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Pastwa-Wojciechowska B, Guzińska K. The relationship between male prisoners' self-efficacy and their participation in addiction treatment. Alcohol 2024; 120:65-72. [PMID: 38163492 DOI: 10.1016/j.alcohol.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/21/2021] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
The purpose of this study was to attempt to verify the existence of a relationship between internal resources (self-esteem and self-efficacy) and motivation (decisional balance) to undergo treatment in prisoners with alcohol addiction participating in voluntary treatment as well as referred to obligatory addiction treatment based on a court decision. The study was carried out in penitentiary units in various parts of Poland in 2018-2019. Participants completed the Decision Balance Scale, Generalized Self-Efficacy Scale, and Multidimensional Self-Esteem Inventory twice - before and after addiction treatment. The study adopted the assumptions of the Transtheoretical Model developed by Prochaska and DiClemente (1984). There were no statistically significant differences between the group of prisoners referred for obligatory treatment and those undergoing voluntary therapy. At the end of the 3-month treatment, there was a significantly smaller number of arguments "for" drinking and less identity integration in both groups studied. The results obtained may indicate that after undergoing therapy, prisoners remain in a contemplation stage due to their inability to adapt therapeutic interactions to individual needs. It seems that changes in identity integration may be indicative of the crisis that is being experienced, which in effect may allow individuals with alcohol addiction to search for and achieve a potentially new, coherent image of themselves.
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Silcox J, Rapisarda SS, Hughto JMW, Vento S, Case P, Palacios WR, Zaragoza S, Shrestha S, Stopka TJ, Green TC. Views and experiences of involuntary civil commitment of people who use drugs in Massachusetts (Section 35). Drug Alcohol Depend 2024; 263:112391. [PMID: 39167986 DOI: 10.1016/j.drugalcdep.2024.112391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/28/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Involuntary civil commitment (ICC) is a court-mandated process to place people who use drugs (PWUD) into substance use treatment. Research on ICC effectiveness is mixed, but suggests that coercive drug treatment like ICC is harmful and can produce a number of adverse outcomes. We qualitatively examined the experiences and outcomes of ICC among PWUD in Massachusetts. METHODS Data for this analysis were collected between 2017 and 2023 as part of a mixed-methods study of Massachusetts residents who disclosed illicit drug use in the past 30-days. We examined the transcripts of 42 participants who completed in-depth interviews and self-reported ICC. Transcripts were coded and thematically analysed using inductive and deductive approaches to understand the diversity of ICC experiences. RESULTS Participants were predominantly male (57 %), white (71 %), age 31-40 (50 %), and stably housed (67 %). All participants experienced ICC at least once; half reported multiple ICCs. Participants highlighted perceptions of ICC for substance use treatment in Massachusetts. Themes surrounding ICC experience included: positive and negative treatment experience's, strategies for evading ICC, disrupting access to medications for opioid use disorder (MOUD), and contributing to continued substance use and risk following release. CONCLUSIONS PWUD experience farther-reaching health and social consequences beyond the immediate outcomes of an ICC. Findings suggest opportunities to amend ICC to facilitate more positive outcomes and experiences, such as providing sufficient access to MOUD and de-criminalizing the ICC processes. Policymakers, public health, and criminal justice professionals should consider possible unintended consequences of ICC on PWUD.
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Affiliation(s)
- Joseph Silcox
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; University of Massachusetts - Boston, Department of Sociology, Boston, MA, USA.
| | - Sabrina S Rapisarda
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; University of Massachusetts - Lowell, School of Criminology and Justice Studies, Lowell, MA, USA
| | - Jaclyn M W Hughto
- Brown University, Center for Health Promotion and Health Equity, Providence, RI, USA; Brown University School of Public Health, Departments of Behavioral and Social Sciences and Epidemiology, School of Public Health, Providence, RI, USA
| | - Stephanie Vento
- Brown University, Center for Health Promotion and Health Equity, Providence, RI, USA; The Sutherland School of Law, University College Dublin, Belfield, Dublin, Ireland
| | - Patricia Case
- Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Wilson R Palacios
- University of Massachusetts - Lowell, School of Criminology and Justice Studies, Lowell, MA, USA
| | - Sofia Zaragoza
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Traci C Green
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Brown University Schools of Medicine and Public Health, Departments of Emergency Medicine and Epidemiology, Providence, RI, USA
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Mills JM, Davidson KM. The prison-based Therapeutic Community: Resident recommendations for program improvement. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209404. [PMID: 38768815 DOI: 10.1016/j.josat.2024.209404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants. METHODS To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program. RESULTS Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system. CONCLUSIONS Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.
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Affiliation(s)
- Jack M Mills
- College of Criminology & Criminal Justice, Florida State University, Tallahassee, USA
| | - Kimberly M Davidson
- College of Criminology & Criminal Justice, Florida State University, Tallahassee, USA.
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Messinger JC, Vercollone L, Weiner SG, Bromstedt W, Garner C, Garza J, Joseph JW, Sanchez LD, Im D, Bukhman AK. Outcomes for Patients Discharged to Involuntary Commitment for Substance Use Disorder Directly from the Hospital. Community Ment Health J 2023; 59:1300-1305. [PMID: 36995493 DOI: 10.1007/s10597-023-01112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
To evaluate the outcomes of patients discharged to involuntary commitment for substance use disorders directly from the hospital. We performed a retrospective chart review of 22 patients discharged to involuntary commitment for substance use disorder from the hospital between October 2016 and February 2020. We collected demographic data, details about each commitment episode, and healthcare utilization outcomes 1 year following involuntary commitment. Nearly all patients had a primary alcohol use disorder (91%) and had additional medical (82%) and psychiatric comorbidities (71%). One year following involuntary commitment, all patients had relapsed to substance use and had at least one emergency department visit while 78.6% had at least one admission. These findings suggest that patients discharged to involuntary commitment directly from the hospital universally relapsed and experienced significant medical morbidity during the first year following their release. This study adds to a growing literature recognizing the harms of involuntary commitment for substance use disorder.
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Affiliation(s)
- John C Messinger
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Lisa Vercollone
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Scott G Weiner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - William Bromstedt
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Carol Garner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | | | - Joshua W Joseph
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Leon D Sanchez
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Dana Im
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Alice K Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
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Adeniran E, Quinn M, Wallace R, Walden RR, Labisi T, Olaniyan A, Brooks B, Pack R. A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100152. [PMID: 37069961 PMCID: PMC10105485 DOI: 10.1016/j.dadr.2023.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
Background Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. Methods A systematic search was conducted with the following databases: "PubMed including MEDLINE", "CINAHL", "Web of Science", "ABI/Inform", and "PsycINFO." We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Results Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). Conclusions This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.
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Affiliation(s)
- Esther Adeniran
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
- Corresponding author at: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Richard Wallace
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Rachel R. Walden
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Titilola Labisi
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Afolakemi Olaniyan
- Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Billy Brooks
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Robert Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
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Slocum S, Paquette CE, Walley AY, Pollini RA. Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104074. [PMID: 37244144 DOI: 10.1016/j.drugpo.2023.104074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. RESULTS While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. CONCLUSIONS Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States.
