Abuse Policy Research Articles

The state of interventions to address substance-related disorders in South African workplaces: implications for research, policy, and practice

Substance abuse in South Africa is highly prevalent and continues to be a major cause of mortality and a risk factor for both communicable and non-communicable diseases. The employer costs associated with substance abuse remain high owing to rising health costs, accidents, absenteeism, and workers’ compensation claims placing the organisation and its employees at risk for harm. This article describes the status of current policy, prevention, and treatment interventions to address substance abuse in the South African workplace. Key issues highlighted are the need for research into the extent and impact of substance abuse in the South African workforce, the promotion of substance abuse policies that are comprehensive in nature, and the need to upscale prevention and treatment initiatives through a move away from a traditional labour approach to addressing substance-related disorders in the workplace to the adoption of a more public health approach. Cost-effectiveness of substance abuse interventions is explored alongside the importance of ensuring that employers, practitioners, and other role players engage with the evidence of what works using international standards as the basis.

Substance Abuse Policies in Long-Term Care Facilities: A Survey with Implications for Education of Long-Term Care Providers

The aging of the Baby Boom presents long-term care with many new challenges. Among these are the historically high levels of drug use by this cohort. This study surveyed administrators of licensed skilled nursing facilities in the Commonwealth of Kentucky regarding their perception of current drug use by residents, facility policies and procedures currently in place regarding illicit drug use, and their attitudes toward use of illicit drugs by residents. The results of interviews with 40 administrators or their designees revealed that they have experienced little problem with use or abuse of illegal drugs by residents. Fewer than one-third of the facilities had formal policies in place regarding illegal drug use. Only 10% had any experience with requests for medical marijuana, but almost one in five had a policy on the matter and nearly one-third stated they would support medical marijuana use by some of their residents if the matter arose. These authors recommend the following: (a) that the issue of illicit drug use needs to be addressed now before the situation becomes critical, (b) that administrators and staff need to be educated about recreational drug use and appropriate responses to drug abuse, (c) that screening instruments for drug abuse in this population should be developed and implemented, and (d) that policies regarding medical marijuana need to be adopted by all such facilities.

Drug Use Patterns and Socio-Demographic Profiles of Substance Users: Findings from a Substance Abuse Treatment Programme in Gaborone, Botswana

Substance abuse is a critical problem in Botswana, yet empirical evidence on substance users is limited. The current study sought to examine patterns of drug use and sociodemographic profiles of clients who sought treatment at a substance abuse treatment centre in Gaborone, Botswana. Findings showed clients’ age ranged from 13-64 years with a mean age of 28.55 years and SD ±12.59 years. More than half of the clients reported use of legal drugs (76.9%, n=307) and alcohol was the most frequently reported drug (n= 236, 59.1%). In contrast, slightly more than half of the clients reported use of illegal drugs (53.1 %, n=212) with marijuana being the most prevalent reported illicit drug (74%, n=104). Chi-square analysis also showed differences in use of illegal drugs as a function of clients’ gender (χ2 (1) =13.51, p ˂001) and as a function of the clients’ age (χ2 (4) = 64.04, p˂ .000). The findings of the current study have implications for the formulation of efficient substance abuse policy and interventions and as such recommendations are provided. Key Words : Substance abuse treatment, drug use, illicit drugs, Botswana, sociodemographic variables

Intersections and Multiple ‘Candidacies’: Exploring Connections between Two Theoretical Perspectives on Domestic Abuse and Their Implications for Practicing Policy

Domestic abuse policy increasingly uses language which indicates that abuse is patterned according to structural factors. However, practicing according to these structural accounts of abuse is problematic because of the policy and organisational contexts that practitioners work within and, we argue, because the implications of the structured nature of victims’ experiences is not fully understood by all practitioners.We ask whether women's differential use and experiences of services with a remit to address abuse can be illuminated using two theoretical perspectives – ‘candidacy’ and intersectionality. We report the findings of a literature synthesis that investigates how these improve our understanding of women's help-seeking and service utilisation and of the responses that they receive. Both concepts were highly congruent with the literature and we conclude that, together, candidacy and intersectionality offer a means of enhancing knowledge of how the political becomes enacted in the personal. Embedding such knowledge within practice repertoires offers the potential to develop more nuanced structural understandings of women's experiences and constraints.

