Abuse Policy Research Articles

Zero Tolerance: Don’t Be a Square!

At Wentworth, rule violations are normally minor in nature and handled at the private school administration‘s discretion. A recent event involving the possession and use of alcohol during an off-campus school overnight activity leads to the development of a zero tolerance substance abuse policy. The zero tolerance policy is tested by one of the school’s top students and her influential parents. This case study examines the possible impact zero tolerance policies can have on behavior management in a niche, private, secondary education institution. Related educational leadership issues include: zero-tolerance education policies; school organizational culture; punitive and restorative mechanisms of social justice; moral and ethical school leader decision-making; and the politics of education.

A Field Experiment in Capitated Payment Systems and Recovery Management: The Women's Recovery Association Pilot Study

Against the backdrop of shifting perspectives regarding substance abuse policy, upcoming changes to the health care system, and progress toward parity for mental health and substance abuse treatment, an exploratory pilot study is being conducted in San Mateo County, California, to assess the potential of a capitated case rate combined with a recovery management approach in a community-based substance abuse treatment program for women. The rationale for developing the approach, planning, and implementation of the pilot project, the struggle of the agency to transform from episodic treatment to a chronic care model, and a case study that highlights organizational changes are discussed. Lessons learned and implications for the second year of the pilot project are also discussed.

Medical student views of substance abuse treatment, policy and training

Purpose: This study examined the impact of medical education on students’ views of substance abuse treatment, public policy options and training.Method: A longitudinal survey was conducted on a single-class cohort of 101 students in a major American, urban medical school. The survey was administered in the Spring semesters of the first to third years of the curriculum. The survey evaluated attitudes in three areas: (1) Treatment: efficacy of treatment and ideal level of physician involvement in substance abuse issues, (2) Public policy: degrees of support for competing public policy strategies and (3) Training: the amount of substance abuse education offered in medical school.Results: Response rates were 92% in the first year, 90% in the second and 75% in the third. About 54% of respondents were female, 55% were white (non-Hispanic) and 71% were 20–24 years old. Treatment: students held consistent views towards treating substance abuse patients, but there was a significant decline in the percentage who felt that drug addiction can be successfully treated (from 47 to 22%, p < 0.001). Public policy: support for public health approaches ranged from 86 to 92%, but most criminal justice approaches were favoured by fewer than 40% of respondents. Training: respondents reported a significant increase in any degree of substance abuse training (p = 0.0001); classroom and clinical experiences were the predominant sources of training.Conclusions: Surveyed medical students retained many of their a priori beliefs about substance abuse, though there were some significant changes during the survey period. Further studies are required to evaluate how these views were established and how medical education impacts potentially malleable attitudes.

Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs. Multivariate analysis was performed to examine the association between a variety of hospital characteristics, in addition to rural location, and presence of child abuse resources. Fifty-five Oregon hospitals were surveyed. A smaller proportion of rural EDs had written abuse policies (62% vs 95%, P= .006) or on-site child abuse advocates (35% vs 71%, P= .009). Thirty-two percent of rural EDs had none of the examined abuse resources (vs 0% of urban EDs, P= .01). Of hospital characteristics studied in the multivariate model, only rural location was associated with decreased availability of child abuse resources (OR 0.19 [95% CI, 0.05-0.70]). Rural EDs have fewer resources than urban EDs for the management of child abuse. Other studied hospital characteristics were not associated with availability of abuse resources. Further work is needed to identify barriers to resource utilization and to create resources that can be made accessible to all ED settings.

Priorities for policy research on treatments for alcohol and drug use disorders

The Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP) supported 368 awards for nearly $60 million to complete policy research related to alcohol, tobacco, and illicit drug use and abuse. As part of its closure in 2009, SAPRP commissioned four papers that articulated policy research priorities for tobacco cessation and control, alcohol prevention, drug prevention, and addiction treatment. The papers were released at a Congressional Briefing on October 2, 2009 and are available on the SAPRP Web site ( http://www.saprp.org/Research_Agenda.cfm). An abridged version of the treatment policy paper summarizes what we know, what we need to know, and research recommendations. The paper examines five categories of policy concerns that are likely to affect addiction treatment services over the next 5 years: (a) organization and delivery of care, (b) quality of care, (c) evidence-based practices, (d) access to care, and (e) financing, costs, and value of care.

