This document contains an undergraduate student's ePortfolio, which includes personal statements, resumes, reflections, and samples of their work. In the personal statement, the student discusses overcoming a 15-year addiction and earning a 3.98 GPA while obtaining their psychology degree. Their resume highlights volunteer work helping the homeless and skills in counseling. Reflections analyze the student's strengths in critical thinking, research, communication, and applying psychology principles. Samples of their work focus on whether gender impacts success in methadone treatment programs.

1. 1 Undergraduate Studies ePortfolio Celena A. Heine BA in Psychology, 2010

2. Personal Statement Helping other addicts along their roads to recovery has been a kind of motto I’ve patterned my life by for the past two years that I’ve been in “recovery” myself. For years I felt so lost and all alone; having dealt first hand with a fifteen year addiction to drugs and alcohol. I wandered aimlessly back and forth down a path known as relapse. In many respects, I thought I had thrown away any hopes of finding my way; finishing college and having a decent career in order to care for my daughters. I remember the moment I decided that my life was mine to change; while completing a ten-month long drug treatment program from a women’s outpatient facility. It was as if I had finally found that perfect, trustworthy, reliable vehicle; a clean and sober mind and body. A new vehicle to set out on the journey that God had been preparing me for all along. I re-enrolled as a junior in college at Argosy University-Tampa, in the spring of 2009; where I have responsibly and diligently maintained a 3.98 GPA while finishing my Bachelor’s degree in Psychology. Just as there are choices to be made, both good and bad, when battling an addiction and deciding to maneuver the biggest “U-turn” of one’s life, I’ve made my share of mistakes. However, out of these mistakes, I’ve learned a little more about “me” and this new “vehicle” I have the privilege of owning. Community service, with an overall theme of “giving back to society”, has become a part of my journey and a value I instill in my children. I have volunteered my time serving nourishment to the homeless, packing food to go out to various charities, reading to four-year olds, and learning how to bathe and care for the sick. What I have found, no matter what form of care I am giving, is that giving back to the community and helping others’ is my true calling in life. I realized a long time ago, even before I had to battle with myself and my addiction, that I am the type of person who can empathize with others’ situations, be a compassionate listener, and help others’ attain the “life’s skills” needed to survive in this world. I saw first hand the uncaring world of people doing a job because of a paycheck; a nurse told me not to worry about talking to a comatose patient because she could not hear me. I looked at the once beautiful woman lying in that hospital bed and saw my mother, my grandmother, and MY sister and friend. I told that too busy nurse that that lady had a family that she needed to look nice for and that I might very well be the last person she ever got to talk to; I would never be “too busy” for my patients. While bathing that sweet woman, who had yet to talk or really even move, a single tear rolled down her check; even in her comatose state, she had heard my compassion and was grateful. I finally have a chance to not only improve my own life and the life of my children, but I also have the opportunity to be a beacon of hope for all those people who have found their way down the same dead-end street of addiction. I have a chance to make a difference in the world. I’m scheduled to graduate with my Bachelor’s in Psychology at the end of August 2010; where I plan to make one more stop in this leg of my journey; I plan to be a substance abuse counselor on my way to obtaining my Master’s in Mental Health Counseling.

3. Resume Celena A. Heine Objective: To obtain an entry-level position as a substance abuse counselor. Skills PC skills: Word, Excel, Power Point; Type: 40-50 wpm, great listening skills; empathetic to others’ challenges in life, able to work creatively in a group or independently, able to cope well with stress. Excellent communication skills: written and oral, interact effectively with others, achieve personal goals, and inspire others, & solve problems effectively and quickly Education B.A. Degree in Psychology Argosy University, Tampa, FL Current G.P.A. 3.98. 2010 Surgical Technology Diploma Americare School of Nursing,Fern Park, FL2003 2003 Two yrs/ One Year Florida State University/ University Of Central Fl. Tallahassee, & Orlando; Majored in Biology with 3.5 G.P.A. 1993-1996 Career History & Accomplishments Owner of a cleaning business, Celena-Rella’s Chores & System 4 of Tampa- Cleaned business and residential homes, scheduled cleans and ordered/stocked supplies, & gave estimates and pricing. 2007-2008 Cleaning/Custodial worker, Maids to Order- Cleaned residential homes, ran estimates and handled some scheduling. 2005-2007 Homemaker/Mother of two 2002-2005 Administrative Assistant, Scott Garrison- Licensed Real Estate Broker- All types of office work including PC: Word, Excel, Power Point; Personal Assistant duties; Assisted in preparing contracts and sales proposals for customers, handled advertisements for paper, & excellent inter-office communication skills 2000-2001 Office Manager, Evergreen Lawn Care- .Handled administrative functions for an office of 15, scheduled 10 workers for pest control lawn care. 2000 Customer Service, Winn-Dixie grocery stores 1998-2000 Pharmacy Tech, Florida Hospital 1997 Pharmacy Tech/Customer Service, Albertsons 1995-1997 Pharmacy Tech, Eckerd Pharmacy 1992-1993 & 1994-1995 Memberships & Affiliations Member, Zeta Tau Alpha sorority at FSU; Member-Student, Friends of SAMHSA, LinkedIn; Member-Student, National Institute on Drug Abuse, LinkedIn; Member-Student, Christian Association for Psychological Studies, LinkedIn; Member-Student, Effective Counseling & Group Counseling, LinkedIn; Member-Volunteer, Bay Life Church; Volunteer, Trinity Café, feeding meals to the less-fortunate of Tampa Bay; Assistant coach to little league soccer and volunteer for Girl Scouts of West Central Florida; Member- Mother’s Against Drunk Driving (MADD); Member- Celebrate Recovery (CR) & Narcotics Anonymous (NA)

4. Reflection I, by all means, have not had your “typical” experience with my undergraduate program; it having taken me over 10 years to FINALLY get here! My road has been a sometimes-rocky one; full of mistakes and “life’s lessons.” However, somewhere along the way I found the real Celena. If someone had told me, the year I graduated high school in 1993, that I would be obtaining my BA in Psychology and going on to work for a Master’s in Mental Health counseling, I would have laughed at them. You see, at one time in my life, psychology and the thoughts of “grad school” were too much work! Today, after battling an addiction for the past 15 years, my “life" and all its strengths and weaknesses has taught me that I don’t belong anywhere else than right here. In regards to my strengths and weaknesses, my SSAL (the Student Self-Appraisal of Learning) has provided me with insight into the depth of work I have been able to accomplish in my undergraduate program. For my Cognitive Abilities: Critical Thinking section, I found that when given a psychological issue, I am able to employ skeptical inquiry and a scientific approach to problem solving. Within written, as well as oral presentations, I am able to formulate reasoned opinions on a wide-range of psychological perspectives and theories, assess a given topic from multiple perspectives; evaluating the merit of each, and I am able to systematically analyze & appraise the complexities of a given issue. When it comes to Information Literacy, I am able to direct and arrange information from a variety of sources dealing with a chosen topic and integrate reasoned appraisals of such information into the work of a project in psychology. Concerning my Research Skills in psychology, from a scholarly article, I am able to efficiently summarize the research design, the statistical & other evaluative tolls, and findings form the article, as well as, use sound reasoning as a basis for criticizing the results. Having taken most of my courses on-line, I do not have an extensive database of Oral Communication skills, however, in analyzing this section, I found that I possess a moderate to significant ability in creating, organizing, & presenting oral presentations; working quite effectively in a group capacity. I am able to analyze my target audience and connect with them emotionally on a very human level. In regards to my Written Communication skills, I am able to develop and apply the appropriate level of conciseness and clarity in content, language use & grammar, and organization using APA formatting. Further, I am able to effectively defend and apply a particular stance related to a psychological concept in written work.

5. Reflection (cont.) My work in Ethics and Diversity has been truly eye opening. I have found that I am able to effectively engage in critical thinking and action; evidenced by my ability to articulate the best practices suitable in any given situation and/or case study. I am able to recognize breeches in ethical conduct, take ownership of my own behavior, and promote ethical decision-making activities accordingly. I effectively engage in multiculturally sensitive issues, able to recognize subtle, as well as blatant, forms of discrimination and prejudices, and claim ownership of my personal biases; working all along to increase awareness and respect for the diverse populations in the field of psychology. In regards to Knowledge of Psychology, I am able to consistently recognize and apply the major theoretic perspectives, concepts, empirical evidence, applications, and historical trends in the field. Furthermore, I am able to synthesize and apply these different aspects in order to explain everyday life situations. When it comes to the Knowledge of Applied Psychology, not only am I able to apply the aforementioned psychological principles and/or empirical data, but I am also able to demonstrate the ability to use these principles in solving problems, explaining social issues, and dealing with everyday life situations. Finally, in regards to Interpersonal Effectiveness, I am able to develop and improve positive relationship skills via effective communication, respect for myself and others, and an appreciation for cultural diversity and sensitivity in my awareness of others. Through each of these pieces of work, I have begun the process of piecing together the puzzle of my life. I have been able to analyze who I am today and how I got here. More than that, I have been made to see that my BA in psychology is just the tip of the iceberg as far as my academic career. I have proven to others and myself that I am where God wants me to be…on a path toward helping others.

