Heroin addict clients' description of their families of origin

Qualitative exploration of the education and skill needs of community pharmacists in Saskatoon concerning substance use disorder

Background

Identifying the skills and educational needs of community pharmacists concerning addiction is critical to improving the services provided for people who suffer from addiction disease (PWSAD).

Methods

Eleven one-to-one semi-structured interviews were conducted with community pharmacists practising in the Saskatoon Health Region, Canada. The interviews were recorded and transcribed verbatim and verified with the participants. Thematic analysis was employed to analyze the transcripts.

Results

Four major themes were identified: 1) effect of the work setting on pharmacists' encounters with PWSAD, 2) pharmacists' knowledge of key aspects of addiction, 3) level of support within the health care system, and 4) educational and training needs.

Conclusion

Participants indicated that a lack of knowledge and training were major hindrances to improving the quality of the services provided to people who suffer from addiction disease. Additional practicum experience at the undergraduate level and interprofessional interactive educational sessions at the continuing educational level were key recommendations emerging from the study.

The Importance of Father Love: History and Contemporary Evidence

This article explores the cultural construction of fatherhood in America, as well as the consequences of this construction as a motivator for understudying fathers—especially father love—for nearly a century in developmental and family research. It then reviews evidence from 6 categories of empirical studies showing the powerful influence of fathers’ love on children's and young adults’ social, emotional, and cognitive development and functioning. Much of this evidence suggests that the influence of father love on offspring's development is as great as and occasionally greater than the influence of mother love. Some studies conclude that father love is the sole significant predictor of specific outcomes after controlling for the influence of mother love. Overall, father love appears to be as heavily implicated as mother love in offsprings’ psychological well-being and health, as well as in an array of psychological and behavioral problems.

The family experiences of narcotic addicts and their subsequent parenting practices

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children.

Male heroin addicts and their female mates: impact on disorder and recovery

A pilot investigation was undertaken to determine whether the social relationships between men who currently used heroin with their female mates differed from those of men who formerly used heroin, but were currently abstinent, with their female mates. Six couples were selected for study via the representative case method. Men currently abstinent from heroin had begun drug use later, had a family history of affective disorders, and had initiated their conjugal relationship after cessation of heroin use. Female mates of males currently abstinent from heroin had never used heroin with their mates in conjunction with sexual activity, had significantly positive ratings of their mates' performance of social roles, and were striving to obtain formal training to improve their employment skills. In contrast, the couples including actively using heroin addicts used opiates together, especially to enhance their sexual activity. The relationships of these couples were not as mutually supportive, and the male's role was less responsible and attracted less respect than that of the abstinent male. The females were depressed and had little positive aspects to their lives. Partners in all couples experienced a large number of stressful events, but current heroin use increased stress and hampered coping efforts. Interaction analysis of dynamics in relationships of men currently abstinent from heroin revealed that participation in mates' family life served to reshape their behaviors into more socially acceptable roles.

Drug addiction and parental rearing style: a controlled study

The parental rearing practices of 43 multiple drug addicts and 111 control subjects were compared using the EMBU, a psychometrically reliable instrument to assess parental attitudes and rearing behavior. Significant differences between addicts and controls were found on three dimensions: Rejection, Lack of Emotional Warmth, and Overprotection. The results were most striking for paternal rejection and lack of paternal emotional warmth.

Patient-treatment interaction: person versus thing centeredness of addicts in methadone and drug-free approaches

A hierarchical regression approach was used to test the hypotheses that there is a lower need for treatment for TC residents demonstrating a person-centered cognitive-perceptual style than an inanimate thing-centered one, and that thing-centered MMT patients would show a lower need for treatment than person-centered ones. The hypotheses were not confirmed. Secondary analysis shows that TC and MMT subjects do not differ for person/thing centeredness. TC subjects do show a greater overall need for treatment than MMT subjects.

