Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Intervening early to reduce developmentally harmful substance use among youth populations

Early-onset or frequent substance use during adolescence increases the risk of developing mental health problems, as well as a range of other adverse outcomes (eg, alcohol or drug dependence, educational underachievement, health problems, social difficulties) during late adolescence and early adulthood.

Increases in rates of risky drinking among young people are particularly concerning, suggesting that an effective, evidence-based alcohol policy and preventive framework needs to be developed.

Restricting the supply of licit and illicit substances to adolescents, delaying the age that licit substances can be legally purchased, reducing positive media portrayals of substance use, and banning targeted promotions, should be universal, public prevention priorities.

Mass-media campaigns need to deliver coherent and credible evidence-based messages to young people, utilising a broad array of dissemination strategies.

Clear policy and guidelines for parents regarding appropriate alcohol use for adolescents also need to be developed.

Prevention programs should target children and adolescents in families with parents who use drugs, young people who have been suspended from school, or those with mental health problems.

Preventive screening and targeted brief interventions can be effectively delivered in a variety of settings by a range of health professionals.

Mental health promotion and socio-economic disadvantage: lessons from substance abuse, violence and crime prevention and child health

Issue addressed: Mental health promotion aimed at populations with low socio-economic status (SES) may benefit by investigating prevention strategies that effectively address related child and adolescent problems.
Methods: Evidence from a number of literature reviews and program evaluations was synthesised. First, the impact of SES on development from childhood to adulthood is considered in light of research on substance
abuse, violence, crime, and child development problems. Second, evaluations of interventions are reviewed to identify those that have shown outcomes in research studies (efficacy) or in real-world settings (effectiveness) in reducing developmental problems associated with low SES. Low SES is measured in different ways including low levels of education and/or income or definitions that combine several variables into a new indicator of low SES.
Results: Factors associated with low SES are also associated to varying extent with the development of violence and crime, substance abuse and child health problems. Interventions that address underlying determinants of low SES show strong efficacy in decreasing adolescent crime and violence and effectiveness in improving child health outcomes. Although there is limited efficacy evidence that substance abuse prevention can be effectively addressed by targeting low SES, programs designed to improve educational pathways show some efficacy in reducing aspects of adolescent substance use.
Conclusion: Mental health promotion strategies can draw on the approaches outlined here that are associated with the prevention of child and adolescent problems within low SES communities. Alternatively, such interventions could be supported in mental health promotion policy as they may assist in preventing related problems that undermine mental health.

Individual, family, school, and community risk and protective factors for depressive symptoms in adolescents : a comparison of risk profiles for substance use and depressive symptoms

This study examines the relationship between adolescent depressive symptoms and risk and protective factors identified for substance use. A questionnaire, developed to measure these factors in a young persons community, family, school, peer group, and individual characteristics for substance use, was used to assess associations with self-reported depressive symptoms. Data were provided by a representative sample of 8984 secondary school students in Victoria, Australia. The prevalence of depressive symptoms was 10.5% (95% CI 9.2,12.0) for males and 21.7% (95% CI 20.3,23.7) for females. Depressive symptoms were associated with factors in all domains, with the strongest associations in the family domain. Strong relationships were found between the number of elevated risk and protective factors and depressive symptoms, maintained after adjusting for substance use. Patterns of associations were similar for users and nonsubstance users. The findings indicate that prevention programs targeting factors for substance use have the potential to impact on depression.

A cross-national comparison of risk and protective factors for adolescent substance use : the United States and Australia

Purpose
To compare risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused polices.

Methods
Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861; 53% female, 7% Non-white) and Oregon (N = 15,542; 51% female, 24% Non-white) in the United States and Victoria in Australia (N = 8442; 54% Female, 11% Non-white) in 1998 (Maine and Oregon) and 1999 (Victoria). Chi-square tests, t-tests, effect size comparisons, and logistic regression analyses that accounted for age and gender were used to investigate cross-national similarities and differences in: (a) rates of cigarette, alcohol, and marijuana use; (b) levels of risk and protective factors; and (c) magnitudes of associations between risk and protective factors and substance use.

Results
More adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. However, adolescents in Maine and Oregon perceived handguns to be more readily available, reported more participation in religious activities, and were higher in sensation-seeking and social skills; and adolescents in Victoria had more favorable attitudes toward drug use and reported community norms and parental attitudes more favorable to drug use. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use.

Conclusions
Inter-country influences on youth substance use are generally similar despite different policy directions. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use.

The BEST plus approach to assisting families recover from youth substance problems

The Best plus program is a whole-of-family therapy option for families to address not only youth substance abuse issues, but also challenging and antisocial adolescent behaviours. It uses an evidence-based strategy that can be implemented widely in the community, and is proving to be a popular and relevant framework for professionals to engage and assist families in reducing adolescent problem behaviours. Evaluations indicate that the program is an effective forum for parents and siblings of adolescent drug abusers to redevelop positive family environments that encourage responsible behaviour and recovery from drug abuse.

Change for the BEST: family changes for parents coping with youth substance abuse

This paper reports family changes for participants in a program for parents coping with youth substance abuse. The Behavioural Exchange Systems Training (BEST) program is a professionally-led, parent training intervention. During 1996 and 1997, six groups of parents participated in the program. High levels of depression were observed at intake and symptoms demonstrated a stable reduction in association with exposure to the program. Parents tended to achieve success in developing common strategies for assertively managing family problems, though couples from more complex blended families found this more difficult. Adolescent improvements were noted during the weeks observed. A two year follow up conducted with a subset of families revealed that parents continued to report that the intervention had helped them cope with youth drug abuse.

