Neonatal outcomes of pregnant women attending integrated and standard substance use treatment programs in Ontario, Canada

BACKGROUND

Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data.

METHOD

We conducted a population-based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada.

RESULTS

Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type.

CONCLUSION

Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long-term service models that support women and children beyond the perinatal and early childhood periods.

Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study

PURPOSE

Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada.

METHODS

Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada.

RESULTS

Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups.

CONCLUSION

The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.

Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice

Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined parenting interventions being implemented in community practice and the extent to which these are informed by current research. We systematically compared parenting interventions offered in 12 maternal substance use treatment programs in one Canadian province with those described in the research literature (K = 21). Few parenting interventions were replicated, either within or across the two samples. However, parenting interventions within both samples were largely similar in their objectives. Across both research and community samples, approximately half of the interventions were developed or adapted for a problematic substance use population. Parenting knowledge, psychosocial risk, and maternal emotional regulation were most commonly addressed. Risks pertaining to the impact of drug craving and substance-related changes in neurobiology associted with parenting were less commonly addressed. Findings highlight current strengths and limitations of parenting interventions within research and community settings, with recommendations offered for future research and knowledge translation.

Multilevel analysis of the determinants of the global assessment of functioning in an inpatient population

BACKGROUND

The Global Assessment of Functioning (GAF) is a widely used measure of psychiatric symptoms and functioning, yet numerous concerns persist about its reliability and validity. The objective of this study was to determine the extent to which GAF scores reflect physician-related differences in addition to information about patients.

METHODS

This is a secondary analysis of clinical data collected between 2005 and 2010 from inpatients at a psychiatric hospital (N = 1,852). Multilevel modeling was used to estimate the influence of physicians on GAF scores at admission and on the change between admission and discharge, controlling for patient clinical presentation.

RESULTS

Controlling for patient-level predictors, 7% of the residual variance in admission GAF scores and 8% of the residual variance in change scores was at the physician level. The physician-level variance was significantly larger than zero in both models.

CONCLUSIONS

Although statistically significant, estimates of physician-level variance were not overwhelming, suggesting that the GAF was rated in a consistent manner across physicians in this hospital. While results lend support to the utility of the GAF for drawing comparisons between patients seen by different physicians across a large institution, further study is necessary to determine generalizability and to assess differences across multiple institutions.

Does the redesign of a psychiatric inpatient unit change the treatment process and outcomes?

OBJECTIVE

This study investigated whether ward atmosphere mediated the associations between the physical and therapeutic characteristics of an inpatient ward and patient outcomes.

METHODS

Individuals (N=290) receiving inpatient care for mood and anxiety disorders before and after an extensive renovation project were surveyed about ward atmosphere, quality of life, and treatment satisfaction. Global functioning at admission and discharge and other clinical characteristics were obtained from patients' charts.

RESULTS

After the redesign, participants perceived improved ward atmosphere, and the improvement was associated with greater treatment satisfaction and quality of life. Change in global functioning was independent of ward atmosphere.

CONCLUSIONS

Efforts to improve the inpatient environment by supporting patient autonomy, peer support, and practical skill development may be expected to meet with improved outcomes, at least for quality of life and satisfaction with treatment. These findings are consistent with patient-centered design as well as with broader perspectives on recovery-oriented services.

Real-world evaluation of the Resident Assessment Instrument-Mental Health assessment system

OBJECTIVE

We evaluated the Resident Assessment Instrument-Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality.

METHOD

Structured interviews with program staff were used for preliminary information-gathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality.

RESULTS

There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system's ability to support outcome monitoring. There was variability in implementation and performance across clinical programs.

CONCLUSIONS

This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to short-term, highly specialized services. In particular, the suitability of the RAI-MH for hospital-based addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.

