Religious/spiritual well-being, coping styles and personality dimensions in people with substance use disorders

Religiosity and spirituality have been found to be negatively associated with a range of addictions. It has been suggested that religious/spiritual well-being might play an important role in the development, course and the recovery from addictive disorders. A sample of addiction in-patients (n=389) was assessed using the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB) and compared with a matched group of non-addicted community controls (n=389). RSWB was found to be substantially lower in people with substance use disorders compared to the normal sample. Discriminate functional analysis showed that Experiences of Sense and Meaning, General Religiosity and Forgiveness were the dimensions of RSWB which strongly distinguished the groups. Within the group of people with substance use disorders, RSWB was strongly positively associated with the personality dimensions of Conscientiousness, Agreeableness and Openness as well as Sense of Coherence and positive Coping styles. The study suggests that therapeutic intervention programs focusing on building a positive and meaningful personal framework, akin to that of a religious/spiritual orientation, may contribute to positive outcomes in addiction treatment.

Introducing mental health and substance use screening into a community-based health service in Australia : usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March–April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Prison substance misuse programs and offender rehabilitation

This article considers the nature of the association between substance misuse and criminal behaviour and how this might inform the development of prison-based substance misuse treatment programs. The literature on what is known about the effectiveness of prison-based treatment is reviewed and the implications for correctional practice considered. It is concluded that prison-based substance misuse treatment should be considered a critical component of rehabilitation programming and that justice outcomes are likely to be improved when a number of program features are incorporated.

Commentary: Ending the ban on recreational substance use in sport: and then what?

 As London 2012 starts to become a distant memory, and Sochi 2014 becomes a near reality, it is timely that Waddington, Christiansen, Gleaves, Hoberman, and Moller (2013) and Henne, Koh, and McDermott (2013) have brought to the fore the inconsistencies within the World Anti-Doping Agency's (WADA's) policies regarding drug use in sport. These inconsistencies are not new; Smith and Stewart (2008) highlighted the inconsistencies and ambiguities of WADA policy, but nothing has changed in this time. Why a substance is placed on the banned list is an important discussion that should be occurring; however, this discussion should not be occurring in the isolation of the sporting world.

A hazardous substance exposure prevention rating method for intervention needs assessment and effectiveness evaluation: the small business exposure index

Aims This paper describes the refinement and adaptation to small business of a previously developed method for systematically prioritizing needs for intervention on hazardous substance exposures in manufacturing worksites, and evaluating intervention effectiveness. Methods We developed a checklist containing six unique sets of yes/no variables organized in a 2 × 3 matrix of exposure potential versus exposure protection at three levels corresponding to a simplified hierarchy of controls: materials, processes, and human interface. Each of the six sets of indicator variables was reduced to a high/moderate/low rating. Ratings from the matrix were then combined to generate an exposure prevention 'Small Business Exposure Index' (SBEI) Summary score for each area. Reflecting the hierarchy of controls, material factors were weighted highest, followed by process, and then human interface. The checklist administered by an industrial hygienist during walk-through inspection (N = 149 manufacturing processes/areas in 25 small to medium-sized manufacturing worksites). One area or process per manufacturing department was assessed and rated. A second hygienist independently assessed 36 areas to evaluate inter-rater reliability. Results The SBEI Summary scores indicated that exposures were well controlled in the majority of areas assessed (58% with rating of 1 or 2 on a 6-point scale), that there was some room for improvement in roughly one-third of areas (31% of areas rated 3 or 4), and that roughly 10% of the areas assessed were urgently in need of intervention (rated as 5 or 6). Inter-rater reliability of EP ratings was good to excellent (e.g., for SBEI Summary scores, weighted kappa = 0.73, 95% CI 0.52–0.93). Conclusion The SBEI exposure prevention rating method is suitable for use in small/medium enterprises, has good discriminatory power and reliability, offers an inexpensive method for intervention needs assessment and effectiveness evaluation, and complements quantitative exposure assessment with an upstream prevention focus.

The role of impulsivity in co-occurring social anxiety and substance misuse

The findings of this thesis suggest that a subset of socially anxious individuals are characterised by a paradoxical symptom profile, including elevated levels of impulsivity and co-occurring substance use problems. These findings enhance knowledge regarding the co-occurrence of social anxiety and substance misuse and may inform prevention and treatment practices.

An examination of a proposed DSM-IV pathological gambling hierarchy in a treatment seeking population: similarities with substance dependence and evidence for three classification systems

Toce-Gerstein et al. (Addiction 98:1661–1672, 2003) investigated the distribution of Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV) pathological gambling criteria endorsement in a U.S. community sample for those people endorsing a least one of the DSM-IV criteria (n = 399). They proposed a hierarchy of gambling disorders where endorsement of 1–2 criteria were deemed ‘At-Risk’, 3–4 ‘Problem gamblers’, 5–7 ‘Low Pathological’, and 8–10 ‘High Pathological’ gamblers. This article examines these claims in a larger Australian treatment seeking population. Data from 4,349 clients attending specialist problem gambling services were assessed for meeting the ten DSM-IV pathological gambling criteria. Results found higher overall criteria endorsement frequencies, three components, a direct relationship between criteria endorsement and gambling severity, clustering of criteria similar to the Toce-Gerstein et al. taxonomy, high accuracy scores for numerical and criteria specific taxonomies, and also high accuracy scores for dichotomous pathological gambling diagnoses. These results suggest significant complexities in the frequencies of criteria reports and relationships between criteria.

When social anxiety co-occurs with substance use: does an impulsive social anxiety subtype explain this unexpected relationship?

Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.

Is access to alcohol associated with alcohol/substance abuse among people diagnosed with anxiety/mood disorder?

To investigate the relationship between access to off-license alcohol outlets and areas with dual treatment for alcohol/drug abuse and anxiety/mood disorder compared to areas with anxiety/mood disorder only in an urban setting in New Zealand.