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Lee KSK, Bullen LM, Zheng C, Dawson A, Munro A, Conigrave KM. Beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal clients to involuntary drug and alcohol treatment: A qualitative study. Drug Alcohol Rev 2023; 42:169-180. [PMID: 36194535 PMCID: PMC10947027 DOI: 10.1111/dar.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Involuntary drug and alcohol treatment occurs in many countries and its role is often controversial. This can be a particular concern in relation to First Nations or other culturally distinct populations. This study explores beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in New South Wales (NSW), Australia. METHODS The Involuntary Drug and Alcohol Treatment program (IDAT) is legislated by the NSW Drug and Alcohol Treatment Act 2007. There are two IDAT units-in urban (Sydney, four beds) and regional NSW (Orange, eight beds). NSW Health drug and alcohol clinicians who had referred clients to IDAT between 2016 and 2018 were invited to participate in a semi-structured 1:1 interview. Eleven clinicians (n = 2, male) from six local health districts (urban through to remote) agreed to participate. A descriptive qualitative analysis of responses was conducted. RESULTS Two key themes summarised the beliefs and attitudes that clinicians reported influencing them when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in NSW: (i) dilemma between saving someone's life and being culturally safe; and (ii) need for holistic wrap-around care. DISCUSSION AND CONCLUSIONS Almost all clinicians were worried that being in IDAT would further erode their Aboriginal client's autonomy and be retraumatising. Strategies are needed to support the involvement of Aboriginal-specific services in IDAT processes and ensure local support options for clients on discharge. Future research should examine the effectiveness, acceptability and feasibility of involuntary drug and alcohol treatment programs.
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Affiliation(s)
- K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Lynette M. Bullen
- Involuntary Drug and Alcohol Treatment UnitWestern NSW Local Health DistrictOrangeAustralia
| | - Catherine Zheng
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology SydneySydneyAustralia
| | - Alice Munro
- Research OfficeWestern NSW Local Health DistrictOrangeAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyAustralia
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Nelson LA, Collins SE, Birch J, Burns R, McPhail G, Onih J, Cupp C, Ubay T, King V, Taylor E, Masciel K, Slaney T, Bunch J, King R, Mahinalani-Garza C, Piper BKS, Squetimkin-Anquoe A. Content Analysis of Preferred Recovery Pathways Among Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorders. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2022. [DOI: 10.1177/00220221221132778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately three fourths of the American Indian and Alaska Native (AI/AN) population lives in urban areas, and urban AI/ANs are disproportionately affected by alcohol-related morbidity and mortality. Although no studies have documented alcohol use disorder (AUD) treatment outcomes specific to urban AI/ANs, studies in other Native communities highlight concerns about the cultural acceptability of directive, abstinence-based approaches, such as cognitive behavioral therapy and 12-step programs. Understanding this population’s desired recovery pathways in their own words may help providers create more culturally appropriate, patient-centered, and effective approaches. Participants ( N = 31) were urban AI/ANs who screened positive for AUD using the AUDIT-C. They participated in semi-structured interviews eliciting their experiences in AUD treatment to date and suggestions for redesigning AUD treatment in their own vision. Conventional content analysis was used to create a thematic description. Findings indicated that intrinsic motivation and not extrinsic pressure (e.g., mandated treatment) was associated with positive treatment engagement and outcomes. Participants appreciated feeling safe and supported in AUD treatment, but also felt AUD treatment could be institutional and oppressive. Participants preferred compassionate counselors with lived experience who could provide insights into recovery; they largely did not appreciate a “tough love” approach or power struggles with counselors. Native-led treatment centers providing access to cultural practices were preferred. Moving forward, participants suggested AUD treatment providers should help patients meet basic needs, prioritize patient-driven versus provider-driven goal-setting, support patients’ reconnection with meaningful activities, facilitate access to a supportive community network, and recognize cultural activities as important recovery pathways.
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Affiliation(s)
| | - Susan E. Collins
- Washington State University, Spokane, USA
- University of Washington School of Medicine, Seattle, USA
| | | | | | | | | | | | | | | | - Emily Taylor
- University of Washington School of Medicine, Seattle, USA
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Seto MC, Healey LV, Ahmed AG. Legally Mandated, Formally Pressured, or Voluntary Anger Treatment: Associations With Treatment Recommendations, Refusal, and Completion. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20012-NP20039. [PMID: 34715763 DOI: 10.1177/08862605211050100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legally mandated treatment is common in the criminal justice system, for example, for anger management, substance misuse, and intimate partner violence. Past studies have compared voluntary and legally mandated treatment participants but have not distinguished a third, in-between group that is formally pressured to participate in treatment, but not mandated by the criminal justice system. The current study aimed to assess differences on individual characteristics (e.g., sociodemographic and psychiatric) and baseline measures of psychopathology (e.g., anger, aggression, and depression) across three levels of voluntariness and to determine whether voluntariness was associated with treatment recommendation, refusal, and completion at an outpatient anger treatment clinic. Data were retrospectively gathered from the clinical charts of 405 participants. Referrals were classified as voluntary (e.g., self-referred, 61%), formally pressured (e.g., required by work, 14%), or legally mandated (e.g., court order, 25%). Legally mandated participants were younger, more likely to have substance use disorder, less likely to be women, to have a high school education, or to be on psychiatric medications compared to the other two groups. Voluntary participants scored higher on measures of self-reported anger, depression, and stress than the legally mandated participants. Legally mandated participants in particular presented with non-clinical levels of anger and aggression. Level of voluntariness did not affect the decision to recommend individual or group therapy after an intake assessment, but legally mandated participants were significantly more likely (OR = 2.30) than voluntary participants to refuse recommended treatment. Level of voluntariness did not have a significant association with treatment completion. Findings support our distinction between legally mandated and formally pressured participants, but do not support previous research that suggests legally mandated individuals have lower attrition rates in similar treatment programs. The study has implications for the criminal justice system and for anger treatment programs who admit participants with varying levels of voluntariness.
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Zavodnick J, Wickersham A, Petok A, Worster B, Leader A. "1,000 conversations I'd rather have than that one:" A qualitative study of prescriber experiences with opioids and the impact of a prescription drug monitoring program. J Addict Dis 2022; 40:527-537. [PMID: 35133217 PMCID: PMC9357854 DOI: 10.1080/10550887.2022.2035168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prescription Drug Monitoring Programs (PDMPs) have shown impacts on a number of opioid-related outcomes but their role in clinician emotional experience of opioid prescribing has not been studied. OBJECTIVES This study explores the impact of PDMPs on clinician attitudes toward and comfort with opioid prescribing, their satisfaction with patient interactions involving discussion of opioid prescriptions, and their recognition of opioid use disorder (OUD) and ability to refer patients to treatment. METHODS Researchers conducted semi-structured interviews with five physicians and two nurse practitioners from a variety of specialties and practice environments. RESULTS Many participants reported negative emotions surrounding opioid-related patient encounters, with decreased anxiety related to PDMP availability. These effects were less pronounced with clinicians who had greater opioid prescribing experience (either longer careers or higher-volume pain practices). Many participants felt uncomfortable around opioid prescribing. Data from the PDMP often changed prescribing practices, sometimes leading to greater comfort writing a prescription that might have felt riskier without PDMP data. Clinicians easily recognized patient behaviors, symptoms, and prescription requests suggesting that opioid-related adverse events were accumulating, but did not usually apply a label of OUD to these situations. PDMP findings occasionally contributed to a diagnosis and treatment referral for OUD. CONCLUSIONS PDMP data is part of a nuanced approach to prescribing opioids. The objectivity of the data may be helpful in mitigating clinician negative emotions that are common around opioid therapy.