The role of therapeutic alliance in substance use disorder treatment for young adults

The therapeutic alliance is deemed to be integral to psychotherapeutic interventions, yet little is known about the nature of its role in treatment for substance use disorders (SUD), especially among young people. We investigated baseline predictors of the therapeutic alliance measured midtreatment and tested whether the alliance influenced during-treatment changes in key process variables (psychological distress, motivation, self-efficacy, coping skills, and commitment to Alcoholics Anonymous/Narcotics Anonymous [AA/NA]) independent of these baseline influences. Young adults in residential treatment (N = 303; age 18-24 years) were assessed at intake, midtreatment, and discharge. Older age and higher baseline levels of motivation, self-efficacy, coping skills, and commitment to AA/NA predicted a stronger alliance. Independent of these influences, participants who developed a stronger alliance achieved greater reductions in distress during treatment. Findings clarify a role for alliance in promoting during-treatment changes through reducing distress.

Assessing self-determined motivation for addiction treatment: validity of the Treatment Entry Questionnaire

Although legal, formal, and informal social controls are frequently used to pressure individuals to enter treatment, motivational consequences of using these tactics have been neglected. Self-determination theory (SDT) provides a useful perspective for understanding client experiences of social controls and highlights the importance of self-determined motivation for long-term behavior change. This study assessed the construct validity of the Treatment Entry Questionnaire (TEQ), a brief scale derived from SDT to measure identified, introjected, and external treatment motivation. Two independent samples of clients entering Canadian residential and outpatient treatment completed TEQ items (ns = 529 and 623). Exploratory and confirmatory factor analyses supported a 9-item version of the scale, with 3 factors aligning with SDT motivational subtypes. Subscales showed high internal consistency and correlated as expected with social controls and perceived coercion at treatment entry. The TEQ-9 is a valid option for assessing self-determined motivation in clinical practice and evaluating coerced addiction treatment.

Understanding genetic risk for substance use and addiction: a guide for non-geneticists

There is considerable enthusiasm for the potential of genetics research for prevention and treatment of addiction and other mental disorders. As a result, clinicians are increasingly exposed to issues of genetics that are fairly complex, and for which they may not have been adequately prepared by their training. Studies suggest that the heritability of substance use disorders is approximately 0.5. Others report that family members of affected individuals experience a 4- to 8-fold increased risk of disorder themselves. Statements that addiction is "50% genetic" in origin may be taken by some to imply one's chances of developing the disorder, or that a lack of a positive family history confers immunity. In fact, such conclusions are inaccurate, their implications unwarranted given the true meaning of heritability. Through a review of basic concepts in genetic epidemiology, we attempt to demystify these estimates of risk and situate them within the broader context of addiction. Methods of inferring population genetic variance and individual familial risk are examined, with a focus on their practical application and limitations. An accurate conceptualization of addiction necessitates an approach that transcends specific disciplines, making a basic awareness of the perspectives of disparate specialties key to furthering progress in the field.

Client-centered design of residential addiction and mental health care facilities: staff perceptions of their work environment

In this article we discuss the findings from a series of focus groups conducted as part of a 3-year, mixed-method evaluation of clinical programs in a large mental health and substance use treatment facility in Canada. We examined the perceptions of clinical personnel on the physical design of new treatment units and the impact on service delivery and the work environment. The new physical design appeared to support client recovery and reduce stigma; however, it brought certain challenges. Participants reported a compromised ability to monitor clients, a lack of designated therapeutic spaces, and insufficient workspace for staff. They also thought that physical design positively facilitated communication and therapeutic relationships among clinicians and clients, and increased team cohesion. We suggest that, from these findings, new avenues for research on achieving the important balance between client and staff needs in health facility design can be explored.

Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale

OBJECTIVE

Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults.

METHOD

Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment.

RESULTS

Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors.

CONCLUSIONS

The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts.

