From the community mental health movement to the war on drugs: A study in the definition of social problems.

In the 1980s, the Reagan and Bush administrations reduced funding for community mental health programs and began instead to support substance abuse treatment agencies. One reason for this shift in policy was that the social problem of mental illness had been captured by progressives in the community mental health movement. Conservatives, therefore, needed a new problem to redefine and use to enact new social control policies. The conservatives' claim that substance abuse is primarily the result of a defect in the character or constitution of the abuser has had profound effects on both social policy and the research community. Greater awareness is needed on the part of researchers as to how social problems have been defined and how government research grants affect our thinking about substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse

Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.     

Ideology and social work practice in substance abuse settings

The profession of social work has a unique role in preventing and treating alcohol and other drug problems. In human services settings shared beliefs or ideologies of care are expected to have substantial influence over the way in which problems are perceived and the types of service technologies used. Thus, it is important that social work professionals be cognizant of what beliefs they hold and how their beliefs about substance abuse treatment and prevention may affect practice. This article discusses current ideologies of care in the substance abuse arena, including the disease/abstinence, psychosocial, ecological, and harm-reduction approaches. In addition, this article examines managers' beliefs about substance abuse programs to determine if there are differences between those who have a social work background (that is, hold at least one social work degree) and those who do not. Suggestions for social work practice and future research also are provided.     

An overview of problem-solving and social skills approaches in substance abuse treatment.

Reviews the research on problem solving (PS) and social skills (SSKs) approaches to treating substance abuse. Populations at high risk for substance abuse have been described as having deficits in these areas. Research shows 2 ways in which poor PS and SSKs can be related to drug use: (1) Deficiencies can lead to failures in interpersonal areas that can precipitate substance use and (2) individuals with deficits may find themselves unable to negotiate their way out of situations that carry a high risk of drug use. PS and SSKs training in substance abuse treatment are designed to give clients new skills that will allow them to maintain their abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile delinquents' perceptions of childhood parental rearing patterns

This study compared individuals who have been identified as engaging in delinquent behavior, but who perceive their childhood differently. It examined the differentiating family and social characteristics between delinquents who were maltreated in childhood (based on self-report data) and delinquents who were not maltreated. The sample consisted of the entire population of juvenile delinquents (N = 287) in all institutions and prisons in Greece. Childhood abuse and neglect were defined on the basis of perceived parental rearing patterns as assessed by the EMBU questionnaire, and groups of abused/nonabused and neglected/non-neglected delinquents were formed. Perceived parental abuse and/or psychological neglect (paternal and/or maternal) were found to be associated with various family and social characteristics. Specific parameters connected to the Greek societal and cultural context have also been identified.     

Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association

We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.     

High risk for children with DAMP/ADHD to become addicts later in life

The prevalence of attention deficit hyperactivity disorder (ADHD) and of the overlapping condition, deficit in attention, motor control and perception (DAMP), among children of early school age is approximately 5 per cent (1.5% being severe cases). Boys are more commonly affected than girls. The symptoms continue to be disabling at 20 years of age in 50 per cent of cases, and social maladjustment is common. Half of the young boys develop oppositional defiant disorder (ODD), very often progressing to conduct disorder (CD) and antisocial personality disorder (ASPD). Low socio-economic status, parental mental disorder, and persistence of DAMP/ADHD symptoms are all predictors of the development of CD/ASPD. Prospective studies of children with DAMP/ADHD have shown them to be characterised by a high level of alcohol and/or drug abuse comorbidity, particularly the subgroup progressing to CD/ASPD. Conversely, studies of drug abuse and of alcohol abuse series have shown them to be characterised by a high level of DAMP/ADHD comorbidity. Approximately one in five alcoholics has or has had DAMP/ADHD, a comorbidity probably even more pronounced among type II alcoholics. Approximately every third substance-abuser has or has had DAMP/ADHD. The need of more persevering support and treatment efforts for the well-defined category of boys at high risk is emphasised. Better awareness, active diagnosis and treatment of adults with persisting DAMP/ADHD is also warranted.     

Les défis diagnostiques posés par l'évaluation clinique des allégations de sévices sexuels concernant des enfants.

Knowledge and expertise acquired in clinical and empirical psychology are increasingly requested by social and judicial authorities when confronted with allegations of sexual abuse on children. In view of this increased demand, various evaluation methods and techniques have been developed, some for which the measurement value and conceptual relevance have not been demonstrated. The article brings us up to date on evaluation methods pertaining to allegations of sexual abuse on children and suggests a practical framework that takes into account recognized clinical principles and recent research results in this field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stability and Impact of Environmental Factors on Substance Use and Problems After Adolescent Outpatient Treatment for Cannabis Abuse or Dependence.

Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnocultural factors and substance abuse: Toward culturally sensitive treatment models.