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Affiliation(s)
- Jillian Zavodnick
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Alexis Wickersham
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Alison Petok
- Division of Infectious Diseases, Massachusetts General Hospital
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University
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Messinger JC, Ikeda DJ, Sarpatwari A. Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms? JOURNAL OF MEDICAL ETHICS 2022; 48:608-610. [PMID: 34045279 DOI: 10.1136/medethics-2020-107160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment-the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.
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Affiliation(s)
| | | | - Ameet Sarpatwari
- Program On Regulation, Therapuetics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Shoham E, Efodi R, Haviv N, Gross Shader C. Dropout from Treatment and Desistance from Crime among Released Prisoners in Jerusalem Halfway House for Prisoners with Substance Misuse Disorder. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1109-1133. [PMID: 33899532 DOI: 10.1177/0306624x211010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study aims to investigate the rates of recidivism among prisoners on parole with a substance misuse disorder who participated in the Jerusalem halfway-house, which combines supervision, employment, and a comprehensive therapeutic program. The study population included all participants who have been treated in the halfway-house (N = 125), whereas the comparison group included all prisoners with a substance misuse disorder who were released after serving their full sentences (N = 321). To reduce possible selection biases, the Propensity Score Matching method was used. Findings show that prisoners, who were treated at the Jerusalem halfway-house, are characterized by higher and frequent rates of recidivism. However, when only completers of the halfway-house were evaluated, it was found that they had lower and slower rates of recidivism. Findings suggest that completing treatment contributes to desistance from crime in the critical post-release years among participants and indicates the importance of optimal diagnostic processes before admitting prisoners to a halfway-house.
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Affiliation(s)
| | - Rotem Efodi
- Prisoner Rehabilitation Authority, Jerusalem, Israel
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13
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Xavier J, Greer A, Crabtree A, Buxton JA. Police officers’ perceptions of their role at overdose events: a qualitative study. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2070057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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14
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Zemore SE, Ware OD, Gilbert PA, Pinedo M. Barriers to retention in substance use treatment: Validation of a new, theory-based scale. J Subst Abuse Treat 2021; 131:108422. [PMID: 34098296 PMCID: PMC8528875 DOI: 10.1016/j.jsat.2021.108422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components. METHODS The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records. RESULTS Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses. CONCLUSIONS The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.
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Affiliation(s)
- Sarah E Zemore
- Alcohol Research Group, Emeryville, CA, United States of America.
| | - Orrin D Ware
- School of Social Work, University of Maryland, Baltimore, MD, United States of America
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, United States of America
| | - Miguel Pinedo
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, TX, United States of America
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15
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Somohano VC, Shank T, Manuel J, Mallik D, Rehder K, Bowen S. The Role of Pretreatment Expectancy on Substance Use Outcomes in Women Mandated to Mindfulness-Based Relapse Prevention. J Altern Complement Med 2021; 27:1147-1155. [PMID: 34516782 DOI: 10.1089/acm.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: More than one-third of justice-involved individuals meet the criteria for substance use disorder (SUD). Many studies show that treatment expectancy predicts longitudinal SUD outcomes; however, results are inconsistent, and the role of treatment expectancy on SUD outcomes for individuals mandated to a mindfulness-based intervention (MBI) is unknown. Mindfulness-based relapse prevention (MBRP) has shown efficacy with justice-involved populations; however, enrollment in MBRP is typically voluntary. The current study assessed whether pretreatment expectancy predicted SUD- and affect-related outcomes in a sample of women (n = 54) mandated to MBRP as part of their residential SUD programming. Method: The authors employed a quasiexperimental design and administered measures at pre-, mid-, and postcourse. Results: Following mandatory participation in MBRP, significant reductions in craving and substance use were observed. However, contrary to hypotheses, higher pretreatment expectancy predicted greater substance dependence at postcourse. Conclusions: Positive treatment expectancy within the context of an MBI was not related to favorable posttreatment outcomes; in fact, it was related to higher postcourse substance dependence. This suggests that MBIs may be suitable for mandated individuals who may not have voluntarily chosen to participate in such an intervention, and thus may have lower expectancy for the treatment. This finding needs to be replicated in a larger sample to warrant a firmer conclusion.
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Affiliation(s)
| | - Taylor Shank
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Jacob Manuel
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Debesh Mallik
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Kristoffer Rehder
- VA Portland Health Care System, Portland, OR, USA.,School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
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16
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Adams ZW, Taylor BG, Flanagan E, Kwon E, Johnson-Kwochka AV, Elkington KS, Becan JE, Aalsma MC. Opioid Use Disorder Stigma, Discrimination, and Policy Attitudes in a National Sample of U.S. Young Adults. J Adolesc Health 2021; 69:321-328. [PMID: 33579622 PMCID: PMC8316251 DOI: 10.1016/j.jadohealth.2020.12.142] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE A small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics). METHODS A national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19-29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes. RESULTS Young adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD. CONCLUSIONS Heterogeneity in young adults' attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.
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Affiliation(s)
- Zachary W. Adams
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, U.S.A
| | - Bruce G. Taylor
- Public Health Department, NORC at the University of Chicago, Bethesda, MD, U.S.A
| | - Elizabeth Flanagan
- Public Health Department, NORC at the University of Chicago, Bethesda, MD, U.S.A
| | - Elizabeth Kwon
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, U.S.A
| | - Annalee V. Johnson-Kwochka
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, U.S.A
| | | | - Jennifer E. Becan
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, U.S.A
| | - Matthew C. Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, U.S.A
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17
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Walker S, Barnett P, Srinivasan R, Abrol E, Johnson S. Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:501-512. [PMID: 33930330 PMCID: PMC8205858 DOI: 10.1016/s2352-4642(21)00089-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I2. This study is registered on PROSPERO, CRD42020099892. FINDINGS 23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3·63, 95% CI 2·43-5·44, p<0·0001), substance misuse (five studies; 1·87, 1·05-3·30, p=0·032), or intellectual disability (four studies; 3·33, 1·33-8·34, p=0·010), as well as presenting with a perceived risk of harm to self (eight studies; 2·05, 1·15-3·64, p=0·015) or to others (five studies; 2·37, 1·39-4·03, p=0·0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3·57, 1·46-8·73, p=0·0052) and being from a Black rather than a White ethnic group (three studies; 2·72, 1·88-3·95, p<0·0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 51·3% to 92·3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation. INTERPRETATION Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors. FUNDING UK National Institute for Health Research and Wellcome Trust.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | | | - Esha Abrol
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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18
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Messinger J, Beletsky L. Involuntary Commitment for Substance Use: Addiction Care Professionals Must Reject Enabling Coercion and Patient Harm. J Addict Med 2021; 15:280-282. [PMID: 33989262 DOI: 10.1097/adm.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ethical and epidemiological concerns should mobilize addiction care providers to deploy their expertise and collective influence to challenge the use of state power to coerce people into treatment settings-especially when such settings often diverge from best clinical practices. Troublingly, with few notable exceptions, the voices of professional organizations on this issue have been largely lacking. This issue of the Journal includes a timely manuscript that sheds light on this resounding silence: "Civil Commitment for Substance Use Disorders: A National Survey of Addiction Medicine Physicians" by Jain et al. provides important and novel insights into the beliefs of physicians regarding civil commitment statutes. This study distributed a web-based survey to physician-members of the American Society of Addiction Medicine with questions gauging awareness of, attitudes toward, and experiences with civil commitment for individuals with substance use disorder. Surprisingly, the study found that the overwhelming majority of addiction medicine providers supported the application of civil commitment for substance use disorder-60.7% reported being in favor of its use whereas only 21.5% reported being opposed.
