Conceptualizing craving : extrapolations from consciousness studies

The key definitional elements of the concept of craving remain highly contentious amongst addiction researchers. We argue that attempts to operationalize the craving construct may benefit from the conceptual and methodological advances that have occurred in the field of consciousness studies. Specifically, it is contended that the concept of craving cannot be fully articulated in the absence of a consideration of Husserl's notion of the intentional structure of human consciousness and related concepts such as phenomenology, discrete states of consciousness and altered states of consciousness. Extrapolating from the consciousness studies literature, we formulate numerous suggestions for future research intended to facilitate the operationalization of craving experiences.

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.

Longitudinal examination of physical and relational aggression as precursors to later problem behaviors in adolescents

Research has addressed the consequences of being a victim of physical and relational aggression but less so the consequences of being an aggressor during adolescence. Consequently, relatively little is known about the extent to which aggression in early adolescence increases the risk of later aggression and other psychosocial problems. This study involves a representative sample of seventh- and ninth-grade students from Washington State ( N = 1,942). Students were surveyed on recruitment and then again 1 and 2 years later to learn about ongoing behavior problems, substance use, depression, and self-harm behaviors. Surveys also included measures of several hypothesized promotive factors: attachment to family, school commitment, and academic achievement. Findings suggest that being physically and/or relationally aggressive in grades 7 to 9 increases the risk of aggression and possibly other problem behaviors after accounting for age, gender, race, and a prior measure of each outcome. Independent promotive effects were observed in most analyses, although family attachment appeared a less robust predictor overall. Implications for prevention include acting on the behavior itself and enhancing promotive influences to lessen the risk of agression and other related problems.

Sentencing of male and female child sex offenders : Australian study

Research suggests that, in line with the chivalry hypothesis of female offending, a range of mitigatory factors such as mental health problems, substance abuse, and personal experiences of abuse are brought into play when women who offend against children are brought to trial. This is reflected in sentencing comments made by judges and in the sanctions imposed on the offenders, and as a result female offenders are treated differently to male offenders. The current study investigated this in an Australian context. Seven cases of female-perpetrated child sexual abuse were identified over a 6-year period through the Austlii database. Seven cases of male-perpetrated child sex abuse matched as far as possible to these were identified. Court transcripts were then located, and sentencing comments and sanctions imposed were analysed. All offenders were sentenced to imprisonment, but in general the women were more likely than the men to receive less jail time and lower non-parole periods because their personal backgrounds or situation at the time of the offending (i.e., difficulties with intimate relationship, male dependence issues, depression, loneliness and anger) were perceived as worthy of sympathy, and they were considered as likely to be rehabilitated. Further investigations are needed to support these findings.

Assessing the risk of suicide at triage

Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems.

The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Vulnerability to drug use and the impact of trauma

Case studies are presented and discussed to provide practical illustrations of the impact that trauma can have and its role as a potential risk factor for later drug use. Trauma together with other risk and protective factors often associated with drug use combine in a series of complex relationships.

Motivation and coercion among mandated and voluntary drug treatment clients

Voluntary and mandated drug treatment clients were interviewed to investigate the role that motivation and perceived coercion had on their outcomes. The major findings were first, there were few differences between these two groups, and second, motivation was an important predictor of treatment outcome.

The role of alcohol consumption in recovering drug users

This thesis found that alcohol consumption by illicit drig users has not been well researched. A qualitative study found alcohol was used as a substitute and believed to be related to illicit substance use. While the quantitative study generated no overall consensus, the research highlighted the need to conduct additional studies into substance abuse. The portfolio explored the relationship between maltreatment and the development of Reactive Attachment Disorder through four case studies of child clients.

The treatment of opiate dependency

The portfolio examines use of opiate antagonist medication (naltrexone hydrochloride) as a safe and effective treatment for opiate dependence. The program incorporates evidence-based assessment, treatment planning and after-care counselling. Detoxification using naltrexone is highly effective. Use of naltrexone predicts long-term abstinence and better health and social outcomes. Naltrexone implants improve compliance and outcomes.

