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Article

Henrike Dirks, Lisa Francke, Verena Würz, Constance Kretschmann, Sonja Dehghan-Sanij and Norbert Scherbaum

Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities related to prenatal alcohol exposure. FASD is a life-long lasting condition with various…

Abstract

Purpose

Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities related to prenatal alcohol exposure. FASD is a life-long lasting condition with various neurocognitive impairments and deficits in daily-life functioning. Research also indicates that FASD patients have an increased prevalence for substance use, substance related disorders and other psychiatric disorders. In Germany, data on adult FASD patients and their mental health are rare. The purpose of this paper is to describe substance use and comorbid psychiatric disorders (in addition to FASD) and suicide attempts in adult FASD patients.

Design/methodology/approach

The German version of the structured “Mini International Neuropsychiatric Interview (MINI)” was administered to a convenience sample of patients attending a specialized FASD diagnostic service at a German university hospital to assess psychiatric disorders. Current and lifetime substance use were examined using sections from the German version of the “European Addiction Severity Index (EUROP-ASI-R)” interview.

Findings

In total, 31 adults with FASD were included. Two patients were diagnosed with a substance related disorder, one for alcohol and one for cannabis. Nearly half of all patients fulfilled the diagnostic criteria for mild mental retardation, a further 16 per cent fulfilled the criteria for another current comorbid psychiatric disorder. In total, 26 per cent reported at least one suicide attempt.

Originality/value

Given that the body of research literature on FASD in adulthood is sparse, even a clinical sample of thirty individuals expands knowledge on mental health and substance use in the adult FASD population. The sample was comprehensively assessed using validated structured interviews on mental health, substance use and FASD.

Details

Advances in Dual Diagnosis, vol. 12 no. 1/2
Type: Research Article
ISSN: 1757-0972

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Article

Alice Bennett and Melanie Hunter

This paper aims to describe: the need for substance misuse treatment with high risk, personality disordered prisoners, and the implementation of two evidence-based…

Abstract

Purpose

This paper aims to describe: the need for substance misuse treatment with high risk, personality disordered prisoners, and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options.

Design/methodology/approach

In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and ‘InsideOut’ interventions are presented. These interventions adopt a risk reduction and health intervention approach respectively. This includes explanations of how they came to be implemented within a prison based personality disorder treatment service and potential ways to evaluate these services.

Findings

Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery.

Practical implications

The high levels of co-morbidity between personality disorder and substance misuse disorders in the high security prison estate highlights the need for substance related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered.

Originality/value

This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

Details

Advances in Dual Diagnosis, vol. 9 no. 2/3
Type: Research Article
ISSN: 1757-0972

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Article

Madeline Naegle

With expanded technologic and communication resources there is growing awareness worldwide of the public health problems caused by alcohol, tobacco, and other drug use…

Abstract

With expanded technologic and communication resources there is growing awareness worldwide of the public health problems caused by alcohol, tobacco, and other drug use, misuse, abuse and addiction. Trends vary by culture and region but use of tobacco and alcohol is almost universal and is associated with high rates of mortality and morbidity. While nurses have not universally embraced the prevention and treatment of substance‐related disorders as their province, this is changing as a function of organisations, World Health Organization (WHO) and national initiatives, and the strengthening of nurse education. Actions to promote consensus, identify and review competencies for nurses must consider national and cultural variations, traditions of social change and the need for evidence‐based practice. Collective action by nurses in newly formed and existing organisations, which focus on addictions prevention and treatment, have resulted in initial professional steps. Such progress can be facilitated if achieved in the context of larger international policies and initiatives and in collaboration with members of other professional disciplines.

Details

Drugs and Alcohol Today, vol. 2 no. 3
Type: Research Article
ISSN: 1745-9265

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Article

Etienne Maffli and Mariana Astudillo

The purpose of this paper is to estimate the share of multiple substance disorders among clients entering treatment for substance-related problems, to identify the most…

Abstract

Purpose

The purpose of this paper is to estimate the share of multiple substance disorders among clients entering treatment for substance-related problems, to identify the most frequent combinations of the substances involved and to investigate the profiles of the clients involved.

Design/methodology/approach

Data were taken from the Swiss treatment monitoring system act-info applied among inpatient and outpatient facilities (reporting years 2013–2015). All cases with information on multiple substance disorders, according to a definition close to the diagnosis F19 from the ICD-10 classification of disease were included. The measurements comprised designated primary substance, existing multiple substance use disorder, substances involved and basic socio-demographics.

Findings

From 10,009 clients included in the study, 1,653 (16.5 per cent) were reported as having multiple substance use disorders. A great variety of substance combinations was identified and alcohol was found in the majority of them.

Practical implications

Treatment strategies targeting accurately substance-related disorders as a whole complex should be promoted. In particular the alcohol-related aspect of the disorder should not be neglected when the focus is on illegal drugs.

Originality/value

Multiple substance use was until recently not sufficiently documented in treatment monitoring systems. A recent version of the European treatment demand indicator (TDI) has introduced the notion of “polydrug use problem” as complementary information to the primary substance, which remains the key variable for reporting treatment demand. This study represents a first attempt to explore systematically this new data.

Details

Drugs and Alcohol Today, vol. 18 no. 3
Type: Research Article
ISSN: 1745-9265

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Article

Rianne Bosch, Farid Chakhssi and Ko Hummelen

Patients with autism spectrum disorder (ASD) are overrepresented in forensic samples. However, research on risk assessment in forensic patients with ASD is scarce. The…

Abstract

Purpose

Patients with autism spectrum disorder (ASD) are overrepresented in forensic samples. However, research on risk assessment in forensic patients with ASD is scarce. The purpose of this paper was to examine the prevalence of short-term inpatient aggression and explore the risk and protective factors for aggression in forensic psychiatric patients with ASD (N = 32).