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Affiliation(s)
- John Messinger
- Harvard Medical School, Boston, MA (JM); Health in Justice Action Lab, Northeastern University, Boston, MA (LB); Division of Infectious Disease and Global Public Health, UC San Diego School of Medicine, La Jolla, CA (LB)
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19
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Rivera D, Dueker D, Sanchez M, Amaro H. Examination of referral source and discharge outcomes among women in residential substance use disorder treatment. J Subst Abuse Treat 2021; 125:108319. [PMID: 34016303 DOI: 10.1016/j.jsat.2021.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/06/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Court-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear. PURPOSE This study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women. METHODS Study staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group's clinically defined treatment discharge outcomes while controlling for covariates. RESULTS Multinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress. CONCLUSIONS This study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.
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Affiliation(s)
- Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA 90089, United States of America.
| | - Donna Dueker
- Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA 90747, United States of America.
| | - Mariana Sanchez
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America.
| | - Hortensia Amaro
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America; Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America.
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20
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Chau LW, Erickson M, Vigo D, Lou H, Pakhomova T, Winston ML, MacPherson D, Thomson E, Small W. The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103208. [PMID: 34058669 DOI: 10.1016/j.drugpo.2021.103208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the Canadian Province of British Columbia (BC), the BC Mental Health Act permits involuntary care for treating mental disorders. However, the Act has also been applied to provide involuntary care to individuals with a primary substance use disorder, in the absence of specific guidelines and legislation, and with insufficient understanding of perspectives of people who use drugs (PWUD) regarding this approach. METHODS As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory. RESULTS Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks. CONCLUSION Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.
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Affiliation(s)
- Leena W Chau
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Margaret Erickson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, David Strangway Building, 4th Floor 209, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Hayami Lou
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Tatiana Pakhomova
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Mark L Winston
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, 3309-515 West Hastings Street, Vancouver, BC, V6B 5K3, Vancouver, Canada
| | - Donald MacPherson
- Canadian Drug Policy Coalition, 101-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Erica Thomson
- BC and Yukon Association of Drug War Survivors, 416 Columbia St, New Westminster, BC, V3L 1B1, Canada; Harm Reduction Program, Fraser Health Authority, BC, Canada
| | - Will Small
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada; British Columbia Centre on Substance Use.
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21
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"A good mother": Impact of motherhood identity on women's substance use and engagement in treatment across the lifespan. J Subst Abuse Treat 2021; 130:108474. [PMID: 34118710 PMCID: PMC8478714 DOI: 10.1016/j.jsat.2021.108474] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/22/2020] [Accepted: 05/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women are underrepresented in substance use disorder (SUD) treatment. Interpersonal and structural factors affect women's access to SUD treatment, but limited research evaluates how motherhood is a potential barrier and facilitator to engagement in SUD treatment. We focus on women from young to middle adulthood, and capture women's identities as mothers, caretakers, and grandmothers, outside of pregnancy and the postpartum period. METHODS Study staff conducted twenty qualitative interviews with women in SUD treatment to assess experiences with SUD treatment, in which motherhood emerged as a key theme. Twelve women then participated in four focus groups centered on motherhood. The study audio-recorded and transcribed interviews, and two independent authors analyzed interviews, followed by group consensus. RESULTS Most women identified their children and responsibilities as mothers and caretakers as important motivators to accessing SUD treatment. Motherhood was also a barrier to treatment, in that women feared losing child custody by disclosing substance use and few residential programs accommodate women with children. Multiple women expressed guilt about their substance use, sensing that it contributed to perceived abandonment or separation from their children. Reunification was important to SUD recovery. CONCLUSION Women with SUD who are mothers experience specific barriers to treatment engagement and recovery. Women need SUD treatment programs that address these interpersonal and structural factors across the lifespan.
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22
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Rivera D, Dueker D, Amaro H. Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:21. [PMID: 33653374 PMCID: PMC7927366 DOI: 10.1186/s13011-021-00357-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
Background Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. Trial registration ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.
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Affiliation(s)
- Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA, 90089, USA.
| | - Donna Dueker
- Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Miami, FL, 33199, USA
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23
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Schaffner D, Weber M, Kochuparackal T, Graf M, Hachtel H. Long-Term Recidivism of Mentally Disordered Offenders Considered "Dangerous to the Public" in Switzerland. Front Psychiatry 2021; 12:639936. [PMID: 33889099 PMCID: PMC8055864 DOI: 10.3389/fpsyt.2021.639936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The commissions for risk assessment of offenders dangerous to the public were established in 1995 in Switzerland. The main goal was to reduce recidivism of offenders released into the community by means of identifying high-risk offenders and recommending measures for offender management. This study investigates long-term recidivism data of this high-risk cohort of offenders. Methods: Baseline data included risk assessment of one of the commissions, the type of index offense, and psychiatric disorders according to ICD-10 for the total cohort of offenders examined by the commissions between 1995 and 2009. Criminal records were drawn in 2019 for all offenders from the Swiss Federal Office of Justice. Results: From a total of 147 offenders 35 recidivated within a median time at risk of 9.1 years (31.8%), of which 10 (9.1%) recommitted a severe offense. Within the treatment status, sentences (imprisonment and preventive detention) were compared to court-ordered measures (in- or outpatient court ordered treatment, civil court mandated treatment, vocational training facility). There were no significant differences comparing treatment status, different diagnostic groups, type of index offense and other risk factors. Except of age at release (or relapse), which predicted recidivism with younger subjects showing higher recidivism rates (p = 0.014). Conclusion: Our study showed that over a long-term time at risk this high-risk cohort showed a similar recidivism rate as many other studies with different cohorts. With appropriate management recidivism rates in high-risk offenders can be lowered allowing them being consecutively reintegrated into society. The finding that younger subjects have higher recidivism rate was reproduced in this population.