Facilitating comprehensive assessment of 12-step experiences: A Multidimensional Measure of Mutual-Help Activity

Existing measures of 12-step mutual-help activity typically capture only a narrow range of experiences and combine fellowships with explicitly different substance-specific emphases (e.g., Alcoholics versus Narcotics Anonymous). To help expand our knowledge in this important area, we report on the development and use of a comprehensive multidimensional measure of 12-step experiences in two clinical samples of young adults and adolescents (N=430). One-week test-retest reliability was verified on a subsample. Results indicated high content validity and reliability across seven dimensions of experience (meeting attendance, meeting participation, fellowship involvement, step work, mandated attendance, affiliation, and safety), and the measure successfully discriminated between samples on anticipated activity levels. This measure provides rich data on mutual-help activities and deepens our understanding of individuals' experiences across different 12-step organizations.

Coerced addiction treatment: Client perspectives and the implications of their neglect

Recent work has criticized the evidence base for the effectiveness of addiction treatment under social controls and coercion, suggesting that the development of sound policies and treatment practices has been hampered by numerous limitations of the research conducted to date. Implicit assumptions of the effectiveness of coerced treatment are evident in the organization and evolution of treatment, legal, and social service systems, as well as in related legislative practices. This review builds upon previous work by focusing in greater detail on the potential value of incorporating client perspectives on coercion and the implications for interpreting and applying existing research findings. Reviewing the existing empirical and theoretical literature, a case is made for greater accuracy in representing coercive experiences and events in research, so as to better align the measured concepts with actual processes of treatment entry and admission. Attention is given to studies of the effectiveness of treatment under social controls or pressures, the connections to coercion and decision-making, and theoretical perspectives on motivation and behaviour change, including Self-Determination Theory in particular. This synthesis of the available research on coerced addiction treatment suggests that it remains largely unclear to what extent many of the commonly employed methods for getting people into treatment may be detrimental to the treatment process and longer-term outcomes. The impact of coercion upon individual clients, treatment systems, and population health has not been adequately dealt with by addiction researchers to date.

Influence of co-occurring mental and substance use disorders on the prevalence of problem gambling in Canada

CONTEXT/BACKGROUND

Research has shown that problem gambling (PG) is associated with substance use disorders (SUD) and also with other mental disorders (MD). Nevertheless, evidence about the relative contribution of each type of disorder for the risk of gambling in the population is very limited.

OBJECTIVE

Study the association of SUD, alone and in combination with MD, with the prevalence and severity of PG.

DESIGN

Cross-sectional national survey (Canadian Community Health Survey-Mental Health and Well-Being) data collected through a multi-stage stratified cluster design.

SETTING

Population-based household survey.

PARTICIPANTS

This analysis includes data on 36 885 participants (99.7% of the survey sample).

MAIN OUTCOME MEASURES

The prevalence and severity of PG were measured using the Canadian Problem Gambling Index. Prevalence of MD (mood and anxiety disorders) and SUD were defined according to the World Mental Health Survey Initiative Composite International Diagnostic Interview, following definitions of the DSM-IV.

RESULTS

Compared to the population, higher prevalence rates of PG are observed when the severity of SUD is higher, but are not impacted by the co-occurrence of MD. For individuals with low risk and moderate risk/problem gambling, the prevalence rate difference (prevalence rate in the subgroup minus prevalence rate in the population) observed among substance dependents was reduced when MD co-occurred (from a prevalence rate difference of 2.5; 99% confidence interval 1.6-3.8 to 1.6; 99% confidence interval 1.2-2.2 for low risk gamblers and from 3.7; 99% confidence interval 1.6-5.5 to 2.9; 99% confidence interval 2.0-4.3 for moderate risk/problem gamblers). Estimates were not statistically different.

CONCLUSIONS

Prevalence of all levels of PG increased with SUD severity, but the pattern did not appear to be affected by MD co-occurrence. Results suggest particular attention be given to SUD in treatment-seeking clients with co-occurring disorders.

Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders

OBJECTIVE

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail.

METHODS

Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups.

RESULTS

Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis.

CONCLUSIONS

The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

Substance abuse and quality of life among severely mentally ill consumers: a longitudinal modelling analysis

BACKGROUND

Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population. The purpose of this study is to test a conceptual model linking these factors together.