6. Table of Contents Cognitive Abilities: Critical Thinking and Information Literacy Research Skills Communication Skills: Oral and Written Ethics and Diversity Awareness Foundations of Psychology Applied Psychology Interpersonal Effectiveness

7. Cognitive Abilities: Critical Thinking & Information Literacy Does Completing A Methadone Maintenance Program Reduce The Occurrence of Relapse To Opiate Drug Use in Women Vs Men? Celena Heine PSY 302- M8A2 Argosy University December 17, 2009 Abstract Whether completing a Methadone Maintenance Treatment (MMT) program reduced the occurrence of relapse to Opioid drug use in women versus men was investigated using a similar method as found in Walton, Blow, & Booth’s (2001) study. Patients (N=500), evenly distributed between male and female, enrolled in a Methadone Maintenance Treatment (MMT) program, completed several surveys during the first three months after entering treatment for Opioid dependency; confirmed by the DSM-IV, or Diagnostic and Statistical Manuel of Mental Disorders, version IV. Assessment packets included: measures of coping, self-efficacy, resource needs, social influences, and future sober activities (Intrapersonal Attribute Scale). Another set of assessments was given which included: the measures of craving, negative social influence, exposure to drugs, and sober activities (Alcohol and Drug Subculture). Analysis focused on gender and race (Caucasian versus African-American) before and after controlling for: age, marital status (yes/no), religious preference, income, poly-substance use (alcohol only/ poly-substance), treatment type (inpatient/ outpatient), and problem severity. The tests used in this study were: the AWARE Questionnaire, the Alcohol and Drug Consequences Questionnaire (ADCQ), and the Opinions about Methadone scale (OAM-5). The prediction is that completing an MMT program will reduce the occurrence of relapse in women, more so than men. The findings support the hypothesis in that the gender differences found were: men reported fewer coping skills and more exposure and negative social influences than women; all skills that can influence/trigger relapse. African-American males and females reported greater coping skills and self-efficacy than Caucasians; however, African-Americans also required greater resource needs in the community than Caucasians. There has been many studies done on the broad topic of substance abuse and treatment programs, however, more studies need to be done that focus on Opioid addiction, Methadone Maintenance Treatment (MMT), and the occurrence of relapse in men and women, as well as the many different ethnicities.

8. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Does Completing A Methadone Maintenance Program Reduce The Occurrence of Relapse To Opiate Drug Use in Women Vs Men? Substance abuse and addiction is a serious disease with over 20% of people in the United States having used and abused prescription pain medicine (NIDA, 2009). Many people loose their health, relationships, finances, and essentially themselves in this illness. “Substance abuse is plagued by high relapse rates following treatment” (Walton, 2001). Treatment programs have attempted to improve relapse rates through the implementation of relapse prevention programs that focus on a variety of counseling techniques and pharmacology aimed at coping skills and increasing self-esteem. Some of these techniques include: methadone maintenance therapy (MMT), nursing support, and psycho-social aspects like cognitive, behavioral, psychodynamic group/family therapies (Walton, 2001). There have been many quantitative studies aimed at identifying main risk factors associated with poor compliance in Methadone Maintenance Therapy (MMT) and hence relapse in chronic opiate drug users (Mutasa, 2001). It is important to be able to identify social conditions, program factors, and client characteristics that improve retention rates of MMT programs “…because time in substance abuse treatment is associated with improved health, mood, and social functioning” (Kayman, 2006). “Most Opioid-dependant addicts require long-term stabilization in methadone maintenance therapy to normalize brain function and control withdrawal symptoms” (Kayman, 2006). This study will show that quality of care and length of time in treatment will show a larger decrease in the occurrence of relapse in women who are opiate dependent. This will be shown by proving, with research, that women have different needs than do men and relapse prevention programs need to design their programs to meet the needs of those individuals. A focus on social support, leisure activities, and acquisition of resources is a key element to relapse prevention (Walton, 2001). All of the designs used for research, except for one, are quasi-experiments; therefore, this study is a quasi-experiment as well. That one experiment done by Goldstein, Deren, Magura, Kayman, Beardsley, & Tortu (2000), is called Cessation of Drug Use: Impact of Time in Treatment, whichbasically investigated whether the amount of time in treatment, less than or more than 90 days, was related to cessation of drug use (Goldstein, et al., 2000). This study used a sample of 993 injection drug users and crack smoker; with a mean age of 38, and no breakdown of men vs. women which clearly shows poor Generalizability. However, because there was no gender variables used, it can be deduced that this is a true experiment. Selection of participant’s was random, therefore “Control by Design” was used and the threats to validity, as previously stated, were: history, maturation, testing, instrumentation, regression, subject attrition, and selection (Shaughnessy et al., 2009). Also, there are several threats to validity that can affect any experiment: contamination, experimenter expectancy effects, and novelty effects (Shaughnessy et al., 2009).

9. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Kayman (2004) did a study called Women and Men in Methadone Treatment. Do Attitudes Predict Outcome? This particular study adds to the relatively new and growing literature on gender-related differences, which has identified characteristics and needs that are unique to women” (Kayman, 2004, abstract). Because of these gender variables, as well as the fact that control was achieved via the use of ANOVA and “Control by Statistical Analysis”, this particular study is a quasi-experiment. According to the lecture for module five in the Research Methods class at Argosy University, quasi-experiments look a lot like true experiments, except because there is no randomization, the control groups are non-equivalent (Argosy University, 2009). “The threats to internal validity that must be considered when using the non-equivalent control group design include: additive effects with selection, differential regression, observer bias, contamination, and novelty effects” (Shaughnessy et al, 2009, p354). With a sample of 338; 25% being female, this study failed to identify gender differences, probably due to the fact that the sample needed to be more evenly distributed between male and female (Kayman, 2004). The study did however prove that the OAM scale is a useful tool in predicting premature termination (Kayman, 2004). That being said, for many of the same reasons, the study done by Walton, Blow, & Booth (2001), and called Diversity in Relapse Prevention Needs: Gender and Race Comparisons among Substance Abuse, was found to be a quasi-experiment. The use of race also defines it as a quasi-design;it uses a sample of 331 people; 192 female and 139 males, aged 18-81, with a mean age of 40.5. A further breakdown was 53.8% being Caucasian, 37.2% African-American, and 9% other minority (Walton, Blow, & Booth, 2001). Again, because it is a quasi-design, control is achieved with “Control by Statistical Analysis”. More specifically, this study controlled for background characteristics: age, income, poly-substance use, marital status, problem severity, and treatment type (Walton, 2001). The threats to validity were the same as Kayman (2004). Mutasa (2001) did a study called Substitution Therapy (MST) and Relapse Among Chronic Opiate Users (in an outer London community). This study is a semi-quantitative descriptive investigation where “…findings are discussed in the light of what is already known about non-compliance and what’s currently happening in clinical practice, and possible recommendations that have significant implications for nursing practice are suggested” (Mutasa, 2001, Introduction). Despite the low Generalizability with only a sample of 45 people, this is still a quasi-design because it compares the variables of race, as well as gender. Again, as stated earlier, because this is a quasi-experiment, control is achieved through the use of ANOVA’s, known as “Control by Statistical Analysis” and the threats to validity are: additive effects with selection, differential regression, observer bias, contamination, and novelty effects” (Shaughnessy et al, 2009). Rowan-Szal, Chatham, Joe, & Simpson (2000) did a study called Services Provided During Methadone Treatment: A Gender Comparison. This particular study took a sample of 635 opiate-addicted clients, 199 female and 436 male; ages 18-70, from 3 different community-based programs (Rowan-Szal, et al., 2000). The research was an empirical, longitudinal study which examined the differences in service needs of men and women for the first three months of treatment and because of this analysis, it is a quasi-experiment. Control is achieved through the use of “Control by Statistical Analysis” and the threats to validity are the same as previously stated for the quasi-experiment (Shaughnessy et al, 2009).

10. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Another study done in 1994 by Joe, Simpson, & Sells, is called Treatment Process and Relapse to Opioid Drug Useduring Methadone Maintenance. This particular study had many different variables which was my first clue to it being a quasi-experiment. Basically, this study asked the question: Do these variables have an effect on “during treatment outcome”, as operationalized by: rates of relapse to Opioid use as measured by positive urine screens (Joe et al., 1994)? Again, because this was a quasi-experiment, the control was achieved through “Control by Statistical Analysis” and the threats to validity include: additive effects with selection, differential regression, observer bias, contamination, and novelty effects (Shaughnessy et al, 2009). There is the addition of subject attrition because of early termination of participants in the study which was un-avoidable (Joe et al., 1994). A sample of 590 patients, who had been in treatment for at least three months, was obtained from 21 clinics; with relapse rates related to client dosage levels and take-home privileges. It was found that if counselors, at intake, obtain a complete history and tailor make each client’s treatment plan, positive associations with treatment outcome is evident (Joe et al, 1994). . Finally, recent research (Kayman, Goldstein, Deren, & Rosenblum, 2006) showed that negative attitudes towards Methadone treatment, at the time of admission, predicted termination from the program within one year of enrollment. Kayman et al (2006) used a sample of 338 people; 25 % being female and a mean age of 39 years. Racial distribution was as follows: 51 %, Hispanic, 33 % non-Hispanic Black, 13 % White, and 3% Native American. Further breakdown looked something like this: 46 % had no high school diploma, 43 % hadn’t injected drugs in the last 30 days, 41 % were never married, 62 % had been in a treatment program before, and 65 % had experienced a detoxification process (Kayman et al, 2006). Participants were given 3 separate tests: Addiction Severity Index (ASI), Risk Behavior Assessment (RBA), and the Opinions About Methadone (OAM) scale. What was found was that out of the 338 participants, 48% dropped out of treatment; the ones who remained were the ones who had more favorable opinions about Methadone (Kayman et al, 2006). The original OAM-5 scale was found to be more effective than the original OAM scale, a 14 question survey; due to greater face validity (Kayman et al, 2006). Overall, the OAM-5 was found to be a very useful tool for counselors to use at intake; to help them identify potential problems and help in the areas needed.

11. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) In summary, Kayman, Goldstein, Deren, & Rosenblum (2006) found that the attitude an individual has towards Methadone is critical in who decides to complete treatment and who decide to quit. Methadone, a synthetic opioid, prevents withdrawal symptoms without inducing euphoria or impairing one’s judgment; those patients who are stabilized on an adequate, daily dose reduce and/or stop their illicit use of opioids (Kayman et al 2006). Ghodse and colleagues (2002) compared the characteristics of patients who completed an MMT program to those who quit. It was found that there was a significant decrease in the amount of relapse, at follow-up interviews carried out 3, 6, 9, & 12 months after discharge, from those who completed an MMT program (Ghodse et al, 2002). Mutasa (2001) looked into the risk associated with non-compliance in an MMT program. The findings showed that routine identification of biopsychosocial risks is critical in both men and women (Mutasa, 2001). Another study done by Kelly and colleagues (2009) showed that counselors can’t be successful in having clients not relapse without the use of individualized treatment plans. Weddington (1990) found that the implementation of psychotherapeutic relapse prevention methods can be introduced into existing treatment plans in order to prevent relapse to Opioid drug use. Still another study done by Kayman (2004) established that the opinion about methadone (OAM) scale is a useful tool in preventing premature termination from the program. Rowan-Szal and colleagues (2000) found that women entered treatment with more psychosocial concerns and symptoms, and with greater HIV/AIDS risky behaviors than men. However, women also presented less criminal activity, less alcohol and/or poly-substance abuse, and a greater motivation and willingness to change their lives (Rowan-Szal et al 2000). The present study is based largely on the work done by Walton, Blow, & Booth (2001). The purpose of that particular study was to document the diversity in psychosocial concerns; based on gender and race. Evidence was found that there is a need for alternative relapse prevention programs; addressing the unique needs of men and women (Walton et al, 2001). It’s critical to continue research in finding variables that lead to termination in substance abuse programs because “…drug users who drop out of treatment are at high risk for extremely serious harms including homelessness, violent victimization, arrest, incarceration, and fatal drug overdoses (Kayman et al 2006). The present study researches the occurrence of relapse to Opioid drug use in men versus women upon completion of an MMT program; with a look at its effect on two races: Caucasian and African-American.

12. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Method Participants Participants for this study will consist of a client sample of opiate addicted individuals participating in a methadone maintenance program like: The DACCO Center for Behavioral Health, otherwise known as the Drug Abuse Comprehensive Coordinating Office, Inc., and PAR, also known as Operation PAR, a prevention, treatment, and research facility for substance abuse. The sample needs to consist of 500 participants, with 250 being men and 250 being women. An age range from 18-81 should be OK. All clients should be self-referred or referred for a drug dependency problem and confirmed using DSM-IV, Diagnostic and Statistical Manuel of Mental Disorders, version IV (Eder, 2005). “The overall motivation level for a client can be a useful predictor of the ability of the client to be compliant with methadone maintenance therapy” (Mutasa, 2001). This is of clinical importance because the “willingness” of a client to accept the need to change voluntarily is an important factor in treatment success. Also, the MMT clients should have been in treatment for at least 3 months so as to eliminate confusion of those people who have actually become abstinent from opiate use and those who are “quitting occasionally. It’s important to chart a natural history of opiate dependency to better understand this form of treatment. Persons addicted to opiates often became dependent on the drugs in their early twenties and have remained “…intermittently dependent for decades” (Mutasa, 2001). “Biological, socioeconomic, and psychological factors determine when an individual will start taking opiates” (Mutasa, 2001). Continuing on this path, once use begins, it often escalates into misuse and then dependence. Essentially repeated use with adverse consequences leads to tolerance, withdrawal, compulsive and uncontrollable taking of the drug. Once an addict gets to this point an “addiction career” has been established; cycles of cessation and relapse (Mutasa, 2001). Again, it is stated that “Therapy can alter the natural history of opiate dependency, commonly by prolonging periods of abstinence from illicit opiate use” (Mutasa, 2001). Research disclosed that therapy is usually targeted in the “action”, “maintenance”, and “relapse” stages of the behavior change model. Motivation being a precondition for an effective substance abuse program makes this model an important tool. Motivational interviewing aims at raising self-esteem and self-efficacy; increasing awareness of one’s problems and “motivating” clients to seek out help and comply with his/her program. It’s believed that there are distinct differences in gender when it comes to personality traits and factors that lead to a continued use of drugs (Mutasa, 2001).

13. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Materials Materials used will be a variety of different tests common to substance abuse treatment and a few scales to determine quality of care, attitudes of clients, and interpersonal attributes. The DSM-IV, or Diagnostic and Statistical Manuel of Mental Disorders, version IV will be used to confirm a diagnosis of opiate dependency. Background characteristics including: age; married (yes/no), income, high school diploma (yes/no), poly-substance use (alcohol only/poly-substance), treatment type (inpatient/outpatient), and problem severity will be entered as covariates based on hypothesized impact on dependent variable. Dependent variables examined include: the Intrapersonal Attribute Scales and their involvement in the Alcohol and Drug Subculture Scale; similar to information acquired from research on the article “Diversity in Relapse Prevention Needs…” (Walton, 2001). Gender and the roles it has on coping skills in craving, negative social influences, and exposure to involvement in using activities, will be looked at, to see if there is a relationship in the needs of men vs. women. Finally, the OAM-5 scale, or the Opinions about Methadone scale; a qualitative study with MMT counselors revealed that this test of 5 opinion statements is relevant to client’s attitudes toward MMT. (See Appendix C). This would help clinicians be able to identify and intervene promptly where a need for support to remain in treatment exists (Kayman, 2006). According to Walton, Blow, & Booth (2001), the specific measures are as follows: Alcohol and Drug Severity The alcohol and drug severity measure, which assesses the severity of alcohol and drug problems based on DSM-IV abuse and dependence diagnoses, is used to confirm an Opioid dependence. “At baseline and follow-up, participants indicated whether they experienced a seriesof 25 symptoms in the past year and whether the symptom was due to alcoholonly, drugs only, or both alcohol and drugs.” (Walton et al, 2001). Items assess tolerance with the following phrase: ‘‘I neededmore and more alcohol or drugs to get the same effect as before’’, withdrawal with: ‘‘Stopping or cutting down on my alcohol or drugs made me sick’’, loss ofcontrol with: ‘‘I kept on using alcohol or drugs even after I promised myself not to’’,and psychosocial consequences with: ‘‘I neglected family or friends for two or moredays in a row as a result of alcohol or drugs’’(Walton et al, 2001). [A Problem Severity scale= summing # alcohol and/or other drugs the participant engaged in (Walton et al, 2001). Alcohol and Drug Consumption Participants were asked about their drug and alcohol consumption in the last 30 days prior to treatment. The average amount of alcohol they used each day, number of days per week they drank, their maximum consumption and the number of days they had more than 5 drinks, otherwise known as “binge drinking”. Participants were then asked their “drug of choice”, otherwise known as the drug they prefer, and the number of days they used each of the following drugs/drug classes: marijuana, prescribed/non-prescribed stimulants, cocaine or crack, prescribed/ non-prescribed sedatives and opiates, heroin, PCP and other hallucinogens, steroids, inhalants, and tobacco (Walton et al, 2001).

14. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Relapse Prevention Interview See the AWARE test. (See Appendix A). Involvement in the Alcohol and Drug Subculture (all scales sought for the 30 days prior to treatment) Craving was assessed by participant’s ratings of the frequency and strength of their urges to use drugs and alcohol across different situations: at home, work/school, sporting events, concerts, bars/clubs, special social gatherings, in other peoples’ homes, in cars, etc. [Craving Scale= craving frequency X craving strength; summing across items/ total # of items] (Walton et al, 2001). Negative Social Influences was assessed by gathering the following information: 1) how supportive were people of their abstinence, and 2) how encouraging were people of their drug use. Each question was asked for a home setting, work/ school setting, and a community setting; for a total of six questions. [Scale was computed by “…reverse coding the ‘a’ questions and computing the mean of the 6 questions] (Walton et al, 2001). Exposure was measured by asking six questions: 1) how often they were offered drugs and alcohol (for home, work/ school, and community settings), and 2) how often someone “used” in front of them (for home, work/ school, and community settings) [The exposure scale= mean response] (Walton et al, 2001). Involvement in substance-using leisure activities was determined by asking participants to list their four favorite leisure time activities, and asking them to rate: 1) how often they were using during those activities, and 2) how often other people were using. [For each activity: ‘a’ X corresponding ‘b’; scores were summed / total #] (Walton et al, 2001). Intrapersonal Attributes Again, using the study by Walton, Blow, & Booth (2001) as a template, in the 30 days prior to entering treatment, coping was assessed by asking participants how often and how effective they did 10 coping strategies. Examples included: “I tried to seek the support of my family and friends”, and “I tried to look at my problems in a more positive light”. (Coping scale= coping frequency X effectiveness; summing across items/ total # items] (Walton et al, 2001). Self-efficacy was assessed by the Alcohol and Drug Consequences Questionnaire (ADCQ). [Self-efficacy scale = the mean response] (Walton et al, 2001). (See Appendix B). Future Sober Activities was assessed by asking the participants to list three activities that they might do; that don’t require drugs and alcohol. They were then asked to rate how often and how fun they thought the activities might be. The future sober activities variable was produced by frequency X fun rating for each activity; summing across the 3 activities/ total] (Walton et al, 2001). Resource Needs Scale was assessed by asking the participants how interested they would be in obtaining different services in the next 6 months. Examples of the services included: employment, school, medical, dental, housing, social work, and counseling. [The resource needs scale= the mean response (Walton et al, 2001).

15. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Procedure The design and procedure of the experiment will consist off 5oo participants, equally distributed between male and female. Individual assessment packages will be given three months into treatment, including: measures of coping, self-efficacy, resource needs, social influences, and future sober activities (Intrapersonal Attribute Scale). Another set of assessment’s will be given which will include: the measures of: craving, negative social influence, exposure to drugs, and involvement in using activities (Alcohol and Drug Subculture Scale). Analysis on gender before and after controlling these measures: age, marital status, income, poly-substance use, treatment type, and problem severity, race/ethnicity, and religion. Walton, Blow, & Booth, (2001) has a similar set-up in design. Factors that need to be kept in mind for non-compliance in MMT programs include: peer association, personality traits (low self-esteem, anxiety, and mood disorders), poor education, family related conflicts, poverty, unemployment, and drug availability. Less frequently cited factors include: poor living environment, sub-cultural belief systems, criminal activity, fashion/reputation, and major life events. The main factors that lead to continued drug use include: social exclusion, lack of structure to the day, un-employment, poverty, decreased educational expectations, and depressive/anxious personality traits (Mutasa, 2001). All of these factors should be acquired from each participant in a series of questionnaires so as to determine a relationship between and gender and these factors. The intention is to demonstrate the differences between men and women and to establish the need for more individualized relapse prevention programs. Results Intrapersonal Attributes First, ANOVA’s were used to compare gender, as well as race (only Caucasian vs. African-American) in the “Intrapersonal Attribute scale”, with the following expected results based upon research done by Walter, Blow, & Booth (2001): Main effects for all scales including Coping, Self-efficacy, Resource Needs, and Future Sober Activities. African-Americans should report greater Coping, Self-efficacy, Future Sober Activities, & Resource Needs than Caucasians. African-American men and women, as well as Caucasian women, should have better Coping scores than Caucasian men. (See Table 1). Second, ANCOVA’s were used to compare gender and race differences in the “Intrapersonal Attribute scale”; controlling for background characteristic (i.e. age, married, socioeconomic status,…), with the following expected results based upon the research done by Walter, Blow, & Booth (2001): Main effects for gender remained significant for Coping; women reporting greater skills than men. Main effects for race will remain significant for Coping, Self-efficacy, and Resources. African-Americans will report greater coping, resource needs, and self-efficacy than Caucasians. Finally, main effects for race on Future Sober Activities and the interaction effect of race X gender will not be significant (Walton et al, 2001).

16. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Alcohol and Drug Subculture Third, ANOVA’s were used to compare gender and race differences in the “Alcohol and Drug Subculture Scale” (Craving, Negative Social Influences, Exposure, & Leisure Activities); based upon the research done by Walton, Blow, & Booth (2001). The following results are expected: main effects for gender will be significant for Negative Social Influences; women reporting fewer social influences than men. African-Americans will report less involvement with these variables than Caucasians. There will be a significant interaction effect for exposure, with African-American men reporting the greatest Exposure, then Caucasian men, women, then African-American women (Walton et al, 2001). (See Table 1). Finally, ANCOVA’s will be used to examine the “Alcohol and Drug Subculture Scale”. According to Walton, Blow, & Booth (2001), the following results are expected: significant gender effects for Negative Social Influences and Exposure, with men reporting more Negative Social Influences than women. Once background characteristics are considered, no significant main effects will be found for race, however, there will be a significant interaction effect for Exposure; with African-American men reporting the greatest Exposure, then Caucasian men, women, and then African-American women reporting the least (Walton et al, 2001). (See Table 2). Discussion The results of this study highlight the diversity that exists between men and women and leads to the conclusion that relapse prevention plans need to be individualized. It has been established that each program in existence should evaluate whether or not they are meeting the unique needs of its clients. Although this subject has been widely discussed in the broad area of substance abuse, more studies should be done like this one that focuses on opiate addiction and Methadone Maintenance Treatment (MMT) programs. There are some gender differences worth noting. Women, both Caucasian and African-American, had greater skills in coping than men with African-American men and women reporting greater resource needs and self-efficacy than Caucasians. Women reported fewer social influences than men; with men falling to peer pressure more frequently and women likely to use substances in private or at home. Finally, when it comes to exposure African-American men report the greatest, then Caucasian men, women, then African-American women The findings in this study pave a clear path for future MMT programs; in which individualized care plans, along with counseling, adequate and daily dosing of Methadone, and support ensure the completion of treatment. Although this study includes a large sample (N=500); with equal distribution of gender, replication is needed to establish Generalizability of the findings for gender and race; specifically to other minority groups. The overall validity can be supported by the use of the national tests: DSM-IV, the AWARE questionnaire, the OAM-5, and ADCQ. Future studies should include more substance use characteristics, such as the route of administration and frequency and duration of use. The issue of sexual orientation might also be a good topic to investigate. Overall, the findings from this study suggest that everyone is unique and attempts to force them into the same cookie-cutter shape are futile. Especially sense, up until recently, substance abuse programs have been focused on the Caucasian male. Future research should further examine the psychosocial factors identified in this study in relation to relapse. An investigation as to whether or not targeting specific approaches toward diversity would improve overall treatment outcomes

17. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) References Argosy University. (2009).Research Methods: Module Four Lecture. Retrieved on October 31, 2009 from http://www.myeclassonline.com Ghodse, A., Reynolds, M., Baldacchino, A., Dunmore, E. et al, 2002). Treating an Opiate-dependent inpatient program: A One-Year Follow-up Study of Treatment Completers and Non-Completers. Addictive Behaviors. 27(5). P 765-776. Retrieved from the EBSCO host database. Goldstein, M., Deren, S., Magura, S., Kayman, D., Beardsley, M., & Tortu, S. (2000). Cessation of drug use: Impact of time in treatment. Journal of Psychoactive Drugs, 32(3), 305-310. Retrieved from the EBSCO host database. Joe, G., Simpson, D., & Sells, S. (1994). Treatment process and relapse to Opioid use During methadone maintenance. American Journal of Drug & Alcohol Abuse, 20(2), 173-197. Retrieved from the EBSCO host database. Kayman, D. (2004). Women and men in methadone treatment: Do attitudes predict Outcome? Dissertation Abstracts International Section A, 65, 288. Retrieved from the EBSCO host database. Kayman, D., Goldstein, M., Deren, S., & Rosenblum, A. (2006). Predicting Treatment Retention with a Brief “Opinions About Methadone” Scale. Journal of Psychoactive Drugs. 38(1). P 93-100. Mutasa, H. (2001, July). Risk factors associated with noncompliance with methadone Substitution therapy (MST) and relapse among chronic opiate users in an Outer London community. Journal of Advanced Nursing, 35(1), 97-107. Retrieved September 22, 2009, from Academic Search Complete database. NIDA.(2009). National Institute of Drug Addiction. Retrieved on December 14, 2009 From http://www.nida.nih.gov Rowan-Szal, G., Chatham, L., Joe, G., & Simpson, D. (2000). Services provided during Methadone treatment: A gender comparison. Journal of Substance Abuse Treatment.19 (1), 7-14. Retrieved from EBSCOHOST database.

18. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Shaughnessy, J., Zechmeister, E., & Zechmeister, J. (2009). Research Methods in Psychology. (8th Edition). Boston. McGraw-Hill Higher Education. Walton, M., Blow, F., & Booth, B. (2001). Diversity in relapse prevention needs: Gender and race comparison among substance abuse …American Journal Of Drug & Alcohol Abuse, 27(2), 225. Retrieved from the EBSCO host database. Weddington, W. (1990).Towards a Rehabilitation of Methadone Maintenance: Integration Of Relapse Prevention and Aftercare. International Journal of the Addictions, 25(9), p 120-1224. Retrieved from PsycInfo database. Appendix A The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982). In a prospective study of relapse following outpatient treatment for alcohol abuse or dependence (Miller et al., 1996) we found the AWARE score to be a good predictor of the occurrence of relapse (r = .42, p < .001). With subsequent analyses, we refined the scale from its 37-item original version to the current 28-item scale (version 3.0) (Miller & Harris, 2000). The items are arranged in the order of occurrence of warning signs, as hypothesized by Gorski. In our prospective study, however, we found no evidence that the warning signs actually occur in this order in real time (Miller & Harris, 2000). Rather, the total score was the best predictor of impending relapse. ADMINISTRATION: This is a self-report questionnaire that can be filled out by the client. Be sure that the client understands the 1-7 rating scale. When the client has finished, make sure that all items have been answered and none omitted. SCORING: Total the numbers circled for all items, but reverses the scoring for the following five items: 8, 14, 20, 24, and 26. For these five items only: If the client circles this number: 1 2 3 4 5 6 7 Add this number to the total score: 7 6 5 4 3 2 1 INTERPRETATION: The higher the score, the more warning signs of relapse are being reported by the client. The range of scores is from 28 (lowest possible score) to 196 (highest possible score). The following table shows the probability of heavy drinking (not just a slip) during the next two months, based on our prospective study of relapse in the first year after treatment (Miller & Harris, 2000).

19. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Probability of Heavy Drinking During the Next Two Months AWARE Score If already drinking in the prior 2 months If abstinent during the prior 2 months 28-55 37% 11% 56-69 62% 21% 70-83 72% 24% 84-97 82% 25% 98-111 86% 28% 112-125 77% 37% 126-168 90% 43% 169-196 >95% 53% This instrument was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, contract ADM 281-91-0006). It is in the public domain, and may be used without specific permission provided that proper acknowledgment is given to its source. The appropriate citation is Miller & Harris (2000). (appendix A cont.) References Gorski, T. F., & Miller, M. (1982). Counseling for relapse prevention. Independence, MO: Herald House - Independence Press. Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol, 61, 759-765. Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-S171.

20. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) AWARE Questionnaire 3.0 Please read the following statements and for each one circle a number, from 1 to 7, to indicate how much this has been true for you recently. Please circle one and only one number for every statement. 1) Never 2) Rarely 3) Sometimes 4) Fairly often 5) Often 6) almost always 7) Always 1. I feel nervous or unsure of my ability to stay sober. 1 2 3 4 5 6 7 2. I have many problems in my life. 1 2 3 4 5 6 7 3. I tend to overreact or act impulsively. 1 2 3 4 5 6 7 4. I keep to myself and feel lonely. 1 2 3 4 5 6 7 5. I get too focused on one area of my life.1 2 3 4 5 6 7 6. I feel blue, down, listless, or depressed. 1 2 3 4 5 6 7 7. I engage in wishful thinking. 1 2 3 4 5 6 7 8. The plans that I make succeed. 1 2 3 4 5 6 7 9. I have trouble concentrating and prefer to dream about how things could be.1 2 3 4 567 10. Things don’t work out well for me. 1 2 3 4 5 6 7 11. I feel confused. 1 2 3 4 5 6 7 12. I get irritated or annoyed with my friends.1 2 3 4 5 6 7 13. I feel angry or frustrated. 1 2 3 4 5 6 7 14. I have good eating habits. 1 2 3 4 5 6 7 1) Never 2) Rarely 3) Sometimes 4) Fairly often 5) Often 6) almost always 7) Always 15. I feel trapped and stuck, like there is

21. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) (Appendix B cont.) No way out. 1 2 3 4 5 6 7 16. I have trouble sleeping. 1 2 3 4 5 6 7 17. I have long periods of serious depression. 1 2 3 4 5 6 7 18. I don’t really care what happens. 1 2 3 4 5 6 7 19. I feel like things are so bad that I might as well drink. 1 2 3 4 5 6 7 20. I am able to think clearly. 1 2 3 4 5 6 7 21. I feel sorry for myself. 1 2 3 4 5 6 7 22. I think about drinking. 1 2 3 4 5 6 7 23. I lie to other people. 1 2 3 4 5 6 7 24. I feel hopeful and confident. 1 2 3 4 5 6 7 25. I feel angry at the world in general. 1 2 3 4 5 6 7 26. I am doing things to stay sober. 1 2 3 4 5 6 7 27. I am afraid that I am losing my mind. 1 2 3 4 5 6 7 28. I am drinking out of control. 1 2 3 4 5 6 7 Never Rarely Sometimes Fairly Often Often Almost Always Always Scoring sheet for AWARE Questionnaire 3.0 For these items, record for these 5 items,

22. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) The number circled reverse the scale (* see below) 1. ______ 2. ______ 3. ______ 4. ______ 5. ______ 6. ______ *for reverse-scaled items: 1 = 7 7. ______ 2 = 6 8. ______ 3 = 5 9. ______ 4 = 4 10.______ 5 = 3 11.______ 6 = 2 12.______ 7 = 1 13.______ 14.______ 15.______ 16.______ 17.______ 18.______ 19.______ 20.______ 21.______ 22.______ 23.______ 24.______ 25.______ 26.______ 27.______ 28.______ TOTALS: _________ + _________ = ______________ Subtotal Subtotal AWARE Score The AWARE Questionnaire (Revised Form): Retrieved on December 14, 2009 from http://tgorski.com/relapse/AWARE_Relapse_Questionaire.pdf

23. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Appendix B Alcohol and Drug Consequences Questionnaire (ADCQ) Circle the number which applies to you. Not Important Slightly Important Moderately Important Very Important Extremely Important Not Applicable1.I will feel better physically.1234502.I will have difficulty relaxing.1234503.I will change a lifestyle I enjoy.1234504.I will have fewer problems with my family.1234505.I will feel frustrated and anxious.1234506.I will have more money to do other things with.1234507.I will be more active and alert.1234508.I will get depressed.1234509.I will have fewer problems with friends.12345010.I will feel better about myself.12345011.I will regain some self-respect.12345012.I will accomplish more of the things I want to get done.12345013.I will have a better relationship with my family.12345014.I will have difficulty coping with my problems.12345015.I will feel withdrawal or craving.12345016.I will have too much time on my hands.12345017.I will have difficulty not drinking or using drugs.12345018.My health will improve.12345019.I will live longer.12345020.I will be more in control of life. 12345021.I will feel bored.12345022.I will be irritable.12345023.I will be more financially stable.12345024.I will miss the taste.12345025.I will have a better relationship with my friends.12345026.I will feel stressed out.12345027.I will save more money.12345028.I will miss the feeling of being high.123450 Retrieved on December 14, 2009 from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A62203&rendertype=table&id=A62219 Appendix C OAM-5 Scale TABLE 2 Opinions About Methadone. 1. Methadone has proven to be the best way of quitting heroin.* 2. Methadone programs help with the crime problem. 3. With methadone you can eventually get off illegal drugs if you want to.* 4. Methadone helps us lead a normal life.* 5. Methadone takes away the craving for heroin.* 6. It is safe to take methadone.* 7. Methadone programs sometimes act as agents for the police. 8. Methadone programs help decrease illegal drug problems. 9. Taking methadone is only replacing one addiction with another. 10. It is better to use no medication than to take methadone. 11. People are afraid to taper off of methadone. 12. My friends think it's practically impossible to get off of methadone. 13.1 would feel empty without methadone or another drug. 14. Most people don't understand how hard it is to get off of methadone. *Item included in the OAM-5, the scale utilized in the outcome analysis.

24. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) DIVERSITY IN RELAPSE PREVENTION NEEDS 233 Table 1. Descriptive Statistics and Analysis of Variance Results for Gender and Race Differences in Intrapersonal Attributes and Involvement 1.) Mean (SD) 2.) Mean (SD) 3.)n (Men) Women) (Caucasian) African-American) 4.) Main Effect 5.) Main Effect 6.) Interaction Effect (Race) (Gender) (Race X Gender) Intrapersonal attributes Coping-1) 2) 3) 4)5) 6) Self-efficacy-1) 2) 3) 4) 5) 6) Resource needs-1)2) 3)4) 5) 6) Future sober activities-1)2) 3) 4) 5) 6) Alcohol/drug subculture Craving- 1) 2) 3) 4) 5) 6) Negative social-1) 2) 3) 4)5) 6) Influences Exposure-1) 2) 3) 4) 5) 6) Leisure activities -1) 2) 3) 4) 5) 6) NOTE: This table and all its values were copied from the study done by Walton, Blow, & Booth (2001). All values are from that study, however all the “expected results” for the present study are based upon these values. Table 2 Table 2. Analysis of Covariance Results for Gender and Race Differences in Intrapersonal Attributes and Involvement in the Alcohol and Drug Subculture Scales (F Tests) Main Effect Main Effect Interaction Effect 1) (n) 2) (Race) 3) (Gender) 4) (Race X Gender) Scales Intrapersonal attributes Coping-1) 2) 3) 4) Self-efficacy-1) 2) 3) 4) Resource needs- 1) 2) 3) 4) Future sober activities- 1) 2) 3) 4)

25. Cognitive Abilities: Critical Thinking & Information Literacy (cont.) Alcohol/drug subculture Craving Negative social influences Exposure Leisure activities Note. Background characteristics included as covariates were: age, marital status (yes/ no), income, high school diploma (yes/no), poly-substance use (alcohol only/poly-substance) use, treatment type (inpatient/outpatient), problem severity, and religious preference. a. p_ .001. b. p_ .01. c. p_ .05. NOTE: This table and all its values were copied from the study done by Walton, Blow, & Booth (2001). All values are from that study, however all the “expected results” for the present study are based upon these values.

26. Research Skills Does Completing A Methadone Maintenance Program Reduce The Occurrence of Relapse To Opiate Drug Use in Women Vs Men? Celena Heine Psy210 Psychological Statistics Final Paper Argosy University April 21, 2009 Substance abuse and addiction is a serious disease! Many people loose their health, relationships, finances, and essentially themselves in this illness. “Substance abuse is plagued by high relapse rates following treatment” (Walton, 2001). Treatment programs have attempted to improve relapse rates through the implementation of relapse prevention programs that focus on a variety of counseling techniques and pharmacology aimed at coping skills and increasing self-esteem. Some of these techniques include: methadone maintenance therapy (MMT), nursing support, and psycho-social aspects like cognitive, behavioral, psychodynamic group/family therapies (Walton, 2001). There have been many quantitative studies aimed at identifying main risk factors associated with poor compliance in Methadone Maintenance Therapy (MMT) and hence relapse in chronic opiate drug users (Mutasa, 2001). It is important to be able to identify social conditions, program factors, and client characteristics that improve retention rates of MMT programs “…because time in substance abuse treatment is associated with improved health, mood, and social functioning” (Kayman, 2006). “Most opioid-dependant addicts require long-term stabilization in methadone maintenance therapy to normalize brain function and control withdrawal symptoms” (Kayman, 2006). I believe that my study will show that quality of care and length of time in treatment will decrease the occurrence of relapse in women who are opiate dependent. I will show this by proving, with research, that women have different needs than do men and relapse prevention programs need to design their programs to meet the needs of those individuals. A focus on social support, leisure activities, and acquisition of resources is a key to relapse prevention (Walton, 2001). Participants for this study will consist of a client sample of opiate addicted individuals participating in a methadone maintenance program like DACCO, a local drug abuse agency. I would like for my sample to consist of 500 participants, with 250 being men and 250 being women. An age range from 18-81 should be OK. All clients should be self-referred or referred for a drug dependency problem and confirmed using DSM-IV, Diagnostic and Statistical Manuel of Mental Disorders, version IV (Eder, 2005). “The overall motivation level for a client can be a useful predictor of the ability of the client to be compliant with methadone maintenance therapy” (Mutasa, 2001). This is of clinical importance because the “willingness” of a client to accept the need to change voluntarily is an important factor in treatment success. Also, the MMT clients should have been in treatment for at least 3 months so as to eliminate confusion of those people who have actually become abstinent from opiate use and those who are “quitting occasionally”. I believe that it’s important to chart a natural history of opiate dependency to better understand this form of treatment. Persons addicted to opiates often became dependent on the drugs in their early twenties and have remained “…intermittently dependent for decades” (Mutasa, 2001). “Biological, socioeconomic, and psychological factors determine when an individual will start taking opiates” (Mutasa, 2001). Continuing on this path, once use begins, it often escalates into misuse and then dependence. Essentially repeated use with adverse consequences leads to tolerance, withdrawal, compulsive and uncontrollable taking of the drug. Once an addict gets to this point an “addiction career” has been established; cycles of cessation and relapse (Mutasa, 2001). Again, it is stated that “Therapy can alter the natural history of opiate dependency, commonly by prolonging periods of abstinence from illicit opiate use” (Mutasa, 2001). My research disclosed that therapy is usually targeted in the “action”, “maintenance”, and “relapse” stages of the behavior change model.

