The relative influence of social support, rehabilitation program participation, and inmate preincarceration characteristics on incarcerated substance abusers' perceptions of adjustment to community reintegration

This dissertation identifies, examines, and assesses the relative influence of identified empirically and conceptually relevant variables on incarcerated substance abusers' expectations of postrelease adjustment. A purposive sampling procedure was used to recruit 101 male and female substance-abusing offenders participating in prison- and jail-based drug treatment programs in south Florida. A 92-item survey questionnaire was used to collect basic demographic data; measure inmate preincarceration characteristics, social support, and rehabilitation program participation; and record archival data. Regression equations were developed utilizing ten different measures of the participants' expectations of their postrelease adjustment. Two equations yielded statistically significant F ratios; maintaining a stable living and maintaining abstinence. Twenty-two percent of the variance in respondents' expectations of maintaining a stable living was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 1.89; df = 13,87; p $<$.05). The only significant predictor variable was perception of social support (b = $-$.05; t = $-$3.6; p $<$.001). Twenty-three percent of the variance in respondents' expectations of maintaining abstinence from substances was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 2; df = 13,87; p $<$.05). Once again, the only significant predictor variable was perception of social support. The results of the analyses indicate that social support was the only important variable for understanding these respondents' efficacy expectations of postrelease abstinence and stable living. The results of this investigation demonstrate the complexity of the social support variable for prisoners, and identify social support as a potential rehabilitative resource for substance-abusing inmates. The results of this investigation underscore the importance of continued, detailed empirical study in order to understand and clarify how social support, efficacy expectations, and actual postrelease performance interrelate for this population of offenders.

Altered adaptive but not veridical decision-making in substance dependent individuals.

Drug addiction is associated with impaired judgment in unstructured situations in which success depends on self-regulation of behavior according to internal goals (adaptive decision-making). However most executive measures are aimed at assessing decision-making in structured scenarios, in which success is determined by external criteria inherent to the situation (veridical decision-making). The aim of this study was to examine the performance of Substance Abusers (SA, n = 97) and Healthy Comparison participants (HC, n = 81) in two behavioral tasks that mimic the uncertainty inherent in real-life decision-making: the Cognitive Bias Task (CB) and the Iowa Gambling Task (IGT) (administered only to SA). A related goal was to study the interdependence between performances on both tasks. We conducted univariate analyses of variance (ANOVAs) to contrast the decision-making performance of both groups; and used correlation analyses to study the relationship between both tasks. SA showed a marked context-independent decision-making strategy on the CB's adaptive condition, but no differences were found on the veridical conditions in a subsample of SA (n = 34) and HC (n = 22). A high percentage of SA (75%) also showed impaired performance on the IGT. Both tasks were only correlated when no impaired participants were selected. Results indicate that SA show abnormal decision-making performance in unstructured situations, but not in veridical situations.

Psychiatric and neurological symptoms in schizophrenia and substance use disorder patients treated for 12-weeks with quetiapine

