When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.

Lesbian, gay, and bisexual (LGB) individuals are more likely than their heterosexual peers to experience a variety of mental health and health-related problem behaviors, including emotional distress, suicidality, substance use, and sexual risk behaviors. This chapter investigates potential ethnic/racial differences in gay-related and non-gay-related stress among a sample of Black, Latino, and White LGB youths in New York City. It further examines whether ethnic/racial disparities exist in various mental health and health-related behaviors of LGB youths. The chapter then examine whether gay-related stress may account for the potential ethnic/racial disparities among LGB youths. The chapter reviews the research on sexual orientation disparities in health among LGB youths, followed by a review of what is currently known about potential ethnic/racial disparities in stress and health among LGB youths.

The treatment of the suicidal individual is perhaps the most weighty and difficult of any of the problems confronted by the clinical social worker. Some frequent comorbid pathology with suicidal behavior includes alcoholism, panic attacks, drug abuse, chronic schizophrenia, conduct disorder in children and adolescents, impulse control deficits, schizophrenia, and problem-solving deficits. Suicidal harmful behavior appears in all ages and characterizes clients in a large spectrum of life. There are four types of suicidal behavior namely rational suicider, psychotic suicider, hopeless suicider and impulsive or histrionic suicider. This chapter presents some primarily cognitive techniques for challenging suicidal automatic thoughts. Recent reports suggest that individuals suffering from alcohol or substance abuse are at an increased risk both for attempting, and for successfully completing, a suicidal act. The therapist must develop an armamentarium of cognitive techniques, and the skills to use these effectively in ways that are appropriate for each individual client.

This chapter provides a general overview of substance-related disorders and the diagnostic criteria. It discusses cognitive behavior therapy (CBT) techniques for treating as well as a review of the neurophysiologic basis of addiction and reward pathways. The chapter examines the impact of substance use and misuse on the patient, the family, and social worker in the therapeutic process. The social worker should be familiar with general assessment guidelines for substance misuse spectrum disorders with and without confounding comorbid conditions such as medical and psychiatric problems. The chapter then discusses the biological-psychological-social components that must be in place for a substance disorder to be diagnosed. According to Freeman and Dolan the five-step stages of change (SOC) model widely accepted in substance misuse treatment settings lacks the specificity that is an essential part of the cognitive behavior treatment model, namely precontemplation, contemplation, preparation, action, and maintenance.

Mental health is integral to personal well-being. According to the National Institute of Mental Health (NIMH), about 58 million adults, or 26” of the American population, suffer from some form of mental illness. The National Alliance of the Mentally Ill (NAMI) is a consumer group that advocates for better mental health services and provides mental health education and support groups for individuals and families. The faith community nurse (FCN) is often the only support person available to such individuals, and providing care to them can overwhelm a health ministry. Bard believes that FCNs can have a role in the prevention and management of problems associated with substance abuse. Researchers have found that illicit drug use is much higher in persons arrested for domestic violence than among the general population and that illicit drug use is more predictive of aggression than alcohol use.

Aging is associated with the emergence of a variety of chronic physical and/or mental health conditions. Chronic conditions like heart disease and diabetes are highly prevalent and are the most common causes of mortality in older adults in the United States. Poor physical health can increase risk for mental illness, particularly depression and anxiety, in combined effect with bereavement, poor social support, and functional decline; for rural older adults, these psychiatric comorbidities occur in a context of limited access to care that greatly complicates effective management. The most common psychiatric diagnoses in older adults are depression, anxiety, substance abuse, and dementia. Informal care networks are even more essential in rural communities with poor access to health care services. Telehealth interventions such as Supporting Caregivers of Rural Veterans Electronically (SCORE) are an emerging method of closing the health care gaps for older adults in rural areas.

Rural America may seem an unlikely setting for new trends in substance abuse. This chapter compares rural and urban areas and the rural continuum for prevalence of substance use and abuse, efforts to prevent substance abuse, treatment availability and accessibility, and continuing care and long-term support for abstinence. It also presents models of service delivery that address resource limitations common to rural areas. Van Gundy also found that substance abuse rates vary across racial and ethnic groups, though rates differ when socioeconomic status and other factors are considered. Nonmedical use of prescription drugs is a growing national problem and one that heavily impacts rural areas. Societal effects include the strain and economic costs absorbed by emergency rooms, treatment agencies, social service agencies, and the legal and criminal justice systems in coping with the consequences of meth abuse. Treatment models with relevance for rural providers address the shortcomings of existing services.

Correctional nurses face multiple circumstances in their work environment that can challenge adherence to the standards of professional practice. The correctional nurse is expected to provide competent, knowledgeable patient care notwithstanding the individual’s reasons for incarceration. The loss of freedom when individuals are detained within the criminal justice system means that they are unable to seek health care on their own in the community. The role of the nurse is to provide holistic care for the patient. The American Nurses Association (ANA) standards emphasize that correctional nurses must recognize their professional responsibility for quality nursing care according to recognized standards. Enhancing clinical performance is part of the professional nurse’s commitment to practice. Developing higher level thinking and competency of nurses to meet the health needs of the population and building knowledge in areas of litigation, advocacy, health literacy, and enhancing proficiencies triaging and managing clinical care is needed.

Correctional nurses working with juvenile patients must consider the additional concerns common in a troubled adolescent population. Adolescents detained in the criminal justice system require special attention, whether they are in a juvenile setting or in an adult setting. Many of the adolescents who get in trouble with the law have problems with substance use, and their offense is tied to their involvement with drugs or alcohol. Adolescence is a time of increased physical growth, sexual cognition, and psychosocial and brain development. A healthy diet in adolescence promotes adequate growth and helps decrease the risk of dental caries, obesity, hypertension, hyperlipidemias, and other chronic health problems that can manifest in adolescence and later on in life. Treatment of juvenile mental health disorders includes medication, psychotherapy, and psychosocial interventions. Cognitive-behavioral therapy (CBT) has shown effectiveness in reducing future delinquency and has shown results in adolescents with anxiety disorders or depression.

Alcohol withdrawal is the syndrome with the highest mortality rate, although withdrawal from opiates and depressant drugs such as benzodiazepines can also prove life-threatening. These statistics emphasize the need for correctional nurses to give special attention to drug and alcohol withdrawal. The correctional nurse’s most important responsibility in handling substance abuse is identifying individuals who may withdraw from any substances, whether they are legally prescribed, illicit, or additive substances. The Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) is a nationally recognized evaluation tool for alcohol withdrawal monitoring. Common medications used in the treatment of alcohol withdrawal treatment include Ativan, folic acid, Haldol, Librium, multivitamins, thiamine, and Valium. In addition to alcohol, correctional nurses are confronted with several other substance withdrawal categories which include Benzodiazepines, Cannabis, Hallucinogens, and Opiates. Correctional nurses should be alert to the emergence of symptoms of mental illness in withdrawing patients and initiate appropriate evaluation and treatment.