International Journal of Mental Health and Addiction

Experiences of stigma from others among people with a history of drug addiction are understudied in comparison to the strength of stigma associated with drug addiction. Work that has studied these experiences has primarily focused on stigma experienced from healthcare workers specifically even though stigma is often experienced from other sources as well. Because stigma has important implications for the mental health and recovery efforts of people in treatment, it is critical to better understand these experiences of stigma. Therefore, we characterize drug addiction stigma from multiple sources using qualitative methodology to advance understandings of how drug addiction stigma is experienced among methadone maintenance therapy patients and from whom. Results demonstrate that methadone maintenance therapy patients experience prejudice, stereotypes, and discrimination from friends and family, coworkers and employers, healthcare workers, and others. Discussion highlights similarities and differences in stigma experienced from these sources.

AIMS: To assess the contribution of patterns of video game play, including game genre, involvement, and time spent gaming, to problem use symptomatology. DESIGN: Nationally representative survey. SETTING: Online. PARTICIPANTS: Large sample (n=3,380) of adult video gamers in the US. MEASUREMENTS: Problem video game play (PVGP) scale, video game genre typology, use patterns (gaming days in the past month and hours on days used), enjoyment, consumer involvement, and background variables. FINDINGS: Study confirms game genre's contribution to problem use as well as demographic variation in play patterns that underlie problem video game play vulnerability. CONCLUSIONS: Identification of a small group of game types positively correlated with problem use suggests new directions for research into the specific design elements and reward mechanics of "addictive" video games. Unique vulnerabilities to problem use among certain groups demonstrate the need for ongoing investigation of health disparities related to contextual dimensions of video game play.

This study explores whether associations between consuming alcohol in bars and alcohol-related harms are consistent across countries and whether country-level characteristics modify associations. We hypothesized that genderedness of bar drinking modifies associations, such that odds of harms associated with bar drinking increase more rapidly in predominantly male bar-drinking countries. Multilevel analysis was used to analyze survey data from 21 countries representing five continents from Gender, Alcohol, and Culture: An International Study (GENACIS). Bar frequency was positively associated with harms overall. Relationships between bar frequency and harms varied across country. Genderedness modified associations between bar frequency and odds of fights, marriage/relationship harms, and work harms. Findings were significant only for men. Contrary to our hypothesis, odds of harms associated with bar drinking increased less rapidly in countries where bar drinking is predominantly male. This suggests predominantly male bar drinking cultures may be protective for males who more frequently drink in bars.

This article describes the socio-demographic characteristics and gambling behavior of 39 pathological gamblers who participated in our treatment study in 2009. The inclusion criteria of the study were: score of five or more on both the South Oaks Gambling Screen (SOGS) and a pathological gambling screen based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The first 39 patients meeting the inclusion criterion were recruited into the study. The average age of the subjects was 39 years, and 80 % were males. The lag-time between active gambling (at least three times per week) and the onset of a pathological gambling problem was short: within 2 years of active gambling, 62 % of the subjects reported having become pathological gamblers. Our results also indicated certain gender-specific differences in the age at initiation and in the severity of the gambling problem.

A literature review of child and youth resilience with a focus on: definitions and factors of resilience; relationships between resilience, mental health and social outcomes; evidence for resilience promoting interventions; and implications for reducing health inequities. To conduct the review, the first two following steps were conducted iteratively and informed the third step: 1) Review of published peer-review literature since 2000; and 2) Review of grey literature; and 3) Quasi-realist synthesis of evidence. Evidence from three perspectives were examined: i) whether interventions can improve 'resilience' for vulnerable children and youth; ii) whether there is a differential effect among different populations; and, iii) whether there is evidence that resilience interventions 'close the gap' on health and social outcome measures. Definitions of resilience vary as do perspectives on it. We argue for a hybrid approach that recognizes the value of combining multiple theoretical perspectives, epistemologies (positivistic and constructivist/interpretive/critical) in studying resilience. Resilience is: a) a process (rather than a single event), b) a continuum (rather than a binary outcome), and c) likely a global concept with specific dimensions. Individual, family and social environmental factors influence resilience. A social determinants perspective on resilience and mental health is emphasized. Programs and interventions to promoting resilience should be complimentary to public health measures addressing the social determinants of health. A whole community approach to resilience is suggested as a step toward closing the public health policy gap. Local initiatives that stimulate a local transformation process are needed. Recognition of each child's or youth's intersections of gender, lifestage, family resources within the context of their identity markers fits with a localized approach to resilience promotion and, at the same time, requires recognition of the broader determinants of population health.

Indigenous communities have engaged in needs and resources assessments for thousands of years. By blending CBPR/TPR approaches with community-driven assets and needs assessments, academic and community based researchers can work together to better understand and identify community strengths as well as issues of concern in Native communities. This best practice approach can set research agendas that are relevant to Native communities and result in interventions and health promotion programs that are respectful of Tribal sovereignty and that incorporate unique traditions and strengths of Native communities. A successful research partnership to develop and implement a needs and resources assessment using CBPR/TPR approaches is presented using a case study that can be used as a model for other research partnerships.

