A study on the mediating-moderate effect of the types of illicit drugs on mental health in China

Background

In China, over 5 million people have been identified and registered by the public security institutions for using illicit drugs. The aim of this study is to compare the influence of different types of illicit drugs on the self-reported mental health of Chinese people. In particular, we want to assess the damage of Heroin, Methamphetamine and Ketamine to mental health in a social environment where drug use is strictly regulated.

Methods

The study is based on survey with 6,906 people who use drugs in Guangdong province, China. Risk of mental health issue is measured using the Brief Symptoms Inventory 18 (BSI-18) Scale, and a higher BSI-18 score indicates more severe mental health problems. The data was analyzed through multilevel regression analysis, propensity score matching analysis and mediation analysis.

Results

The three major types of illicit drugs have both moderating and mediating effects on the length of drug-use history, that Heroin use leads to longer drug-use duration, while Ketamine use causes more damage on mental health per unit time of drug-use duration. Average duration of Methamphetamine use is 0.7 year shorter than average duration of Heroin use, and average duration of Ketamine use is 1.7 year shorter than average duration of Heroin use. For each year of increase of drug-use duration, Ketamine use leads to 1.2 times more of BSI score increase than Heroin use, and 2.3 times more of BSI score increase than Methamphetamine use.

Conclusion

These three drugs are associated with severe mental health issue in a society with strict drug regulation. Attention should be paid to the mental health of people regardless of the type of drugs they use.

The impact of a combined mentalisation-based therapy and therapeutic community programme for adolescents with borderline personality disorder traits on service utilisation in Western Australia

This study assessed the effect of a mentalisation-based therapy (MBT) treatment programme on the utilisation of Western Australian public hospitals for mental health presentations over an 18-month period. Hospital data included the number of visits to the emergency department (ED), the number of inpatient admissions to hospital and length of stay of the admissions. Participants included 76 adolescents aged 13-17 years old, who presented with borderline personality disorder (BPD) traits. The Touchstone treatment programme is a time-limited intensive programme that utilises MBT in the context of a therapeutic community. Hospital data for the participants were collected and analysed from three time points; 6 months prior to attending the programme, during the 6-month programme (active treatment) and 6 months after the programme. Results found a statistically significant decrease in hospital utilisation from pre to post programme, with a decline in ED visits, inpatient admissions and admission length of stay. This study presents promising preliminary evidence for the effectiveness of an intensive MBT programme as an intervention for adolescents with BPD features and has significant implications for the public health system in terms of providing effective community-based treatment for this difficult to treat population as well as reducing pressure on tertiary care.

Duration of stay and rate of subsequent criminal conviction and hospitalisation for substance use among young people admitted to a short-term residential program

INTRODUCTION

This study examined the association between program duration and rate of criminal conviction and hospitalisation for substance use up to 15 years later among young people admitted to a short-term residential program for drug and alcohol use.

METHODS

Data were derived from linked administrative records of all clients referred to a modified therapeutic community for young people from January 2001 to December 2016 in New South Wales, Australia (n = 3059). Cox proportional hazards regression analyses examined the rate of conviction (separately for any offence, violent offence, non-violent offence and administrative offence) and hospitalisation for substance use, up to 15 years post-program among young people who attended treatment for 1-29 days, 30-59 days, 60-89 days and 90-120 days.

RESULTS

Thirty days or more in treatment was independently associated with a lower rate of conviction for any offence and a non-violent offence, as well as hospitalisation for substance use, while 60 days or more was associated with a lower rate of conviction for a violent and administrative offence, relative to those who spent 1-29 days in the program. Additional months in the program were also associated with reduced rates of conviction and hospitalisation, although 90-120 days appeared to confer no additional benefits than 60-89 days.

DISCUSSION AND CONCLUSIONS

At least 60 days may be the minimum duration needed for short-term, therapeutic community programs to reduce the risk of conviction across all crime types and hospitalisation for substance use.

Hospitalisation following therapeutic community drug and alcohol treatment for young people with and without a history of criminal conviction

INTRODUCTION

This study examines the association between treatment in a therapeutic community for adolescents with drug and alcohol problems on hospitalisation outcomes up to 15 years later for all clients, and separately for those with and without a history of criminal conviction.

METHOD

A quasi-experimental design was used to examine the linked administrative health and criminal justice records for all adolescents admitted to the Program for Adolescent Life Management (PALM) from January 2001 to December 2016 (n = 3059) in Sydney, Australia. ICD-10AM codes were used to designate hospitalisation outcomes as either physical injury, mental health problems, substance use disorders, or organic illness. The treatment and comparison groups were matched on factors associated with program retention, resulting in a final sample of 1266 clients. We examined the rate of hospitalisation up to 15 years posttreatment for all clients and stratified by prior conviction status using Cox regression analyses.

