Publication Abstracts

Corrigan, J.D., Bogner, J., Lamb-Hart, G., Heinemann, A.W., & Moore, D. (in press). Increasing substance abuse treatment compliance for persons with traumatic brain injury. Psychology of Addictive Behaviors
This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N=195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74 percent) and financial incentive (83 percent) groups were more likely to sign within 30 days compared with the motivational interview (45 percent) and attention control (45 percent) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate."

Hollar, D., & Moore, D. (in press). Relationship of substance use by students with disabilities on long-term educational, employment, and social outcomes. Substance Use & Misuse.
The study is based on data from the National Education Longitudinal Study of 1988-2000 (NELS: 88). The results indicate that adolescents with disabilities who used either cigarettes or marijuana or who engaged in binge drinking had significantly higher dropout rates, lower high school graduation status, lower college attendance, lower high school grade point averages, and fewer earned core credit units in English, science, and mathematics than nonusers. In addition, adolescents with disabilities who used either cigarettes, alcohol, or drugs were significantly more likely to engage in sexual activity at a younger age. The findings support the need for improved substance use prevention programming targeting the needs of youth with disabilities.

McAweeney, M.J., Forchheimer, M., Moore, D., & Tate, D.G. (in press). Psychosocial aspects related to the dual-diagnosis of substance use disorder and disability. In K.J. Hagglund & A.G. Heinemann (Eds.), Advances in Disability and Rehabilitation Research. Washington, DC: Springer Publishing.
The chapter focuses on the psychosocial implications and/or consequences for persons with disabilities who have coexisting SUD. This dual-diagnosis is often referred to as the "double negative" that is being socially stigmatized with both disability and SUD. The chapter covers 5 sections: (1) a summary of the past 25 years of research which has reported on the prevalence of SUD and disabilities; (2) an overview of the unique psychosocial issues facing persons with disabilities who have coexisting SUD; (3) an example of psychosocial issues encountered by a specific disability group, spinal cord injury (SCI), an incorporation of the alcohol and drug data collected by the Model Spinal Cord Injury Systems (MSCIS) project; (4) a discussion of the lessons learned at the Rehabilitation Research and Training Center on Drugs and Disability (RRTC), funded by the National Institute on Disability and Rehabilitation Research (NIDRR); and (5) finally, future directions for practice and research.

Moore, D., & Lorber, C. (2004). Clinical characteristics and staff training needs of two substance use disorder treatment programs specialized for persons with disabilities. Journal of Teaching in the Addictions 3(1), 3-20.
The clinical aspects and staff training needs for two substance use disorders (SUD) treatment programs that serve persons with co-existing disabilities are described. The article addresses SUD prevalence among persons with disabilities and the corresponding specialized treatment needs and accomodations that may be necessary. The philosophical orientations, demographic profiles, and treatment outcome data are presented. Considerations about staff training are reviwed, and strategies for implementing a comprehensive staff training program are discussed.

Heinemann, A.W., Corrigan, J.D., & Moore, D. (2004, May). Case management for traumatic brain injury survivors with alcohol problems. Rehabilitation Psychology 49(2), 156-166**
To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (N=217); a comparison group was recruited that did not receive case management (N=102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related quality of life. Results: For those receiving case management, employment at recruitment and early referral were associated with employment 9 months later. Community integration and physical well-being increased for both groups. Earlier program referral was associated with larger gains in physical well-being, employment, and community integration. Conclusions: Case management appears to have beneficial effects for adults with TBI and substance abuse problems in terms of life and family satisfaction as well as to have potential cost savings.

Bombardier, C.H., Blake, K.D., Ehde, D.M., Gibbons, L.E., Moore, D., & Kraft, G.H. (2004). Alcohol and drug abuse among persons with multiple sclerosis. Multiple Sclerosis, 10, 35-40.**
To examine the one-month prevalence and impact of substance abuse in a large community sample of persons with multiple sclerosis (MS). Method: Members of the Multiple Sclerosis Society of King County were surveyed by mail. This multifacted health survey included questions pertaining to substance abuse. Seven hundred and thirty nine out of 1374 potential participants (54 percent) returned the survey, while 708 reported a medically confirmed diagnosis of MS and provided sufficient data. Results: Fourteen per cent of the sample screened positive for possible alcohol abuse or dependence, and 7.4 percent reported misusing illicit drugs or prescription medications within the previous month. Possible alcohol abuse and drug misuse were associated with younger age, less severe MS related disability and being employed, as well as greater self-reported depressive symptomatology. Most persons with alcohol problems indicated interest in learning more about ways to stop or cut down. Conclusions: Substance abuse may be present in up to 19 percent of this sample and contribute to high rates of depression. There may be greater risk of harm due to substance abuse in people with MS because of the potential magnification of motor and cognitive impairments. Comprehensive MS care should include substance abuse screening and advice to cut down or abstain.

Ford, J.A., Glenn, M.K., Li, L., & Moore, D. (2004). Substance abuse and women with disabilities. In S.L. Welner & F. Haseltine (Eds.), Welner's guide to the care of women with disabilities (pp. 315-332). Philadelphia, PA: Lippincott Williams & Wilkins.