A review of school drug policies and their impact on youth substance use

Youth substance use is an important social and health problem in the United States, Australia and other Western nations. Schools are recognized as important sites for prevention efforts and school substance use policies are a key component of health promotion in schools. The first part of this paper reviews the known status of school policies on tobacco, alcohol and other illicit drugs in a number of Western countries and the existing evidence for the effectiveness of school drug policy in preventing drug use. The review shows that most schools in developed countries have substance use policies but that there is substantial variation in the comprehensiveness of these policies (i.e. the breadth of people, places and times of day that are explicitly subject to policy prohibitions), and the orientation of their enforcement (e.g. punitive versus remedial), both across and within schools. The few studies of policy impact focus solely on tobacco policy and provide preliminary evidence that more comprehensive and strictly enforced school policies are associated with less smoking. The second part of the paper introduces the International Youth Development Study, a new longitudinal research project aimed at comparing school policies and the developmental course of youth drug use in the United States, where drug policies are abstinence-based, with Australia, which has adopted a harm minimization approach to drug policy

Risk and protection factors for different intensities of adolescent substance use: when does the prevention paradox apply?

The 'Prevention Paradox' applies when low-risk individuals in a population contribute the most cases of a condition or problem behaviour by virtue of their being in the majority, thereby recommending a universal or whole of population approach to prevention. The applicability of a universal as opposed to a targeted high-risk approach to the prevention of youth substance use was examined in two studies of children and adolescents conducted in Victoria, Australia. These studies were reanalysed by recombining developmental, social and individual measures to form cumulative risk indices for substance use. In Study 1, a cross-sectional survey of students, most regular tobacco, alcohol and cannabis use by 15/16-year-olds occurred in the moderate and low-risk groups, recommending a universal prevention strategy . However, the majority of illicit drug use occurred in the highest-risk group (top 15%). Furthermore, in younger age groups both legal and illegal drug use was concentrated mainly in the highest risk group. Study 2 used data from a major longitudinal study where risk factors at around age 11/12 years were used to predict substance use at age 17/18 years. Most students who admitted involvement in frequent smoking, heavy drinking and, although to a lesser degree, cannabis were classified as low or average risk. It is concluded that universal prevention strategies are needed for late adolescent alcohol, tobacco and cannabis use and more targeted strategies for addressing harm related to early age drug use, frequent cannabis use and illegal drug use. [Stockwell T, Toumbouru JW, Letcher P, Sanson A, Bond L. Risk and protection factors for different intensities of adolescent substance use: when does the prevention paradox apply?

Substance use and its implications for the critical care nurses: a literature review

Background
Illicit drug use in Australia has been increasing and studies indicate that illicit drug users have a higher risk of accidents which may result in the user needing critical care. However, there is a significant gap in the literature specifically pertaining to the implications of drug use in critical care.

Aims
The primary objective was to examine the literature for the physiological effects of methylenedioxymethamphetamine (MDMA), cocaine and amphetamines in critically ill patients.

Methods
A comprehensive literature review was undertaken and a body systems framework was used to categorise the effects of these illicit drugs.

Results
The illicit substances addressed have potentially fatal and long-term side effects. For those users involved in accidents or trauma requiring intensive or critical care nursing, the mortality and co-morbidity risks are increased significantly. It is, therefore, important that nurses are able to recognise the specific physiological effects and possible complications that can occur with the use of each illicit drug.

Conclusion
Both nursing and medical staff need to have a thorough understanding of how illicit substances work and how they can affect the critical care patient and the care they are given.

Including the siblings of youth substance abusers in a parent-focused intervention : a pilot test of the best plus program

Substance use is common among young people and can escalate into significant problems for affected individuals and their families. Family responses can influence the course of youth substance use and its consequences for family members, including parents and siblings. Family-level interventions developed to date have neglected the important role that siblings can play. This article describes a pilot test of an intervention designed to assist parents and siblings affected by youth substance use and related problems. The BEST Plus intervention consisting of professionally-led, multifamily groups sequenced over eight sessions is described with reference to the intended therapeutic processes. Professionally observed and self-reported changes for family participants including siblings suggested that the program had a beneficial therapeutic impact. This evaluation of early impacts suggests the BEST Plus program
offers a promising means of assisting families to respond to substance use problems in young people.

Does family intervention for adolescent substance use impact parental mental health? A systematic review

Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress. Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative’s substance use, and improved social support. The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials.

Family recovery from youth substance use related problems : a pilot study of the BEST plus program

Youth substance use related problems are increasingly common, and families experience considerable stress in attempting to cope with these problems. A pilot study of 34 Australian parents from 21 families (38% sole parent families) participating in an 8-week group program, designed to assist families recover from youth substance use related problems, provided the context to explore family change processes. Participants reported a number of significant improvements over the course of the four groups that ran from late 2003 and through 2004. Regression analyses found general support for the program logic model in identifying significant associations between program-targeted parent changes and post-program improvements in stress symptoms and cohesive family behaviors. The study's limitations are noted.