RESULTS

The treatment group had significantly lower rates of hospitalisation for a physical injury (HR = 0.77 [95% CI = 0.61-0.98]), mental health problem (HR = 0.62 [95% CI = 0.47-0.81]), substance use disorder (HR = 0.59 [95% CI = 0.47-0.75]), and organic illness (HR = 0.71 [95% CI = 0.55-0.92]). There was a significant interaction between treatment and prior criminal conviction status on rate of hospitalisation for physical injury, suggesting that the effect of treatment on physical injury was significantly greater for clients with a prior criminal conviction.

CONCLUSIONS

Adolescents who engage in a therapeutic community treatment program may have a long-lasting reduction in the risk of subsequent hospitalisation. This also appears to apply to those with a history of criminal conviction.

Body Mapping in a Drug and Alcohol Treatment Program: Eliciting New Identity and Experience

Arts-based approaches have not been widely used in the drug and alcohol treatment sector. In this study, we examined the utility of the arts-based method of Body Mapping in an Australian residential treatment centre. Two workshops were held to explore young people’s strengths and support networks in order to improve understandings of young people’s lives, identities and experiences of treatment. Semi-structured follow-up interviews were conducted and triangulated with observational notes and staff interviews. We identified four major themes: engaging through art; removing the mask; revealing strengths; and a sense of achievement. Overall, this study highlighted the value of Body Mapping as an approach to engage with young people, providing rich in-depth data about their lived experiences, including in the alcohol and other drug (AOD) treatment context.

The therapist, the group and I: how therapeutic alliance moderates the effect of group cohesion on outcomes

Purpose

This study aims to investigate whether the influence of group cohesion on the outcomes depended on the levels of the therapeutic alliance.

Design/methodology/approach

Sixteen individuals with a substance use disorder who were undergoing treatment in a therapeutic community responded to therapeutic alliance, group cohesion, craving and outcomes measures after every therapeutic small group session for a period of six weeks. Data analysis was performed using hierarchical linear modeling.

Findings

Results indicate that the effect of group cohesion is stronger when there is a high therapeutic alliance between resident and therapist.

Originality/value

Even on group interventions, to enhance group cohesion effects on outcomes, therapists must foster higher therapeutic alliance levels. The findings point out the importance of studying the effect of common factors on outcomes.

Prison Addiction Program and the Role of Integrative Treatment and Program Completion on Recidivism

This study examines whether there is variability between the effects of three different drug rehabilitation programs operating in the Israeli Prison Service (IPS) on completers' recidivism. By performing comparative analysis, this study attempts to address the problem of assessing the role of participants' motivation. The study uses a rich administrative data obtained from the IPS system to develop a propensity score matching (PSM) approach where the treatment groups consist of only those who completed the programs, and the comparison groups consist of drug-addicted prisoners who have not taken part in any drug rehabilitation program. After matching, prisoners in the treatment and comparison groups are found to be similar on all known characteristics. Findings show that the only rehabilitation program that promised significant and positive outcomes for its completers was the more comprehensive one operating at Hermon Prison. Prisoners who completed the treatment were incarcerated and arrested less than their comparison group. The "golden strategy" for rehabilitating drug-using prisoners, then, will be twofold. The program should be based on the promising components of rehabilitation, that is, cognitive behavioral therapy, therapeutic community, long duration, intensity, and positive social climate. The program should also succeed in retaining its participants through completion.

The alumni club: interpersonal contact and the exchange of recovery oriented helping in a sample of former residents of a therapeutic community for women

Purpose

Aftercare is an important predictor of outcomes following treatment for substance abuse. Despite this, there is evidence that the great majority of substance abusing clients choose not to participate in aftercare. Aftercare programs that are tied to specific residential treatment facilities, sometimes known as alumni groups or alumni clubs, might increase participation by offering former residents the opportunity to maintain treatment oriented social networks. Therapeutic communities (TCs), which emphasize mutual aid between residents, are ideal candidates for such programs. The paper aims to discuss these issues.

Design/methodology/approach

In total, 100 randomly chosen former TC residents were randomly surveyed regarding their contact with fellow alumni and their exchange of recovery oriented helping behaviors. A thirty day timeline follow-back methodology was used.

Findings

Contact was primarily through electronic means, particularly phone calls, texts and the alumni club Facebook page. Participants who reported more electronic contact also reported more days in which they offered and received recovery oriented help. Participants who were African American or had spent more time in TC treatment offered and received recovery oriented help on more days.