Contexte Autant dans une population schizophrène que non schizophrène, l‘abus de substance a pour conséquence la manifestation de symptômes psychiatriques et neurologiques. Dans les présentes études cas-témoins, nous avons examiné les différences initiales ainsi que les changements suite au traitement de 12 semaines à la quetiapine au niveau de la sévérité de la toxicomanie et des symptômes psychiatriques et neurologiques chez 3 groupes distincts. Ces 3 groupes sont: des patients schizophrènes avec une toxicomanie (double diagnostic: DD), des patients schizophrènes sans toxicomanie concomittante (SCZ) et finalement, des toxicomanes non schizophrènes (SUD). Parallèlement, afin de nous aider à interpréter nos résultats, nous avons mené deux revues systématiques: la première regardait l‘effet d‘antipsychotiques dans le traitement de troubles d‘abus/dépendance chez des personnes atteintes ou non de psychoses, la deuxième comparait l‘efficacité de la quetiapine et sa relation dose-réponse parmi différents désordres psychiatriques. Méthodes Pour nos études cas-témoins, l‘ensemble des symptômes psychiatriques et neurologiques ont été évalués via l‘Échelle du syndrome positif et négatif (PANSS), l‘Échelle de dépression de Calgary, l‘Échelle des symptômes extrapyramidaux (ESRS) ainsi qu‘avec l‘Échelle d‘akathisie de Barnes. Résultats À la suite du traitement de 12 semaines avec la quetiapine, les groupes SCZ et DD recevaient des doses de quetiapine significativement plus élevées (moyenne = 554 et 478 mg par jour, respectivement) par rapport au groupe SUD (moyenne = 150 mg par jour). Aussi, nous avons observé chez ces mêmes patients SUD une plus importante baisse du montant d‘argent dépensé par semaine en alcool et autres drogues, ainsi qu‘une nette amélioration de la sévérité de la toxicomanie comparativement aux patients DD. Par conséquent, à la fin de l‘essai de 12 semaines, il n‘y avait pas de différence significative dans l‘argent dépensé en alcool et drogues entre les deux groupes de toxicomanes iv or, les patients DD présentait, comme au point de départ, un score de toxicomanie plus sévère que les SUD. Étonnamment, aux points initial et final de l‘étude, le groupe DD souffrait de plus de symptômes parkinsoniens et de dépression que le groupe SCZ. Par ailleurs, nous avons trouvé qu‘initiallement, les patients SUD présentaient significativement plus d‘akathisie, mais qu‘en cours de traitement, cette akathisie reliée à l‘abus/dépendance de cannabis s‘est nettement améliorée en comparaison aux patients SCZ. Enfin, les patients SUD ont bénéficié d‘une plus grande diminution de leurs symptômes positifs que les 2 groupes atteints de schizophrénie. Conclusions Bref, l‘ensemble de nos résultats fait montre d‘une vulnérabilité accentuée par les effets négatifs de l‘alcool et autres drogues dans une population de patients schizophrènes. Également, ces résultats suggèrent que l‘abus de substance en combinaison avec les états de manque miment certains symptômes retrouvés en schizophrénie. De futures études seront nécessaires afin de déterminer le rôle spécifique qu‘a joué la quetiapine dans ces améliorations.

Chronic volatile substance abuse among the adult Kickapoo traditional tribe of Texas: Disease and disability profiles, neuropsychosocial consequences, and social implications for treatment

The purpose of this study, based on secondary data from attendees at a substance abuse clinic for the Kickapoo Healing Grounds in Eagle Pass, Texas, is two fold: (1) to elucidate neuro-behavioral performance of volatile substance abusers in the Kickapoo tribe and (2) to determine factors associated with their treatment completion and rehabilitation as measured by their employment at follow-up. Volatile substance abuse (VSA) is associated with a host of neurological manifestations, and secondary prevention or clinical treatment and rehabilitation remains the mainstay of control efforts. Very little is known about VSA in general, and especially among Native American populations. It is anticipated that the results will help determine and assist other tribes and non-tribal substance abuse centers with treatment planning for volatile substance abusers among Native American populations. ^

The effects of peer teaching of infant massage on general elf-efficacy and mother infant attachment among mothers in a residential rehabilitation facility for drug addiction and substance abuse