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Affiliation(s)
- Daniela Schaffner
- Department of Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Weber
- Office of Corrections, Canton of Zurich, Zurich, Switzerland.,Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Tanya Kochuparackal
- Department of Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Henning Hachtel
- Department of Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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Bright DA, Martire KA. Does Coerced Treatment of Substance‐Using Offenders Lead to Improvements in Substance Use and Recidivism? A Review of the Treatment Efficacy Literature. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00072.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David A Bright
- School of Social Sciences, University of New South Wales
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25
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Christopher PP, Anderson B, Stein MD. Comparing views on civil commitment for drug misuse and for mental illness among persons with opioid use disorder. J Subst Abuse Treat 2020; 113:107998. [PMID: 32359671 PMCID: PMC7200755 DOI: 10.1016/j.jsat.2020.107998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/23/2020] [Accepted: 03/04/2020] [Indexed: 11/20/2022]
Abstract
Despite the growing use of civil commitment for drug use disorders, little is known about attitudes among individuals who might be subject to civil commitment. This study examined attitudes of persons with opioid use disorder toward civil commitment for drug misuse and for psychiatric illness. Consecutive persons entering a brief, inpatient opioid detoxification (n = 254) were surveyed regarding their attitudes about civil commitment for mental illness and for drug use, and responses were compared by commitment type and by individual history of being civilly committed for opioid misuse. Participants endorsed high support for civil commitment (both psychiatric and drug misuse-related) when used to address risk of harm to self, to others, and of criminal activity. Respondents were more likely to support civil commitment for psychiatric disorders than for drug misuse, expressing higher support for civil commitment in general, higher agreement with the criteria used to justify civil commitment, and greater perceived efficacy of commitment. Individuals previously committed for opioid misuse were less likely to support drug misuse-related commitment on the basis of its perceived efficacy. These results suggest individuals with opioid use disorder hold more favorable views toward civil commitment for mental health disorders than for drug misuse, and reinforce the need for more research on the procedures and outcomes related to civil commitment for drug misuse.
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Affiliation(s)
- Paul P Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, United States of America.
| | - Bradley Anderson
- General Medicine Unit, Butler Hospital, Providence, RI, United States of America
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
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The Impact of Treatment Orders for Residential Treatment of Comorbid Severe Substance Use Disorders for Youth Suffering from Early Psychosis: a Case Series. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Pilarinos A, Barker B, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T, DeBeck K. Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada. Addiction 2020; 115:97-106. [PMID: 31379008 PMCID: PMC6933075 DOI: 10.1111/add.14769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/26/2018] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment. DESIGN Data from three linked prospective cohort studies of PWUD were used. McNemar's test and non-linear growth curve modeling were employed to: (a) assess changes in substance use patterns before and after coerced addiction treatment and (b) compare these changes with changes in PWUD who (1) voluntarily accessed and (2) did not access treatment. SETTING Vancouver, Canada. PARTICIPANTS A total of 3196 community-recruited PWUD. MEASUREMENTS The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment. FINDINGS Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar's test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all P > 0.05). In subanalyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician. CONCLUSIONS Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.
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Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, B.C., Canada V6T 1Z4
| | - Brittany Barker
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- First Nations Health Authority, 100 Park Royal S, West Vancouver, B.C., Canada, V7T 1A2
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Room 11300, Blusson Hall, Burnaby, B.C., Canada, V5A 1S6
| | - Evan Wood
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- School of Public Policy, Simon Fraser University, 3277-515 West Hastings Street, Vancouver, B.C., Canada, V6B 5K3
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Opsal A, Kristensen Ø, Clausen T. Readiness to change among involuntarily and voluntarily admitted patients with substance use disorders. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:47. [PMID: 31694664 PMCID: PMC6836455 DOI: 10.1186/s13011-019-0237-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Health care workers in the addiction field have long emphasised the importance of a patient's motivation on the outcome of treatments for substance use disorders (SUDs). Many patients entering treatment are not yet ready to make the changes required for recovery and are often unprepared or sometimes unwilling to modify their behaviour. The present study compared stages of readiness to change and readiness to seek help among patients with SUDs involuntarily and voluntarily admitted to treatment to investigate whether changes in the stages of readiness at admission predict drug control outcomes at follow-up. METHODS This prospective study included 65 involuntarily and 137 voluntarily admitted patients treated in three addiction centres in Southern Norway. Patients were evaluated using the Europ-ASI, Readiness to Change Questionnaire (RTCQ), and Treatment Readiness Tool (TReaT). RESULTS The involuntarily admitted patients had significantly lower levels of motivation to change than the voluntarily admitted patients at the time of admission (39% vs. 59%). The majority of both involuntarily and voluntarily admitted patients were in the highest stage (preparation) for readiness to seek help at admission and continued to be in this stage at discharge. The stage of readiness to change at admission did not predict abstinence at follow-up. The only significant predictor of ongoing drug use at 6 months was SUD severity at baseline. CONCLUSIONS The majority of involuntarily admitted patients scored high on motivation to seek help. Their motivation was stable at a fairly high level during their stay, and even improved in some patients. Thus, they were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization. Therapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity. TRIAL REGISTRATION ClinicalTrials.gov, NCT00970372. Registered 1 September 2008, https://clinicaltrials.gov/ct2/show/NCT00970372. The trial was registered before the first participant was enrolled. The fist participant was enrolled September 02, 2009.
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Affiliation(s)
- Anne Opsal
- University of Agder, Faculty of Health and Sport Sciences, Post-box 422, 4604, Kristiansand, Norway. .,Sørlandet Hospital, Addiction Unit, Post-box 416, 4604, Kristiansand, Norway.
| | - Øistein Kristensen
- Sørlandet Hospital, Addiction Unit, Post-box 416, 4604, Kristiansand, Norway
| | - Thomas Clausen
- Sørlandet Hospital, Addiction Unit, Post-box 416, 4604, Kristiansand, Norway.,Norwegian Centre for Addiction Research (SERAF), Institute of Clinical medicine, University of Oslo, Post-box 1039, Blindern, 0315, Oslo, Norway
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Pilarinos A, Kendall P, Fast D, DeBeck K. Secure care: more harm than good. CMAJ 2019; 190:E1219-E1220. [PMID: 30322985 DOI: 10.1503/cmaj.180700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Perry Kendall
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Danya Fast
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Kora DeBeck
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
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Shaul L, Blankers M, Koeter MWJ, Schippers GM, Goudriaan AE. The Role of Motivation in Predicting Addiction Treatment Entry Among Offenders With Substance Use Disorders Under Probation Supervision. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:2453-2465. [PMID: 31088187 DOI: 10.1177/0306624x19849554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many offenders with a substance use disorder (SUD) do not enter addiction treatment. The aim of this study was to examine predictors of addiction treatment entry and to get more insight in the predictive value of treatment motivation. A total of 83 male offenders with a SUD under probation supervision in the Netherlands were assessed at the start of probation supervision and at 12-month follow-up. A total of 38 offenders (45.5%) entered addiction treatment in the follow-up period. Offenders with any mandated treatment (p = .028) and higher treatment motivation (p = .005) were more likely to enter treatment. Multiple logistic regression analysis showed that treatment motivation predicts addiction treatment entry in the first year of probation (OR = 2.215, p < .01). This emphasizes the relevance of treatment motivation for addiction treatment entry among offenders with a SUD. Pretreatment motivational interventions are therefore recommended for offenders with low motivation for treatment in probation settings.
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Affiliation(s)
| | - Matthijs Blankers
- 1 Amsterdam UMC, Amsterdam, The Netherlands
- 2 Arkin Mental Health Care, Amsterdam, The Netherlands
- 3 Trimbos Institute, Utrecht, The Netherlands
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Sant'Anna WT, Mitsuhiro SS, Figlie NB, Diehl A, Pillon SC, Laranjeira R. Relapse in involuntary substance treatment: a transversal study. ACTA ACUST UNITED AC 2019; 49:255-261. [PMID: 33328018 DOI: 10.1016/j.rcp.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. METHODS This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. RESULTS Relapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. CONCLUSIONS In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.