This study reports findings on Internet gambling and problem gambling among Icelandic youth. Participants were 1.537 13–18year-old students, 786 boys and 747 girls. Results revealed that 56.6% had gambled at least once in the past 12months and 24.3% on the Internet. Gender and developmental differences were found for Internet gambling, as boys and older age-groups were more likely to gamble on the Internet than girls or younger age groups. Problem gambling for the total sample was 2.2%, but Internet gamblers were more likely to be classified as problem gamblers (7.7%) than non-Internet gamblers (1.1%). A comparison of the findings of this study to earlier studies on adolescents conducted in 2003 and 2004 reveals that Icelandic adolescents are gambling less in land-based types of gambling and more on the Internet. In general, the results of this study thus suggest that the gambling habits of Icelandic youth are changing. KeywordsAdolescent–Gambling–Internet–Problem gambling

This study reconstructs the image of the ‘normal’ child in Ontario from 1867 to 1900. During this time period the ‘normal’ child was modeled after the idealized image of a bourgeois adult. The idealized bourgeois adult was the embodiment of Protestantism, industriousness, decency, and culture. Any deviation from this image usually meant delinquency, or lunacy, or both, on the part of the child and brought about jail-time or committal to asylums. A combination of religious, economic, political, and legal beliefs provided the conditions necessary for the emergence of this image. This reconstruction not only aims to contribute to the social history of ‘adolescence’ in Canada, but also it seeks to point out the historical variability of conceptions of adolescence normality and abnormality and, thereby, help to broaden the existing views of mental health and disorder.

New Mexico experienced a surge in the gaming industry during the mid-1990s with the initiation of a state lottery and other new gaming opportunities, as well as the development of many Indian gaming establishments. This paper explores patterns associated with gambling in two random samples of the adult population (N = 2674) in the entire State of New Mexico in 1996 and 1998. Specifically, the purpose of this paper is to describe the relationship between gambling and such variables as age, gender, and ethnicity. Overall, an increase occurred in the number of people who reported having ever gambled, from 86.4% in 1996 to 92.5% in 1998. From 1996 to 1998, respondents’ reports of their past month gambling showed that certain forms of gambling (e.g., playing cards and betting on animals for money) decreased, while other forms of gambling either remained unchanged or increased in frequency (e.g., sports and investment gambling). The relationship of gender and age to gambling was also examined. Survey results indicated that while males and females reported many similar gambling habits, there are gender differences, particularly with regard to investment gambling. Specifically, females show a greater increase in investment gambling from 1996 to 1998, than do males. Overall results indicate a small positive correlation between age and dollar amount spent on gambling in the past month. In addition, ethnicity and age-specific patterns for certain forms of gambling are described.

Included in both the 1996 and 1998 Survey of Gambling Behavior in New Mexico was a scale of individual problem gambling. To assess problems related to gambling behavior, questions were developed using the DSM-IV criteria for pathological gambling. The purpose of this paper is to describe problem gamblers in New Mexico. Descriptive data indicate that 12% (n = 321) of the respondents (N = 2,674) reported problem gambling behavior. Further analysis reveal that 51% of those reporting problem gambling behavior were male, and 48% of respondents were married. Forty-eight percent of problem gambler respondents identified themselves as Hispanic ethnicity and 37% non-Hispanic whites. The mean age of problem gamblers was 37.4years, and the mean annual income was $45,638. Data were separated by survey year to analyze any changes in reported problem gambling. Overall, 12,008 people per 100,000 population reported a mild to severe gambling problem in the period 1996–1998. Statistical significance was revealed in some gambling activities between low/moderate and serious problem gamblers. Recommendations include replicating this survey in New Mexico to determine additional patterns of problem gambling.

Without Abstract

This study provides analysis of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9003 adults aged 16years and over), all participants who had gambled online, bet online, and/or who had used a betting exchange in the last 12months (6% of the total sample) were compared with all other gamblers who had not gambled via the Internet (62% of the sample). Results showed that Internet gambling and non-Internet gambling had a significant association with smoking (nicotine) and drinking (alcohol). Self-reported general health status was not significantly associated with Internet gambling but was significantly associated with offline gambling. Analysis of DSM-IV scores showed that problem gambling prevalence rate was significantly higher among Internet gamblers than non-Internet gamblers (5% versus 0.5%) and that Internet gamblers were significantly more likely to endorse individual DSM-IV items compared to non-Internet gamblers. KeywordsInternet gambling–Online gambling–Gambling–Addiction–Alcohol use–Cigarette smoking–Health

For more than a century, the US nursing profession has been aware of substance abuse problems among its practitioners and student nurses but has generally dealt with the issue by taking disciplinary action rather than pursuing nonpunitive options. The latter course would allow more healthcare providers, following successful rehabilitation, to remain in the profession. Since the early 1980s, the American Nurses Association (ANA), National Council of State Boards of Nursing (NCSBN), American Association of Colleges of Nursing (AACN), and the International Nurses Society on Addictions (IntNSA) have actively promoted nonpunitive substance abuse policies, and many states have adopted alternative-to-discipline programs that have achieved good outcomes. At the same time, very little is known about the success rates of alternative-to-dismissal programs in nursing schools. After reviewing policies for both practicing nurses and those still in training, the authors recommend that all states adopt nonpunitive policies and that nursing schools develop alternative approaches for students that parallel and expand upon the procedures applied to practicing nurses who have a chemical dependency.