Images of alcohol among Italian adolescents. Understanding their point of view

Aims: This study aims to plug the gap about how young people understand their direct and indirect experience with alcohol by investigating the prevalent images of alcohol among 15-year-olds. The study also aims to clarify the position of young Italians towards traditional Italian drinking culture.Methods: Twenty-two focus groups were organized in two Italian towns, Torino and Cosenza. The focus groups (FGs) used the Reception Analytical Group Interview (RAGI) method, wherein respondents are invited to discuss after seeing video clips used as a stimulus. The material thus collected was analysed through an approach that takes both the participants’ interpretative processes and their socio-cultural environment into consideration.Findings: Using ‘drinking situations’ as an analytical tool, it was found that young people's images about drinking are still in line with tradition, as are the importance assigned to social drinking and the stigma attached to intoxication. Young people also appear to be aware of the negative consequences of drinking, even if the risks related to pharmaceutical use seem to be underestimated.Conclusions: Results cast doubt on the supposed convergence of drinking patterns within Europe and provide useful insights for the development of alcohol use and abuse policies and prevention.

Trends and emerging drugs in Kenya: A case study in Mombasa and Nairobi County

Background: Increasing popularity of emerging drugs or the ‘legal high’ is of major concern to the Government. Emerging psychoactive substances e.g. morphine, carnabinoids, cathinones are not controlled and are believed to cause harm if not more than controlled drugs. They are being sold all over as legal substances and consumed openly.Objective: To evaluate the trends and patterns of emerging drugs use, magnitude and their impact in the Counties.Methods: A questionnaire was administered to 702 respondents in Nairobi and Mombasa Counties. The social dynamics, types of emerging drugs, drug initiation age, source of drugs, venue of consumption, and their effects on respondents among other issues were investigated. Qualitative, univariate and multivariate logistic regression analyses were done.Results: The drug initiation age ranged from 5 to 28 years though most started abusing the drugs at 21years (18%), with over 81% being introduced by friends. They are abused for their stimulating, hallucinating, depressants effects on the streets, club, drug dens, party but rarely at home and schools. Forty one (41) emerging drugs (see text) comprising of one or combinations of drugs were recorded, with Nairobi recording significant higher number of emerging drugs than Mombasa. Most of the highly abused drugs were ‘kuber, shisha, shashaman, mau, tambuu, jet fuel, kukumanga, mkorogo, mshomoro, rohypnol, Artaine and kamusi. ‘Shisha’ and ‘kuber’ were most commonly abused drugs in both counties. Over 25% of the shisha and kuber abusers aged between 26 to 35 years. The emerging drugs were purchased drugs from various outlets, thus making it difficult to track. Some respondents injected either heroin or cocaine while others injected both heroin and cocaine thus, placing the individuals at risk of contracting Human Immunodeficiency Virus (HIV) and Hepatitis C. The emerging drugs have a lot of impact on the county’s security, economy, education, school drop-out rate, non performance at work place and reproductive health.Conclusion and recommendations: The Government should set up of rehabilitation centres, training programmes on alcohol and drug abuse, establish Employee Assistant Programmes, wellness centres, control sale of prescription medicine, stiff penalties on drug peddlers and ban of advertisement on media. There is need for all stakeholders to review the alcohol and Drug Abuse policy to include new and emerging drugs in order to mitigate illnesses deaths and associated with emerging drugs. Government should come up with ways of tracking and controlling the emerging drugs especially shisha, kuber, and prescription medicine. Alcohol and Drug Abuse (ADA) issues should be incorporated in the education curriculum at all levels.Key words: Emerging drugs, shisha, kuber, causes, mitigations, combinations, administration

Constructions of ‘vulnerability’ in comparative perspective: Scottish protection policies and the trouble with ‘adults at risk’

This paper places Scottish adult support and protection (ASP) policy in the context of debates about the nature of ‘vulnerability’ and its usefulness as a defining concept in law and social policy. It examines the construction of ‘adults at risk’ in ASP policy, using a comparison with the construction of children in Scottish child protection policy, on the one hand, and women in Scottish domestic abuse policy, on the other, to illuminate the nature of the vulnerability that ASP considers itself to be addressing. It then problematises this construction, drawing both on the social model of disability and on an ethic of care. It concludes that current ASP policy remains underpinned by unhelpful assumptions about disabled people, older people and people with mental or physical health problems. A more inclusive understanding of vulnerability would be more empowering to these people and others, in policies concerned with mistreatment and abuse.