Research limitations/implications

While this is an exploratory study limited to one TC, this alumni club allows for the maintenance of a mutual aid network after termination. That network primarily consists of electronic forms of contact. A longer time spent in TC treatment may allow for the internalization of the practice of mutual aid. Further research on alumni clubs is warranted.

Originality/value

This is the first survey of TC alumni club members.

Adolescent therapeutic community treatment – an Australian perspective

Purpose

The purpose of this paper is to provide an overview of the adolescent therapeutic community (ATC) literature – drawing on studies primarily from the USA with consideration made to the Australian context.

Design/methodology/approach

A review of the efficacy research for ATCs is considered, and the characteristics of Australians accessing ATC treatment are discussed in the context of developmental needs.

Findings

Similarities are found in what precipitates and perpetuates adolescent substance use in the USA and Australia, and therefore, what appears to facilitate effective treatment utilising the therapeutic community model.

Originality/value

The paper provides a valuable perspective for Australian services, and explores the application of the ATC model within the Australian treatment context.

Knowledge displays: Soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction

OBJECTIVE

To examine knowledge displays (KDs), a practice by which Therapeutic Community (TC) professionals exhibit previous knowledge about their clients' circumstances and experiences.

METHODS

Conversation analysis is used to examine 12 staff-led meetings recorded in Italy (8 in a drug addiction TC; 4 in a mental health TC).

RESULTS

The TC professionals use KDs within broader sequences of talk where they solicit their clients to share personal information and where the clients provide insufficient or inconsistent responses. In these circumstances, the staff members employ KDs to pursue responses that redress emerging knowledge gaps and discrepancies regarding the clients' experiences or circumstances.

CONCLUSION

KDs allow the staff members to achieve a balance between respecting their clients' right to report their own experiences and influencing the ways in which they report them. KDs help to reinforce the culture of openness that is central to many forms of therapeutic interaction, to forward the therapeutic agenda and to expand the staff members' knowledge of the clients' experiences and circumstances.

PRACTICE IMPLICATIONS

KDs can be used to solicit clients to share personal information. This paper illustrates core features that underlie the function of KDs (where they are used and how they are constructed).

Continuing Care and Trauma in Women Offenders' Substance Use, Psychiatric Status, and Self-Efficacy Outcomes

Using secondary data analysis of 3 separate trauma-informed treatment programs for women offenders, we examine outcomes between those who received both prison and community-based substance abuse treatment (i.e., continuing care; n = 85) and those who received either prison or community aftercare treatment (n = 108). We further account for differences in trauma exposure to examine whether continuing care moderates this effect on substance use, psychiatric severity, and self-efficacy outcomes at follow-up. The main effect models of continuing care showed a significant association with high psychiatric status and did not yield significant associations with substance use or self-efficacy. However, the interaction between trauma history and continuing care showed significant effects on all 3 outcomes. Findings support the importance of a continuing care treatment model for women offenders exposed to multiple forms of traumatic events, and provide evidence of the effectiveness of integrating trauma-informed treatment into women's substance abuse treatment.

Rehab, respite and recovery: the experiences of methadone users in a modified therapeutic community (MTC) in Scotland

Purpose

– There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms.

Design/methodology/approach

– A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software.

Findings

– Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”?

Research limitations/implications

– A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative.

Practical implications

– Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers.

Social implications

– This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success.

Originality/value

– There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.

Parents' perceptions of their adolescent sons' recovery in a therapeutic community for addicted clients

A qualitative phenomenological study of parents of addicted male adolescents who were residents of a Jewish therapeutic community (TC) describes and interprets the parents' perceptions of the recovery process. Deep, semistructured interviews with 14 parents provided the data. The parents' perceptions were clustered into three main themes of meaning: (a) the process of change, (b) the experiences of family members in the course of the son's recovery process, and (c) the parents' perception of the treatment at Retorno. According to the parents, the admission of their sons into the TC brought notable relief to the family life, which enabled the whole family to begin a recovery process. The findings support the positive criminology perspective that emphasizes the disintegration-integration vector as significant in the recovery process. Recommendations for intervention planning are provided.

The notion of self in the journey back from addiction

In this study we explored how those recovering from addiction negotiated self, and the role supported accommodation played in the journey back from addiction. Transcripts from 11 in-depth interviews were analyzed by 2 coders who identified the most salient themes relevant to the self in recovery within the personal contexts of participants. The participants noted that reclaiming the self that had been lost to addiction was of primary importance to them. The recovery journey exposed a self that had reached the lowest point in life; one that was hardly recognizable; one that was undesirable. Engaging with supported accommodation provided participants with a sanctuary within which to reclaim the self, and was seen as central to their recovery.