This paper details a four-stage methodology for developing early alcohol interventions for at-risk Aboriginal youth. Stage 1 was an integrative approach to Aboriginal education that upholds Aboriginal traditional wisdom supporting respectful relationships to the Creator, to the land and to each other. Stage 2 used quantitative methods to investigate associations between personality risk factors and risky drinking motives. Stage 3 used qualitative interviews to further understand the contexts and circumstances surrounding drinking behaviour within a larger cultural context. Stage 3 involved tailoring personality-matched, motive-specific brief interventions to meet at-risk adolescents’ needs. Stage 4 involved an efficacy test of the interventions. This novel methodology has significance for future program development to meet diverse social, cultural and health needs of at-risk adolescents. KeywordsDrinking motives-Aboriginal adolescents-Early intervention-Personality risk-Alcohol abuse

In many cultures, approximately one third of people with drug dependence are women of child-bearing age. Substance use among pregnant and parenting women is a major public health concern. Aboriginal people have some of the highest rates of substance abuse in Canada, increasing concern for detrimental health impacts, including those for women and their children. For many women, substance abuse offers a means of coping with trauma, such as childhood abuse, partner violence, and, for Aboriginal women, the intergenerational effects of colonization. In this paper, we review treatment issues for Aboriginal mothers with substance use problems and their children. We discuss gender-specific issues in substance abuse, the need for women-specific treatment, the impact of substance abuse on children and parenting, the additional risks for Aboriginal women and children, and the need for integrated programs (those that integrate pregnancy-, parenting-, and child-related services with women-specific addiction treatment). We describe New Choices as an example of an integrated program, review research on existing treatment for Aboriginal mothers with substance use issues, and describe Sheway as a promising integrated program for Aboriginal women with substance abuse issues and their young children. There are few treatment programs specifically for Aboriginal mothers with substance use issues and their children and very little research on their effectiveness. Based on our review of existing evidence, we offer recommendations for future research and practice. KeywordsAboriginal-Women-Substance use-Children-Treatment-Pregnancy-Parenting

Important to the assessment of adolescent alcohol misuse is examination of alcohol-related problems. However, most measurement tools have only been validated among Euro-American cultures. The present study assessed the ability of the Rutgers Alcohol Problem Index (RAPI) to identify problem drinkers among groups of First Nations Mi’kmaq and non-Aboriginal adolescents from rural Nova Scotia and compared cut-point scores across cultural groups. Receiver Operating Characteristic (ROC) curve analyses revealed that the RAPI adequately distinguished between problem and non-problem drinkers in both groups with similar levels of precision. Cut-points were lower for First Nations Mi’kmaq as compared to non-Aboriginal adolescents. Results support the use of the RAPI with First Nations Mi’kmaq and non-Aboriginal adolescents and suggest that cut-points may need to be lowered for use with First Nations Mi’kmaq adolescents. Findings highlight the need for empirical examination of the cross-cultural psychometric applicability of alcohol assessment tools and cut-points among First Nations adolescents. KeywordsRutgers Alcohol Problem Index (RAPI)-Adolescence-Binge drinking-First Nations-Mi'kmaq-Cross-cultural-Cut-point scores-Assessment

Child sexual abuse (CSA) lead to short-term sequelae and long-lasting pervasive outcomes. Research has started addressing CSA as a potential risk factor for later addictions, including pathological gambling. Among Aboriginal peoples, it is plausible that the legacy of residential schooling and other historical traumas have led to unresolved grief that contribute to social problems, such as pathological gambling. The purpose of this brief paper is to report on the few available studies examining the connection between CSA and later pathological gambling. Results show that gambling is more prevalent among Aboriginal than non-Aboriginal populations. Although no causal relationship has been confirmed, experiences of CSA may be related to the later development of pathological gambling among the general population as well as among Aboriginal peoples. However, this link appears complex and indirect and future researches are highly needed. Recommendations based on the implications of this link are proposed for prevention, treatment, and research. KeywordsAboriginal peoples-Gambling-Pathological gambling-Child sexual abuse-Trauma-First Nations-Prevalence

This study was designed to identify predictors of the choice to abort or deliver a child within 18 months of a previous birth and to compare mothers who chose to abort or deliver relative to substance use and adverse partner behavior. Using a systems perspective, data from the Fragile Families and Well-Being Study were examined. The sample included participants from 16 cities, and within the selected cities, hospitals with high rates of unmarried births were chosen for inclusion in the survey. The data analysis process entailed two steps: 1) predictors of the choice to abort were identified statistically; 2) mothers who chose to abort and deliver were compared relative to heavy drinking, cigarette smoking, and adverse partner behavior after controlling for potentially confounding factors identified in step one. The results indicated that several variables pertaining to the father's commitment to raising a previously born child and to his relationship with the mother predicted the choice to abort. Further, a recent abortion was related to substance use and partner perpetrated physical aggression after the effects of confounding variables were removed.Professionals who work with women from impoverished environments facing an unplanned pregnancy should be encouraged to sensitively explore the woman’s support system. If the father is unavailable, counselors can assist women in identifying other sources of support within and outside the family.

