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International Society Honors Nursing Professor
for Work on Addictions
From sixth graders to the elderly, Marcus works to prevent, identify and treat substance abuse
When Marianne Marcus, Ed.D., won the 2004 President's Award for commitment to addictions nursing from the International Nursing Society on Addictions in October, she missed the awards ceremony. As a member of the national board for Cenikor, she was attending a meeting in Louisiana while the international society met in California.
Marianne Marcus, Ed.D., professor at the UT School of Nursing at Houston, has received an international award for her commitment to addictions nursing.
Photo by Ina Fried
"I just keep running," said Marcus, the John P. McGovern Professor in Addictions Nursing at The University of Texas School of Nursing at Houston.
A past recipient of the UT Health Science Center at Houston President's Scholar Award for Teaching, she was recognized by the same international society with the award for education several years ago. She chaired the nursing school's Department of Nursing Systems and Technology for 15 years before stepping down to devote time to heading the school's Center
for Substance Abuse Education, Prevention and Research.
Since 1982 Marcus has worked with Cenikor, where a two-year drug
recovery program helps people develop social, behavioral, vocational, educational and recreational skills to live a lifestyle free of substance abuse.
Ninety percent of those who graduate from Cenikor each year remain clean and sober, but Marcus has been concerned by the high dropout rate. She has received a four-year $1.4 million grant from the National Institute on Drug Abuse to look at mindfulness-based meditation as an adjunct therapy to help prevent dropouts.
Mindfulness meditation focuses on breathing to maintain a calm, non-judgmental awareness, allowing thoughts, feelings and sensations to come and go without getting enmeshed in them. "It's very restful," Marcus said.
"We're among the first to do this with drug addicts," she said. "We're measuring the stress levels of everyone in the program and seeing how they change over the year. The hypothesis is that with lower stress levels, the participants will be able to stick it out and complete the Cenikor program."
Serving as consultant on the project is Jon Kabat- Zinn, Ph.D., who founded the Center for Mindfulness 25-30 years ago. In February Kabat-Zinn, who is former director of the Stress Reduction Clinic and emeritus associate professor of medicine at the University of Massachusetts Medical Center, led a public program on alternative and complementary medicine co-sponsored by the School of Nursing and UT M. D. Anderson Cancer Center. He also spoke at psychiatry grand rounds for the UT Medical School at Houston.
Marcus is collaborating with researchers at M. D. Anderson on a project in which mindfulness meditation is combined with smoking cessation classes.
In another collaboration - with the Association for Medical Education and Research in Substance Abuse - Marcus directs Project MAINSTREAM a national interdisciplinary effort to educate health professionals about identifying and treating substance abuse problems. Now in its sixth year, the project has trained 39 fellows in 15 disciplines so far.
"This year we're evaluating the program and designing a new curriculum to go on for more funding and expansion," she said. She is taking some of the lessons learned in Project MAINSTREAM to consult on a newer project to train frontline nurses and physicians in the Harris County Hospital District to screen patients for drug abuse. As part of a $17.5 million grant from the U.S. Center for Substance Abuse Treatment to the Texas Department of State Health Services, the project seeks to identify at-risk individuals and refer them for services.
"We're trying to train physicians and nurses in emergency rooms, medical clinics, inpatient units and school-based clinics - as many people as possible," she said. "We hope to find at-risk but non-dependent individuals and determine how much, how often and why they use drugs or alcohol. Then we give them appropriate feedback, such as 'It's good that your alcohol use does not pose a risk,' or 'We are concerned about your drug use and we'd like to refer you.'"
Marcus also is co-principal investigator on Project CREST (Consortium for Research in Elder Selfneglect of Texas), along with principal investigator Carmel Dyer, M.D., associate professor of medicine at Baylor College of Medicine and co-director of the Texas Elder Abuse and Mistreatment Institute.
"One of the reasons the elderly may be at risk for self-neglect is drug or alcohol abuse," Marcus said. With a three-year exploration research grant from the National Institutes of Health, they seek to define and characterize elder self-neglect.
"This is a complex issue," she said, "and an exciting collaborative project." In addition to Baylor and the School of Nursing, the consortium includes faculty members from the UT School of Public Health at Houston, UT Medical Branch at Galveston, NASA, and the schools of social work and law at the University of Houston, in cooperation with the Harris County Hospital District and the Texas Adult Protective Services Program.
As these projects are just getting under way, another one has ended recently. Marcus led Project BRIDGE (Bold, Ready, Intelligent, Dedicated, Guided and Equipped), a substance abuse and HIV/AIDS prevention study funded by more than $800,000 from the federal Center for Substance Abuse Prevention (CSAP).
Project BRIDGE was one of 47 CSAP-funded programs around the country, but one of only a handful with a faith-based component. In cooperation with Windsor Village United Methodist Church, a team from the UT schools of nursing, medicine and public health aimed to head off risky behaviors among African-American sixth- through eighth-graders.
Results of the three-year study were published in the November 2004 issue of the Journal of Interprofessional Care, a theme issue on community-based participatory research. The study found that students who participated in Project BRIDGE were less likely to engage in risky behaviors than a comparison group. Equally important, Marcus said, is the fact that the church received training in the delivery of an evidence- based curriculum and the UT team gained valuable insights into community collaboration.
"There's a give and take when the community has a lot of input into what's going on. Even though the grant has ended, the project is still seeing about 100 kids a week and still using that framework," Marcus said. "That's what you would hope to have happen."
By Ina Fried, Public Affairs