Adolescent Drug Use and the Family Environment: A Review

A broad based review was done which is not restricted to any particular drug or class of drugs, nor to any particular aspect of family interaction. The review attempts to identify the general family interactional and drug variables which potentially underly adolescent drug use. Of particular importance theoretically has been the development of homeostatic models, which depart from previous linear “cause and effect” models. Suggested variables for further assessment in regard to their relationship to adolescent drug use include birth order, family size, and family makeup (intactness) especially in regard to when parents divorced. Less research has been done on couple variables as opposed to family origin variables. Family dynamics hold much promise for study. Variables such as parental roles and parent-child relationships especially in terms of distance regulation and overinvolvement call for further study. Although these variables have been studied, numerous methodological problems often exist when they have been incorporated into studies.

Perceived marital and family environment of opiate addicts

Addicts have described their family environment as providing inadequate modeling of social and role skills, while having high expectations for achievement. These self-reports have not been compared to either the reports of other family members or observer ratings of addict families. Observer ratings are important because addicts have also described their families as having significantly less conflict than normative families. We administered the Moos Family Environment Scale (FES) to 73 addicts and found that our addicts' scores supported the previous descriptions of addicts' perceived family environment. Addicts' perceived family environment differed from normative samples. They perceived their family as providing little preparation for social roles, while expecting high achievement. When addicts' wives or mothers completed the FES (n = 27), they disagreed with the addicts' perceptions of having high expectations for achievement in the marriage or family. Relative to their mothers and wives, the addicts seemed to be insensitive to the lack of effective organization and limit setting in either their family of origin or marriage. However, the mothers and wives agreed with the addicts in reporting low levels of conflict, but behavioral ratings of the married addicts and their wives (n = 16) showed a poor correlation between the observed behavior and the couples' perceptions. Furthermore, the level of conflict appeared to be above rather than below normative samples. Thus, addicts' perceptions of their family environment demonstrated significant discrepancies from the perceptions of their wives and mothers and from ratings of their marital behavior.

Client types in drug-free and methadone treatment: comparison of personality traits

The Drug-Free Therapeutic Community (TC) and Methadone Maintenance Treatment (MMT) modalities provide environmental conditions that are particularly well suited for examining addict personality characteristics suggested as important to the treatment of addiction. This study examines 174 addicts of two programs to determine how their relatedness to others varies with a self-selected treatment modality. Results indicate a generally low relatedness to others for the sample of addicts studied based on measures of the enduring trait associated with dependency on others and the more situational characteristic of interpersonal behavior. The MMT subsample showed greater social dependency in terms of the more enduring personality trait while the TC subsample was more interpersonally oriented based on the situational context. The absence of a relationship between the two measures suggests that there is a self-selection of treatment types which may serve to compensate for trait-related deficiencies or liabilities in addicts, and that the techniques employed by the approaches interact with these personality attributes that are probably accrued in the midst of learning how to cope with troubled familial settings and life as an addict.

Ego development, dragon fights, and chronic drug abusers

Developmental antecedents of adult behavior are described for four matched groups of chronic drug users (cocaine, amphetamine, opiates, barbiturates, and sedative-hypnotics) and a comparable group of nonusers, each group having been studied intensively for approximately 1.5 years. Integration is provided by a theory that views psychological development as a series of ego transformations, which appear metaphorically in legend and mythology as dragon fights. Each group is characterized theoretically by a core conflict, an upper limit on individuation, and a typical character. Results imply that radically new approaches to psychological treatment may be needed, especially for chronic users of barbiturates, opiates, and cocaine.

Success and failure in rehabilitation: the case of methadone maintenance

This research addresses itself to two problematic aspects of methadone maintenance: definition and measure of success of methadone rehabilitation programs and the location and prediction of those features which characterize patients successfully rehabilitated by such programs. For the first time, this research used a differentiated criterion to evaluate success, utilizing five different measures for its evaluation: consumption of methadone, consumption of illicit drugs, group therapy attendance, crime rate, and employment patterns. At the same time, we have theoretically and empirically established that two distinct types of patients exist: the future-oriented and the past-oriented. This time orientation remains constant throughout the patient's stay on the program. Future-oriented patients met with a significantly greater degree of success in the program than past-oriented patients.

Heroin addiction as a family phenomenon: a new conceptual model

The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment.