Multi-Level Approach to Theories of Addiction: A Critical Review

Addictive behavior and mental health of adolescents aged 11-17 years in Bangladesh in 2014: A cross-sectional study

Background and Aims

This study aimed to evaluate the factors associated with addictive behavior and mental health in adolescents aged 11-17 years in Bangladesh.

Methods

This study analyzed data from the Bangladesh Global School-based Health Survey (GSHS) conducted in 2014. Adolescents aged 11-17 years studying government schools were considered as respondents for this survey. A two-phase group sample design was utilized to deliver illustrative information of all understudies in grades (classes) 7-10 in Bangladesh. Bivariate analyses followed by a weight-adjusted multiple logistic regression was fitted to a sample of size 2989 adolescents.

Results

One in ten and one in four adolescents had different substance addictions and some forms of mental health conditions, respectively. Sex of participants (adjusted odds ratio [AOR]: 4.49; confidence interval [CI]:2.28-8.84), being bullied (AOR: 3.08; CI:1.46-6.49), use of tobacco among parents (AOR: 5.82; CI:3.16-10.75), parental understanding of adolescents' problems (AOR: 0.45; CI:0.23-0.82), and food affordability (AOR: 1.24; CI:1.09-1.42) were associated with addictive behaviors of adolescents. Bullied males with nonempathetic parents were found to be more vulnerable to addictive behaviors and bullied females showed higher tendencies to mental health issues.

Conclusion

Considering the elevated prevalence of reported mental health concerns, identifying vulnerable groups and formulating intervention-oriented policies engaging youths can pave the way towards achieving robust health and well-being for them in Bangladesh.

Addiction interprofessional experiences of care: Stress, coping and transformation

This study aimed to explore healthcare professionals' attribution of meaning to the concept of addiction, treatment and recovery. The study was conducted through semi-structured interviews with 18 healthcare professionals in the field of addiction: nine nurses, six psychologists, a psychiatrist, a social worker and a psychosocial technician. Based on a qualitative methodology, a thematic analysis was performed using the NVivo software. Regarding professional stress, the results revealed several stress factors related to the intervention (e.g. strategic powerlessness and uncertainty of intervention's effectiveness), the addicted individuals (e.g. motivation, difficulties in adhering to treatment, patient behaviour, negative patient emotionality and lack of socio-economic resources) as well as the healthcare services (e.g. team stress). Adaptive coping strategies were reported, both used in the work context (e.g. cognitive coping strategies and acceptance) and in personal life (e.g. work-family boundaries and family support and closeness). Despite the professional stress experienced, the participants' narratives indicated positive transformations of the self, which suggests resilient professional trajectories.

An Integrated Approach to Addictive Behaviors: A Study on Vulnerability and Maintenance Factors

This study aimed to explore the relationships among the variables involved in a Comprehensive Model of Addiction (CMA), which posits that the presence and severity of addictive behaviors are related to the configuration of seven psychological variables, namely childhood trauma, insecure attachment, affect dysregulation, dissociation, impulsivity, compulsiveness, and obsessiveness. A vulnerability model was proposed, in which it was suggested that affect dysregulation and complex trauma mediated the association between insecure attachment and dissociation. Furthermore, a maintenance model was elaborated, in which it was hypothesized that dissociation influenced affect dysregulation via impulsivity, compulsiveness, and obsessiveness. A clinical sample of 430 individuals with substance use disorder was involved. All participants received a DSM-5 clinical diagnosis of Substance-Related and Addictive Disorders and were recruited from the Italian National Health System. A parallel mediation emerged, confirming the vulnerability model, with complex trauma and affect dysregulation mediating the relationship between insecure attachment and dissociation. Furthermore, a mixed serial–parallel mediation described the maintenance model, where impulsiveness, compulsiveness, and obsessiveness significantly mediated the relationship between dissociation and affect dysregulation. Our findings offer a better understanding of the variables associated with addictive disorders, thus providing important indications for both treatment and preventive interventions.