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The purpose of this paper is to examine pre- to post-change in two components of implicit cognitive functioning following craving induction – attentional bias (AB) and executive control – of patients in a long-term drug-free residential treatment center that incorporated dialectical behavioral therapy (DBT) with usual therapeutic community (TC) practices.

Three groups of alcohol and cannabis dependent female adolescents were compared: pre-treatment (n=12), following four months of treatment (n=11), and following 12 months of treatment (n=7).

The results indicate significantly lower AB (as measured by visual probe task) and improved response inhibition (as measured by stop signal task) under craving conditions, after 12 months of DBT.

Naturalistic character of the study did not allow the use of repeated measures design, drug using control groups, randomized clinical trial, or performing a longitudinal follow-up. However, the findings show that DBT for drug abusing female adolescents in a long-term residential setting may be an effective intervention to enhance cognitive and executive functions critical to the risk chain involved in relapse and recidivism, supporting the implementation of DBT in TC residential settings.

This is the first research paper that examined effects of DBT+TC on substance dependent female adolescents’ cognitive mechanisms using well-validated behavioral tasks. The research provides some empirical evidence for the improvement in AB and response inhibition under craving conditions following treatment.

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.

Research has shown mindfulness-based therapies to be an effective therapeutic intervention for a wide range of illnesses and disorders. However, little is known about how it may be helpful to individuals with addiction problems. The purpose of this paper is to evaluate by qualitative approach the impact of the newly introduced mindfulness-based relapse prevention programme (MBRP) programme on the TC to which it was introduced and to explore clients perception of and attitude to the programme. More specifically it aimed to examine how it may be helpful for individuals with substance abuse problems.

A qualitative approach was drew upon using both focus group methods and individual semi-structured interviews with clients of the TC to which it was introduced. Thematic analysis was performed on data collected.

Notwithstanding implementation issues, findings suggest MBRP to be a valuable and worthwhile programme with real perceived benefits.

Clients’ detoxing cited real perceived gains as a result of participating which has clear implications for a TC which offers methadone detoxification.

It is noted that MBRP research is in its infancy, and whilst a number of quantitative studies have been carried out, little qualitative research exists. If MBRP is to be considered an effective relapse prevention strategy, research must clarify the process underlying participant’s use of mindfulness in a drug-free setting.

The purpose of this paper is to present the first of two articles about substance abuse as a human disorder that defies resolution, with the primary care physician the intended audience.

The paper is about the phenomenon of relapse as an extension of the formation of the underlying addictive‐oriented thinking. Both relapse and acceptance are about the “why” of substance abuse and not the “what.”

According to the Substance Abuse and Mental Health Services Administration, the number of US adults who were classified as having substance dependence or abuse in 2008 based on criteria specified in the DSM‐IV was 22.2 million. Subtract on a mutually exclusive basis the 1.2 million who participate in Alcoholics Anonymous (AA) and the 1.7 million persons who are in some configuration of institutional therapy and this leaves 19.3 million persons as a potential pool of need.

Focusing on the primary care physician is no more trivial than the two topics to be discussed.

The potential pool of need in the USA is much larger than the 19.3 million persons on the strength of what is implied by the to‐be‐developed views of relapse and acceptance as the “why” of substance abuse, as a subset of addictive‐oriented thinking.

While the paper is in line with the World Health Organization's position that substance abuse is the most serious health problem globally, the advocated approach to the resolution of addiction is the efficiency of the relationship between the primary care physician and the patient.

Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project.

Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings.

Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program.

As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits.

Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term “healing” benefits.

Prisoners with substance use disorder (SUD) are at risk of mental health problems. Given the common co-occurring of psychopathic traits with SUDs, probably because of underlying impulsive traits (Ellingson et al., 2018), this study aims to examine the relation between psychopathy (impulsive antisociality and fearless dominance) and the functioning of incarcerated individuals with SUD. The authors investigated whether impulsivity (motor, nonplanning and attentional) can account for the relationship between one psychopathy facet (impulsive antisociality) and craving and mental health problems.

The authors assessed self-reported impulsivity, psychopathy, craving and mental health problems in 121 male incarcerated individuals with SUD and calculated cross-sectional linear regression analyses and mediation models.