Remixing the Remix: Fannish Appropriation and the Limits of Unauthorised Use

Remixing the Remix: Fannish Appropriation and the Limits of Unauthorised Use

Working at the frontline in cases of elder abuse: ‘It keeps me awake at night’

To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse. In-depth interviews with 16 Tasmanian community-based health and welfare practitioners regarding their experiences of working in 49 recent cases of elder abuse. Interview transcripts were analysed using thematic analysis. All participants found working in cases of elder abuse challenging and the work itself was perceived as difficult, complex and at times dangerous. The cumulative effect of intimidating work contexts, practice dilemmas and a lack of support resulted in frustration and stress for many practitioners. Nevertheless, participants were committed to providing ongoing services and support for older people experiencing abuse. Frontline practitioners working in cases of elder abuse face significant challenges and could be better supported through strengthening organisational elder abuse policies, increased management support and more age-inclusive family violence support services.

Publicness in Policy Environments: A Multilevel Analysis of Substance Abuse Treatment Services

Building on the publicness, organizational theory, and policy diffusion literatures, we describe and evaluate the relationships between organizational and two distinct types of environmental publicness and organizational practices. Through hierarchical linear modeling, we integrate organizational-level data on substance abuse treatment centers participating in the National Survey of Substance Abuse Treatment Services in the year 2009, with data on the larger substance abuse policy environment at the state level to predict whether organizations offer public service practices. Our findings indicate that publicness at the organizational and state policy levels are both important determinants of the offering of public service practices. Generally, we find that privately owned organizations are more likely to offer these services when they operate in policy environments with greater publicness. However, we also find that private organizations are less likely to offer public services that result in clear economic loss if they operate in policy environments with a greater number of public organizations.

Reinhold Niebuhr's Quest for Balance in the Public Oversight of Market Economies

Three basic themes played indispensable roles in Reinhold Niebuhr’s engagements with economic issues: (1) the foundational importance of a theological anthropology for his critical assessment of complex social, economic, and political issues; (2) his focus on two clashing theories of economic order: Adam’s Smith’s doctrine of laissez-faire capitalism and Karl Marx’s revolutionary vision for the collective ownership of property within a centralized state system; and (3) his endorsement of a realistic yet viable alternative to these two classic theories, one that involved pragmatic and incremental steps toward fostering economic justice through the public regulation and oversight of a free-market economy. These pragmatic measures included allocating government resources for vitally important public goods and services at federal, state, and local levels. Though Niebuhr was initially drawn to some form of democratic socialism, he embraced this incremental strategy within the context of President Franklin Delano Roosevelt’s implementation of his New Deal agenda. My analysis of Niebuhr’s contributions concludes with attention to new challenges confronting contemporary quests for economic justice in a post–New Deal era, one marked Soundings, Vol. 95, No. 4, 2012 Copyright © 2012 The Pennsylvania state University, University Park, Pa di sc us sio n diussion

Facilitators and barriers to screening for child abuse in the emergency department

BackgroundTo identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.MethodsThis qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.ResultsLack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.ConclusionsED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.

Increasing use of nonmedical analgesics among younger cohorts in the United States: a birth cohort effect.

Nonmedical use of prescription pain drugs (hereafter "analgesics") has increased substantially in recent years. It is not known whether today's youth are disproportionately driving this increase or, instead, the trend is a general one that has affected cohorts of all ages similarly. To address this question we present the first age-period-cohort analysis of nonmedical use of analgesics. Data come from the National Survey on Drug Use and Health, a series of annual, nationally representative, cross-sectional surveys of the US civilian, noninstitutionalized population. The analysis focuses on the years 1985-2009 and uses the recently developed "intrinsic estimator" algorithm to disentangle age-period-cohort effects. Substantial increases in the prevalence of nonmedical analgesics use (NAU) have occurred across all cohorts and ages in recent years, but this increase is significantly amplified among today's adolescents. The odds of past-year NAU for today's youngest cohort (born 1980-1994) are higher than would be expected on the basis of their age and broad, historical period influences that have increased use across people of all ages and cohorts. The independent influence of cohort on past-year NAU is about 40% higher for today's youth cohort than any of the cohorts that came before them. This finding is present among men, women, non-Hispanic whites, non-Hispanic blacks, and Hispanics. Although nonmedical use of analgesics is evident among all ages, cohorts, and periods, today's younger cohorts warrant special attention for substance abuse policies and interventions targeted at reversing the increase in NAU.