Doninger, N.A., Heinemann, A.W., Bode, R.K., Sokol, K., Corrigan, J.D., & Moore, D. (2003). Predicting community integration following traumatic brain injury with health and cognitive status measures. Rehabilitation Psychology, 48(2), 67-76.**
Objective: To examine measurement properties of the Community Integration Questionnaire (CIQ) and the Short-Form Health Survey (SF-36) and assess the contributions of cognitive regression analysis data on basic cognitive functioning and health collected from 289 individuals with traumatic brain injury. Results: Person reliabilities indicated substantial measurement error. Ceiling effects weakened the model (adjusted R2_.143) specifying the contributions of age, gender, cognitive functioning, and health to community integration. Conclusion: Poor measurement properties and definitional problems associated with community integration weakened the results. The extent to which potential familial and environmental characteristics contributing to role fulfillment change across time requires further research.

Glenn, M.K., Ford, J., Moore, D., & Hollar, D. (2003). Employment issues as related by individuals living with HIV or AIDS. The Journal of Rehabilitation, 69(1), 30-36**
This study outlines the issues that are confronting people living with HIV and AIDS as they work to move out of disability benefit dependence into the world of work. In order to assist people in exploring these work transitions, rehabilitation counselors must have an understanding of a number of barriers that face individuals living with HIV or AIDS in today's environment. The information must consider the experience of the individuals themselves and be revised on an ongoing basis because of the changing nature of the treatment options and functional limitations connected with the disability.

Hollar, D., Weber, J., & Moore, D. (2002). Educational and employment outcomes for youth with disabilities who use alcohol and drugs: Analysis of NELS:88 longitudinal data. Drug and Alcohol Dependence, 66(Suppl. 81).

Moore, D., Ford, J., & Hollar, D. (2002). Barriers to employment for individuals with HIV/AIDS: Alcohol and drug use. Drug and Alcohol Dependence, 66(Suppl. 1), S123-S124.

Li, L., & Moore, D. (2001). Disability and illicit drug use: An application of labeling theory: Deviant Behavior, 22(1), 1-21.
Applying the concept of "secondary deviance" from Labeling Theory, this study hypothesizes that perceptions of disability labeling are revelant to individuals' acceptance of disability. Such reactions may lead to an entitlement attitude toward substance use and encourage further deviant activities such as illicit drug use. The findings from our analyses tend to confirm our expectations that perceived discrimination and acceptance of disability play important roles in illicit drug use by persons with disabilities. The present study also suggests that perceived discrimination against persons with disabilities is significantly associated with disability acceptance, and, in turn, indirectly related to illicit drug use attitudes and practice. In addition, severe disability conditions, such as the presence of multiple disabilities, are important factors in predicting negative reactions to labeling that might result in drug abuse. This study does not support all elements of the labeling perspective, but it suggests that the labeling approach provides a useful framework for understanding the relationships between disability and substance abuse.

Demers, J., French, D., & Moore, D. (2000, Fall). The Preliminary evaluation of a program to help educators address the substance use/prevention needs of special students.Journal of Alcohol and Drug Educations, 46(1), 14-26.**
Presents a study that examined a substance abuse prevention education program aimed at addressing the needs of special education students in the U.S. Overview of the program; Effects of the program on participating students' related attitudes and understanding; Assessment of changes in the students' criterion- related attitudes and awareness.

Li, L., Ford, J., & Moore, D. (2000). An exploratory study of violence, substance abuse, disability, and gender. Social Behavior and Personality, 28(1), 61-71.
Using a random sample of 1,876 individuals with disabilities, this study examines relationships between victimization as a result of violence, substance abuse, disability, and gender. Multivariate analyses reveal that women with disabilities are more likely to be victims of substance-abuse related violence than are male counterparts. Some disability conditions such as disability onset, multiple disabilities and chronic pain, are significantly associated with violence for both men and women with disabilities. For people with disabilities, this study finds that victims of substance abuse-related violence are more likely to have their own substance abuse problems than are those who have not been victimized. The authors discuss several issues relevant to a better understanding of violence, substance abuse, disability, and gender.

