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1 – 10 of over 2000This paper considers parents who misuse substances. The potential impacts of their substance misuse on their ability to parent effectively and safely (parenting capacity) are…
Abstract
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.
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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 psychological…
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.
Margaret Richards, Mike Doyle and Peter Cook
Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services…
Abstract
Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services for this patient group. Substance use that has been a feature of the index offence must be taken into account as much as psychosis or the offending behaviour. Treatment of dual diagnosis relies heavily on cognitive‐behavioural therapies. Relapse in either psychosis or substance use increases risk and re‐admission rates to medium security. This paper reviews the literature on family interventions in dual diagnosis and its applicability to forensic mental health inpatient services. As there appeared to be limited direct evidence, various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.
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Jeremy Sandbrook, Tom Clark and Karen Amanda Cocksedge
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Practical implications
This study provides an up-to-date overview of the provision of treatment for substance misuse within MSUs.
Originality/value
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.
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Margaret Richards, Mike Doyle and Peter Cook
With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al…
Abstract
With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al, 2009), detailing their literature review on family interventions in dual diagnosis and with reference to forensic mental health care. There appeared to be limited direct evidence, therefore various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.
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Hannah Sophia Holland and Anna Tickle
This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD…
Abstract
Purpose
This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.
Design/methodology/approach
Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.
Findings
Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.
Research limitations/implications
This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.
Practical implications
Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.
Originality/value
Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.
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Linda Bell, Rachel Herring and Fizz Annand
The purpose of this paper is to review the following research questions from the available literature: What evidence is there to suggest that substance misuse specifically by…
Abstract
Purpose
The purpose of this paper is to review the following research questions from the available literature: What evidence is there to suggest that substance misuse specifically by fathers (including alcohol and other drugs) causes wider harms, including child welfare concerns? substance misuse, recovery, parents, fathers, fathering, drugs/ alcohol services. How do professionals respond specifically to substance misuse by fathers? Do interventions aimed at parental substance misuse (particularly in the UK) include both mothers and fathers and if so how?
Design/methodology/approach
A scoping literature review was conducted which identified 34 papers (including scoping reviews published in 2006 and 2008, covering the period 1990-2005) and 26 additional studies published between 2002 and 2020.
Findings
The review in this paper is organised into six themes: Negative impact of men’s substance misuse problems on their parenting behaviours; quality of the relationship between parents affected by substance misuse of the fathers, in turn affecting the parenting behaviour and outcomes for children; importance to fathers of their fathering role (for example, as a financial provider); difficulties fathers may face in developing their fathering role; sidelining of the fathering role in substance misuse services; and professionals tending to focus on the mother’s role in parenting inventions and services.
Originality/value
This paper focusses on fathers and substance misuse, which is an under-researched field within the wider contexts of fathering research and research into parental substance misuse.
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Rob Hill, Megan Underhill, Katherine Atnas and Jenny Harris
In this paper, we explore the role that psychology can play in enhancing dual diagnosis provision in substance misuse wards. In order to understand what can be achieved, we will…
Abstract
In this paper, we explore the role that psychology can play in enhancing dual diagnosis provision in substance misuse wards. In order to understand what can be achieved, we will review: the nature of the client group presenting to substance misuse wards; the role and function of such wards; the role of clinical psychology within these wards; and specific issues relating to inpatient substance misuse treatment. We conclude by identifying some key elements that we believe can enhance effective dual diagnosis working within inpatient substance misuse services.
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Rossi Owen, Paul Hughes, Catherine Baker and Laurence Chesterman
Individuals diagnosed with severe mental illness have higher rates of alcohol and substance misuse than the general population. This can present the client and the care team with…
Abstract
Individuals diagnosed with severe mental illness have higher rates of alcohol and substance misuse than the general population. This can present the client and the care team with a variety of issues around physical and psychological well‐being, as well as social and occupational functioning. In forensic psychiatry, the effect of comorbid substance misuse on offending behaviour is particularly pertinent. There have, however, been few studies examining the treatment of alcohol and substance misuse within this particular patient group.At a regional secure unit in North Wales, a group for inpatients was set up to provide education on alcohol and substance misuse over a course of six informal meetings, and to then evaluate participants' attitudes towards substance misuse. Of the six participants, five reported that their knowledge of substances had increased, and that they had no intention to use drugs again after discharge. Staff and client participants also suggested useful future topics for the group.
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