Background The stability of personality disorders in substance abusers have been questioned. Previous research has suggested that personality disorder features change when substance use is reduced, but remain stable when substance use is continued. The current study extended this finding to alcohol patients. Materials and Methods Alcohol dependent subjects treated for alcohol problems were tested with the Millon Clinical Multiaxial Inventory II (MCMI-II) at intake to inpatient treatment, discharge from treatment, and at 6 months follow-up. Test-retest correlations were calculated and compared with discriminant correlations, and measures of change were calculated. The association between percent of days abstinent and change in MCMI-II personality disorder scales was assessed using hierarchical regression controlling for baseline scores. Results MCMI-II personality disorder scales were significantly correlated across assessment waves, and comparison violations were relatively few. Large changes occurred during treatment, and only small changes from discharge to follow-up. Changes were associated with percent days abstinent for avoidant, dependent, and masochistic personality disorder scales. No significant differences were observed in the stability between the control and experimental condition. Conclusions The MCMI-II was found to be stable, and little evidence was found that there was a lack of discriminant validity. Changes in personality disorder severity as measured by self-report took place during treatment, rather than after. There was some indication that decreases in personality disorder scales from discharge to follow-up were associated with abstinence from drinking during follow-up.

Objective The purpose of this study is to explore the attitudes of abstainers from drug use that relate to the factors leading to long-term abstinence. Materials and Methods Cross-sectional study was carried out in Al-Amal Hospital to examine, which attitudes of abstainers related to long-term abstinence. A random survey was conducted on 62 subjects from extended care units. All participants were male (no female patients). Their mean age was (37.9) (SD 6.5). The Majority had already completed in-patient treatment programs and joined the extended care unit program. The survey included 39–items. Results The results demonstrate that about 70% of the subjects had completed residential rehabilitation treatment programs (Unit D) and 53% had completed behavior modification program (Unit C). 74% of the subjects found both the inpatient and outpatient program useful. Moreover 85% of the sample reported that regular performance of prayers was very effective way of gaining coping skills to resist the urge to abuse substances. The majority of subjects (60–90%) frequently used problem solving, feelings expression, forgiveness, refusal and avoidance, and positive thinking as major coping strategies against relapse. In addition, the majority of the abstainers declared that about 88% of social and family relationship improved after treatment. Similarly, 80% of subjects stated that 81% of their physical health and 64% of their mental health improved significantly. As expected onset of long-term abstinence was predicted from in-patient treatment programs(C + D). Interestingly, almost three quarters of respondents reported that their quality of life had improved.

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential ‘Namgis Treatment Centre (NTC) program in Alert Bay, British Columbia. Intake files (n = 218) were reviewed for clients who participated in 17 different 6-week sessions over a period of two and a half years. The assessment included a telephone follow-up survey, developed in conjunction with all of the NTC staff, for clients who had been out of treatment for 3–37months (n = 91, 52.7% male and 47.3% female participants). In total, 24 clients (26.37%) were abstinent at the time of the interview, and 67 clients (73.6%) had had a relapse on average 155.29 (SD = 167.77) days after completing treatment. Cox regression univariate and bivariate analysis revealed that pre-treatment variables were not associated with time to relapse or what happened after relapse (abstinence again, harm reduction or resuming pre-treatment consumption levels). However, the greater number of supports the client had, the more likely they were to be completely abstinent, and the less supports the client had, the more likely they were to completely relapse. NTC staff and community members were consulted on the implications of the data, and recommendations were shared with NTC policy makers. Based on the findings of this project, it is apparent, that in this context, follow-up and aftercare are critical for effective treatment. KeywordsSubstance abuse-Treatment outcomes-Aboriginal-Program evaluation

Introduction Violence against women is one of the main, yet neglected, social problem in many countries. Unpublished reports and other anecdotes suggest a high rate of violence against women in Iran. This preliminary study was developed to examine the frequency and correlates of physical, sexual, and psychological violence against women in this country. Materials and Methods The study undertook structured interviews to identify the women who were abused by their spouse. This study was performed in two phases. The first phase involved the clarification of the concept of spouse abuse, designing a survey instrument, and fine-tuning the survey instrument through validity and reliability testing. The second phase consisted of the recruitment process through a multistage sampling method and administration of the survey instrument. Results In total, 650 women consented to participate in this study. Thirty nine percent of women were victims of physical violence. Thirty percent of participants were frequently insulted and 24% of women were sometimes threatened by their husbands. The rate of physical violence decreased as the education level of either spouses increased. Twenty three percent of women believed that their husbands had the right to exert violence against them. Discussion Factors such as erroneous beliefs and traditions, gender inequality, lack of social support for abused women, low education level, and women’s lack of knowledge about their rights play an important role in extending this social dilemma. Empowering women through education, increased access to financial services, and increased participation in decision making; and increasing public awareness of human rights through education and awareness campaigns are keys in dealing with violence against women in Iran.

The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of anxiety, major depressive disorder, dysthymia, and dependent personality disorder. Quality of life indicators suggested that the flight attendants were slightly above average in life satisfaction for a treatment population. Implications for clinical practice with this population were also discussed. KeywordsFirst responders–Flight attendants–Substance abuse–Mental health

Although outcomes monitoring and the collection of other performance data holds benefits for service managers and policy makers, the extent to which these data are collected by South African substance abuse service providers is unknown. To describe (i) the extent to which substance abuse service providers in South Africa monitor and evaluate their programmes and (ii) the availability of structures to support monitoring and evaluation activities within these services. Cross-sectional surveys of substance abuse treatment services were conducted in Gauteng and KwaZulu-Natal provinces (2006–2007) and the Central and Northern region of the country (2007–2008). A survey of prevention services was conducted in the Cape Town metropole (2008). Across all sites approximately half of the services reported never having evaluated their programmes. In addition, less than two thirds of treatment facilities routinely monitor client outcomes. Even where monitoring and evaluation did occur, less than a third of facilities used standardised questionnaires and less than two-thirds used urinalyses to collect outcomes data. Based on the above findings, a number of recommendations are made to expand monitoring and evaluation within South African substance abuse services. KeywordsOutcomes monitoring-Substance abuse-Programme evaluation-Service quality-South Africa

To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services during the course of treatment and to compare mental health service provision in these settings by type of facility and staff composition. Cross-sectional audits of substance abuse treatment facilities were conducted in Gauteng and KwaZulu-Natal provinces. Data were collected using the Treatment Services Audit Questionnaire. A response rate of 84% was obtained. Few treatment facilities provide clients with access to mental health services. Inpatient facilities are more likely than outpatient facilities to provide clients with access to mental health services. Facilities with for-profit ownership status are more likely than facilities with non-profit status to provide access to mental health care. Based on the above findings, a number of recommendations are made to increase the provision of mental health services during the course of substance abuse treatment.

Alcohol misuse is commonly associated with problem gambling and suicide attempts. This study included seventy patients admitted to an Auckland (New Zealand) hospital immediately following a suicide attempt. The first paper in the study identified 12 (17.1%) patients from the sample as being positive on the Eight Gambling Screen. Of these individuals, 75% were also positive on the CAGE alcohol screen. Problem gambling patients who had attempted suicide were also more likely to be Maori (indigenous New Zealanders). The severity of the suicide attempt between patients screened as problem gamblers and those who were not did not differ.

The study focuses on the serious issue related to the adolescents’ and adults’ behavior and health. It aims to identify the risk factors for drug abuse from samples taken from a town of Eastern Nepal. This is a matched case-control study. The conditional logistic regression method was adopted for data analysis. The diagnosis cut off was determined by Receiver Operating Characteristic curve. A representative sample of 150 matched pairs was recruited from Dharan in 2006. The final model after adjusting 17 possible variables each other, detected some factors like education, occupation, short temper, depression, etc that were significantly associated with drug abuse, but shy behavior was not a significant predictor for drug abuse among the study sample. The level of education, occupation and depression were the strong predictors as identified by the model. The findings of the study may have implications to aware families and schools in developing countries like Nepal.

Mindfulness is a concept that has taken quite a hold on the therapeutic world in recent years. Techniques that induce “mindfulness” are increasingly being employed in Western psychology and psychotherapy to help alleviate a variety of conditions. So while mindfulness has its conceptual roots in Buddhism it has been translated into a Western non-religious context. Mindfulness skills are now included as a technique for coping with urges to engage in substance use and relapse in addiction. The research at this date has not revealed the ultimate effectiveness of mindfulness for substance abuse and addiction. It might be that mindfulness is a helpful, but not a sufficient factor as a means to address substance abuse. The relationship between spirituality and mindfulness should be explored further.

Despite our increasing knowledge of the complexity of concurrent disorders the majority of research has involved either institutionalized or specific clinical populations and there have been limited opportunities to directly examine issues at the community level particularly if any differences exist between women and men. Using four standardized instruments, 150 male and 150 female community-based consumer-survivors in the London, Ontario area were interviewed. Eight focus group sessions including 65 individuals were also conducted. Differences between male and female respondents included primary diagnosis, history of family mental illness, family substance abuse, social supports and problematic parental substance abuse. While the overall level of functioning was similar for both sexes, men reported more problems with substance use while women reported a greater overall problem severity. Surprising was the lack of importance of substance abuse issues in respondents’ lives, particularly among focus group members as only four comments regarding substance abuse were made in over 10h of dialogue. The findings support the belief that specific services by sex are required for this population though the likelihood of attending such programs would be increased if rudimentary income, housing and transportation needs were addressed.

Mentally disordered patients that abuse drugs or alcohol have a larger number of criminal convictions. Early starters who had their first conviction before the age of 18, especially, more often have a diagnosis of substance abuse and are more often intoxicated at the time of the offense compared to late starters. The present study involved four groups of Dutch patients (n = 137): three groups of violent offenders (psychotic and personality disordered patients) and one group of non-delinquent psychotic patients from general psychiatry. All data were retrieved retrospectively. The results showed that early starters were intoxicated more often, started with substance abuse at an earlier age and more often had a diagnosis of substance abuse at the time of the index offense than late starters. Personality disordered offenders were intoxicated more often and more often had a prior diagnosis of substance abuse at the time of the offense than psychotic offenders. To a limited extent, psychotic offenders with a diagnosis of a substance-related disorder or intoxication at the time of the offense had a more extensive criminal history than personality disordered offenders. Substance abuse has an aggravating effect on criminogenic behavior, depending on the age at first conviction and diagnosis.