Approximately 200 million people, 5% aged 15-64 worldwide are illicit drug or substance abusers (World Drug Report, 2006). Between 2002 and 2005, an average of 8.2% of 12 year olds and older in the Miami, Fort Lauderdale metropolitan areas used illicit drugs (SAMHSA, 2007). Eight percent of pregnant women, aged 15 to 25, were more likely to have used illicit drugs during pregnancy than pregnant women aged 26 to 44. Alcohol use was 9.8% and cigarette use was 18% for pregnant women aged 15 to 44 (SAMHSA, 2005). Approximately a quarter of annual birth defects are attributed to the exposure of drugs or substance abuse in utero (General Accounting Office, 1991). Physical, psychological and emotional challenges may be present for the illicit drug/substance abuse (ID/SA) mother and infant placing them at a disadvantage early in their relationship (Shonkoff & Marshall, 1990). Mothers with low self efficacy have insecurely attached infants (Donovan, Leavitt, & Walsh, 1987). As the ID/SA mother struggles with wanting to be a good parent, education is needed to help her care for her infant. In this experimental study residential rehabilitating ID/SA mothers peer taught infant massage. Massage builds bonding/attachment between mother and infant (Reese & Storm, 2008) and peer teaching is effective because participants have faced similar challenges and speak the same language (Boud, Cohen, & Sampson 2001). Quantitative data were collected using the General Self-Efficacy and Maternal Attachment Inventory-Revised Scale before and after the 4-week intervention program. A reported result of this study was that empowering ID/SA mothers increased their self-efficacy, which in turn allowed the mothers to tackle challenges encountered and created feelings of being a fit mother to their infants. This research contributes to the existing database promoting evidence-based practice in drug rehabilitation centers. Healthcare personnel, such as nurse educators and maternal-child health practitioners, can develop programs in drug rehabilitation centers that cultivate an environment where the ID/SA rehabilitating mothers can peer teach each other, while creating a support system. Using infant massage as a therapeutic tool can develop a healthy infant and nurture a more positive relationship between mother and infant.

The effects of American Sign Language on general self-efficacy and anxiety among mothers in a residential rehabilitation facility for drug addiction and substance abuse

Globally, approximately 208 million people aged 15 and older used illicit drugs at least once in the last 12 months; 2 billion consumed alcohol and tobacco consumption affected 25% (World Drug Report, 2008). In the United States, 20.1 million (8.0%) people aged 12 and older were illicit drug users, 129 million (51.6%) abused alcohol and 70.9 million (28.4%) used tobacco (SAMHSA/OAS, 2008).Usually considered a problem specific to men (Lynch, 2002), 5.2% of pregnant women aged 15 to 44 are also illicit drug and substance abusers (SAMHSA/OAS, 2007). During pregnancy, illicit drugs and substance abuse (ID/SA) can significantly affect a woman and her infant contributing to developmental and communication delays for the infant and influencing parenting abilities (Budden, 1996; March of Dimes, 2006b; Rossetti, 2000). Feelings of guilt and shame and stressful experiences influence approaches to parenting (Ashley, Marsden, & Brady, 2003; Brazelton, & Greenspan, 2000; Ehrmin, 2000; Johnson, & Rosen, 1990; Kelley, 1998; Rossetti, 2000; Velez et al., 2004; Zickler, 1999). Parenthood is an expanded role that can be a trying time for those lacking a sense of self-efficacy and creates a high vulnerability to stress (Bandura, 1994). Residential treatment programs for ID/SA mothers and their children provide an excellent opportunity for effective interventions (Finkelstein, 1994; Social Care Institute for Excellence, 2005). This experimental study evaluated whether teaching American Sign Language (ASL) to mothers living with their infants/children at an ID/SA residential treatment program increased the mothers’ self-efficacy and decreased their anxiety. Quantitative data were collected using the General Self-Efficacy Scale and the State-Trait Anxiety Inventory showing there was both a significant increase in self efficacy and decrease in anxiety for the mothers. This research adds to the knowledge base concerning ID/SA mothers’ caring for their infants/children. By providing a simple low cost program, easily incorporated into existing rehabilitation curricula, the study helps educators and healthcare providers better understand the needs of the ID/SA mothers. This study supports Bandura’s theory that parents who are secure in their efficacy can navigate through the various phases of their child’s development and are less vulnerable to stress (Bandura, 1994).

