Managing depressive symptoms in the context of abstinence: findings from a qualitative study of women

A Causal Analysis of Young Adults' Binge Drinking Reduction and Cessation

BACKGROUND

This study, using the multiple disadvantage model (MDM), sought to identify factors (disadvantaging social disorganization, social structural, social integration, health/mental health, co-occurring substance use, and substance treatment access factors) in young adults' binge drinking reduction and cessation in the United States.

METHODS

We extracted data on 942 young adult binge drinkers (25-34 years, 47.8% female) from the National Longitudinal Study of Adolescent to Adult Health (Add Health), carrying out a temporal-ordered causal analysis, meaning the evaluation of select variables' impacts on an outcome at a subsequent time.

RESULTS

MDM found a relatively high reduction likelihood for non-Hispanic African Americans and respondents with relatively more education. MDM found a relatively low reduction likelihood accompanying an alcohol-related arrest, higher income, and greater number of close friends. Change to nondrinking was found more likely for non-Hispanic African Americans, other non-Hispanic participants having minority ethnicity, older respondents, those with more occupational skills, and healthier respondents. Such change became less likely with an alcohol-related arrest, higher income, relatively more education, greater number of close friends, close friends' disapproval of drinking, and co-occurring drug use.

CONCLUSIONS

Interventions incorporating a motivational-interviewing style can effectively promote health awareness, assessment of co-occurring disorders, friendships with nondrinkers, and attainment of occupational skills.

Narratives reflecting the lived experiences of people with brain disorders: common psychosocial difficulties and determinants

BACKGROUND

People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders.

OBJECTIVES

To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson's disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors.

METHODS

Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders.

RESULTS

First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups.

CONCLUSIONS

The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that 'a great deal can be done' to improve the lived experience of persons with brain disorders when medical interventions are exhausted.

Nursing knowledge about alcohol use and alcohol problems in women: a review of the literature

In this article, the authors review the nursing empirical literature on alcohol and women's health published over the past 5 years (2005-2010). A total of 36 data-based articles authored by nurse investigators met eligibility criteria and were included in this review. Most were single studies by individual nurse investigators; few studies reflected ongoing programs of research related to alcohol and women's health. Studies were categorized into four main groups, including (a) determinants of alcohol use and alcohol problems; (b) patterns of use, assessment of alcohol use, and comorbidity; (c) consequences of alcohol use; and (d) the effects of treatment or specific interventions and the contributions of nursing research to the knowledge base of each group are summarized. The authors then propose a research agenda for nursing that addresses the most pressing issues related to alcohol use and alcohol problems in women.

Childhood trauma in substance use disorder and depression: an analysis by gender among a Brazilian clinical sample

OBJECTIVE

In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses.

METHODS

The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the "Childhood Trauma Questionnaire."

RESULTS

A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men.

CONCLUSION

Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment.

Managing high-acuity-depressed adults in primary care

PURPOSE

To identify strategies for managing high-acuity-depressed adults in primary care settings. Patients who do not achieve remission with initial treatment, patients at risk for suicide, and patients with co-occurring substance use disorders are specifically addressed.

DATA SOURCES

Scientific literature and evidence-based practice guidelines.

CONCLUSION

Accurate diagnosis is best accomplished using screening instruments as an adjunct to a thorough history and assessment. The goal of interventions is remission of symptoms as opposed to a partial response. Patient preferences regarding choice of intervention must be considered. Initial pharmacotherapy must include adequate doses and a trial of adequate duration. Patients who do not respond to two medication trials are at risk for suicide and/or have a co-occurring substance use disorder may require: (a) a combination of medications coupled with psychotherapy; or (b) referral to mental health specialists to achieve the best outcomes.

IMPLICATIONS FOR PRACTICE

High-acuity patients with mental health needs will continue to be seen in primary care settings. Through educational preparation and a patient-centered focus, advanced practice nurses in primary care settings are in an optimal position to set a high standard of care for complex mental health patients.

Struggling to Reconnect: Women's Perspectives on Alcohol Dependence, Violence, and Sexual Function

Until recently, substance use disorders and sexual function were two areas in which women received comparatively less attention then men. Recent studies have challenged sexual stereotypes about women who drink and use other substances. This study explores the experiences of women dependent on alcohol and/or other substances who have stopped their use. These women were subjected to significant abuse during both childhood and adulthood. A pattern of using alcohol and other substances as a means of managing negative feelings, disconnecting from abuse, reconnecting to form new relationships, and disconnecting from subsequent abuse was prominent in the women's stories. The women in this study also experienced problems with sexual function both while using and following cessation of use. Findings highlight the complex relationships among substance abuse, trauma, and sexual problems as well as the importance of routinely assessing for sexual problems. Suggestions for treatment and future research are offered. J Am Psychiatr Nurses Assoc, 2009; 14(6), 421-428.