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Article

Jeff Fernandez

The purpose of this paper is to illustrate how local drug services use their senior staff to respond to emerging ethnic groups presenting to treatment using flexible…

Abstract

Purpose

The purpose of this paper is to illustrate how local drug services use their senior staff to respond to emerging ethnic groups presenting to treatment using flexible thinking and innovative processes.

Design/methodology/approach

The methodology was a case study design that used a semi-structured questionnaire that looked at two drug services and their staff’s influence on service delivery in different boroughs of east London.

Findings

The research found very innovative findings from the two boroughs. The boroughs had different racial mixes and therefore differing populations presenting to their local drug services. However, they used flexible approaches to structure their services to engage with emerging ethnic minority populations in drug treatment. From the findings, these different approaches and structures of providing drug treatment were very important. Approaches, for example, of clinical staff offering a “rapid assessment” are particularly important in engaging and retaining ethnic minority populations. Also, using flexible thinking within the staff team enables drug services to adapt treatments to be flexible in responding to emerging ethnic populations.

Practical implications

This paper shows that thinking in designing approaches to drug treatment shows that ethnic minority populations can be successfully engaged in drug treatment. This has implications for drug treatment nationally and across Europe where there are “emerging” ethnic populations presenting for drug treatment.

Originality/value

This paper shows that drug services can adapt and change to their different ethnic minority populations if they can able to be flexible in their clinical approach to service provision.

Details

Drugs and Alcohol Today, vol. 15 no. 2
Type: Research Article
ISSN: 1745-9265

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Article

John Farley, Shawn Vasdev, Benedikt Fischer, Jürgen Rehm and Emma Haydon

Hepatitis C virus (HCV) infection is a major public health concern in Canada, which now mostly affects marginalized populations, including correctional inmates. These…

Abstract

Hepatitis C virus (HCV) infection is a major public health concern in Canada, which now mostly affects marginalized populations, including correctional inmates. These populations ‐ until recently ‐ have largely been excluded from HCV pharmacotherapy. We report preliminary data on HCV treatment in a federal correctional population sample in British Columbia (BC), using Pegetron combination therapy. HCV RNA results are presented at week 12 of treatment, a strong predictor of treatment outcome. Just over four‐fifths (80.8%) of inmate patients had no detectable HCV RNA at week 12; inmates with genotype 2 and 3 fared better than those with genotype 1. These preliminary results suggest that HCV treatment is feasible and promises to be efficacious in correctional populations.

Details

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

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Article

Lynne Magor-Blatch, Navjot Bhullar, Bronwyn Thomson and Einar Thorsteinsson

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment

Abstract

Purpose

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment of substance-use disorders with reference to substance-use, crime, mental health and social engagement outcomes.

Design/methodology/approach

A systematic search with broad inclusion criteria resulted in the review of 11 studies. The studies investigated community-based TCs, as well as TCs modified for prisoners, prisoners transitioning to community living and TCs for individuals with co-occurring substance-use and mental health issues.

Findings

Results were analysed by comparing the findings of the studies under investigation, of which three studies investigated within-subjects outcomes, four compared TC treatment with a no-treatment control condition and four compared TC treatment with another treatment condition. Conclusion: consistent with previous systematic reviews of TCs, outcomes varied across studies but indicated TCs are generally effective as a treatment intervention, with reductions in substance-use and criminal activity, and increased improvement in mental health and social engagement evident in a number of studies reviewed.

Research limitations/implications

Variability in outcomes suggests further TC research and research syntheses focusing on a second key research question in the evaluation of complex interventions – how the intervention works – could play an important role in understanding TC effectiveness, and for whom it is effective and in what contexts.

Practical implications

Although there is some variability in treatment populations included in this review, evidence reported in other studies suggests individuals with severe substance-use disorders, mental health issues, forensic involvement and trauma histories, will benefit from TC treatment. This is supported by the literature which has found a general relationship between severity of substance use and treatment intensity (Darke et al., 2012; De Leon et al., 2008) with outcomes further enhanced by self-selection into treatment and appropriate client-treatment matching (see De Leon, 2010; De Leon et al., 2000, 2008). The weight of evidence gleaned from multiple sources of research, including randomised control trials and field outcome studies (De Leon, 2010) suggests TCs are an important and effective treatment for clients in improving at least some aspects of their quality of life, specifically mental health and social engagement, and in reducing harmful behaviours, including substance-use and crime. Variability in treatment setting and populations reflect the real-world setting in which TC treatment is delivered, providing a multifaceted treatment modality to a complex population in variable circumstances.