Design/methodology/approach

The association between two commonly used violence risk assessment instruments (HKT-R and SAPROF) and physical aggression during ten weeks of inpatient stay was examined in a Dutch forensic psychiatric hospital.

Findings

Results showed no significant association between HKT-R and SAPROF and incidents of physical aggression. This suggests that the commonly used assessment instruments may be of limited use for assessing the risk of short-term inpatient aggression in patients with ASD.

Research limitations/implications

Limitations to the current study include the relatively small sample size and the lack of information on index offenses. Further research with a larger, more homogeneous sample and longer follow-up is indicated to confirm the results of this study. Future research should also include the possible association between aggressive behavior of people with ASD and other factors that might be relevant, such as social cognition deficits, cognitive and sensory impairments, deficient empathy and emotion regulation problems.

Originality/value

To the authors’ knowledge, this is the first study to directly examine the prevalence of inpatient aggression of forensic psychiatric patients with ASD and its association with risk and protective factors.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 11 no. 2
Type: Research Article
ISSN: 2050-8824

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Book part

Mark Elam

Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new…

Abstract

Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new understandings of addictions as ‘appetitive disorders’ rather than ‘dependence disorders’ derive from treatment technology development as well as advances in basic scientific research.

Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.

Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.

Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.

Details

Critical Perspectives on Addiction
Type: Book
ISBN: 978-1-78052-930-1

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Book part

Cynthia A. Plotts

Assessment and identification of children with emotional and behavioral disorders (EBD) is complex and involves multiple techniques, levels, and participants. While…

Abstract

Assessment and identification of children with emotional and behavioral disorders (EBD) is complex and involves multiple techniques, levels, and participants. While federal law sets the general parameters for identification in school settings, these criteria are vague and may lead to inconsistencies in selection and interpretation of assessment measures. Assessment practice across school settings is greatly influenced by clinical guidelines such as the DSM-IV, which more specifically defines emotional and behavioral disorders and highlights the issue of co-morbidity. Before a student is assessed for special education eligibility under the IDEIA category of emotional disturbance, screening techniques and pre-referral interventions are needed. Positive Behavioral Supports and Response to Intervention models provide empirically supported frameworks for establishing the need for formal psychological assessment. Collaboration among members of the multidisciplinary team, including parents, helps to ensure that identification and intervention efforts have ecological validity. Tests and techniques vary considerably, but developmental histories, interviews, observations across settings, and behavioral checklists and rating scales are recommended, along with cognitive and achievement testing. While problems exist in the reliability and validity of projective techniques, they continue to be used in school-based assessment for EBD. Multitrait, multisetting, and multimethod approaches are essential for culturally fair assessment and reduction of bias in identification and placement.

Details

Behavioral Disorders: Identification, Assessment, and Instruction of Students with EBD
Type: Book
ISBN: 978-1-78052-504-4

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Abstract

Details

The Broad Autism Phenotype
Type: Book
ISBN: 978-1-78441-657-7

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Article

Irene Brackenridge and Catrin Morrissey

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The…

Abstract

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation on aspects of trauma experience and post‐trauma symptoms in the current population. File information and self‐reports indicated that most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma‐related symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was limited information about the events themselves, and there was no information to suggest that any trauma‐specific assessments had been used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma‐specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and abuse by conducting routine structured assessments, offering adapted evidence‐based psychological interventions where appropriate, and providing trauma‐specific education for staff to promote a compassionate approach.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 4 no. 3
Type: Research Article
ISSN: 2044-1282

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Article

Grace Trundle, Leam A. Craig and Ian Stringer

The purpose of this paper is to explore the different clinical features of pathological demand avoidance (PDA) and antisocial personality disorder (ASPD) presented in the…

Abstract

Purpose

The purpose of this paper is to explore the different clinical features of pathological demand avoidance (PDA) and antisocial personality disorder (ASPD) presented in the form of a single case study. The study highlights the potential of misdiagnosis and conceptual confusions to practitioners in forensic settings between the two conditions when working with offenders with personality disorders.

Design/methodology/approach

A case formulation using the “five Ps” method based on the personal history of an incarcerated male is presented and the clinical similarities and differences between PDA and ASPD are delineated. These differences and similarities are evaluated and applied to offender management including intervention options.

Findings

There are considerable similarities between ASPD and PDA making the two conditions difficult to separate. Both diagnostic criteria identify childhood behavioural problems, aggression, destructiveness, conduct disorder (CD), manipulation and non-compliance as indications of the disorder. For example, the criteria for later adult ASPD are the presence of childhood antisocial behaviour and CD. However, these behaviours may also be suggestive of the attention deficit hyperactivity disorder and non-compliance that are part of PDA. Violent behaviours and aggression can also be perceived in a similar way. Misdiagnosis of PDA as ASPD reduces the efficiency of treatment programmes.

Originality/value

The implications of these findings could prove useful in the successful risk management of offenders with PDA. Given the similar behavioural characteristics between PDA and ASPD, the prevalence of PDA among offenders may be higher than observed. The aim of this study is to raise awareness of potential conceptual complications and clinical confusions between the two conditions with a view to aid offender management through case formulation. A large scale study into offenders with PDA would draw attention to the prevalence of the condition as well as its association with offending behaviour.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 8 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

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