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Article

Morten Hesse

Assessment of personality disorders in substance abusing patients may produce important insights. Little is known about the value of routine personality disorder…

Abstract

Assessment of personality disorders in substance abusing patients may produce important insights. Little is known about the value of routine personality disorder assessment in a clinical context. Adults with past‐year substance dependence seeking treatment at a centralised intake unit for substance abusers in the City of Copenhagen were randomised to assessment of personality disorders and individual psychoeducation vs. attention placebo (n=75). All patients received psychoeducation for attention deficit hyperactive disorder (ADHD) and anxiety/depression when indicated. Patients were followed at three and six months post‐treatment. The psychoeducation for personality disorder did not result in improved functioning. Significant differences indicated a larger drop in substance use in the experimental group. Assessing personality disorders and providing psychoeducation is a promising treatment in a clinical context. There is a need for relevant treatment options to improve functioning and quality of life for this group of patients.

Details

Drugs and Alcohol Today, vol. 10 no. 1
Type: Research Article
ISSN: 1745-9265

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Article

Dana Murphy‐Parker and Ruby Martinez

Substance abuse and dependence to alcohol, tobacco and other drugs (ATOD) is a universal public health problem extending across all borders, and including all ethnic…

Abstract

Substance abuse and dependence to alcohol, tobacco and other drugs (ATOD) is a universal public health problem extending across all borders, and including all ethnic, cultural, religious and socioeconomic boundaries. It is a condition that the nursing profession worldwide struggles to better understan. At the global level, differences in beliefs and practices regarding ATOD have resulted in a wide variation of how these problems are handled and treated.Examining and comparing those between the US and the UK can illustate an example of the differences in addictions nursing practice. Underlying assumptions of the current alcohol and drug policies in the US have been mainly based on prohibition, criminalisation and a drug‐free society ideology (Nadelmann, 1997) while the UK policies have been based on the belief of ‘harm reduction’ (Coyne & Clancy, 1996). This paper discusses some of the historical, philosophical and cultural differences between the US and the UK that have led to the respective differences in societal attitudes and treatment practices for substance abuse or ‘substance misuse’ within these two separate societies.

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Drugs and Alcohol Today, vol. 1 no. 1
Type: Research Article
ISSN: 1745-9265

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Article

Albert M. Kopak

Recent political commentary in the USA has suggested that there is great potential for current criminal justice practices designed for drug-involved offenders to be…

Abstract

Purpose

Recent political commentary in the USA has suggested that there is great potential for current criminal justice practices designed for drug-involved offenders to be significantly overhauled in the near future. It is imperative to plan for these changes by assessing how well current programs serve drug-involved criminal justice populations. The paper aims to discuss these issues.

Design/methodology/approach

This critical assessment begins with an overview of the most recent research on the prevalence and impact that substance use disorders have within the criminal justice system. Although the evidence demonstrates that relying on incarceration as a crime control method for drug-involved offenders has many shortcomings, there are innovative new programs being adopted across the country. Two of these promising programs are discussed, as well as the potential results that could be realized from integrating medication assisted treatment into appropriate criminal justice programs designed for drug-involved offenders.

Findings

Incarceration is a failed practice for attending to the underlying reasons why many drug-involved offenders become involved in criminal activities. There are encouraging new programs emerging in different parts of the USA, but the inclusion of supplemental treatment options could further promote positive outcomes.

Originality/value

The impending expansion of criminal justice programs for drug-involved offenders must consider how innovative new programs can be fused with supplemental treatment options to achieve the best results.

Details

International Journal of Prisoner Health, vol. 11 no. 1
Type: Research Article
ISSN: 1744-9200

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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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Article

Yasmina Frem, Marta Torrens, Antonia Domingo-Salvany and Gail Gilchrist

The purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and…

Abstract

Purpose

The purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and determine factors associated with non-SUD psychiatric disorders independently for males and for females.

Design/methodology/approach

Secondary analysis of five cross-sectional studies conducted in Barcelona, Spain during 2000-2006. Lifetime DSM-IV substance use and non-SUD psychiatric diagnoses were assessed using the Spanish Psychiatric Research Interview for Substance and Mental disorders (PRISM) among 629 people who use substances (68 per cent male) recruited from treatment (n=304) and out of treatment (n=325) settings. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using binary logistic regression.

Findings

The prevalence of any lifetime psychiatric (non-SUD) disorder was 41.8 per cent, with major depression (17 per cent) and antisocial personality disorder (17 per cent) being the most prevalent disorders. After adjusting for age and study, the odds of having any lifetime non-SUD (OR 2.10; 95%CI 1.48, 2.96); any mood disorder (OR 2.13; 95%CI 1.46, 3.11); any anxiety disorder (OR 1.86; 95%CI 1.19; 2.92); any eating disorder (OR 3.09; 95%CI 1.47, 6.47); or borderline personality disorder (OR 2.30; 95%CI 1.36, 3.84) were greater for females than males. Females were less likely than males to meet criteria for antisocial personality disorder (OR 0.59; 95%CI 0.36, 0.96) and attention deficit disorder (OR 0.37; 95%CI 0.17, 0.78).

Research limitations/implications

Psychiatric disorders are common among people who use substances, with gender differences reported for specific disorders. Gender-sensitive integrated treatment approaches are required to prevent and to address comorbidity psychiatric disorders among this population.

Originality/value

This secondary analysis of five cross-sectional studies included a large sample size allowing sufficient power to examine the differences between men and women. An additional strength of the methodology is the use of the gold standard PRISM which was used to assess disorders.