METHODS

Subjects were participants in a longitudinal evaluation of community mental healthcare in Ontario (n = 133). Comprehensive consumer assessments were conducted at treatment entry, and at 9 and 18 months. Subjects were receiving intensive case management or assertive community treatment throughout the 18-month study period. Structural equation modelling was used to examine the concurrent and longitudinal relationships between substance abuse, symptoms and distress, and QOL.

RESULTS

The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.

CONCLUSIONS

The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems. Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI.

Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders

OBJECTIVES

This study contributes to knowledge of the processes underlying help seeking by those with mental and substance use disorders by examining relationships among need, service use, and satisfaction with mental health care in a population-based sample.

METHODS

Secondary data analyses were performed on responses to the 2002 Canadian Community Health Survey (N=36,984). Diagnostic algorithms classified respondents by past-year diagnostic status, including substance dependence and selected mood and anxiety disorders. Logistic regressions examined associations between diagnostic status and service use, satisfaction, and unmet need for care.

RESULTS

Ten percent of Canadians and 39% of Canadians with a mental disorder or substance dependence sought services in the year preceding data collection. Although those with co-occurring substance dependence and mental disorders reported the poorest mental health and were most likely to seek care, the presence of a mental disorder, regardless of co-occurring substance dependence, contributed primarily to help seeking. Among those who sought services, the use of informal sources of care, including self-help groups, was more common among those with substance dependence. Those with co-occurring disorders reported the lowest satisfaction with care and the greatest prevalence of unmet need.

CONCLUSIONS

The differential use of services, satisfaction, and unmet need across diagnostic status allowed for speculation on differing levels of disability and stigma in the help-seeking process for different types of disorders. The strong association between co-occurring disorders and unmet need for care, including a large proportion of respondents who stated they preferred to self-manage their symptoms, is particularly troubling and deserves future research attention.

Characteristics of people seeking treatment for problem gambling in Ontario: Trends from 1998 to 2002

This report summarizes the characteristics of individuals who sought help within Ontario's specialized problem gambling treatment system during its first four years of operation. All clients recorded in the provincial information system database as having entered a gambling treatment program between April 1, 1998, and March 31, 2002, are included. Broad trends and gender differences in demographic characteristics, gambling behaviours, and problem severity are considered and compared by fiscal year. Compared to population-based estimates of problem gambling, the number of clients served by this specialized treatment system is low but steadily increasing. Women have consistently made up approximately one third of clients entering treatment in each fiscal year, and their sociodemographic profile, their gaming preferences, and the duration of their problem gambling careers differ from those of male clients. The growing proportion of clients of both genders seeking help for problems related to slot machines is of primary concern and warrants further study.

Individuals seeking treatment for cannabis-related problems in Ontario: demographic and treatment profile

We report on the extent of cannabis treatment-seeking within an addiction treatment system in Canada. Data represent all new admissions in fiscal year 2000 to substance abuse treatment agencies in the province of Ontario (n = 47,995). Analyses examine the prevalence of cannabis problems by demographic and treatment characteristics and provide contrasts with other client subgroups (alcohol, cocaine, and opiates). Clients reporting cannabis as their primary problem substance (13%) were more likely to be male, single, under age 20 and in high school. Legal system involvement and school- or family-based pressure to enter treatment were commonly reported, but less so by older cannabis clients. The distinctiveness of these clients within the larger treatment system raises questions of the relevance to cannabis clients of interventions designed for other substance-abusing populations.

The use of preventive healthcare by Canadian women who drink alcohol

BACKGROUND

Despite established links among heavy alcohol consumption, other poor health behaviors, and poor health status, no Canadian study has specifically addressed the relationship between drinking and the use of preventive healthcare services. This study examines the relationship between drinking and female-specific preventive health service use through a secondary analysis of the 1996-1997 NPHS.

METHODS

Recent use of Pap smears and mammograms was examined in relation to current alcohol consumption, using multivariate logistic regression (weighted n = 25,095).