Intergenerational associations between a consensual childhood sexual experience and adult substance abuse among Latina mothers and daughters

Purpose: Early onset of sexual activity has been linked to later substance abuse. Our study aimed to further describe the associations between Latina mothers’ and daughters’ early sexual activity and adult substance abuse. Methods: A survey was conducted with 92 Latina mother–daughter dyads whose members never experienced sexual abuse. Childhood sexual experience was defined as the occurrence of a consensual sexual encounter at the age of 15 years or younger. Substance abusers were identified by the extent of substance use during the 12 months prior to the interview. Path analysis was used to fit our conceptual models to the data. Main findings: Daughters’ current, adult substance abuse was associated independently with: their own childhood sexual experience (odds ratio [OR] = 6.0) and mothers’ current, adult substance abuse (OR = 2.0). Compared with daughters who first experienced sex after the age of 19, the odds of using substances were 17.7 times higher among daughters who had childhood sexual experience and 3.8 times higher among daughters who first experienced sex between the age of 16–19 years. Explicitly, sexual experiences between the ages of 16–19 years were also risk factors for later adult substance abuse. Mothers’ childhood sexual experience (OR = 7.3) was a strong predictor for daughters’ childhood sexual experience. Conclusions: Our study supported a link between mother and daughter childhood sexual experience among Latinas, and indicated it is a correlate of adult substance abuse. Family based substance abuse prevention efforts and future longitudinal studies should consider maternal childhood sexual experience as a potential indication of risk for Latina daughters.

The Effects of American Sign Language on General Self- Efficacy and Anxiety Among Mothers in a Residential Rehabilitation Facility for Drug Addiction and Substance Abuse

Globally, approximately 208 million people aged 15 and older used illicit drugs at least once in the last 12 months; 2 billion consumed alcohol and tobacco consumption affected 25% (World Drug Report, 2008). In the United States, 20.1 million (8.0%) people aged 12 and older were illicit drug users, 129 million (51.6%) abused alcohol and 70.9 million (28.4%) used tobacco (SAMHSA/OAS, 2008).Usually considered a problem specific to men (Lynch, 2002), 5.2% of pregnant women aged 15 to 44 are also illicit drug and substance abusers (SAMHSA/OAS, 2007). During pregnancy, illicit drugs and substance abuse (ID/SA) can significantly affect a woman and her infant contributing to developmental and communication delays for the infant and influencing parenting abilities (Budden, 1996; March of Dimes, 2006b; Rossetti, 2000). Feelings of guilt and shame and stressful experiences influence approaches to parenting (Ashley, Marsden, & Brady, 2003; Brazelton, & Greenspan, 2000; Ehrmin, 2000; Johnson, & Rosen, 1990; Kelley, 1998; Rossetti, 2000; Velez et al., 2004; Zickler, 1999). Parenthood is an expanded role that can be a trying time for those lacking a sense of self-efficacy and creates a high vulnerability to stress (Bandura, 1994). Residential treatment programs for ID/SA mothers and their children provide an excellent opportunity for effective interventions (Finkelstein, 1994; Social Care Institute for Excellence, 2005). This experimental study evaluated whether teaching American Sign Language (ASL) to mothers living with their infants/children at an ID/SA residential treatment program increased the mothers’ self-efficacy and decreased their anxiety. Quantitative data were collected using the General Self-Efficacy Scale and the State-Trait Anxiety Inventory showing there was both a significant increase in self efficacy and decrease in anxiety for the mothers. This research adds to the knowledge base concerning ID/SA mothers’ caring for their infants/children. By providing a simple low cost program, easily incorporated into existing rehabilitation curricula, the study helps educators and healthcare providers better understand the needs of the ID/SA mothers. This study supports Bandura’s theory that parents who are secure in their efficacy can navigate through the various phases of their child’s development and are less vulnerable to stress (Bandura, 1994).

