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Alcohol misuse and mental health problems in parents are both known to contribute to impaired outcomes in children, although little is known about the specific parenting behaviours that might be affected. Mental health problems in parents who misuse alcohol may impact parenting in specific ways, and these may be different for mothers and for fathers. The purpose of this paper is to make a preliminary investigation of alcohol misuse and mental health problems in mothers, and explore ways in which these might affect their parenting.

Semi-structured interviews were carried out with professionals involved in services for mothers who misuse alcohol, including those working in addiction psychiatry, in primary care, and in the provision of parenting services. These interviews were then examined using thematic analysis.

Themes emerged including specific mental health problems (depression, anxiety and personality disorders), and related issues, such as self-medication. Particularly relevant for mothers were post-natal depression, the effect on maternal alcohol misuse and mental health when children are removed, the role of domestic violence, and the importance for identification of home visits by services. Different types of alcohol misuse were linked to different mental states and different parenting behaviours in parents. Findings in the general parenting and substance misuse literature were confirmed, and a new addition was that expressed emotion may play a role in families where mothers misuse alcohol.

The findings increased the understanding of the relationships between maternal alcohol misuse, mental health issues and parenting, raising several new points for consideration.

This paper considers parents who misuse substances. The potential impacts of their substance misuse on their ability to parent effectively and safely (parenting capacity) are explored, as are some of the barriers many parents face when attempting to seek treatment for problematic substance misuse. The terms ‘use’ and ‘misuse’ are used interchangeably in this paper and ‘substances’ refers to alcohol, illicit drugs and overuse of prescribed medicines. It is important to make the distinction between parents whose use of substances does not constitute dependency and might be best described as ‘recreational or hazardous’. Such individuals might not seek treatment and estimates of prevalence rates of use among this cohort are difficult as they remain hidden from services. Parents who might already be in treatment services or who might be seeking treatment might be described as ‘problematic or dependent’ although presentation at services is neither necessary nor sufficient to assume that the individual's misuse of substances is problematic or indicative of a dependency. The use of substances is associated with numerous harms to the individual: psychologically, socially, interpersonally and physically, and is a risk factor towards negative parenting practices. The use of substances in itself is not an indication of neglectful or harmful parenting, as many parents who use substances have adequate parenting skills, however, it is more frequently associated as a risk rather than a protective factor when considering potential harms. Most of the research refers to mothers although we are aware that some fathers may have sole parenting responsibility for their children. Parents, in particular mothers, face many barriers when trying to access substance misuse treatment services. When they are in treatment, services often lack the skills and experiences to be able to balance managing child protection issues and engaging the parent in treatment. A full review of the issues associated with parenting and substance misuse is beyond the scope of this paper and the reader is referred to Fowler (2003), Cleaver et al (1999), Velleman and Templeton (2007) and Day and George (2005) and the British Psychological Society's Child Protection Portfolio (2007) for further discussion.

Rates of co-morbid substance misuse are high within forensic populations. Addressing these problems should be a priority as mental disorder with co-morbid substance misuse is associated with worse outcomes, including rates of re-offending and violence recidivism. A study undertaken in 2006 by the Royal College of Psychiatrists’ Research and Training Unit concluded that the provision of substance misuse treatments in medium-secure units (MSUs) at that time was inadequate. The purpose of this paper is to investigate how services may have developed since then to inform discussion over future development and best practice.

A postal survey, supported by the Quality Network for Forensic Mental Health Services, was sent to 62 MSUs across the UK and Ireland. This questioned prevalence, interventions and staff training in substance misuse.

In total, 41 units responded (66 per cent). The data suggest rates of substance misuse within MSUs have reduced and provision of treatment has increased in recent years. The majority of MSUs provide a variety of interventions to address substance misuse and are internally resourced, in tune with current national guidance. However, the data suggest many MSU staff are not receiving adequate training in substance misuse treatments and some MSUs do not appear to have a cohesive strategy that would be consistent with best practice.

This study provides an up-to-date overview of the provision of treatment for substance misuse within MSUs.

There is no other source for this information, which will provide an invaluable reference point for services seeking to develop or improve their clinical services.

This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs.

The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients.

The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed.

The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs.

This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes.

This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

This paper offers readers a review of the literature on alcohol and illicit drug misuse in people with learning disabilities, focusing on six key areas. First, clarity is provided on the definition of ‘misuse’. Second, prevalence rates are examined along with the methodological difficulties involved in such studies, the authors arguing that prevalence rates are higher than current estimates. Third, the authors explore the relationship between the intra‐ and inter‐personal risk factors. Fourth, the nature of the substance misuse is explored, with a focus on offending behaviour. Fifth, a range of treatment modalities are described with a series of recommendations for more robust evidence‐based interventions. Last, the authors explore the gaps in policy that lead to a dearth in service provision as well the barriers which people with learning disabilities face on entering treatment services. The paper cites four innovative projects that address this population's needs in England, and illustrates how Northern Ireland has positioned the needs of this hidden population within the Department of Health, Social Services and Public Safety (Northern Ireland).

