Women & drug abuse : you and your community can help.

"Printed 1994"--P. [12].

Epidemiologic trends in drug abuse : proceedings /

Issues for published in 2 vols.; v. 1 is highlights and executive summary; v. 2 is edited texts of specialized reports; <1999->, v. 2 is proceedings.

Substance-use disorders and psychological distress among police arrestees

Objectives: To determine the 12-month prevalence of substance-use disorders and psychological morbidity in an Australian arrestee population. Design: Cross-sectional descriptive study. Participants and setting: 288 police arrestees at the Brisbane City Police Watch House in February and March 2001. Outcome measures: Prevalence of drug and alcohol disorders; psychological caseness according to the 28-item General Health Questionnaire; demographics and index offences. Results: 86% of the arrestees had at least one substance-use disorder; most had multiple disorders. More than 80% were substance dependent. The predominant substances used were amphetamines, marijuana, opioids and alcohol. 82% of the men and 94% of the women were suffering significant psychological distress. Conclusions: Development of services for detoxification and treatment of this population is a pressing need. The findings provide crucial information for the planning and implementation of drug courts and court diversion systems.

Substance misuse in first-episode psychosis: 15-month prospective follow-up study

Background Well-designed prospective studies of substance misuse in first-episode psychosis can improve our understanding of the risks associated with comorbid substance misuse and psychosis. Aims To examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis. Method The study was a prospective 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services. Results Substance misuse was independently associated with increased risk of in-patient admission, relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors, Substance misuse was not associated with remission or time to remission of positive symptoms. Heavy substance misuse was associated with increased risk of in-patient admission, relapse and shorter time to relapse. Conclusions Substance misuse is an independent risk factor for a problematic recovery from first-episode psychosis.

A phenomenology of crack abuse

The aim of this dissertation is to identify, describe, and explain the common experiences defining the crack abuser's life-world. Its method is phenomenological. Using basic cybernetic premises, a neurophysiologically oriented phenomenological framework concerning the constitution of thoughts, memories, and perceptions is first written. The framework is designed to hypothetically represent the neuropathology of crack abuse within a perspective that prescinds and describes the constitution, flow, and interdependence of experience. After the framework is written, the dissertation outlines the neuro-psychopharmacology of crack abuse and delimits crack abusers as a specific group within the more general population of cocaine users. It then represents the neuropathology of crack abuse within its phenomenological framework and uses the first-person accounts of forty-two crack dependents to actualize a phenomenological sketch of the crack abuser's life-world. The ethnographies afford the possibility of writing a “thick” description of the crack abuser's daily life—one that communicates the substance, order, and subjective and cultural dimensions of the dependent's defining experiences. ^ The dissertation's goals are successfully realized. The framework written and the ethnographies recorded and transcribed, the dissertation is able to identify, describe, and to a certain extent explain some of the common experiences defining the crack abusers life-world. The dissertation concludes that the crack abuser's life-world is organized around three primary and four secondary experiences. His primary experiences include: (1) an almost complete, yet fleeting, satisfaction of the ego's innate insufficiency and sublime, erotic-like stimulation of its core, (2) a fundamental inclination and expansion of the uniquely oriented euphoria-dysphoria dynamic that vivifies and orients the flow of consciousness, and (3) a change in the ego's innate structure. His secondary experiences include: (a) a characteristic aiming of projects, actions, and conduct toward the procurement and consumption of crack, (b) a denigration in the hold of legitimations and institutionalizations on the thematic field, (c) a strict alignment and a contraction in the scope of logical types pointing to the salient experiences within the stock of knowledge, and (d) for some crack abusers, ontological insecurity, despair, and exhaustion. ^

Differences between journalistic and academic accounts of child sexual abuse in Australia

The paper uses qualitative textual analysis to compare journalistic and academic accounts of child sexual abuse. There are seven main differences. Academic accounts suggest higher levels of neglect, emotional abuse, and physical abuse than sexual abuse in Australia, by contrast, journalistic accounts highlight sexual abuse. Academic accounts suggest that child sexual abuse in Australia is decreasing; journalistic accounts suggest that it is increasing. Academic accounts suggest that the majority of cases of child sexual abuse are perpetrated by family members; journalistic accounts focus on abuse by institutional figures (teachers, priests) or by strangers. Academic accounts have shown that innocent sexual play is a normal part of childhood development; journalistic accounts suggest that any sexual play is either a sign of abuse, or in itself constitutes sexual abuse. Academic accounts suggest that one of the best ways to prevent sexual abuse is for children to receive sex education; journalistic accounts suggest that children finding out about sex leads to sexual abuse. Academic accounts can gather data from the victims; journalistic accounts are excluded from doing so. Academic researchers talk to abusers in order to understand how child sexual abuse can be prevented; journalistic accounts exclude the voices of child sexual abusers.

Expressed emotion as predictor of relapse in patients with comorbid psychoses and substance use disorder

Objective: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue. Method: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview. Results: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow up Q1 and (surprisingly) an absence of childhood attention deficit hyperactivity disorder. Conclusions: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.

Current evidence on integrated treatment for serious mental disorder and substance misuse

Substance misuse in people with serious mental disorders is common and has a wideranging negative impact. The multiplicity of problems suggests that this comorbidity is better conceptualized as a type of complex disorder than by ‘dual diagnosis’. Problems with sequential and parallel treatments have led to the development of integrated approaches, with one practitioner or team addressing both the substance use and mental disorder. These treatments are typically characterized by motivation enhancement, minimizing treatment-related stress, emphasizing harm reduction as well as abstinence, and assertive outreach. A review of published randomized trials demonstrates that superior effects to controls are rarely consistent across treatment foci and over time. While motivational interventions assist engagement, more intervention is usually required for integrated treatment programs to improve long-term outcomes more than control conditions. More intensive case management does not consistently improve impact, but extended cognitive-behavioral therapies have promise. Suggestions for maximizing treatment effects and improving research evidence are provided.

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders : a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis (Start Over and Survive: SOS), comparing it with Standard Care (SC). Twenty-five in-patients aged 18-35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.