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Affiliation(s)
| | | | | | - Alessandra Diehl
- Psychiatric Department, Federal University of São Paulo (UNIFESP), Brazil
| | - Sandra Cristina Pillon
- Psychiatric Nursing and Human Science Department, Faculty of Nursing at Ribeirão Preto, University of São Paulo (USP), Brazil; PAHO/WHO Collaborating Centre for Nursing Research Development
| | - Ronaldo Laranjeira
- Psychiatric Department, Federal University of São Paulo (UNIFESP), Brazil
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Hachtel H, Vogel T, Huber CG. Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors. Front Psychiatry 2019; 10:219. [PMID: 31031658 PMCID: PMC6474319 DOI: 10.3389/fpsyt.2019.00219] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/26/2019] [Indexed: 12/23/2022] Open
Abstract
Court-mandated treatments imply a dual role for therapy providers not only of caring for, but also of having control over, involuntary clients. The impact of legal coercion on the therapeutic relationship and feelings of stigma is widely regarded as negative and detrimental for treatment outcomes. This point of view stands in contrast to advocates of the perspective that involuntary treatment can ameliorate social functioning and thus promote a better quality of life. Regarding other outcome measures, there is evidence that offender treatment is effective and leads to reduced recidivism in criminal behavior. This narrative review provides an overview of research assessing the effects of mandatory treatment on therapeutic process and outcome factors. We conclude that legal mandatory treatment does not have to necessarily result in perceived coercion and reduced satisfaction with treatment and that a caring and authoritative treatment style aids a favorable therapeutic alliance, motivation, and therapy outcomes.
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Affiliation(s)
- Henning Hachtel
- Forensic Department, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Tobias Vogel
- Forensic Department, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, Faculty of Medicine, University of Basel, Basel, Switzerland
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Bath K, Hawke LD, Skilling T, Chaim G, Henderson J. The service-seeking profiles of youth reporting a legal mandate or perceived coercion for substance use treatment. Addict Behav 2019; 90:27-34. [PMID: 30352342 DOI: 10.1016/j.addbeh.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION There is paucity of research on treatment-related coercion in youth: most research focuses on adult populations and legally mandated treatment. This study aims to examine the service-seeking profiles of youth with substance misuse issues who report a legal mandate or perceived coercion to enter treatment. METHODS Differences between youth who were legally mandated and not legally mandated, and differences between youth reporting high and low perceived coercion, were examined for demographic characteristics, mental health and substance use profiles, motivation, and readiness to change. RESULTS Compared to participants reporting low perceived coercion, those experiencing high perceived coercion reported more substance use problems, greater mental health needs, and greater external and introjected motivation. Legally mandated youth reported fewer mental health issues, lower identified motivation, and greater readiness to change than those reporting no legal mandate. DISCUSSION Many youth who present for substance use services report experiencing a sense of coercion, which suggests the potential importance of considering youth-centered strategies for involving youth in treatment planning and the development of treatment goals. Youth seeking treatment also have multiple intersecting needs which may benefit from a collaborative and integrative approach.
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Warshawski T, Charles G, Vo D, Moore E, Jassemi S. Secure care can help youth reduce imminent risk of serious harm and prevent unnecessary death. CMAJ 2019; 191:E197-E198. [PMID: 30782646 DOI: 10.1503/cmaj.71451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Tom Warshawski
- Pediatrician, BC Pediatric Society Secure, Care Working Group, Kelowna, BC
| | - Grant Charles
- Social worker, School of Social Work, University of British Columbia, Vancouver, BC
| | - Dzung Vo
- Head, Division of Adolescent Health and Medicine, BC Children's Hospital, Vancouver, BC
| | - Eva Moore
- Division of Adolescent Health and Medicine, BC Children's Hospital, Vancouver, BC
| | - Sara Jassemi
- Division of Adolescent Health and Medicine, BC Children's Hospital, Vancouver, BC
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Ratnam A, Das RC, Madhusudan T, Sharma P, Panda SP. Absolute Abstinence as a Treatment Outcome in Servicemen with Alcohol Dependence: A Retrospective Cohort Study. Subst Use Misuse 2019; 54:2304-2316. [PMID: 31386599 DOI: 10.1080/10826084.2019.1646284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Within India's military medical framework, alcohol dependence syndrome (ADS) is deemed a treatable medical illness incompatible with military service, and complete abstinence is the only acceptable successful treatment outcome. Objective: This study was designed to identify factors which were able to differentiate treatment outcomes of abstinence and relapse among ADS patients in a military framework. Method: Recognizing personal incentives to misrepresent alcohol consumption, abstinence, and relapse outcomes were established using official reports from a patient's parent unit, in combination with biochemical parameters and clinical examination. Patients serially admitted for ADS treatment or follow-up review were surveyed, and their socio-demographic and alcohol consumption profiles, coping styles, life events and specific relapse precipitants were recorded and compared as contributory variables in a cognitive-behavioral model of ADS. From this survey of 140 patients, membership to abstainer or relapser groups was then predicted using a discriminant analysis. Results: 34% of patients achieved early absolute abstinence. No baseline socio-demographic or drinking profile distinctions existed between abstainers and relapsers. Differences were forthcoming on coping styles, life-event, and relapse-precipitant exposure measures. Stepwise discriminant analysis produced a final equation comprising 10 independent variables (including two positive life event measures), which predicted an abstinence/relapse outcome with an 86% and 79% hit-rate (original and cross-validated). Conclusion: Using prevailing cognitive-behavioral constructs, early absolute abstinence emerged as an actionable objective and an achievable goal without any contributory socio-demographic predilections. This preliminary evaluation suggests it is a tenable and realistic target of current ADS treatment programs.
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Affiliation(s)
- Ashutosh Ratnam
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - R C Das
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - T Madhusudan
- Department of Psychiatry, Command Hospital (Central Command), Lucknow, India
| | - Pankaj Sharma
- Department of Psychiatry, Military Hospital Jalandhar Cantt, Punjab, India
| | - S P Panda
- Department of Psychiatry, Military Hospital Jalandhar Cantt, Punjab, India
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Christopher PP, Anderson B, Stein MD. Civil commitment experiences among opioid users. Drug Alcohol Depend 2018; 193:137-141. [PMID: 30384320 PMCID: PMC6239959 DOI: 10.1016/j.drugalcdep.2018.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Civil commitment is an increasingly used policy intervention to combat the opioid epidemic. Yet little is known about persons who get committed and outcomes following commitment for opioid use. In the current cross-sectional study, we compared the characteristics of persons with and without a history of civil commitment, and the correlates of post-commitment abstinence. METHODS Between October 2017 and May 2018, we surveyed consecutive persons entering a brief, inpatient opioid detoxification (n = 292) regarding their lifetime experiences with civil commitment for opioid use. RESULTS Participants averaged 34.6 years of age, 27.1% were female, and 78.1% were White. Seventy-eight (26.7%) experienced civil commitment for opioid use at least once in their lifetime. Committed individuals had significantly higher rates of fentanyl, heroin, and injection drug use, drug overdoses, past incarceration, current criminal justice involvement, and past medication treatment for opioid use (p < .05). The average time to relapse following commitment was 72 days, although 33.8% relapsed on the same day of their release. Longer post-commitment abstinence was significantly associated with post-commitment medication treatment, higher perceived procedural justice (i.e., fairness) during the commitment hearing, positive attitude and higher motivation at the end of commitment, and improvement in attitude during commitment (p < .05). CONCLUSION Opioid users who experience civil commitment constitute an especially high risk group. A positive commitment experience and post-commitment medication treatment are associated with longer post-commitment abstinence.
