Somers Research Group

This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

BACKGROUND: Drug treatment courts (DTCs) have proliferated on the basis of their promise to reduce criminal recidivism among the burgeoning numbers of drug-related offenders. Empirical research on the effectiveness of DTCs indicates that they produce reductions in recidivism, primarily drawn from experiences in the US. There are no published outcome studies on Canadian DTCs. Canada's second DTC has operated in Vancouver's Downtown Eastside since 2001. We examine longitudinal changes in recidivism and characteristics of participants in the DTC in Vancouver (DTCV). METHODS: DTCV participants (n=180) were included in a longitudinal cohort design (intent-to-treat), and a comparison group was derived using the propensity score matching method. Matching variables represented the domains of health, offending, and socio-economic histories as well as demographics. Annualized rates of offending were compared for the two years prior to entering DTCV and two years following programme ...

Background: Problem solving courts (PSC) have been implemented internationally, with a common objective to prevent reoffending by addressing criminogenic needs and strengthening social determinants of health. There has been no empirical research on the effectiveness of community courts, which are a form of PSC designed to harness community resources and inter-disciplinary expertise to reduce recidivism in a geographic catchment area.

Background: Homelessness and mental illness have a strong association with public disorder and criminality. Experimental evidence indicates that Housing First (HF) increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders. HF is also associated with lower residential costs than common alternative approaches. Few studies have examined the effect of HF on criminal behavior.

Background: Individuals with mental illnesses are overrepresented among the homeless. Housing First (HF) has been shown to promote positive outcomes in this population. However, key questions remain unresolved, including: how to match support services to client needs, the benefits of housing in scattered sites versus single congregate building, and the effectiveness of HF with individuals actively using substances. The present study aimed to recruit two samples of homeless mentally ill participants who differed in the complexity of their needs. Study details, including recruitment, randomization, and follow-up, are presented. Methods: Eligibility was based on homeless status and current mental disorder. Participants were classified as either moderate needs (MN) or high needs (HN). Those with MN were randomized to HF with Intensive Case Management (HF-ICM) or usual care. Those with HN were randomized to HF with Assertive Community Treatment (HF-ACT), congregate housing with support, or usual care. Participants were interviewed every 3 months for 2 years. Separate consent was sought to access administrative data. Results: Participants met eligibility for either MN (n = 200) or HN (n = 297) and were randomized accordingly. Both samples were primarily male and white. Compared to participants designated MN, HN participants had higher rates of hospitalization for psychiatric reasons prior to randomization, were younger at the time of recruitment, younger when first homeless, more likely to meet criteria for substance dependence, and less likely to have completed high school. Across all study arms, between 92% and 100% of participants were followed over 24 months post-randomization. Minimal significant differences were found between study arms following randomization. 438 participants (88%) provided consent to access administrative data.

Objective: This study examines key themes from narrative interviews conducted with 43 homeless adults with mental disorders 18 months after random assignment to Housing First with intensive supports or to treatment as usual (no housing or supports through the study). Method: Coding and thematic analysis of semistructured interviews was based on 2 research questions from participants' perspectives: (a) What changes were perceived over time? (b) What factors facilitated or hindered change? Results: The majority of participants assigned to Housing First reported positive change across multiple domains as a result of stable housing; whereas the majority of treatment as usual participants reported negative or neutral change. Key themes included feelings of security and pride; adjusting to living alone; housing as a learning process; and developing meaningful activity. The sense of security associated with stable housing was the most influential factor that supported change. Factors that helped or hindered change clustered into 4 key themes: the type and quality of services; the cumulative effects of trauma; social ties; and concurrent substance use. Conclusions and Implications for Practice: Our findings provide important context to the emerging body of quantitative research on Housing First and recovery from homelessness. Participants' experiences of recovery, particularly as it relates to housing and supports, shifts in identity, and meaningful activity must be acknowledged and incorporated into the design and evaluation of public services, and policy and service reforms.

To present the results of a systematic review of literature published between January 1, 1980, and December 31, 2000, that reports epidemiologic estimates of substance-related disorders. We conducted a literature search of substance-related epidemiologic studies, using medline and HealthSTAR databases and applying a set of predetermined inclusion and exclusion criteria to identify relevant studies. We extracted and analyzed prevalence and incidence data for heterogeneity. A total of 19 prevalence studies of substance-related disorders met inclusion criteria for this review. Heterogeneity analyses revealed significant variability across 1-year and lifetime prevalence of both alcohol and other substance use disorders. The corresponding 1-year and lifetime pooled rates were 6.6 per 100 and 13.2 per 100, respectively, for alcohol use disorders and 2.4 per 100 and 2.4 per 100, respectively, for other substance use disorders. We observed variability among countries and also among regions ...

To present the results of a systematic review of literature published between 1980 and 2004 reporting findings of the prevalence and incidence of anxiety disorders in the general population. A literature search of epidemiologic studies of anxiety disorders was conducted, using Medline and HealthSTAR databases, canvassing English-language publications. Eligible publications were restricted to studies that examined age ranges covering the adult population. A set of predetermined inclusion and exclusion criteria were used to identify relevant studies. Prevalence and incidence data were extracted and analyzed for heterogeneity. A total of 41 prevalence and 5 incidence studies met eligibility criteria. We found heterogeneity across 1-year and lifetime prevalence rates of all anxiety disorder categories. Pooled 1-year and lifetime prevalence rates for total anxiety disorders were 10.6% and 16.6%. Pooled rates for individual disorders varied widely. Women had generally higher prevalence ra...

Drug Treatment Courts (DTCs) integrate therapeutic interventions for substance using offenders with the administration of justice. Available evidence indicates that DTCs are effective at reducing recidivism, but it is not yet established whether they are equally effective for all subgroups of offenders. The current study investigates the comparative effectiveness of a Canadian DTC among subgroups defined by ethnicity, gender, prior offending, and the presence of a co-occurring mental disorder. Results indicate greater reductions in recidivism among female and Aboriginal participants, and no differences in recidivism associated with the presence or absence of co-occurring mental disorders or the number of prior convictions. Longer duration of involvement with the DTC program was positively associated with reduced recidivism. The effectiveness of DTCs with distinct subpopulations may be related to their composition and inclusion of expertise relevant to the needs of diverse participants.

To present the results of a systematic review of literature published between January 1, 1980, and December 31, 2000, that reports findings on the prevalence and incidence of mood disorders in both general population and primary care settings. We conducted a literature search of epidemiologic studies of mood disorders, using Medline and HealthSTAR databases and canvassing English-language publications. Eligible publications were restricted to studies that examined subjects aged at least 15 years and over. We used a set of predetermined inclusion and exclusion criteria to identify relevant studies. We extracted and analyzed prevalence and incidence data for heterogeneity. Of general population studies, a total of 18 prevalence and 5 incidence studies met eligibility criteria. We found heterogeneity across 1-year and lifetime prevalence of major depressive disorder (MDD), dysthymic disorder and bipolar I disorder. The corresponding pooled rates for 1-year prevalence were 4.1 per 100, ...