27. Research Skills (cont.) Motivation, being a precondition for an effective substance abuse program, makes this model an important tool. Motivational interviewing aims at raising self-esteem and self-efficacy; increasing awareness of one’s problems and “motivating” clients to seek out help and comply with his/her program. As I will touch on later, I believe that there are distinct differences in gender when it comes to personality traits and factors that lead to a continued use of drugs (Mutasa, 2001). Materials used will be a variety of different tests common to substance abuse treatment and a few scales to determine quality of care, attitudes of clients, and interpersonal attributes. Background characteristics including: age, married (yes/no), income, poly-substance use (alcohol only/poly-substance), treatment type (inpatient/outpatient), and problem severity will be entered as covariates based on hypothesized impact on dependent variable. Dependent variables examined include: the Interpersonal Attribute Scales and their involvement in the Alcohol and Drug Subculture Scale; similar to information I acquired from research on the article “Diversity in Relapse Prevention Needs…” (Walton, 2001). I will also take a look at gender and the roles it has on coping skills in craving, negative social influences, and exposure to leisure activities to see if there is a relationship in the needs of men vs. women. The DSM-IV, or Diagnostic and Statistical Manuel of Mental Disorders, version IV will be used to confirm a diagnosis of opiate dependency. QCI-1, or Quality of Care Index-1, is a 7 item scale revealing 3 distinct quality criteria to conditions of patient care in methadone maintenance therapy. “Quality assurance is the first step toward monitoring of quality of care is the development of valid criteria” (Oyefeso, 1998). Donebedian (1980) used a model for the evaluation of quality of care through the analysis of structure, process and outcome. “Process relates to treatment variables such as setting, duration, dosing, and therapeutic interaction between patients and clinicians, while outcome indicates the condition of the patient during or after treatment” (Oyefeso, 1998). Even though this study is a little old, I feel the results still hold true today! A quality program is one whose structure and design yields favorable outcomes. Another research article leads me to the OAM-5 scale, or the Opinions about Methadone scale. Basically, a qualitative study with MMT counselors revealed that this test of 14 opinion statements is relevant to client’s attitudes toward MMT. This would help clinicians be able to identify and intervene promptly where a need for support to remain in treatment exists (Kayman, 2006). Finally, the BDI, or Beck Depression Inventory, will be used to self-report symptoms of depression. The design and procedure of the experiment will consist off 5oo participants, equally distributed between male and female. Individual assessment packages including measures of coping, self-efficacy, resource needs, cravings, social influences, and leisure activities. Analysis on gender before and after controlling these measures: age, marital status, income, poly-substance use, treatment type, and problem severity. A similar set-up in design can be seen in one of the articles I researched: “Diversity in Relapse Prevention Needs: Gender and Race Comparisons among Substance Abuse…” Walton, M., Blow, F., & Booth, B. American Journal of Drug and Alcohol Abuse, May 2001, vol 27, issue 2, p 225. Factors that need to be kept in mind for non-compliance in MMT programs include: peer association, personality traits (low self-esteem, anxiety, and mood disorders), poor education, family related conflicts, poverty, unemployment, and drug availability. Less frequently cited factors include: poor living environment, sub-cultural belief systems, criminal activity, fashion/reputation, and major life events. The main factors that lead to continued drug use include: social exclusion, lack of structure to the day, un-employment, poverty, decreased educational expectations, and depressive/anxious personality traits (Mutasa, 2001). All of these factors should be acquired from each participant in a series of questionnaires so as to determine a relationship between and gender and these factors. It is my intention to demonstrate the differences between men and women to establish the need for more individualized relapse prevention programs.

28. Research Skills (cont.) The data analysis, or analytic strategies, for this experiment will be as follows: data will be in an interval scale level where descriptions using mean values, standard deviations, minimum and maximum scores will be used. Comparison of the mean values between groups will be done by analysis of variance, or ANOVA. The data compared will be done using a one-tailed test because I am predicting a change in direction. (A decrease in the occurrence of relapse in women). To begin, an ANOVA will be used to examine variation in the interpersonal attributes (resource needs, coping, self-efficacy, and future sober leisure activities). Also an ANOVA for the involvement of the Alcohol and Drug Subculture scale (negative social influences, exposure, craving, & leisure activities) (Walton, 2001). An ANOVA will be used to examine the relationship between quality of care and length of time in treatment, as well as to compare gender differences in the interpersonal attribute scale. I will anticipate there to be main effects for gender; a significance for coping with women scoring higher than men. ANOVA will compare gender with Alcohol and Drug Subculture scale and I will anticipate that the main effects for gender should be significant for negative social influences with women scoring fewer than men. Discussion of the proposed study has many points to consider. First of all, in doing my research, I’ve found many experiments to do with the topic of substance abuse treatment and relapse. This was encouraging and definitely an area of interest for me seeing as how I want to be a substance abuse counselor. I’m hoping to highlight unique psycho-social profiles by gender that may reflect different relapse prevention needs. Debate abounds in both the literary and treatment communities regarding whether men and women should be treated separately in drug treatment programs. Although a number of articles have been written that argue the unique needs of women in substance abuse programs, as well as articles on quality of care an the relationship of MMT and length of time in treatment, few studies have been documented on gender differences that relate to subsequent relapse prevention (all sources cited). From the research I gathered several conclusions can be made leading to the possibility of more research needing to be done in this field. First of all, women have reported better coping skills because of less peer pressure to use. They also are less likely to use in social situations and more apt to use with intimate partners or at home. Therefore, we may need to investigate the possibility of programs for men that focus on ways to cope with social influences, peer pressure and ways to deal not using in leisure activities. Past sexual abuse or victimization of violent crimes might also lead to relapse prevention programs for women that lead to ways of working through these issues. (Walton, 2001). Little research has been done in the area that takes into account gender differences for early intervention and prevention of ever trying that first opiate. Lastly, I feel that research on the pharmacological aspects of opiate addiction would be helpful! Finding a drug, like buprenorphine, that is less addictive that methadone would solve a lot of people’s problems with the idea that addicts are “trading one substance for another”. Again, more research needs to be done to see if that drug is just as effective as methadone. I tend to want to listen to what my grandmother always taught us kids: “If it ain’t broke, don’t fix it”. Meaning: Methadone has been around for decades and has been successful in treating opiate addicted individuals…why mess with a good thing? For my particular experiment several limitations might be expected: N of 500 might be too small to accurately represent the population as a whole, and the majority of clients that were in treatment for at least 3 months will make the results biased since it will not contain the large percentage of short-term clients in the program. The data needed for this set of treatment processes would generally not be available for early-terminee’s leading to this unavoidable limitation in the sample (Walton, 2001). Lastly, maybe a correlation could be done on race and relapse rates to see if socioeconomic/financial situations will be a concern for relapse prevention measures. I would like to take this opportunity to let you know why I am so interested in being a substance abuse counselor and why this field of study excites me! I believe that “all things happen for a reason”! Next week I have been clean and sober for 8 months and I’m currently about to graduate from one of these drug treatment programs. I believe the knowledge I’ve gained by experiencing addiction “first hand” will be invaluable to me in my pursuit as a substance abuse counselor. I’ve gone through many feelings of shame and guilt, but no longer will I hang my head in shame! If I can help others along the road to recovery…then all I’ve been through won’t be for nothing!

29. Research Skills (cont.) References Eder, H. &. (2005). Comparative Study of Effectiveness of Slow-released Morphine and Methadone for Opioid Maintenance Therapy. Addiction , 1101-1109. Kayman, D. G. (2006). Predicting Treatment Retention with a Brief "Opinions About Methadone" Scale. Journal of Psychoactive Drugs , 93-100. Mutasa, H. (2001). Risk Factors Associated with Non-Compliance with Methadone Substitution Therapy and Relapse Among Chronic Opiate Users in An Outer London Community. Journal of Advanced Nursing , 97-107. Oyefeso, A. C. (1998). Developing a Quality of Care Index for Outpatient Methadone Treatment Programs. Journal of Evaluation in Clinical Practice , 39-47. Walton, M. B. (2001). Diversity in Relapse Prevention Needs: Gender and Race Comparisons among Substance Abuse Individuals. American Journal of Drug and Alcohol Abuse , 225.

30. Communication Skills: Written & Oral Group Project B: Effective Mediated Communication PSY 180 XJ-N Celena Heine Ebonee Robinson Laura Johnson Yavis Henry M7: Assignment 2 Argosy University April 20,2009 Times have changed since my grandmother was a little girl in the 1930's. The main form of mediated communication was the telegraph or a handwritten letter. My father thought he was funny by saying, “I think you can add smoke signals to that list!”. I doubt they even knew what mediated communication was back then. “Mediated communication is the process by which a message, or communication, is transmitted via some form, or medium” (Kasch associates, 2009). When my mother was a little girl in the 1960's, the most widely used form of mediated communication was the telephone. When I was growing up in the late 1980's, the initial entrance of the personal computer was just emerging. We certainly didn’t have the luxuries that my ten year old has today in 2009: the telephone and texting, PDA’s, Social Networking Sites, Chat- rooms, Instant Messenger, video conferencing, and e-mail. Just to name a few! Personal digital assistant, or PDA, is a palm-sized computer that comes with attachments to allow it to “synch” to a personal computer. The Palm has been around since 1996 and has an easy to use interface, as well as and abundance of “freeware” and “shareware” available. The PocketPC, from Microsoft, has been on the market since 2000 and doesn’t have as much software available yet , but it does have an easy interface based on the Windows application program (GSM,2005). “Personal digital assistants (PDA) have become the most popular apparatus with the majority of consumers because of its small size, multi-function data processing, large storage capacity, etc...” (Electronics,2006, p1). These devices are easily carried and stored because of their size and can be easily accessed in places where it’s not possible to access a standard computer. PDA’s serve as multi-media devices; small portable computers and wireless communication devices. “With a typical PDA, users can arrange schedules, search for contact information, browse outstanding appointments, take immediate memos, send and receive e-mails, play games and perform other tasks” (Electronics,2006,p1). One really awesome feature of the PDA is “beaming”. Essentially, this function works like a T.V. remote control with infrared beams allowing the user to connect with other PDA’s so information can be exchanged back and forth. Freeware, or software that is free of charge to download, can be found on Palm software sites and include: AvantGo, a software that saves condensed versions of web pages and MedCalc, a program used for medical calculations. Another feature of the Palm is shareware. Where for a small fee, usually around twenty dollars, an individual can download commercial software for free trial periods before buying it (GSM, 2005). A very business savvy idea! Aside from all the convenient uses as a business tool, the PDA has it uses for personal use also! How cool is it to be able to log onto the Internet anywhere! To be able to answer you e-mails or even log-in to a social network site to find that “special” someone!