The history of psychoactive substance use in Africa is relatively short except for the reports on the use of traditional substances such as alcohol, cannabis and khat. The introduction of prescription drugs to Africa drastically increased the availability and use of psychoactive substances. This notwithstanding, alcohol, cannabis and khat still remain the most common substances of abuse in Africa. More recently, trafficking in heroin and cocaine has made narcotic drugs easily available across Africa despite the existing legal control measures. Complications arising from the use/abuse of psychoactive substances often draw public attention to their deleterious effects, which culminate in drug control policy formulation. This paper highlights the contribution of poverty, political instability, social unrest and refugee problems to the rapid spread of psychoactive substance use/abuse in Africa particularly among the youth. The review also points to a possible linkage between psychoactive drug use and HIV infection. At present in Africa, systematic evidence-based drug information is sparse. Also, drug policies are skewed towards formal control measures that may not encourage community participation. Poor funding, insufficient skilled health personnel, poor laboratory facilities, inadequate treatment facilities, and lack of political will are some of the impediments to controlling substance use/abuse in Africa. The paper argues that well-coordinated civil society participation is necessary in the control of drug problems in Africa in order to achieve a balance between supply and demand reduction efforts.

This article explores the relationships between certain cognitive and emotional factors (sensation seeking, impulsivity, self-esteem, anxiety sensitivity and loneliness) and regular consumption of alcohol and other drugs by a university population from Almería (South Spain). During 2005 and 2006 students were given a battery of questionnaires related to these personality variables and the substances they had consumed. After filling out the psychometric tests, the participants gave a urine sample which was then analyzed. The findings stress the role of sensation seeking and loneliness, understood as social maladjustment, in the regular consumption of alcohol and other drugs, in both men and women.

Adolescent methamphetamine use is a prominent concern for Canadian media and government. Few empirical studies, however, have established the scope of adolescent methamphetamine use or associated outpatient substance abuse treatment utilization. The current study aimed to answer the following questions: (1) What was the overall proportion of primary methamphetamine-related cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005–2006?; (2) What kind of treatment programming did these treatment centres offer primary methamphetamine users?; and (3) How prepared were these treatment programs to provide services to primary methamphetamine users? We developed a comprehensive list of all sites offering outpatient substance-abuse treatment programs for youth in British Columbia. We asked the Executive Director (or designate) of each facility about the program’s annual caseload, proportion of primary methamphetamine-related cases, treatment approach, and preparedness to provide effective treatment for methamphetamine users. Responses were received from 68 of the 80 centres on our final master list. Approximately 11% (780/6,840) of all cases at the sites were due primarily to methamphetamine use. The proportion of primary methamphetamine-related cases varied widely across sites in B.C., with contacted centres reporting between 0–65% of their caseload in 2005–2006 as primarily methamphetamine-related. Almost all facilities integrated primary-methamphetamine users into treatment-as-usual, and few centres (12%) felt inadequately prepared to offer treatment for methamphetamine users. The current study found a substantial proportion of all cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005–2006 were primarily due to methamphetamine misuse. While most treatment sites integrated youth methamphetamine users into regular treatment programming and few treatment directors indicated that their programs were inadequately prepared to offer treatment services to methamphetamine-using clients, more evidence is needed to ascertain the most effective treatment strategies for methamphetamine users.

Directors’ and treatment staff’s perceptions of organizational functioning within substance abuse treatment facilities in four provinces in South Africa were examined via the Texas Christian University’s Organizational Readiness for Change instrument. Forty-four treatment facilities (out of 89) participated in the study. Results indicated that directors and staff displayed favorable perceptions with regard to organizational climate and staff attributes, and were indecisive about the motivation for change domain. Certain demographic factors were associated with both directors’ and staff perceptions towards the organizational functioning of treatment facilities. KeywordsOrganizational functioning–Substance abuse treatment–Organizational readiness for change–South Africa

Substance abuse is an important health issue facing children involved with child welfare, but little is known about the associated factors. The purpose of this study was to build on findings from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003 and use a national sample of 10–15year old children to examine the factors associated with substance abuse for all investigations and substantiated investigations of maltreatment. Our findings showed that almost 14% of all investigated children were abusing substances and that this proportion was even greater among those whose investigation of maltreatment had been substantiated (almost 16%). The severity of the experienced maltreatment, in addition to behavioural factors, was found to be associated with substance abuse. While the pathways to substance abuse are complex, understanding the risk factors associated with substance abuse in this population are important for targeted interventions for prevention and treatment. KeywordsChild abuse–Child neglect–Child welfare–Adolescent substance abuse–Pre-adolescents