A Glass Half Full: The Dubious History of Elder Abuse Policy

This article highlights the brief 30-year history of major U.S. policies that address elder abuse. The history of elder abuse policy is checkered and incomplete, reflecting a lack of comprehensive federal legislation. We begin our review by discussing the scope of elder abuse policy and, in particular, the Social Security Block Grant, which has become the sole source of federal aid for Adult Protective Services programs. The other source of federal aid, typically for helping efforts by Area Agencies on Aging, is the Older Americans Act. We document the incremental but increasing attention paid to elder abuse by chronicling key initiatives, including early congressional reports and hearings; White House Conferences on Aging; and efforts by pioneers such as Mario Biaggi, Claude Pepper, John Breaux, and Orin Hatch—efforts that we believe have led to the various introductions of the Elder Justice Act.

Future Directions for Social Policy and Elder Abuse: Through the Looking Glass of Generational Characteristics

The future directions for social policy and elder abuse are forecast using the characteristics of three contiguous generations: Baby Boomers, Gen Xers, and Nexters. The results suggest greater potential victimization for the Boomers than previous generations, particularly neglect and exploitation. Gen Xers may experience more self-neglect. Social policy will continue to emphasize the criminalization of elder abuse, reflecting Boomer self-righteousness and severity. Elder abuse victimization will have a medical hue, given the Boomer obsession with health and wellness. Although Gen Xers are less cynical than Boomers, they will be more concerned about their immediate lives and pass the elder abuse policy torch to the Nexters, who will elevate it in deference to the Boomers and in quest for a higher moral order.

'Resistors,' 'Helpless Victims,' and 'Willing Participants': The Construction of Women's Resistance in Canadian Anti-Violence Policy

Integrating insights from a problem representation approach and a feminist bargaining framework, I explore the “lived effects” of Canada's anti-wife abuse policy frameworks. The policy frameworks are premised on protection, which requires removal from danger. In effect, anti-violence policy problematizes the behavior of women, constructing women's resistance to abuse as only exit, falsely classifying the women who leave as “resistors” and those who stay as either “helpless victims” or “willing participants”. Where the “helpless victims” are constructed as policy problems, the other women are defined away from the policy frameworks, offered no protection from the state. The analysis reveals that anti-violence policy, far from protecting women, actually increases their vulnerability to abuse.

Illicit drug use in South Africa: Findings from a 2008 national population-based survey

&lt;p&gt;&lt;strong&gt;Objective.&lt;/strong&gt; The aim of this secondary analysis of the South African National HIV, Incidence, Behaviour and Communication (SABSSM) 2008 survey is to provide current data on illicit drug use that could assist in the development and implementation of effective substance abuse policies and intervention programmes aimed at these populations in South Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method.&lt;/strong&gt; A multistage random population sample of 15 828 people age ≥15 (56.3% women) was included in the survey. Illicit drug use was assessed by 2 sections of the Alcohol, Smoking and Substance use Involvement Screening Test (ASSIST). Frequency analyses for different age groups, geolocality, educational level, income, and population group were calculated, as were odds ratios for these variables regarding combined illicit drug use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Current cannabis use was reported by 3.3% of the population sample – 6.1% of the men and 1.2% of the women – and the use of combined all-other illicit drugs (cocaine, amphetamines, inhalants, sedatives, hallucinogens, opiates) was reported by 1.8% of the participants. Coloured men (14.3%) were most likely, and Indian or Asian women (0.6%) least likely, to be cannabis users. Illicit drug use (combined) among men was associated with the 20 - 34 year age group and the coloured and white population groups, and among women in the younger age groups, the coloured and white population groups, and low and higher income.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; An increase of cannabis and other illicit drug prevalence rates was observed from 2005 (2.1%) to 2008 (3.3%) in the population sample. Multilevel interventions are required to target illicit drug users, in addition to creating awareness in the general population of the problems associated with illicit drug use. There is a need to address illicit drug use in national and provincial policy planning and intervention efforts and, in terms of treatment, a need to ensure that treatment practitioners are adequately trained to address illicit drug use. Future prospective studies are necessary to assess the impact of illicit drug use.&lt;/p&gt;

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Ronald Reagan and the 1980s: perceptions, policies, legacies