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Affiliation(s)
- Paul P Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence RI 02912 United States.
| | - Bradley Anderson
- General Medicine Unit, Butler Hospital, Providence RI United States
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States
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Aldemir E, Berk G, Coşkunol H. The Effects of the Addiction Programme of Probation on Treatment Motivation, Abstinence and Quality of Life: a Comparative Study with Motivational Interviewing and Individual Intervention. ACTA ACUST UNITED AC 2018; 55:261-270. [PMID: 30224874 DOI: 10.5152/npa.2017.19440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
Introduction The aim of this study is to evaluate the effectiveness of Addiction Programme of Probation (APP) created by the Substance Abuse Treatment Commission of Ministry of Health. Methods The sample was consisted of probationers who were referred to Ege University by probation offices in February 2010. Literate probationers aged above 18, who fulfilled the SCID-I criteria for substance dependence, or had positive urine sample for illegal drugs were included. The probationers were allocated respectively to three treatment groups: APP (n=28); Motivational Interviewing (MI; n=30); Individual Intervention (II; n=30). The effectiveness of the treatment modalities was assessed by the State Anxiety Inventory; the WHO Quality of Life-Brief form; the Treatment Motivation Questionnaire. Visual analogue and Likert-type scales were used to assess the sense of the importance and the readiness of quitting drugs also the levels of craving. Urine toxicological analyses were performed fortnightly. Results The APP increased the readiness of quitting drugs. The MI increased both the sense of importance and readiness of quitting drugs, decreased the frequency and severity of craving. The II improved the mental and physical health, increased the confidence in treatment also readiness of quitting drugs. Additionally, II decreased the level of anxiety, the severity, frequency and duration of craving. There was a significant decrease in positive urine samples of all groups. Conclusion Because of changing only "the level of being ready to quit substance abuse", APP is considered as an inadequate program compared with MI and II.
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Affiliation(s)
- Ebru Aldemir
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, İzmir, Turkey
| | - Güneş Berk
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, England
| | - Hakan Coşkunol
- Department of Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
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Anderson SR, Tambling R, Yorgason JB, Rackham E. The mediating role of the therapeutic alliance in understanding early discontinuance. Psychother Res 2018; 29:882-893. [DOI: 10.1080/10503307.2018.1506949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Rachel Tambling
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | | | - Erin Rackham
- School of Family Life, Brigham Young University, Provo, UT, USA
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Lunze K, Lermet O, Andreeva V, Hariga F. Compulsory treatment of drug use in Southeast Asian countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:10-15. [PMID: 29966803 DOI: 10.1016/j.drugpo.2018.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/28/2018] [Accepted: 06/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several Southeast Asian countries have implemented compulsory drug detention centres in which people who use or are suspected of using drugs, mainly amphetamine-type stimulants, are confined without their consent and in most cases without due process and clinical evaluation of their substance use disorder. Given these facilities' lack of access to evidence-based drug dependence treatment, and the human rights implications of peoples' arbitrary detention under the pretext of "treatment", international organizations have called for their closure. The aim of this study was to estimate recent numbers of compulsory drug treatment centres and of people in these centres in the region. METHODS We conducted an analysis of cross-sectional governmental data collected from seven countries in the region with compulsory drug detention centres, namely Cambodia, China, Lao PDR, Malaysia, the Philippines, Thailand and Viet Nam. We computed descriptive data provided by government representatives for the period between 2012 and 2014. RESULTS The total number of people in compulsory detention centres overall decreased by only 4% between 2012 and 2014. In 2014, over 450,000 people were detained in 948 facilities in the seven countries. While only two countries decreased the number of compulsory detention centres, most countries increased the number of people detained. CONCLUSIONS In spite of international calls for the closure of compulsory detention centres, the number of facilities and detained people remained high in the seven countries included in the analysis. These officially reported figures are concerning regarding access to effective drug dependence treatment and given the potential for additional human rights abuses within compulsory detention centers. Further concerted policy and advocacy efforts should support transition of treatment for people with drug dependence towards human rights-based and evidence-based drug dependence treatment. Expansion of existing drug and HIV services in the community rather than compulsory treatment modalities will effectively address the region's drug and HIV burden.
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Affiliation(s)
- Karsten Lunze
- Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave. Crosstown 2079, Boston, MA, 02118, USA.
| | - Olivier Lermet
- United Nations Office on Drugs and Crime, Regional Office for Southeast Asia and the Pacific, UN Secretariat Building, 3rd Floor, Rajdamnern Nok Avenue, Bangkok, 10200, Thailand.
| | - Vladanka Andreeva
- UNAIDS, Regional Support Team, Asia and the Pacific, UN Building Room 906, Rajadamnern Nok Avenue, 10200, Bangkok, Thailand.
| | - Fabienne Hariga
- United Nations Office on Drugs and Crime, Room D1426, P.O Box 500 A-1400 Vienna, Austria.
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Bhalla IP, Cohen N, Haupt CE, Stith K, Zhong R. The Role of Civil Commitment in the Opioid Crisis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:343-350. [PMID: 30146976 DOI: 10.1177/1073110518782943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article seeks to shed light on civil commitment in the context of the opioid crisis, to sketch the existing legal landscape surrounding civil commitment, and to illustrate the relevant medical, ethical, and legal concerns that policymakers must take into account as they struggle to find appropriate responses to the crisis.
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Affiliation(s)
- Ish P Bhalla
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Nina Cohen
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Claudia E Haupt
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Kate Stith
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Rocksheng Zhong
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
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Killian M, Cimino AN, Mendoza NS, Shively R, Kunz K. Examining Trauma and Readiness to Change among Women in a Community Re-Entry Program. Subst Use Misuse 2018; 53:648-653. [PMID: 28885864 DOI: 10.1080/10826084.2017.1355387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and co-occurring substance use disorders (SUDs) are common among women who are incarcerated. OBJECTIVE The purpose of this study was to examine the relationship between trauma and readiness to change substance use behaviors. METHODS This study used data from 103 participants enrolled in a residential re-entry program for women with SUDs and trauma history. Women reporting clinically elevated Trauma Symptom Inventory (TSI) subscale scores were compared to those without elevated scores on the University of Rhode Island Change Assessment (URICA) readiness to change instrument. Primary analyses included t-tests and ANCOVA to control for age and ethnicity. RESULTS In general, women with clinically elevated trauma scores also reported greater readiness to change. The analyses revealed significant differences on the URICA Readiness to Change scores between women who had elevated Defensive Avoidance and Impaired Self-Reference according to the TSI. Results approached significance for women who had elevated TSI subscale scores for Sexual Concerns and Dissociation. CONCLUSIONS These results point to a need to further understand links between trauma and readiness to change, particularly, the role of posttraumatic growth and psychological distress. This study has implications for social workers and clinicians delivering evidence-based treatment. Women who had high trauma symptoms were more willing to address change. Findings also suggest a need to tailor interventions to include motivational components that are also trauma-informed.