Childhood maltreatment and adolescent substance abuse are important health issues that have been linked by research and theory for at least 50years. Considering the intricacies of child maltreatment research, this paper aims to answer the question: which models show the most promise to explain why child maltreatment is a risk indicator for adolescent substance abuse? Models of the mechanisms of this association are reviewed and evaluated in the context of the many complexities of defining and measuring child maltreatment. We offer three recommendations for future research in this area: 1) measures of the severity of child maltreatment should be used where possible; 2) positive childhood relationships should be assessed as a potentially important protective factor; 3) more research should involve system-involved children and adolescents. KeywordsChild maltreatment–Substance abuse–Adolescent–Review

The purpose of this study was to examine the individual characteristics and mental health factors of dysthymic and nondysthymic substance abusers. Out of a total of 1,209 medical records reviewed to select cases of dysthymic and nondysthymic substance abusers attending a community drug treatment program, 183 medical records were selected, 48% of which were dysthymic substance abusers. Bivariate analyses indicated that dysthymic substance abusers were more likely to be male, older individuals, reported high levels of alcohol dependence, lower quality of life, and higher number of previous substance abuse treatment. Results from hierarchical multiple logistic regression analyses indicated that age, gender, and quality of life were significant predictor for having dysthymia. Implications for the mental health field are discussed, underlining the importance of developing and providing competent treatment for substance abusers with co-occurring disorders.

There is a strong association between pathological gambling and substance abuse. The objective of this study is to identify the differences between substance abusers with and without gambling problems. A cross sectional study was conducted interviewing with Addition Severity Index (ASI) and South Oaks Gambling Screen (SOGS), alcohol and drug abusers (N = 147) who sought treatment in specialized treatment facilities. SOGS was used to access and classify individuals into two groups: social gamblers (n = 96) and probable pathological gamblers (n = 32). Scores on ASI provided data about severity on seven areas. Several differences were found between the two groups. Cocaine was the major reason for treatment among drug abusers with gambling problems. This group had more severity problems in the areas of drug use, psychiatric, legal and family-social. Furthermore, they had more suicidal ideas, parents with gambling problems and started to play earlier than the social gamblers group. These results indicate the need to improve the services that provide treatment to alcohol and drug abusers, including routines for screening to early identification and professional education on specific treatment to substance abusers with pathological gambling.

A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Baserate scores indicated a prevalence of 95% of personality disorders. A logistic regression analysis correctly identified 95% of the sample, and showed that antisocial personality disorder traits were characteristic of the prison sample, and masochistic personality disorder traits were characteristic of the inpatient sample. The findings indicate that treatment models used in prison settings should be adjusted to meet the needs of antisocial patients.

The existing literature indicates high comorbidity rates between depressive disorders and substance abuse disorders. Despite these elevated rates, there is limited empirical work devoted to understanding predictors of depressive symptoms among substance abusers. The aim of this study was to examine the effect of spirituality, believing in God’s presence, Post-Traumatic Stress Disorder (PTSD), parental bonding and demographic characteristics on depressive symptoms among inpatient substance abusers. Findings indicated that spirituality, believing in God’s presence, PTSD and income were significant predictors of depressive symptoms among substance abusers. Spirituality, PTSD, and income were inversely related to depressive symptoms, whereas believing in God’s presence was positively related to depressive symptoms.

This article aims to examine specific substance use profiles among former Soviet Union (FSU) immigrant and native-born women in Israeli therapeutic treatment facilities. Individuals were sampled at drug treatment facilities and assessed using the Addiction Severity Index. ASI scores suggest differences between the two groups. Among the findings are native born females have been using heroin and amphetamines longer than FSU immigrants; however, immigrant women have more years of alcohol use. FSU women are more inclined to be injection drug users, prefer shorter forms of treatment, and to use alcohol when receiving treatment for heroin addiction. FSU women have higher levels of chronic medical problems, HCV, and HIV/AIDS. The study results tend to support the position that treatment of special populations may be enhanced if their particular needs associated with personal attributes and background characteristcs are considered and met in a treatment environment.

Background There is currently evidence that methadone and buprenorphine maintenance is effective in reducing substance abuse. However, it is not known whether psychosocial support improves the outcome of methadone maintenance in the absence of control measures, such as regular urine testing. Materials and Methods In a prospective observational study, the effectiveness of standard psychosocial support [SPS] was compared with enhanced psychosocial support [EPS]. EPS included intensive case management and drop-in centres. Subjects were administered the Addiction Severity Index before and after treatment and were followed up at 18 months post-treatment, and case files were reviewed. No subjects in either SPS or EPS condition were subjected to a substantial amount of control measures such as urine testing. Results Clients in EPS support received more treatment according to case-files, and showed a lower proportion of no-shows compared with those receiving SPS. Subjects in both SPS and EPS reduced drug use and legal problems, but enhanced care was more effective at reducing social problems, family problems and psychiatric severity. Mortality was slightly, although non-significantly higher in the control group. Change in psychiatric and social problems were associated with the absence of no-shows. Discussion Enhanced psychosocial support appeared to be effective at reducing problems associated with drug use in a low-threshold buprenorphine or methadone maintenance setting without substantial measures of control.