Introduction C.Hudson& G. Davies PART I: PERCEPTIONS Ronald Reagan: Communicating the America Within D.Rather Only an Actor: Memories of a Reagan Biopic G.Hodgson 'Just Say No': Drug Abuse Policy in the Reagan Administration P.G.Bourne Ronald Reagan and the End of the Cold War J.F.Matlock, Jr. PART II: POLITICS AND POLICIES Reagan, Nuclear Weapons, and the End of the Cold War S.Head Reaganomics and its Legacy I.Morgan African American Protest during the Reagan Years: Forging New Agendas, Defending Old Victories S.Tuck Reagan's Religious Right: The Unlikely Alliance between Southern Evangelicals and a California Conservative D.K.Williams Ronald Reagan and the Republican Party: Responses to Realignment R.Mason PART III: LEGACIES The Baptist and the Messiah: Ronald Reagan and Margaret Thatcher D.Sandbrook Transforming the Presidency: The Administration of Ronald Reagan J.D.Aberbach The Road to Mount Rushmore: The Conservative Commemoration Crusade for Ronald Reagan N.Bjerre-Poulsen Toward a Historiography of Reagan and the 1980s: Why Have We Done Such a Lousy Job? G.Troy Epilogue: Ronald Reagan and the Historians M.J.Heale

Racial and Ethnic Differences in Substance Abuse Service Needs, Utilization, and Outcomes in California

Racial and Ethnic Differences in Substance Abuse Service Needs, Utilization, and Outcomes in California

Medical student views of substance abuse treatment, policy and training

Medical student views of substance abuse treatment, policy and training

Housing Homeless Alcohol Abusers Brings Substantial Cost Savings

Back to table of contents Previous article Next article Professional NewsFull AccessHousing Homeless Alcohol Abusers Brings Substantial Cost SavingsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:15 May 2009https://doi.org/10.1176/pn.44.10.0009aPlacing homeless people with severe alcohol-use problems into free housing without requiring abstinence or treatment reduced costs, medical use, and contacts with the criminal justice system, according to University of Washington researchers.Such Housing First programs “can reduce the public burden associated with overuse of crisis services and reduce alcohol consumption,” wrote Mary Latimer, Ph.D., and colleagues in the April 1 Journal of the American Medical Association. Other research has shown Housing First programs to be successful in getting homeless mentally ill people off the streets while reducing some costs.Chronic public inebriates—sometimes referred to as “frequent flyers” by police and emergency medical system crews—disproportionately use publicly funded health- and justice-system resources. Conventional interventions, like shelters, treatment programs, and abstinence-based housing, have poor records in breaking those patterns.The Seattle researchers developed a list of 388 individuals who incurred the highest costs in 2004 for use of alcohol-related hospital emergency services, the local sobering center, and the King County jail. A total of 134 participants were eventually recruited for the study from November 2005 to March 2007. There were 119 people in the interventional housed group and 39 in a wait-list control group. Their average age was 48, and they had first become homeless at an average age of 31. Nearly all (94 percent) were male, and 30 percent had attended college at some time. Many had serious medical problems such as hepatitis (40 percent) and tuberculosis (18 percent). They each had been treated an average of 16 times for alcohol abuse.The trial was not randomized for ethical reasons. Also, because participants were approached in rank order of services used and consequent costs in the year prior to the study, the treatment group had incurred larger expenses than did the control group.The treatment group was housed at a Housing First facility where participants were offered meals and on-site health services. They had no treatment requirements, but case managers did engage residents about substance-use issues. Costs for housing and services averaged $1,120 a month.The researchers collected administrative data at six months and one year from area medical, social services, and correctional departments, as well as Medicaid. The individuals who received housing had incurred more than $8 million in costs in the year preceding the trial, but only about $4 million in the first year of intervention. Monthly charges dropped for both housed and wait-list cohorts, but the average had dropped for the housed group at six months and still further at 12 months (see table). Treatment differences were produced mainly by fewer nights in shelters and reduced use of the sobering center.All measures of service use (except days in detoxification) dropped more with longer time in housing. Cost reductions occurred in charges to Medicaid, Harborview Medical Center, and emergency medical systems.At one year, average daily alcohol use dropped from an average of 15.7 drinks a day to 10.6 a day.The study demonstrates the value of stable housing, which is seen as a greater need than alcohol treatment by homeless persons with alcohol problems, said the authors. The lower burden on shelters, hospitals, and jails could mean greater access to care for other people who need it and more attention by police and emergency services to more significant matters of public safety, they suggested.The study was funded by grants from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation, National Institute on Alcohol Abuse and Alcoholism, and National Institutes of Health and received support from Seattle's Downtown Emergency Service Center, which runs the housing program site.An abstract of “Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems” is posted at<http://jama.ama-assn.org/cgi/content/abstract/301/13/1349>.▪ ISSUES NewArchived

Addressing substance abuse among nursing students: development of a prototype alternative-to-dismissal policy.