Impulsive antisociality was positively related to all impulsivity facets, craving and mental health problems. Attentional impulsivity mediated the relationship of impulsive antisociality with craving and mental health problems. Fearless dominance was related to lower attentional and nonplanning impulsivity, craving and mental health problems.

Future studies should investigate these relations in longitudinal studies and evaluate tailored approaches, for example, mindfulness interventions.

Interventions to reduce craving and improve mental health might be important for those who display self-centered, antisocial behavior but are less relevant for those with fearless, dominant interpersonal behavior. Addressing attentional impulsivity may be of special interest in this regard.

To the best of the authors’ knowledge, this study was the first to investigate the mediating role of different impulsivity facets for the association of impulsive antisociality with craving and with mental health problems in incarcerated individuals with SUD.

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes.

All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes.

It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life.

This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.

This paper aims to explore the influence of four types of imagery stimuli (i.e. visual, olfactory, gustatory and auditory) on food craving intensity based on the Elaborated Intrusion theory and the central role of mental imagery in the food craving experience. The roles of overall perception of sensory imagery attributes and perceived availability in moderating this process were also tested. The aim is to extract the positive aspects of food cravings by increasing them and shifting them toward healthy foods.

In an online experiment, 314 participants were randomly primed with each imagery condition. After being exposed to either healthy or unhealthy food pictures, participants completed a questionnaire measuring their craving state, trait food craving, imaging ability, BMI, dietary restraint, hunger and mood. At the end, the impact of food craving intensity on marketing outcomes (i.e. willingness to pay, price sensitivity and food intake) were tested.

As predicted, visual imagery was found to be the strongest stimulus inducing food craving followed by olfactory, gustatory and auditory stimuli. Furthermore, the results indicate that perceived availability of food is the only important variable moderating this process. Additionally, the results show that hunger makes consumers more susceptible to food cravings than mood. Moreover, food craving intensity showed significant impact on the two marketing outcomes: willingness to pay and food intake.

First, the authors used a cheeseburger as unhealthy food and salad as healthy food, future studies can increase the generalizability of the findings by using other types of food. Second, physiological and psychological disorders should be considered and studied as influential factors on food cravings in future studies. Third, future studies should include some behavioral measures besides the analysis of state and trait craving. Fourth, although the main objective of this study was to compare the effect of different imagery stimuli on consumers’ food craving, there was no control (no-stimulus) condition.

Marketing strategists may benefit from the fact that encouraging consumers to visualize some specific type of food product along with informing them about its availability will elevate their craving for that food product. Hence, using this strategy in shopping environments could be beneficial. In the context of improving people’s diet, our results showed that encouraging people to visualize healthy foods (e.g. fruits and vegetables) might be more helpful than priming them with the benefits of eating healthy.

There has been a recent enthusiastic interest in identifying the role of food related mental imagery and stimuli in consumers’ decision making and their final consumption (Christian et al., 2016). Nevertheless, very few studies in marketing have paid attention to these underpinning stimuli driving food craving and the significant influence of this food craving phenomenon on marketing outcomes.

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.

The treatment of substance use amongst mentally disordered offenders (MDOs) remains a challenge for secure forensic mental health services. The purpose of this paper is to present an integrated three-stage substance use treatment programme (SUTP) for male and female MDO’s in medium security.

In total, 45 (72.6 per cent) MDO’s were referred (39 males/6 females). Standardised outcome measures were administered pre-SUTP, post-SUTP and at one year follow-up. Abstinence rates and location was determined via case notes at three year follow-up.

All MDO’s had a past history of substance use, approximately three-quarters reporting problematic use prior to admission. Over half completed all three SUTP stages, less than 5 per cent dropping out during active treatment. The SUTP supported abstinence throughout the one year follow-up period and significantly improved MDO’s adaptive beliefs about substances and craving by one year follow-up amongst attendees. At three years, most MDO’s were in the community and almost three-quarters were abstinent. There was no significant difference in abstinent rates between community and hospital. There was a non-significant trend suggesting SUTP attendance supported abstinence. Both male and female participants appear to have benefited from treatment and satisfaction was high, reflecting the specific aims and objectives of treatment.

The small non-randomised sample from one area limits the generalisability of findings and statistical power.

Findings indicate further support for the limited evidence base that small but clinically meaningful and maintained changes to problematic substance use are possible following integrated substance use treatment for male and female MDO’s.