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Article

Thomas James Parkman and Charlie Lloyd

The purpose of this paper is to explore the theme of dependence on mutual aid identified in a previous paper. It is a theme which to date, has had very little empirical…

Abstract

Purpose

The purpose of this paper is to explore the theme of dependence on mutual aid identified in a previous paper. It is a theme which to date, has had very little empirical attention, especially in a UK context.

Design/methodology/approach

A phenomenological approach was adopted. Interviews with service users, mentors and professional staff involved with the Learning to Live Again project were undertaken over a ten-month period of data collection. Thematic analysis was used to analyse the data.

Findings

It was found that service users with very little access to recovery capital or social support are at risk of developing a dependency on mutual aid. Dependence seemed to manifest itself in two different forms – those that over engaged with the project and those that under engaged with the project. Consequently, there were a cohort of service users identified that seemed to strike a balance with the project and their life outside the project that was “just right”. They were referred to as the “Goldilocks group”.

Originality/value

This paper explored a theme which has had very little attention paid to it. The theme of dependence on mutual aid will raise the awareness of such a threat, thus helping to identify those in treatment most at risk of developing dependency on mutual aid, thus detrimentally impacting on mental wellbeing.

Details

Drugs and Alcohol Today, vol. 15 no. 1
Type: Research Article
ISSN: 1745-9265

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Content available
Article

Farrukh Alam, Nat Wright, Paul Roberts, Sunny Dhadley, Joanne Townley and Russell Webster

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in…

Abstract

Purpose

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

Design/methodology/approach

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Findings

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Originality/value

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

Details

International Journal of Prisoner Health, vol. 15 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

Content available
Article

Rebecca Schiff, Bernie Pauly, Shana Hall, Kate Vallance, Andrew Ivsins, Meaghan Brown, Erin Gray, Bonnie Krysowaty and Joshua Evans

Recently, Managed Alcohol Programs (MAPs have emerged as an alcohol harm reduction model for those living with severe alcohol use disorder (AUD) and experiencing…

Abstract

Purpose

Recently, Managed Alcohol Programs (MAPs have emerged as an alcohol harm reduction model for those living with severe alcohol use disorder (AUD) and experiencing homelessness. There is still a lack of clarity about the role of these programs in relation to Housing First (HF) discourse. The authors examine the role of MAPs within a policy environment that has become dominated by a focus on HF approaches to addressing homelessness. This examination includes a focus on Canadian policy contexts where MAPs originated and are still predominately located. The purpose of this paper is to trace the development of MAPs as a novel response to homelessness among people experiencing severe AUD and to describe the place of MAPs within a HF context.

Design/methodology/approach

This conceptual paper outlines the development of discourses related to persons experiencing severe AUD and homelessness, with a focus on HF and MAPs as responses to these challenges. The authors compare the key characteristics of MAPs with “core principles” and values as outlined in various definitions of HF.

Findings

MAPs incorporate many of the core values or principles of HF as outlined in some definitions, although not all. MAPs (and other housing/treatment models) provide critical housing and support services for populations who might not fit well with or who might not prefer HF models.

Originality/value

The “silver bullet” discourse surrounding HF (and harm reduction) can obscure the importance of programs (such as MAPs) that do not fully align with all HF principles and program models. This is despite the fact that MAPs (and other models) provide critical housing and support services for populations who might fall between the cracks of HF models. There is the potential for MAPs to help fill a gap in the application of harm reduction in HF programs. The authors also suggest a need to move beyond HF discourse, to embrace complexity and move toward examining what mixture of different housing and harm reduction supports are needed to provide a complete or comprehensive array of services and supports for people who use substances and are experiencing homelessness.

Details

Housing, Care and Support, vol. 22 no. 4
Type: Research Article
ISSN: 1460-8790

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Article

Victoria Defelippe, Anna Schlütter, Annelen Meriaan, Bjorn Winkens, Veronika Kavenská, Gary Saucedo Rojas and Matteo Politi

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of…

Abstract

Purpose

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy.

Design/methodology/approach

Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ2 analysis and a logistic regression analysis were performed.

Findings

Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre.

Originality/value

It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 40 no. 2
Type: Research Article
ISSN: 0964-1866

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Article

Tom Decorte

Objective. The objective of this study was to examine practices and policies in place for the provision of targeted prevention and treatment of cocaine and Amphetamine…

Abstract

Objective. The objective of this study was to examine practices and policies in place for the provision of targeted prevention and treatment of cocaine and Amphetamine Type Stimulant (ATS) users in prison in nine European countries. Methodology. Across nine European member states (Belgium, the Netherlands, Czech Republic, Lithuania, Slovenia, Sweden, Malta, Ireland and Portugal), interviews were conducted with ministerial representatives and professionals (i.e. service providers and security officials) working in prisons and a total of 16 focus groups with a total of 125 prisoners. Results. The use of stimulants in prison is associated with aggression and violence, financial problems, and psychological and physical problems in prisoners (depression, anxiety and psychological craving). Both security and healthcare staff in prison often feel ill‐equipped to deal with stimulant‐related problems, leading to a lack of equivalence of care for stimulant users in prison, therefore the variety and quality of drug services outside is not reflected sufficiently inside prison. There is a need for more specific product information and harm reduction material on stimulants, for clear guidelines for the management of acute stimulant intoxication and stimulant withdrawal, for structural adjustments to improve potential diagnosis of personality and psychiatric disorders, for more non‐pharmacological treatment strategies and more opportunities for prisoners to engage in purposeful activities.

Details

International Journal of Prisoner Health, vol. 3 no. 1
Type: Research Article
ISSN: 1744-9200

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