The Effects of Peer Teaching of Infant Massage on General Self-Efficacy and Mother Infant Attachment Among Mothers in a Residential Rehabilitation Facility for Drug Addiction and Substance Abuse

Approximately 200 million people, 5% aged 15-64 worldwide are illicit drug or substance abusers (World Drug Report, 2006). Between 2002 and 2005, an average of 8.2% of 12 year olds and older in the Miami, Fort Lauderdale metropolitan areas used illicit drugs (SAMHSA, 2007). Eight percent of pregnant women, aged 15 to 25, were more likely to have used illicit drugs during pregnancy than pregnant women aged 26 to 44. Alcohol use was 9.8% and cigarette use was 18% for pregnant women aged 15 to 44 (SAMHSA, 2005). Approximately a quarter of annual birth defects are attributed to the exposure of drugs or substance abuse in utero (General Accounting Office, 1991). Physical, psychological and emotional challenges may be present for the illicit drug/substance abuse (ID/SA) mother and infant placing them at a disadvantage early in their relationship (Shonkoff & Marshall, 1990). Mothers with low self efficacy have insecurely attached infants (Donovan, Leavitt, & Walsh, 1987). As the ID/SA mother struggles with wanting to be a good parent, education is needed to help her care for her infant. In this experimental study residential rehabilitating ID/SA mothers peer taught infant massage. Massage builds bonding/attachment between mother and infant (Reese & Storm, 2008) and peer teaching is effective because participants have faced similar challenges and speak the same language (Boud, Cohen, & Sampson 2001). Quantitative data were collected using the General Self-Efficacy and Maternal Attachment Inventory-Revised Scale before and after the 4-week intervention program. A reported result of this study was that empowering ID/SA mothers increased their self-efficacy, which in turn allowed the mothers to tackle challenges encountered and created feelings of being a fit mother to their infants. This research contributes to the existing database promoting evidence-based practice in drug rehabilitation centers. Healthcare personnel, such as nurse educators and maternal-child health practitioners, can develop programs in drug rehabilitation centers that cultivate an environment where the ID/SA rehabilitating mothers can peer teach each other, while creating a support system. Using infant massage as a therapeutic tool can develop a healthy infant and nurture a more positive relationship between mother and infant.

La place de la psychothérapie dans les soins aux personnes toxicodépendantes

Cet article présente une réflexion au sujet de la psychothérapie destinée spécifiquement aux personnes toxicodépendantes. La prise en charge de ce type de problématiques a longtemps été considérée comme difficile, voire quasi impossible dans une pratique « classique » de la psychothérapie. Après avoir fourni quelques repères épidémiologiques et psychiatriques, cet article aborde la place et les spécificités (par exemple niveau de soin, aménagement du cadre et relation thérapeutique) du travail psychothérapeutique dans les soins proposés à la personne toxicodépendante. This article proposes a reflection about the psychotherapeutic work in the treatment of persons with substance use disorders. For a long time, substance abusers have been stereotyped by mental health practitioners, notably as being unresponsive to psychotherapy. After a brief survey of epidemiological and psychiatric elements, this article tackles the role and the specificities (e.g. level of care, setting and therapeutic relationship) of the psychotherapy practice in the care of patients suffering from substance use disorders.

Substances psychoactives au volant: quelle conduite ? [Psychoactive substances and driving: which approach?]

Les problèmes médicaux concernant la conduite automobile deviennent de plus en plus compliqués et de plus en plus fréquents. Dans la plupart des cantons suisses, chaque médecin peut potentiellement être interpellé en tant que médecin-conseil d'un de ses patients. Le présent article s'intéresse particulièrement aux problèmes de toxicodépendance dans le cadre du contexte législatif actuel et de la complexité croissante des soins. Medical problems involving driving aptitude are more and more common nowadays. Each doctor in Switzerland could be asked to give a certificate of driving aptitude for one of his/her patient. This paper relates to the problem of substance abusers in the current legal context and the growing complexity of care.