31. Communication Skills: Written & Oral (cont.) The Internet has become a key instrument in the lives of many people. Every subject known to man-kind can be looked up on search engine sites like Google.com. It is no wonder that people have turned to the computer to even look for love. “The Internet has become a standard fixture in the lives of many people, with communication being one of its popular uses” (Bonebrake, 2002). Social networking sites , or SNS’s, emerged on the scene in 1997 and have progressively increased in popularity with such sites as: Friendster, MySpace, Yahoo!360, FaceBook, MyChurch, and Twitter. A social networking site focuses on building a “network” of friends. Basically, an individual constructs a profile about themselves; practicing the art of self-disclosure. “A self-disclosing statement is generally regarded as being personal- containing relatively “deep” rather than “surface” information. (Adler,2010,p86). Choosing what to reveal is half the fun of sites like these . After an individual sets up a profile, they form a list of “friends”, or other users, who they want to converse with and then they traverse the list of connections, as well as those of others’ made on the sites. I’ve yet to join one of these sites but I have many friends who love them. One girlfriend named Julie said: “I love being able to come home from work, log on to Facebook, and in a matter of a few keystrokes, find out what 15 different friends have been doing without having to pick up the phone and talk to anyone”. These sites: are a way for some to connect with high school friends, some to remember birthdays and other events, some to catch up with family that live far away, and still for others they are places to find romance. “Social networking is a wonderful way to interact and communicate with others. But, just like any communication device, it needs to be used carefully and cautiously” (Brown, 2009). The idea of permanence has to always be in an individuals mind when deciding to post information on a site. A lot of employers are using these kinds of sites to weed out potential employees.(Brown,2009). Beyond profiles, friends, comments and reminders, social network sites have private messaging, instant messaging, blogging, and photo and video download capabilities. Popular, free, and downloadable software such as Yahoo Messenger, Windows Live Messenger and AOL instant messenger have opened up more options to the ways that we choose to communicate effectively. Instant Messaging has enhanced the way we communicate in our personal life with friends, relatives and even co-workers. With products like Microsoft Office Communicator 2007, it allows business and corporations to “be more productive by enabling them to communicate and collaborate easily with others in different locations or time zones using a range of different communication options” (Corporation, 2009). With me formerly working at Microsoft, we used instant messaging to relay quick messages faster or ask simple questions that we did not feel like opening up a new email message box to send. In my work life, it also helped me communicate with executive employees at Microsoft that were higher in the chain and could not be bothered with too many emails or face to face contact because of their busy schedules. In a business setting, instant messenger allowed me to multitask and work more effectively because I was able to hold several conversations at once. There were many times were I could be holding an instant messenger conversation, talking on the phone and dealing with someone that had stepped into my office for a brief question.

32. Communication Skills: Written & Oral (cont.) Outside of the business setting, Instant Messaging allows you to communicate in the comfort of your own private setting. Whether you’re on a personal computer, away using a shared computer, a PDA, or have the luxury of using an iPhone, you can access your contacts easily by signing in anywhere. I feel the extra added bonus to Instant Messaging is that majority of it is free, you don’t have to use up your cell phone day time minutes, or have extra long distance charges added to your bill for people you choose to communicate with outside of your city, state or country. This technology has allowed us to now listen with our eyes, and develop a more clear perception of what it is people are trying to say when they are communicating with us. Unfortunately, some people in life aren’t good at talking in person and expressing their true emotions on how they feel about something when engaged in a face to face conversation with another individual. Therefore, they are left with feeling unheard and misunderstood. Instant Messaging can resolve this problem with using emoticons “to convey body language or emotional content” (Wang & Beasley, 2005). People are easily sometimes be mislead with words, but adding a smiley face or emoticon to a conversation helps express to the other person how you are really feeling. For users who disagree that effective mediated communication can be achieved through Instant Messaging because it lacks the essential component of face to face communication; there’s a resolution for that. Instant messaging software has now integrated the Webcam and Voice feature to work with your conversations held on IM. A user of the feature indicated that “the recipient's voice is just as clear as, if not clearer than, on a mobile phone call” (Cante, 2006). Important relationships and friendships can be formed through instant messaging. Speaking from personal experience, I have met many friends by holding conversations this way and have developed relationships through using instant messaging. I use Yahoo Messenger and sometimes Windows Live Messenger to communicate with and see my friend in California every Wednesday via Webcam. It has improved the way we communicate because it’s like we are there together, although in reality we both know we are not. My how technology rules the world! As technology advanced, the first Video Conferencing service became available in the1990's. Using internet protocol and advanced software, video conferencing systems became available through the use of the desktop computer (Poiente, 2007). Video Conferencing can involve an unlimited number of participants. People can sit at their desk and communicate face-to-face with others who are thousands of miles away. Video Conferencing has become very popular because it allows people to communicate in real time. All of this is done through audio and video transmission over the internet (Gorman, 2006). Business executives no longer have to travel to meetings at other locations. This makes Video Conferencing cost effective, and it saves time. Video Conferencing is more personable than a phone conference because the participant can view each others body language. Video Conferencing has been a great advantage for my family due to the video phone. By having three hearing impaired grandchildren, this has enhanced their ability to communicate more effectively with other deaf peers. This technology has boosted their confidence due to their ability to become more self-sufficient method of communication among internet users. Email is the shortened form of electronic mail. There are protocols that must be followed for receiving, sending, and storing electronic messages. The number of emails sent out far out number the amount of postal mail that is delivered around the world ( Black, 2003). Although emails are not as personable as a handwritten letter or telephone call it conveys the message.

33. Communication Skills: Written & Oral (cont.) This is one of my most convenient method of communication. Emails are also cost effective and time saving because you don’t have to spend time handwriting a letter or buying postage stamps. Unlike postal mail which can take days, emails can be received in a matter of seconds. This is very beneficial for businesses and individuals who need to receive information very quickly. There are many email service providers, such as Yahoo and AOL, that offer free internet email accounts. In the course of our almost daily emails, we have exchanged stories about our families, swapped jokes, and shared our achievements and sorrows. We marvel at the fact that it’s possible to have a solid friendship-let alone write a book about interpersonal communication-with very little face-to-face interaction (Adler, Rosenfeld, Proctor II, 2010). The telephone was invented by a Scottish-born scientist, inventor, and innovator by the name of Alexander Graham Bell. Bell’s mother and wife were deaf which profoundly influenced his life’s work. By researching hearing and speech, led him further to experiment with different devices. At which led him to being the first U.S. Patent for the telephone. Since this invention, the telephone has almost become one of life’s essentials. Most people have them in their homes and use them frequently. They are really essential for the elderly and have been known to save many lives throughout the years. They also aided help in putting stop to a lot of crime on the city streets. Communication is important for a variety of reasons; aside from practical reasons, “...meaningful communication contributes to physical health, plays a major role in defining our identity, and forms the basis for our social relationships” (Adler,2010,p31). In today’s day and age, if you don’t have a computer of one of the new , handy Smartphones, you’re living in the Dark ages! Everyday life runs on new age inventions and the world only seems to be becoming more technologically advanced. Research has confirmed that even though face-to face interaction is the preferred method or communication, computer mediated communication, or CMC, increases both the quality and amount of interpersonal communication. Challenges of distance and multiple time zones have made e-mail invaluable: “...the asynchronous nature of e-mail provides a way to share information that otherwise would be impossible.”(Adler,2010,p22). Instant messaging is like running into a friend at the store; aside from the lack of the visual non verbal cues, you are able to carry on a conversation in “real time”. Many people area also finding love in social networking sites where once you had to go on several physical dates. Now people are able to connect on a more intimate level; “Even text-only CMC has the power to stimulate both self-disclosure and direct questioning between strangers, resulting in greater interpersonal attraction” (Adler,2010,p22).

34. Communication Skills: Written & Oral (cont.) Aside from love and relationships, this on-line classroom has depended entirely on computer mediated communication. I’ve never met any of my classmates face-to-face and yet I still feel like I’ve known a few of them for a long time. I think that has everything to do with having a group assignment due! I’m sure every group has had some problems with organizing the project, but speaking for group B, I feel that the project has finally come together at the end. As with any situation where you are relying on the skills of multiple people: teamwork, good leadership and time management are a must. The only thing that might make a next group project go smoother would be for the class to get to know each other better and to be able to pick our own teams based on that knowledge. I’ve never been a fan of group projects for the simple reason that no two students are alike! References: Adler, R.B., Rosenfeld , L.B., & Proctor, R.F. (2010) Interplay: The Process of Interpersonal Communication. New York, Oxford University Press. Black, K. (2003). What is Email?. Retrieved April 16, 2009, from wiseGeek.com Web site: http://www.wisegeek.com/what-is-email.htm Bonebrake, Katie College Students' Internet Use, Relationship Formation, and Personality Correlate CyberPsychology & Behavior; Dec2002, Vol. 5 Issue 6, p551-557, Cante, N. T. (2006). Yahoo! Messenger 8.0 with Voice. PC Magazine , 106-106. Corporation, M. (2009). Microsoft Office Communicator 2007 R2 Product Overview. Retrieved April 12, 2009, from Microsoft Office Communicator 2007: http://office.microsoft.com/en-us/communicator/HA102037151033.aspx Gorman, T. (2006). The top advantages of videoconferencing. Retrieved April 16, 2009, from Ezine Articles Web site: http://ezinearticles.com/?The-Top-Advantages-Of-Video-Conferencing&id=282728 http://www.electronics-manufacturers.com/info/portable-electronics/personal-digital-assistant-pda.html; (Electronics,2006) http://gsm.utmck.edu/med_library/pda/tutorial/intropage.htm; (Gsm,2005) http://www.mafcs.com/documents/Brown_presentation.pdf (Brown,Karen, 2009, Mississippi State University) Poniente, J. (2009). The History of Videoconferencing. Retrieved April 16, 2009, from Ezine Articles Web site: http://ezinearticles.com/?The-History-of-Videoconferencing&id=707634 Wang, h.-C. C., & Beasley, W. (2005). Type II Technology Applications in Teacher Education: Using Instant Messenger to Implement Structured Online Class Discussions. Computers in School , 71-84.