Accessibility to gambling has been linked to gambling behaviour but remains poorly understood. This study used data from semi-structured focus groups and interviews with 38 participants (Median age 42years) to explore wider aspects of accessibility. People preferred venues which were open long hours and located close to home, work or regular routes, i.e., geo-temporal accessibility. This was particularly influential for problem gamblers. Social and personal accessibility related to venues as safe, social, easy entertainment experiences, and as an accessible retreat from life issues. The attraction of an accessible retreat was restricted to problem gamblers. Finally, low outlay games and easy access to money increased financial accessibility. Accessibility should therefore be considered multidimensional. Further, results suggested that while gambling as safe, social entertainment may be relatively harmless, the attraction of geo-temporal accessibility and a retreat from problems may encourage excessive gambling in some individuals. KeywordsGambling–Accessibility–Social–Escape–Environment

It is argued that the analytical comparison of gambling regulatory frameworks across jurisdictions requires the identification of salient dimensions to provide the basis for such. It is further suggested that governmental ‘conflict of interest’ might provide a useful dimension for such comparison, as operationalised by concomitant EGM harm and government dependence criteria. The same ‘conflict of interest’ criteria are then suggested as a guide for gambling regulation within single jurisdictions, this being named the ‘Public Accountability Approach.’ These points are discussed within broader reference to lines and webs of harm production within a public health analysis. Broader reference is also made to the proper role of government within contemporary democracy.

Twenty college students from a private Midwestern university were interviewed about their past and present experiences with taking medication for Attention Deficit Disorder. Analysis of respondent interviews suggested the following themes that were discussed and analyzed: recruitment of the young, little personal stigma, societal issues, side effects and abuse. Social and personal factors associated with taking medication for ADD were explored and compared with prior studies on anti-depressant medication. Practice implications were presented. KeywordsMedicating for ADD-Attention deficit disorder-Medication-Self-concept

In 2009, one of the major Dutch addiction care organizations initiated a pilot program to explore the possibility of using an existing Cognitive Behavioral Therapy and Motivational Interviewing based treatment program (‘Lifestyle Training’) to treat internet addiction. The current study evaluates this pilot treatment program by providing a qualitative analysis of the experiences of the therapists with the treatment of 12 self-proclaimed internet addicts. Therapists report that the program, which is ordinarily used for substance dependence and pathological gambling, fits the problem of internet addiction quite well. Interventions mainly focused on controlling and reducing internet use, and involved expanding (real life) social contacts, regaining a proper daily structure, constructive use of free time, and reframing beliefs. Therapists further indicated that the treatment achieved some measure of progress for all of the 12 treated patients, while patients reported satisfaction with the treatment and actual behavioral improvements. KeywordsInternet addiction–Treatment–Cognitive behavioral therapy–Motivational interviewing–Thematic analysis

The progressive approaches First Nations, Métis, and Inuit communities use to address health and wellness concerns are rarely written about or acknowledged in a positive manner. This paper speaks to a concept introduced through the Canadian Aboriginal Aids Network (CAAN) entitled “wise practices”. CAAN saw a wise practices model as more useful and inclusive of Aboriginal community practice and knowledge exchange than the current “best practice” model. In addition, wise practices acknowledge and express the notion of “Changing the Face of Aboriginal Canada”, a metaphor frequently used by the senior author of this paper, as a long overdue vehicle for lifting up the collective morale of Aboriginal peoples in Canada. Indigenous peoples worldwide have long articulated an inherent wisdom in developing recovery processes. This natural wisdom has been chronically dismissed and underutilized as a framework for re-building a healthy social construct and worldview. The social and emotional utility of constructing and implementing a “wise practices” healing model based on what are commonly referred to as the Seven Sacred Values, has great potential for addressing violence, mental illness and addictions in Aboriginal communities and can better serve health promotion alongside the western model of “best practices.” A wise practices model becomes another, deeply humane way, of expressing and operationalizing the traditional knowledge base of Aboriginal Canada and returns a sense of self-efficacy and social strength to Aboriginal communities. KeywordsAboriginal-Addictions-Values-Wise practices-Healing

The cost of health care services and supports for mental health and addictions is important to know. In order to calculate it, one must know who is receiving what is being provided by whom at what price. Without tracking these types of data, it is difficult to know the cost of the activities being provided. The systematic collection and analysis of such data allows decision makers to become more aware of how money is being spent. Without this information, it is difficult to evaluate different models of care or determine relative responsibilities of different government players. As a case study, we describe the analysis and findings of a project to assess the costs of mental health and addiction services within homeless shelters in Toronto, Ontario, Canada.

This paper provides further thoughts and observations on Richard Wood’s paper “Problems with the concept of video game “addiction”: Some case study examples (this issue). Wood argues against the concept of ‘videogame addiction’ but very few of the arguments presented by Wood negate its existence. Just because the few empirical studies appear to overestimate the prevalence of ‘videogame addiction’, it does not mean that the condition does not exist. Furthermore, some of the assertions made by Wood are arguable. Furthermore, Wood does not put forward his own preferred criteria for addiction. This is especially problematic when using his own case studies to negate whether ‘videogame addiction’ exists. Until addiction researchers agree on what it is to be addicted, we will never get agreement on whether behavioural excesses like videogame playing can be classed as a ‘genuine’ addiction.