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Affiliation(s)
- Michael Killian
- a School of Social Work , University of Texas at Arlington , Arlington , Texas , USA
| | - Andrea N Cimino
- b School of Nursing , The Johns Hopkins University , Baltimore , Maryland , USA
| | - Natasha S Mendoza
- c School of Social Work , Arizona State University , Phoenix , Arizona , USA
| | | | - Kami Kunz
- d Alvis, Inc. , Columbus , Ohio , USA
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Kerr T, Small W, Ayutthaya PPN, Hayashi K. Experiences with compulsory drug detention among people who inject drugs in Bangkok, Thailand: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:32-38. [PMID: 29227881 DOI: 10.1016/j.drugpo.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada.
| | - Will Small
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | | | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
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44
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Nicolini M, Vandenberghe J, Gastmans C. Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework. Scand J Caring Sci 2017; 32:1237-1246. [DOI: 10.1111/scs.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Nicolini
- Department of Psychiatry; University Hospitals Leuven; Leuven Belgium
- Center for Clinical Bioethics; Georgetown University Medical Center; Washington D.C. USA
| | | | - Chris Gastmans
- Center for Biomedical Ethics and Law; KU Leuven; Leuven Belgium
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Pregnancy and substance use – the Norwegian z 10–3 solution.1 Ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/v10199-012-0011-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by z 10–3 of the Norwegian Municipal Health and Care Services act. Material The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of z 10–3 in these cases. Methods Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, non-maleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. Results The application of z 10–3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. Conclusions Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to z 10–3, foetal protection and the promotion of parental competences should be given equal priority.
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Abstract
A significant gap in current network research relates to understanding the factors that shape the health matters (HM) networks of marginalized, socially disadvantaged populations. This is noteworthy, given that these networks represent a critical resource for mitigating the adverse health effects of both acute and chronic strains associated with marginalized status. Further, research has suggested that the networks of such populations—especially low-income African American women—are unique, and may operate in substantively different ways than those of other groups. Using two waves of data from a sample of low-income African American women, this research identifies the demographic, health status, and health behavior measures at time one that correspond to HM network characteristics at time two, six months later. This study offers preliminary insights on the relationship between key sociodemographic and health status characteristics of low-income African American women and their HM networks, including criminal justice involvement. Findings reveal that though poorer health status and criminal justice involvement correspond to smaller health matters networks, they also correspond to more active and supportive networks.
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47
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Giertsen H, Nylander PÅ, Frank VA, Kolind T, Tourunen J. Prisoners' experiences of drug treatment and punishment in four Nordic countries. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims This article describes and analyses prisoners' experiences of drug treatment in prison in four Nordic countries: Denmark, Finland, Norway and Sweden. The article examines how prisoners experience drug treatment, control and sanctions as related to three main topics, namely motivation; the content of the measure and relations to staff; and control and sanctions. Methods & DATA – The article is based on data from twelve prisons, three in each of the four countries; 91 interviews with prisoners; and around six months of observation. The two main kinds of drug treatment measures are drug treatment units and day programmes. Results – Prisoners described several motives to participate in drug treatment measures: to leave drugs and crime; to renew relations with family and friends; to solve health problems; and to improve their prison conditions. Prisoners found that drug treatment measures offered possibilities to acquire new ways of being. Staff behaviour seemed to be more important to prisoners than the methods used, and some prisoners seemed more positive to staff involved with the drug treatment than to other staff. A surprising finding was the prisoners' limited critique of controls and sanctions. We see this as embedded in the situation of being a prisoner, and also in relation to contexts outside prison. Conclusion In discussing their experiences in the treatment units, prisoners are not so concerned about the rehabilitative features or the controls and sanctions. They evaluate their present situation in light of a future, which is their real concern. This is in line with a main task for staff, which is to prepare prisoners for release.
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Cimino AN, Mendoza N, Nochajski TH, Farrell MG. Examining the Relationship between Psychological Functioning, Childhood Trauma, and Types of Perceived Coercion Among Drug Court Enrollees: Results from A Pilot Study. COGENT PSYCHOLOGY 2017; 4. [PMID: 31008146 PMCID: PMC6474663 DOI: 10.1080/23311908.2017.1320859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Drug court interventions produce positive results—especially among mandated populations. Many criminal justice-involved persons, including drug court enrollees, have cooccurring substance abuse and childhood trauma disorders associated with psychological dysfunction. Given the coercive nature of mandated drug court treatment, it is important to understand whether childhood trauma and psychological functioning influence perceived coercion to enter treatment. Objectives: The purpose of this study was to describe the degree to which adverse childhood trauma and psychological functioning were associated with six domains of perceived coercion— self, family, legal, financial, health, and work—among a population of drug court enrollees. Methods: Data from 54 enrollees in a drug court pilot study were used to examine the relationship between childhood trauma, psychological functioning, and perceived coercion. Results: The pilot study data showed that psychological dysfunction and traumatic experiences in childhood were associated with higher perceived coercion to treatment, explaining 29% of the variance in coercion, controlling for gender and pre-arrest alcohol and drug use. Results indicated that the associations between psychological dysfunction and trauma were driven by non-legal types of coercion. In particular, childhood trauma was correlated with family (r = .32), financial (r = .32), and health (r = .47) types of coercion. Conclusions: Based on these preliminary findings, drug court practitioners are urged to assess perceived coercion, in addition to the behavioral health and childhood trauma of their clients, and to utilize non-legal types of coercion such as family, health, and financial impact to enhance treatment engagement.
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Affiliation(s)
- Andrea N Cimino
- Faculty Research Associate, Johns Hopkins University, School of Nursing, The State University of New York
| | - Natasha Mendoza
- Assistant Professor, Arizona State University, School of Social Work, The State University of New York
| | - Thomas H Nochajski
- Research Professor, Buffalo Center for Social Research, University at Buffalo, The State University of New York
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Pearlman J. Combatting Massachusetts's Opioid Epidemic: Reducing the Social Stigma of Addiction Through Increased Access to Voluntary Treatment Services and Expansion of Mandatory Clinician Education Programs. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:835-857. [PMID: 29086651 DOI: 10.1177/0098858817701962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Julie Pearlman
- J.D. candidate, Boston University School of Law, 2017; B.A. Political Science, University of Rochester, 2012
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Zaller N, Cheney AM, Curran GM, Booth BM, Borders TF. The Criminal Justice Experience of African American Cocaine Users in Arkansas. Subst Use Misuse 2016; 51:1566-1576. [PMID: 27486889 PMCID: PMC5844222 DOI: 10.1080/10826084.2016.1188954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States. OBJECTIVES We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state. METHODS Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas. RESULTS Numerous important themes emerged from participants' narratives, including chronic involvement with the criminal justice system (being a "career criminal"), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.
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Affiliation(s)
- Nickolas Zaller
- a Department of Health Behavior and Health Education , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Ann M Cheney
- b Department of Social Medicine and Population Health , University of California Riverside School of Medicine , Riverside , California , USA
| | - Geoffrey M Curran
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Tyrone F Borders
- d Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA
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