After discovering that the Advisory Council on the Misuse of Drugs, in their 38 years of public service, had not sought, nor been provided, independent legal advice regarding the breadth and scope of their statutory remit under the Misuse of Drugs Act 1971 (HM Government, 1971), Casey Hardison wrote the following letter to the Council chair addressing this failure.

The concept of “buy now pay later” leads Malaysian Generation Y (Gen Y) to excessively use their credit cards for spending. To gauge the extent of this worrisome scenario, the purpose of this paper is to attempt to investigate the factors, including credit attitudes, knowledge on credit card, materialism, social norm and self-efficacy, that influence credit card misuse amongst Gen Y in Malaysia.

The authors have collected responses from a total of 501 respondents in two urban areas in Malaysia and estimated six multiple regression models to test five hypotheses.

The results suggest that credit card knowledge and self-efficacy are negatively related to credit card misuse amongst Gen Y in Malaysia. In contrast, positive relationships were found to exist between credit card attitudes, materialism and social norm and the dependent variable.

In this study, the authors limit the data collection to the two biggest urban areas in Malaysia, namely, Klang Valley and Ipoh.

For the regulator’s perspective, the results can be used to understand the alarming indebtedness behaviour amongst working members of Gen Y and outline appropriate and effective policies to reduce their serious indebtedness. Financial service providers, however, can collaborate with regulators to curb credit card misuse amongst Gen Y, so that the latter can avoid high bad debt from line of credit facilities and bankruptcy.

The study’s findings will further enrich the existing literature on the factors affecting the credit card misuse, especially for the unique Gen Y cohort in Malaysia.

Alcohol misuse leads to a massive drain upon an already stretched NHS budget. High numbers of individuals with alcohol related physical and health needs are being admitted into the secondary health care setting at great financial cost. This paper examines a profile of this population presenting to the secondary care setting over a 12‐month period. It is suggested that the misuse of alcohol does not take place in isolation. It is often accompanied by other problematic behaviours such as domestic violence, inappropriate, neglectful parenting, or child abuse, offending behaviour, and psychological problems. Evidence for the nature and extent of these associated behaviours is reported and discussed. Comparisons are made particularly with data related to tobacco smoking, and the positive aspects of smoking cessation programmes are outlined. Almost all of the population reported on over the 12‐month period were tobacco smokers. The re‐emergence of the incidence of smoking with the reduction of smoking cessation programmes is noted. The challenge for substance misuse services is how best to respond to the needs of this growing population who often present withalcohol misuse together with smoking behaviours. A collaborative model of response is outlined and suggested as the best way forward. This involves substance misuse services working together with professional colleagues within the acute hospital environment and community to ensure sustainable positive clinical outcomes following hospital discharge.

This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings.

In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model.

These changes were:

• Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients.

• To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services.

• Introduction of substance misuse workers as team members on acute mental health and rehab wards.

• Group Substance Misuse programmes.

Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances.

Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

Noting that a fundamental tenet of service‐dominant (S‐D) logic is the co‐creation of value‐in‐use, this paper aims to explore the theoretical possibility that the interactions between service systems cannot only co‐create value, but also have adverse consequences leading to actual value co‐destruction.

This conceptual paper critically reviews the dominance of value co‐creation and value‐in‐use in S‐D logic. Noting the relative lack of research in the converse possibility, the study proposes and explores the implications of value co‐destruction as a new concept which should be introduced within the framework of S‐D logic.

The study proposes a formal definition for the new proposed concept of value co‐destruction. It describes in detail the process by which it occurs, showing that value can be co‐destroyed through the interactions between different systems, resulting in value destruction‐through‐misuse. Indeed, value co‐destruction occurs when a service system accidentally or intentionally misuses resources (its own resources and/or those of another service system) by acting in an inappropriate or unexpected manner.

This paper is purely conceptual and exploratory. Empirical examination of the theoretical findings regarding value‐co‐destruction is required. Possible avenues of interest for such empirical research of value co‐destruction are suggested.

Limiting the occurrence of misuse by aligning the mutual expectations of interacting service systems should reduce the risks of value co‐destruction. Recovering from misuse should also be considered.

This study is apparently the first to have introduced the notion of value co‐destruction into the conceptual framework of S‐D logic.