Discusses the role of ethnocultural factors in understanding and treating substance abuse disorders. Research and theory suggest that acculturation experiences, sources of stress, coping mechanisms, social support variations, and beliefs about substance use are key factors associated with differential patterns of substance abuse among some ethnic groups, particularly African Americans, Hispanics, and Native Americans. In recent years, models of substance abuse intervention specifically targeting these ethnic groups have been developed. The author examines the movement toward culturally sensitive psychosocial treatment models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal abuse from outsiders versus insiders: Comparing frequency, impact on emotional exhaustion, and the role of emotional labor.

Research on aggression from organizational outsiders (customers, clients or patients) has ignored insider-instigated aggression, and has been limited to employees in emotional labor jobs (e.g., social work and customer services). The authors argue that customer-employee interactions have distinct characteristics from organizational insider interactions, and provide two studies to compare the frequency and strain of verbal abuse from customers, supervisors and coworkers. Furthermore, they assess whether customer verbal abuse is only a critical issue for employees in jobs requiring emotional labor, measured with both O*NET job codes and self-reported display rules. With a national random sample of U.S. employees (n = 2446) and a convenience sample of U.S. employees who have customer contact (n = 121), the authors find that verbal abuse from outsiders (1) occurs more frequently than insider verbal abuse, particularly for those with higher emotional labor requirements, and (2) predicts emotional exhaustion over and above insider verbal abuse, regardless of emotional labor requirements. The authors conclude that better integration of customer aggression and insider aggression research is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexually transmitted diseases and child sexual abuse: results of a Canadian survey of three professional groups

The purpose of this national survey was to determine the knowledge and attitudes of Canadian health and social services professionals about the occurrence of sexually transmitted diseases (STDs) in children and its implications for child sexual abuse. A mailed questionnaire was sent to a randomly selected sample of 4,500 nurses, physicians, and youth/social workers across the country. Response rates varied from over 60% of nurses and youth/social workers to only 38% of the physicians. Nurses and youth/social workers were younger than physicians, had a proportionately higher number of females within their groups, and more frequently reported that they had or might have been sexually abused as children. Although there was no statistically significant difference among the groups on the composite knowledge score, physicians scored higher than the other two groups on knowledge about STDs, and youth/social workers had the highest knowledge scores about sexual abuse. Some differences in attitudes among the groups were also noted. Overall, the rates of respondents reporting confidence in their ability to treat children with STDs or child sexual abuse were low (26% and 35% respectively). This paper presents the overall results of the survey, and makes recommendations for strategies to enhance professional expertise in the area.     

Alcohol dependence and domestic violence as sequelae of abuse and conduct disorder in childhood

OBJECTIVES: To examine in the Navajo population: (1) the importance of childhood abuse as a risk factor for conduct disorder; (2) the importance of each form of abuse and conduct disorder as risk factors for alcohol dependence; and (3) the relative importance of each form of abuse, conduct disorder, and alcohol dependence as risk factors for being a perpetrator and/or victim of domestic violence. METHOD: The study is based on a case-control design. Cases (204 men and 148 women) between the ages of 21 and 65 were interviewed in alcohol treatment program and matched to community controls. There were two groups of controls: alcohol dependent (374 men, 60 women) and nonalcohol dependent (157 men, 143 women). When adjusted for stratification by age, community of residence, and sex, the combined control groups comprise a representative sample of the Navajo male and female population 21-65 years of age. RESULTS: The prevalence of physical and sexual abuse before age 15 is within limits observed in other populations. Each form of abuse is a risk factor for conduct disorder. Along with conduct disorder, physical abuse is a risk factor for alcohol dependence. Physical abuse and alcohol dependence are independent risk factors for being involved in domestic violence as both perpetrator and victim. There appears to have been no secular trend in the incidence of childhood abuse over the past several generations, but there is suggestive evidence that domestic violence has become more common. CONCLUSIONS: Physical abuse is a significant risk factor for alcohol dependence as well as for domestic violence independent of the effects of alcohol abuse. The effects of sexual abuse with regard to both domestic violence and alcohol dependence do not appear to be significant.     

Single-portal endoscopic treatment of carpal tunnel syndrome. Results of a preliminary series]

The authors assessed social-evaluative anxiety in 50 cocaine abusers attending an outpatient therapeutic-community (TC)-oriented clinic. This group-based modality presumes that the ability of clients to self-disclose is key to recovery. Fully half of the clients tested, some of whom had been attending treatment for a number of months, showed an elevation of social withdrawal and distress. Newcomers with higher social anxiety scores were less likely to drop out of treatment over the first 3 months, and self-reported level of social anxiety decreased over this time interval. These findings suggest that social anxiety may be an important consideration in treatment for cocaine abuse and that the rigors of a modified TC with intense focus on group involvement may reduce social anxiety.     