Originality/value

The strength of the current study is that it provided a broad evaluation of TC effectiveness across a range of outcomes (substance-use, criminal activity, mental health and social engagement), and is therefore valuable in updating the current literature and providing context for future research in this area. It aimed to address a key question in evaluating complex interventions: whether they are effective as they are delivered. Findings suggest that TC treatment is generally effective for the populations of concern in reducing substance use and criminal activity and contributing to some improvement in mental health and social engagement outcomes.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 4
Type: Research Article
ISSN: 0964-1866

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Book part

Michael Lechner

Lechner and Miquel (2001) approached the causal analysis of sequences of interventions from a potential outcome perspective based on selection-on-observables-type…

Abstract

Lechner and Miquel (2001) approached the causal analysis of sequences of interventions from a potential outcome perspective based on selection-on-observables-type assumptions (sequential conditional independence assumptions). Lechner (2004) proposed matching estimators for this framework. However, many practical issues that might have substantial consequences for the interpretation of the results have not been thoroughly investigated so far. This chapter discusses some of these practical issues. The discussion is related to estimates based on an artificial data set for which the true values of the parameters are known and that shares many features of data that could be used for an empirical dynamic matching analysis.

Details

Modelling and Evaluating Treatment Effects in Econometrics
Type: Book
ISBN: 978-0-7623-1380-8

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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

Raina V. Lamade, Elise Lopez, Mary P. Koss, Robert Prentky and Alexandra Brereton

The purpose of this paper is to summarize the development of a treatment program for students found responsible of sexual misconduct.

Abstract

Purpose

The purpose of this paper is to summarize the development of a treatment program for students found responsible of sexual misconduct.

Design/methodology/approach

This project, supported by the SMART (Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering and Tracking) of the Department of Justice, was requested by The White House toward the end of President Obama’s last term and was intended to identify the confluence of factors related to sexual misconduct on college campuses, and to design a treatment program to address those factors.

Findings

This paper will discuss the unique factors of this population that ought to be considered to successfully develop an effective program, and the complexities of implementing treatment programs to this population, within a higher education system. This will include a discussion of barriers to implementation and challenges of employing treatment. This paper will present steps for implementing a treatment program and outline the core components of a treatment intervention for this population.

Originality/value

Implementing a treatment option for students found responsible of sexual misconduct that specifically targets the associated risk factors as part of a comprehensive approach to help improve campus safety.

Details

Journal of Aggression, Conflict and Peace Research, vol. 10 no. 2
Type: Research Article
ISSN: 1759-6599

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Book part

Matthew E. Archibald

Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse…

Abstract

Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse treatment provision among individuals of varying socioeconomic and racial/ethnic backgrounds. This study investigates that achievement by analyzing the relationship between community socioeconomic and racial/ethnic disadvantage and organizational provision of substance abuse treatment, treatment need and utilization across United States counties, 2000, 2002 and 2003. Results confirm equity in service provision in poorer communities and those with higher concentrations of African Americans. Significant disparities remain, however, in communities with higher concentrations of Hispanics, youth and female-headed households. Limitations and implications for future studies of health care provision are discussed.

Details

Inequalities and Disparities in Health Care and Health: Concerns of Patients, Providers and Insurers
Type: Book
ISBN: 978-0-7623-1474-4

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Article

Sarah Weldon and Gordon Ritchie

Empirical evidence suggests that a complex relationship exists between substance misuse, mental illness and violence in forensic populations. Therefore, effective treatment

Abstract

Empirical evidence suggests that a complex relationship exists between substance misuse, mental illness and violence in forensic populations. Therefore, effective treatment and intervention is essential in order for this population to live a life free from substance use and offending behaviour. This paper discusses the literature related to interventions for dual diagnosis and how this may be related to mentally disordered offenders. The paper also highlights paucities in the literature where further research is needed to inform practice, and concludes with current recommendations for best practice.

Details

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

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Article

Ian Hamilton, Charlie Lloyd, Mark Monaghan and Kirsteen Paton

– The purpose of this paper is to examine recent trends in presentation to treatment where cannabis is identified as the primary drug.

Abstract

Purpose

The purpose of this paper is to examine recent trends in presentation to treatment where cannabis is identified as the primary drug.

Design/methodology/approach

Data is drawn from the recently published Public Health England report and supplemented with Home Office and European data.

Findings

The data shows a marked increase in presentations for cannabis treatment over recent years. The authors offer some potential explanations for this trend.

Research limitations/implications

The authors need to improve our understanding of the type of cannabis that is available and how specifically it is used. In parallel there is a pressing need for an evaluation of evidence in relation to treatment for problematic cannabis users.

Originality/value

This paper highlights this recent trend in treatment presentations, offers some potential explanations and makes associated recommendations.

Details

Drugs and Alcohol Today, vol. 14 no. 3
Type: Research Article
ISSN: 1745-9265

Keywords

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Article

Michael Mokhlis Mina, Lilie Herawati, Tony Butler and Andrew Lloyd

Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in…

Abstract

Purpose

Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in Australian prisons at any one time, with more than 30 per cent testing positive for HCV antibodies. Prisoners have been identified in the National Hepatitis C Strategy as a priority population for assessment and treatment. The purpose of this paper is to examine the rates of HCV testing and treatment, as well as barriers and opportunities for development of infrastructure for enhanced services.

Design/methodology/approach

Interviews were conducted with 55 stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment; and other stakeholders for qualitative information regarding barriers and opportunities.

Findings

Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved.

Originality/value

Many personal and systems-level barriers relevant to the delivery of HCV treatment services in the custodial setting were identified. Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease.

Details

International Journal of Prisoner Health, vol. 12 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

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