Training frontline workers : drug education from theory to practice

This study investigated the effectiveness of alcohol and other drug education by examining practice change in workers when they returned to their workplace, identifying barriers to and supports for that practice change. The influencing characteristics of the individual, their team environment and their organisation have also been identified.

Relapse prevention : a critique and proposed reconceptualisation

Relapse prevention (RP) plays a significant role in current treatments and post-treatment approaches to substance abuse problems. It is also widely used in a number of other problem areas, including other addictive behaviours and sexual offending. The widespread use of RP in various fields is due to both its clearly articulated theoretical basis, which has significant face validity, and its transferability into clinical practice. Also, there is a growing (though arguably still modest) body of empirical evidence that demonstrates its efficacy in a range of therapeutic contexts. However, arguably, in terms of both the theoretical underpinnings and the practical application of RP there is room for improvement. This article hypothesises that one of the key weaknesses of RP is that it takes a generally unconstructive approach to the therapeutic process through the use of negative concepts and avoidance goals. It is suggested that a 'good lives' framework of psychological wellbeing can provide a means of remedying these weaknesses of the traditional RP model. It is argued that a good lives framework can lead to a more optimistic approach to the prevention of relapse among individuals with substance use problems.

Client-reported reasons for non-engagement in drug and alcohol treatment

Introduction and Aims.To examine client-reported reasons for missed early appointments at a drug and alcohol treatment service and to compare characteristics of those who missed appointments with those who attended. Design and Methods. Clients who missed a first or second appointment between 1 May and 31 August 2007 at a public community-based outpatient treatment facility were invited to participate in a semistructured telephone interview.This consisted of an open-ended question asking the reason(s) for nonattendance, followed by a questionnaire of items for therapeutic alliance and service satisfaction, perceived impact of substance use and previous treatment experience, mostly rated on Likert scales. Database information on demographic and clinical variables was gathered for all clients who were accepted for treatment within the study time frame. Characteristics of those who missed a first or second appointment (n = 66) were compared with those who attended at least their first two appointments (n = 97). Results. Of clients who missed their appointments, 80.6% provided reasons for nonattendance, which included extraneous factors (50.0%), service shortcomings (29.7%), no further need for service (16.2%) and motivational ambivalence (4.1%). They generally had high ratings of therapeutic alliance and service satisfaction and identified their substance use as having a negative impact on their lives. Clients who missed appointments were more likely to be male, unmarried and have a history of polysubstance use. Discussion and Conclusions. Extraneous issues relating to the client may be a dominant obstacle in early treatment engagement. Efforts to overcome these issues may therefore improve early engagement.

The utility of the Mood Disorders Questionnaire as a screening tool in a methadone maintenance treatment program

Objective. Comorbid mental illness amongst methadone maintenance therapy clients may be common and screening may be warranted. The Mood Disorders Questionnaire (MDQ) is a screening tool for bipolar disorder that has been validated in other treatment settings. Its utility for patients with substance use disorders is assessed in this study.

Methods. Clients of a methadone maintenance program were invited to complete the MDQ when they attended a public Drug and Alcohol Service for their regular scheduled appointments. Information about their history of substance use was also collected.

Results. Eighty clients (43 females, 37 males) aged 35 8.0 years (mean SD) participated in the study. Seventy-four clients completed the MDQ of which 36 (48.6%) obtained a positive screen. A check of client fi les suggested that only three of the 74 participants had a current working diagnosis of bipolar disorder. These three participants had screened positive on the MDQ.

Conclusions. There was a high prevalence of manic symptoms reported by participants, suggesting that screening for bipolar disorder in this population may be warranted. However, there is a risk of false positives with the MDQ, as it does not clearly differentiate between symptoms of mania and drug intoxication.