Downward Spiral: a pedagogical game depicting the dangers of substance abuse

We have developed a pedagogical game called Downward Spiral that illuminates the dangers associated with continued drug use (including alcohol). The game provides facts, quotes, and episodic consequences that can adversely affect each player's mental and physical health, social support, and financial/legal situation over the course of the game. The conceptual and empirical foundations of the game (both a college prevention version and substance abuse treatment version) are discussed. Pilot studies with college students and residents at a substance abuse treatment facility for probationers indicate that Downward Spiral is engaging, informative, and thought provoking. Plans for examining the impact of this game as a preventive technique (for the college setting) and as an approach to increasing motivation for substance abuse treatment are described.     

Are social supports in late midlife a cause or a result of successful physical ageing?

BACKGROUND: Many studies have noted a strong association between poor social support and premature mortality. A limitation of such studies has been their failure to control adequately for confounders that damage both social supports and physical health. METHODS: A 50-year prospective multivariate study of 223 men was used to examine the possible causal relationships between social supports and health. Alcohol abuse, prior physical health and mental illness prior to age 50 were controlled. Relative social supports were quantified over the period from age 50 to 70. RESULTS: Adequacy of social supports from age 50 to 70 was powerfully correlated with physical health at age 70 (P < 0.001). However, such social supports were also powerfully predicted by alcohol abuse (P < 0.001), smoking (P < 0.001) and indicators of major depressive disorder (P < 0.01) assessed at age 50. When prior smoking, depression and alcohol abuse were controlled, then the association of physical health with social supports was very much attenuated. Some facets of social support like religion and confidantes were unassociated with health even at a univariate level. Surprisingly, in this sample friends seemed more important for sustained physical health than closeness to spouse and to children. CONCLUSIONS: While social supports undoubtedly play a significant role in maintaining physical well-being in late life, much of the association between poor social supports and mortality may be mediated by alcoholism, smoking and pre-morbid psychopathology.     

The impact of perceived child physical and sexual abuse history on Native American women's psychological well-being and AIDS risk.

The impact of perceived child abuse history on 160 adult, Native American women's emotional well-being (i.e., depressive mood and anger) and AIDS risk was examined. How sense of mastery and social support might lead to women's greater resiliency was also investigated. Child physical-emotional abuse was found to have greater impact on depressive mood and anger and AIDS risk than did child sexual abuse. This finding was independent of current stress in women's lives. Women who were physically- emotionally abused as children had 5.14 times greater odds of having a sexually transmitted disease in their lifetimes than did women who experienced only marginal or no physical- emotional abuse. Moreover, consistent with the communal culture of Native Americans, social support was found to contribute more to resilience than sense of mastery did. Reasons for the greater predictive power of child physical- emotional abuse compared with child sexual abuse in a growing number of studies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The abuse of dextromethorphan-based cough syrup: a pilot study of the community of Waynesboro, Pennsylvania

Drug abuse has been a national social problem in the United States for decades and is often complicated by the emergence of new types of abused drugs or new forms of abuse. In the late 1980s, the community of Waynesboro, Pennsylvania began to detect behavior among its teenagers that suggested a new form of drug abuse and thus a new social problem. The drug was dextromethorphan, used in cough syrup-principally Robitussin DM. The form of abuse is often referred to as "roboing" or "robo-copping." This paper presents the results of the first phase of a comprehensive investigation of this phenomenon in the Waynesboro school district. Data from a survey of school personnel indicate that abuse of cough syrup (Robitussin or other brands) has increased over the years and is increasingly perceived as a problem by the community.     

Main, mediating, and moderating effects of social support on the well-being of survivors of intimate partner violence across 2 years.

Intimate partner violence is a serious and pervasive social problem with deleterious consequences for survivors’ well-being. The current study involved interviewing 160 survivors 6 times over 2 years to examine the role of social support in explaining or buffering these negative psychological consequences. The authors examined both between- and within-persons variability to explore women’s trajectories regarding their experiences of abuse, social support, depression, and quality of life (QOL). Findings revealed the complex role of social support on women’s well-being. Evidence was found for main, mediating, and moderating effects of social support on women’s well-being. First, social support was positively related to QOL and negatively related to depression. Social support also partially explained the effect of baseline level and subsequent change in physical abuse on QOL and depression over time, partially mediated the effects of change in psychological abuse, and moderated the impact of abuse on QOL. The buffering effects of social support were strongest at lower levels of abuse. Implications for future research and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgeon-related factors and outcome in rectal cancer

A fatality in a teenager from the recreational intranasal abuse of methylphenidate (Ritalin) is reported. The prescribed use of methylphenidate (Ritalin) in the treatment of attention deficit and/or hyperactivity disorder is widespread. The intranasal abuse of methylphenidate (Ritalin) among teenagers is becoming increasingly more recognized. Previous deaths from the parenteral abuse of methylphenidate (Ritalin) have been reported. This fatality is the first reported from its intranasal abuse.