Substance abuse and dependency are health issues that require effective policies within nursing education. In 2007, the University of Memphis School of Nursing drafted a new substance abuse policy using the American Association of Colleges of Nursing's Policy and Guidelines for Prevention and Management of Substance Abuse in the Nursing Education Community. These guidelines include the assumption that addiction is an illness that can be treated and the philosophy that schools of nursing are committed to assisting students with recovery. The new policy at University of Memphis School of Nursing incorporated prevention, education, identification, evaluation, treatment referral, and reentry guidelines, as well as disciplinary action for students unwilling to undergo rehabilitation. It is hoped this new substance abuse policy will serve as a prototype for other institutions.

Treating Nurses and Student Nurses with Chemical Dependency: Revising Policy in the United States for the 21st Century

For more than a century, the US nursing profession has been aware of substance abuse problems among its practitioners and student nurses but has generally dealt with the issue by taking disciplinary action rather than pursuing nonpunitive options. The latter course would allow more healthcare providers, following successful rehabilitation, to remain in the profession. Since the early 1980s, the American Nurses Association (ANA), National Council of State Boards of Nursing (NCSBN), American Association of Colleges of Nursing (AACN), and the International Nurses Society on Addictions (IntNSA) have actively promoted nonpunitive substance abuse policies, and many states have adopted alternative-to-discipline programs that have achieved good outcomes. At the same time, very little is known about the success rates of alternative-to-dismissal programs in nursing schools. After reviewing policies for both practicing nurses and those still in training, the authors recommend that all states adopt nonpunitive policies and that nursing schools develop alternative approaches for students that parallel and expand upon the procedures applied to practicing nurses who have a chemical dependency.

(Re)Constructing women's resistance to woman abuse: Resources, strategy choice and implications of and for public policy in Canada

While there has been considerable attention paid to Canada's anti-woman abuse policy framework, much of this attention has neglected its implications for women's resistance to abuse. This paper attempts to address this gap by using the lens of women's resistance to analyse the anti-woman abuse policy in Canada. I begin by exploring the ways in which the policy framework constructs the `problem' and considering its implications for women's choice in resistance strategy. Using the Canadian General Social Survey on Victimization (1999), I apply independent samples tests to explore women's (non)usage of various strategies, as it varies by class, race, and ability. I conclude with suggestions for policy reform.

Marijuana Use in Potential Liver Transplant Candidates

Concern exists that liver transplant center substance abuse policies may have an inappropriate and disproportionate impact on marijuana users. Our hypothesis is that patients with chronic liver disease who were marijuana users will have inferior survival. This is a retrospective (1999-2007) cohort study. The primary outcome measure is time-dependent, adjusted patient survival from the time of liver transplant evaluation. The primary exposure variable is a positive cannabinoid toxicology screen during the liver transplant evaluation period. Overall, 155 patients qualified as marijuana users while 1334 patients were marijuana non-users. Marijuana users were significantly (p < 0.05) younger (48.3 vs. 52.1), more likely to be male (78.1% vs. 63.0%), have hepatitis C (63.9% vs. 40.6%) and were less likely to receive a transplant (21.8% vs. 14.8%). Marijuana users were more likely to use tobacco, narcotics, benzodiazepines, amphetamines, cocaine or barbiturates (p < 0.05). Unadjusted survival rates were similar between cohorts. Upon multivariate analysis, MELD score, hepatitis C and transplantation were significantly associated with survival, while marijuana use was not (HR 1.09, 95% CI 0.78-1.54). We conclude that patients who did and did not use marijuana had similar survival rates. Current substance abuse policies do not seen to systematically expose marijuana users to additional risk of mortality.

Child Abuse and Neglect: Counseling and Healing Practices with People of African Ancestry

Communities worldwide condemn child abuse and agree that any form of harm should be mitigated by culturally sensitive methods. In African settings such methods are underrepresented in the literature. This article sought to identify and highlight the healing practices that counselors should consider when dealing with abused children of African descent. It further, proposes prevention that should be prioritized since most African communities are living in precarious circumstances which could expose children to further abuse. The article recommends that counselors in African settings need to adopt holistic approaches such as involving parents, community and other relevant institution when dealing with survivors of abuse, rather than to work in isolation. In addition, the legislation that protects children and the traditional support system needs to be strengthened and aligned to international conventions as inconsistencies could undermine their effectiveness and hamper the implementation of anti-child abuse policies.

The Link Between Homeless Women's Mental Health and Service System Use

The Link Between Homeless Women's Mental Health and Service System Use