Allen, J.B., Moore, D., & Sample, E.B. (1999). Relationship between substance abuse severity and indicators and cognitive performance in a dual-diagnosis population. Journal of Neuropsychiatry and Clinical Neurosciences, 11, 126-164.
Background: The high occurrence rate of traumatic brain injury and substance abuse are well known (Drubach et al., Maryland Medical Journal, October 1993, pp. 989-993). Indeed, estimates of substance abuse in the TBI population approach 76 percent by some accounts (Sparedeo & Gill, Journal of Head Trauma Rehabilitation 1989; 4[1]:75-82). Additionally, the relationship between cognitive deficits and substance abuse treatment outcome has been indicated (Glenn & Parsons, International Journal of Addictions 1991; 26:327-254; Goldman, Neuropsychol Rev 1990; 11:75-101). However, the relationship between neuropsychological functioning and readiness for treatment has yet to be examined. The current study investigated the relationship between substance abuse severity, neuropsychological functioning, and readiness to enter treatment. Methods: The current study included 28 individuals dually diagnosed with a neurological disorder and substance abuse difficulties (52 percent males; mean age 33 years; 68 percent Caucasian, 21 percent African American; 80 percent reported 12 or more years of education). Upon admission to a treatment program, each individual was administered a number of measures of substance abuse severity (MAST), readiness for change/treatment (SOCRATES), community integration (CIQ) and quality of lfie (SWLS). The clients were also administered the Cognistat as a brief indicator of neuropsychological status. Along with descriptive information on the sample, correlation and regression analysis were used in an attempt to identify the general relationship between the various cognitive domains measured by the Cognistat and the SOCRATES as a measure of treatment readiness. Results: The mental calculation subtest of the Cognistat was significantly related to clients' readiness for change (r=0.393, P<0.05). The memory subtest of the Cognistat was also related to overall scores on the CIQ (r=.0337, P<0.05). An expected relationship between the client's reported substance abuse symptomology and general quality of life also emerged (r=0.327, P<0.05). Conclusions: Implications of patients' cognitive functioning levels for decision making regarding time to enter treatment, as well as the need for flexibility in the manner in which treatment is delivered, are discussed.

Moore, D., & Li, L. (1998, Spring). Prevalence and risk factors of illicit drug use by people with disabilities. The American Journal on Addictions, 7(2), 93-102.
The authors examined patterns and risk factors of illict drug use among people with disabilities by use of a random sample of 1,876 persons actively involved in vocational rehabilitation services in three Midwestern states. Compared with regional drug use data from the general population, respondents with disabilities reported higher rates of illicit drug use for nearly every drug category. Factors significantly associated with illicit drug use included level of disability acceptance, best friends' drug use, attitude of disability entitlement, self-esteem, and risk-taking. These findings provide additional insight into illicit drug use among people with disabilities. The authors discuss implications from these findings for rehabilitation and disability policy.

Glenn, M., Garcia, J., Li, L., & Moore, D. (1998, March). Preparation of rehabilitation counselors to serve people living with HIV/AIDS. Rehabilitation Counseling Bulletin, 41(3), 190-200.
Investigated the relationship among rehabilitation counselors' years of experience in rehabilitation, age, sex, previous training, and experience with HIV/AIDS and 3 criterion variables, namely their perceptions, knowledge, and self-reported level of skill in working with people living with HIV/AIDS. The study also explored relationships among perception, level of HIV/AIDS knowledge, and self-reported skill levels. Results indicated statistically significant correlations between predictor and criterion variables. Professional implications and recommendations for specialized training are also discussed.

Li, L., & Moore, D. (1998, February). Acceptance of disability and its correlates. Journal of Social Psychology, 138(1), 13-25.
In a sample of 1,266 US adults with disabilities, relationships were examined between acceptance of disability and (a) demographic characteristics (i.e., age, gender, race, education, marital status, and income); (b) disability conditions (i.e., disability onset, multiple disabilities, and chronic pain); and other psychosocial factors (i.e., self-esteem, emotional support, perceived discrimination, and hostility). Self- esteem and emotional support from family and friends played important roles in the participants' adjustment to disability. Furthermore, perceived social discrimination against people with disabilities had a significant impact on acceptance of disability. Disability conditions such as acquired disability, multiple disabilities, and chronic pain were also important variables related to lower levels of disability acceptance. Implications for disability rehabilitation programs are briefly discussed.

Li, L., & Ford, J. (1998). Illicit drug use by women with disabilities. The American Journal of Drug and Alcohol Abuse, 24(3), 405-418.
Using a random sample of 900 women with disabilities, the authors conducted a study of the patterns of illicit drug use and risk factors relating to ilicit drug use among women with various disabilities. Multiple regression analyses revealed that age, illicit drug use by a best friend, being a victim of substance-abuse- related violence, and attitudes toward substance abuse by people with disabilities were significantly related to illicit drug use by the Ss.

Wolkstein, E., & Spiller, H. (1998). Providing vocational services to clients in substance abuse rehabilitation. Directions in Rehabilitation Counseling, 9, 65-77.

Pringle, D.D., Li, L., Sample, E.B., Moore, D., Imbrogno, D.R., & Glaser, R.M. (1997, May). Evaluation of physical fitness, activity level, and substance abuse in vocational rehabilitation patients (abstract). Medicine in Science in Sports and Exercise, 34(5), S1172.

Sample, E.B., Li, L., & Moore, D. (1997). Alcohol use, ethnicity, and disability: Comparison of African American and Caucasian groups. Social Behavior and Personality, 25(3), 265-276.
Previous research has consistently reported that alcohol consumption among the general population varies across cultural groups. However, studies investigating risk factors and drinking patterns of African-Americans and Caucasians with disabilities have been limited. The current study explored the factors of alcohol use among African-Americans and Caucasians with disabilities who were seeking rehabilitation services in three mid-western states. Multivariate data analysis revealed that African-Americans were more likely to use alcohol than their Caucasian counterparts when other demographic and disability variables were controlled. Additionally, separate multiple-regression models differentiated patterns between African-Americans and Caucasians in selected variables on alcohol use. Cultural issues and implications for rehabilitation services are discussed.

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