewed interest in rural areas generated by the farm crisis will produce additional programs addressing the needs of these often underserved populations.
{"title":"Mental health service delivery in rural areas: organizational and clinical issues.","authors":"M. Wagenfeld, J. Murray, D. Mohatt, J. DeBruyn","doi":"10.1037/e495612006-018","DOIUrl":"https://doi.org/10.1037/e495612006-018","url":null,"abstract":"The mental health funding cuts and the block grant shift of the last decade have placed an increased emphasis on fee-generating services. In already underserved rural areas, this has generated immense challenges for mental health professionals on how to provide services to persons other than those with chronic mental illness. This chapter has discussed alternatives and innovations that have proven successful. Linkages with primary care physicians and indigenous residents who have been trained to provide basic mental health services under the supervision of mental health professionals are just two of the ways in which mental health professionals have risen to meet the challenges placed before them. A review of the literature produced few articles about rural programs addressing the issues of substance abuse, services to women, children, the elderly, those with severe mental illness or developmental disability, and the homeless, or crisis intervention programs. Much work needs to be done to provide adequate services to these special rural populations. It is hoped that the renewed interest in rural areas generated by the farm crisis will produce additional programs addressing the needs of these often underserved populations.","PeriodicalId":76229,"journal":{"name":"NIDA research monograph","volume":"168 1","pages":"418-37"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57802784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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