Effects of quetiapine on anhedonia induced by withdrawal from chronic amphetamine administration

Contexte: L’anhédonie, un état caractérisé par une capacité réduite d’éprouver du plaisir. Des études cliniques récentes montrent qu’un médicament antipsychotique atypique, la quétiapine, est bénéfique pour le traitement de la toxicomanie qui est supposé d’atténuer les symptômes de sevrage associés à l’usage abusif des drogues psychotropes. Le but de la présente étude était d’étudier les effets de l'administration aiguë de quétiapine sur la récompense chez des animaux en état de sevrage après un traitement chronique avec l’amphétamine. Notre hypothese est que la quetiapine va diminuer l’anhedonie causer par le sevrage. Méthodes: Les expériences ont été effectuées avec des rats mâles de la souche Sprague-Dawley entraînés à produire une réponse opérante pour obtenir une courte stimulation électrique au niveau de l'hypothalamus latéral. Des mesures du seuil de récompense ont été déterminées chez différents groupes de rats avant et pendant quatre jours après le traitement avec des doses croissantes (1 à 10 mg/kg, ip toutes les 8 heures) de d-amphétamine sulfate, ou de son véhicule, au moyen de la méthode du déplacement de la courbe. L’effet de deux doses de quétiapine a été testé 24 h après le sevrage chez des animaux traités avec l’amphétamine ou le véhicule. Résultats: Les animaux traités avec l’amphétamine ont montré une augmentation de 25% du seuil de récompense 24 h après la dernière injection, un effet qui a diminué progressivement entre le jour 1 et le jour 4, mais qui est resté significativement plus élevé en comparaison de celui du groupe contrôle. La quétiapine administrée à 2 et 10 mg/kg pendant la phase de sevrage (à 24 h) a produit une augmentation respective de 10 % et 25 % du seuil de recompense; le meme augmentation du seuil a été observe chez les animaux traitées avec le véhicule. Un augmentation de 25 % du seuil de recompense a aussi été observés chez les animaux en état de sevrage à l'amphétamine. Un test avec une faible dose d’amphétamine (1 mg/kg) avant et après le sevrage a révélé une légère tolérance à l’effet amplificateur de cette drogue sur la récompense, un phénomène qui pourrait expliquer l’effet différent de la quétiapine chez les animaux traités avec le véhicule et ceux traités avec l’amphétamine. Conclusions: Ces résultats reproduisent ceux des études précédentes montrant que la quétiapine produit une légère atténuation de la récompense. Ils montrent également que le sevrage à l’amphétamine engendre un léger état d'anhédonie et que dans cet état, une dose élevée de quetiapine et non pas une dose faible accentue l’état émotionnel négatif. Ils suggèrent qu’un traitement à faibles doses de quétiapine des symptômes de sevrage chez le toxicomane devrait ni aggraver ni améliorer son état émotionnel.

Le traitement de la toxicomanie comme alternative à l’incarcération : un sentier rocailleux

Toxicomanie et criminalité sont des comportements fréquemment associés. Dans un objectif de réduction de la récidive, le traitement des toxicomanes apparaît dans la littérature américaine comme une solution plus efficace que l'incarcération et beaucoup moins dispendieuse. Qu'en est-il au Québec ? Pour répondre à cette question, 20 intervenants de la région de Montréal et de Trois-Rivières œuvrant dans le domaine de la justice, de la sécurité publique et de la santé et des services sociaux ont été rencontrés dans le cadre de groupes de discussion. Les résultats de la consultation montrent que si le traitement des toxicomanes judiciarisés est une idée intéressante en soi, plusieurs difficultés surgissent dans son application en raison notamment de la différence de culture des milieux impliqués. Cependant, une bonne communication, le respect des expertises de chacun, et une certaine tolérance vis-à-vis des objectifs de ses partenaires constituent des conditions qui rendraient possible, du moins sur papier, les expériences de déjudiciarisation en matière de toxicomanie.

Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent - child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.