35. Ethics & Diversity Awareness Planting a Seed: What I’ve Learned & What I Can Do SOC 416: M8A2 Celena Heine Argosy University March 3, 2010 I’ve learned a lot in this course; it almost seems unfair to narrow it down to just four things. One of the number one things that stands out for me is the fact that we, as humans, all have inherently good qualities; available to everyone. Those qualities are: our capacity to love, our power to take power/charge & affect change, our capacity for rational & intelligent thinking, our ability to feel & be sensitive to our own & each others’ humanity, and our capacity for complete joy & excitement (Barone, 1998). The human race has the ability to learn from its mistakes. Stereotypes are embedded within our culture; taught to our children from birth onward. In essence, they are how we make sense of the world around us (Argosy University, 2010). Despite the stereotypes that I was taught as a child: devaluing those from different races and even being sexist toward my own gender, I will not teach my girls such hate. I will lead by example and teach, to all those will listen, that we are all part of the human race; to see no differences. To make a difference in this world, from this day forward, I plan to continue to educate myself and those around me; more specifically my two little girls. I plan to: be open for discussion at anytime and place, defend my views no matter how difficult it may be, and point out any injustices as they occur. I will realize that my “common sense” needs to be questioned daily and “…just when I figure everything out, I need to ask more questions” (Stepp, 2010). Lastly, I plan “…to not take things so personally unless I want them to define me” (Smith, 2010). I plan to do what I’ve always done, which is to accept everyone for who they are; I just plan to “plant a seed” in others to see what may grow out of it. The one concept that I feel might encourage Americans to understand one another a little better would be to look at the world through the two lenses: the dominant and subordinate groups’ point of view. If you “put yourself in someone else’s shoes”, so to speak, you have a better chance of understanding the world you live in. If you can understand your world a little better, then you can get along with other people easier. Take for example social stratification, which “…is the ranking of individuals in a hierarchy of unequal wealth, occupational prestige, & power” (Argosy University, 2010, Module One Lecture). According to the lecture material, stratification is a feature of society and not a reflection of an individual’s differences, and it’s universal because “…no society can function without structured inequality” (Argosy University, 2010, Module One Lecture). At first I was disheartened at this seemingly “dominant” view. However, the more I read and learned, the more I was able to look at it from a different point of view: “…social mobility is possible because stratification is based not only on ascribed status, but also on individual achievements (Argosy University, 2010, Module Two Lecture). Meritocracy & the elements of race, ethnicity, and gender all have a say in an individual’s socio-economic status (Argosy University, 2010). Just because there are “classes” in our society doesn’t mean I can’t work hard to “move-up in the world”! The one lesson from this example alone: is that becoming aware of the structural inequalities in our society is the first- step in getting rid of all the “-IST” ideologies that keeps them in place to begin with (Bakanic, 2009, Ch4).

36. Ethics & Diversity Awareness (cont.) References: Argosy University. (2010). SOC 416: Entire Class. Retrieved during Spring I Term from http://www.myeclassonline.com Bakanic, V. (2009).Prejudice: Attitudes about Race, Class, & Gender. New Jersey. Pearson-Prentice Hall. Barone, C. (1998). “Extending Our Analysis of Class Oppression: Bringing Classism more fully into the Race & Gender Picture”. Retrieved on 1/21/ 2010 from http://users.dickinson.edu/~barone/ExtendedClassRGC.pdf Smith, M. (2010). Personal Remark: during last SOC 416 class. Retrieved on 3/2/ 2010 at Argosy University, Tampa. Stepp, B. (2010). Personal Remark: during last SOC 416 class. Retrieved on 3/2/ 2010 at Argosy University, Tampa.

37. Foundations of Psychology Awareness, Education, & Prevention: Effective Strategies for Preventing Substance Abuse Problems Celena A. Heine PSY 480: M8A2 Argosy University April 24, 2010 It is common sense to think, and know, that the world would be a much better place if we never had to have treatment programs or relapse prevention programs; all because we had been successful at substance abuse PREVENTION. There are several strategies, or prevention approaches, according to the Centers for Substance Abuse Prevention (CSAP); seven to be exact: Policy, Enforcement, Collaboration, Communications, Education, Early Intervention, & Alternatives (Centers for Substance Abuse Prevention (CSAP), 2009). Although each has been attempted by itself at one point in time or another, research has shown that using multiple strategies together is the most effective route to prevent young people from using alcohol, drugs, and/or tobacco (CSAP, 2009). For example, communications appears to work well when combined with education, policy, and/or enforcement; while policy is most effective when paired with collaboration and communication (CSAP, 2009). Whatever the combinations, the goal is to try and prevent adolescent youth from ever trying the first substance. First and foremost, one of the most powerful approaches, an approach that has some of the most success, is policy. Society absolutely has to run on rules and regulations; in other words, the law, which eventually turns into policies. Just some of the examples of public policies include: increasing the price of tobacco and alcohol, having restrictions on where smoking is allowed in public, having “open container” laws that prohibit alcohol in public places, and setting the Blood Alcohol Content (BAC) to .08 as the legal limit, as well as, setting the legal BAC limit for those younger than 21 as .00; no higher than .02 (CSAP, 2009). IF people are going to follow all the “rules” then there has to be something to deter people from breaking the law; there has to be penalties and they have to be enforced. Enforcement would be the next approach and it’s achieved through constant community surveillance, policing, and arrests (CSAP, 2009). For example, there are some pretty hefty fines that have to be paid when someone speeds, as well as increased insurance rates. People can loose their driver’s licenses’ for non-payment of fines. Speaking of which, most states have adopted “Zero Tolerance” laws which doesn’t allow people younger than 21 to drink any alcohol; if they do they loose their licenses and can even go to jail (CSAP, 2009). Communities will oftentimes work together to accomplish goals that they otherwise wouldn’t be able to; this is known as collaboration. A great example of this would be “Nuisance Abatement”, which is where neighborhoods can come together and either clean up the yard, board up the home, and/or turn off the water (CSAP, 2009). Once research has been done on who owns the property, which probably has been involved in drug-dealing, then ample time and “warning” is given for the owner to abate the residence; if nothing is done, the neighborhood is allowed to take action and abate the residence themselves; they then can sue the owner for the costs incurred for cleaning up the eyesore of the community (CSAP, 2009).

38. Foundations of Psychology (cont.) Communications and Education can be dealt with together. Effective communication has to reach the young people within the school system to be of any use. According to the Centers for Substance Abuse Prevention (2009), “Historically, schools have played an important role in preventing abuse among young people” (CSPA, 2009, p14). Kris, Hart, & Ray 2008) state that, “Current school-based approaches use refusal skills, countering advertising, public commitments, and teen leaders” (p20.7). Aside from school-based health programs and prevention education for children, education and training for the adults who come in contact with them has proven successful (CSPA, 2009). Education in the workforce is also a good practice. For example, waiters and waitresses must be taught to ID anyone who doesn’t look thirty years old in order to eliminate serving alcohol to minors; this also goes for clerks in liquor stores and convenience stores, as well as tobacco products. Last but not least, early intervention and alternatives seems to be quite effective as well. The Centers for Substance Abuse Prevention (2009) state that early intervention includes such strategies as “…screening, assessment, referral, and treatment of youth at risk for substance abuse and related factors; home visitation, early education (i.e. Head Start); student assistance programs; employee assistance programs; and treatment and counseling service” (p16). Many different programsare being offered after school across the country, as an alternative to the dangerous activities that can lead to drug use; which then leads to abuse; and finally, dependence (Argosy University, 2010). For example, just some of the programs include things like: community service activities, dances, mentoring programs, tutoring, and other many more (CSAP, 2009). Researchers with the Centers for Substance Abuse Prevention (2009) “…conclude t h at alternative approaches alone is not enough to prevent substance abuse among youth. Enrichment and recreational activities must be paired with other strategies that have been proven effective, such as policies that reduce the availability of alcohol , tobacco, and other drug s, as well as social and personal skill-building instruction” (p18). Hawkins, Catalo no, and Miller (1992) listed some risk factors associated with leading to substance abuse: not being able to follow laws and norms, having a greater availability of drugs, disorganization of the neighborhood in which one lives, extreme economic depravity, family conflict, disorganization, & low bonding, low commitment to school & early academic failure, peer rejection in elementary school , association with drug-using friends, alienation & rebelliousness, and favorable attitudes towards the use of substances and early use. If the youth who exhibit these risk factors can be approached early-on in their childhoods, maybe just maybe drug use can be thwarted. Community service associated with an increased sense of well-being and more positive attitudes toward people, the future, and the community seems to be sure-fire way of achieving this (CSAP, 2009).

39. Foundations of Psychology (cont.) Substance abuse can be prevented across the “facet of human existence”; it affects the elderly, minorities, and even single mothers and college-age kids (AU, 2010). Much of the same techniques can be applied to this vast diversity of people. The only differences lie in where the education, communication, collaboration, policy, enforcement, and alternatives are given. Ultimately, all people have the choice on whether or not to use substances. Society has to invest the time and money into programs that will educate the masses, they have to set the policy and laws for people to follow, and follow through on enforcement of these laws. Society has to recognize peoples’ differences and communicate accordingly; above all else, they have to come together and collaborate as a community to eliminate substance abuse by preventing it from ha