RESULTS

In general, there was a trend toward greater odds of recent service use among light and moderate drinkers than among heavy drinkers and lifetime abstainers. However, only moderate drinkers were significantly (P < 0.01) more likely than abstainers to have recently had a Pap smear.

CONCLUSIONS

The trend toward lower use of preventive services by heavy drinkers is concerning considering the established harmful effects of prolonged alcohol consumption on health and the tendency for multiple risk behaviors to cluster together in the same individuals. Early detection of departures from good health may alleviate the elevated use of healthcare services among those diagnosed with alcohol use disorders.

Who seeks treatment for cannabis-related problems?

PURPOSE

To examine the types of presenting problems and symptoms among individuals seeking treatment for cannabis-related problems in a large treatment centre in Ontario.

METHODS

Data from assessment interviews conducted with clients who identified cannabis as their primary drug problem (n=426) were analyzed using descriptive statistics.

RESULTS

The majority of people seeking treatments were male (80%) and single (77%). Cannabis treatment seekers varied in their socio-demographic characteristics, drug consumption, pressure to seek treatment, and adverse consequences of cannabis use. They experienced a broad range of substance-related problems, however, the majority were classified as below the action stage in terms of readiness to change their drug consumption. Daily users were older, more likely to be employed, to be cannabis dependent, to suffer from an anxiety disorder, and to use multiple substances.

DISCUSSION

Cannabis treatment seekers are a heterogeneous group. A better understanding of the relationship between client characteristics and different interventions may improve outcomes.

Physicians' enquiries into their patients' alcohol use: public views and recalled experiences

AIMS

To examine public opinion and experiences of family physician involvement in alcohol use issues and to identify patient characteristics associated with these opinions and experiences.

DESIGN

A secondary analysis of population survey data from the 1993 Ontario Alcohol and Other Drug Opinion Survey (OADOS), a random household telephone survey of adults in Ontario, Canada. Opinion and experiences regarding alcohol use were examined by drinking status.

PARTICIPANTS

All survey respondents (n = 941; 65% response rate). Population expansion weights were applied to ensure the sample's representativeness of the adult population of Ontario.

MEASUREMENTS

Measures assessed the prevalence of opinions and experiences of family physicians: (1) asking patients about their drinking; (2) advising regular drinkers to cut down/quit; and (3) helping patients with alcohol problems. Self-reported past-year alcohol consumption and related problems were used to construct a categorical variable describing current drinking status.

FINDINGS

Public opinion supported routine inquiries into patients' drinking habits and advising regular drinkers to cut down. However, the experience of being asked by a physician about drinking, being advised to cut down or being helped with alcohol problems was uncommon. Respondents' drinking status was associated with experiences of being asked about drinking and being advised to cut down.

CONCLUSIONS

Physician training should inform physicians that public opinion supports inquiries about drinking and advisement to reduce consumption, as it does not appear that family doctors are meeting these expectations of patients.

Characteristics of People Seeking Help from Specialized Programs for the Treatment of Problem Gambling in Ontario

Objectives: The objectives of this study are to estimate the number of people seeking treatment on an annual basis in Ontario at specialized problem gambling treatment programs and describe important characteristics of clients. Method: Agency staff prospectively collected four broad information categories from clients: demographics, gambling activities, problem severity and services received, and submitted the data to a central database. Sample: The report includes submissions (total caseload equals 2224) from 44 designated problem gambling programs between January 1, 1998 and April 30, 2000. Results: Of the 2224 clients in treatment, 1625 (73.5%) were seeking help for their own gambling problem, and 504 (22.8%) were seeking help in dealing with a family member/significant other's gambling problem. The overall gender ratio of cases in treatment was about 1.4:1 (58.3% to 41.7%) males to females. A wide range of gambling activities was reported as problematic. Conclusion: Only a small percentage of people experiencing problems related to gambling are seeking help from specialized treatment programs. Population survey data are needed in Ontario to assess the potential over- or under- representation of particular sub-groups in treatment compared to the epidemiology of problem gambling in the community.