Without a Family: Public Order, Social Welfare and Street Children in the Wartime Soviet Union

Homeless and delinquent children presented a serious problem for public order in the Soviet Union during the Second World War. Even though on paper the government was committed to re‐socialisation of street children, in practice it was a low priority for the state, busy fighting a war. The state's interventionist policies were more about exercising control over the population than protecting the children from the hardships of war. Inattentive to the consequences of its actions, the system not only undermined its own child welfare programme by producing additional orphans and displaced children, but also continued to spawn street urchins and delinquents through poor administration of criminal justice, the criminalisation of labour violations and the ineffective management of local resources. As a result, not only did the Stalinist state fail to live up to the image of an “extended family”, it had taken upon itself, but it also enacted some of the most abusive policies in the history of Soviet child welfare, sending out public volunteers to clean up the mess afterwards.

Elder Mistreatment and the Elder Justice Act

Elder mistreatment is unrecognized, hidden, and underreported. Studies show that health professionals, nurses among them, are largely unaware of the various forms of elder mistreatment that take place and of the proper course of action to pursue when mistreatment is suspected. In this article, we describe elder mistreatment policies, examining them in the light of the United States national elder abuse policies with a focus on important provisions of the Elder Justice Act. Next, we review the various types of abuse, the identification of abuse, and the nurses role in addressing elder mistreatment. We present an example of a case of physical abuse and conclude by discussing nurses' advocacy role and issuing a call to action, challenging nurses to ‘"act now" to protect the well being of elders.

Substance abuse in anaesthetists

Anaesthesiologists have a significantly higher frequency of substance abuse by a factor of nearly 3 when compared with other physicians. This is still a current problem that must be reviewed. Many hypotheses have been formulated to explain why anaesthesiologists appear to be more susceptible to substance abuse than other medical professionals (genetic differences in sensitivity to opioids, stress, the association between chemical dependence and other psychopathology or the second-hand exposure hypothesis). Environmental exposure and sensitization may be an important risk factor in physician addiction. There is a long debate about returning to work for an anaesthetist who has been depending on opioid drugs, and recent debates are discussed. Institutional efforts have been made in many countries and physician health programmes have been developed. As drug abuse among anaesthesiologists has continued, new studies have been conducted to know the theories about susceptibility. Written substance abuse policies and controls must be taken in place and in all countries.

Domestic abuse prevention after Raoul Moat

This article charts the development of domestic abuse policy between May 2010 and June 2011, a period in which: the UK witnessed a high profile domestic abuse case – that of Raoul Moat – pass almost without recognition as such; whilst the dismantling of much of the infrastructure used to prevent domestic abuse outside the criminal justice system commenced, in anticipation of cost-cutting reform designated necessary to the advent of the ‘Big Society’. The article uses both the research literature on domestic abuse and the case of Raoul Moat to argue that preventative work in this field needs to keep issues of gender – especially masculinity – in the political frame. This focus on masculinity should not, however, be reduced merely to attitudes accepting of violence or macho values, but should, the article argues, also keep the relationships between violence, emotional dependency, heterosexual propriety, and life crises in view. The article queries whether the Coalition government’s focus on ‘payback’, ‘discipline’ in schools and the ‘sexualization of children’ is likely to help more than hinder in this regard, and points to the real risks entailed in economic restructuring that increases the proportion of women and children vulnerable to repeat victimization.

States Pursue Elusive Savings by Limiting Buprenorphine

Back to table of contents Previous article Next article Professional NewsFull AccessStates Pursue Elusive Savings by Limiting BuprenorphineLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:16 Sep 2011https://doi.org/10.1176/pn.46.18.psychnews_46_18_7_1AbstractMisplaced concerns about cost and safety may be leading many state Medicaid programs to mistakenly restrict the use of buprenorphine for the treatment of opioid addiction, despite the drug's approval by the Food and Drug Administration for that purpose in 2002. Buprenorphine may offer a better option for those seeking treatment for opiate addiction, without the stigma and access issues of methadone injections.Credit: Beneda Miroslav/ShutterstockMost Medicaid programs limit buprenorphine use by requiring prior authorization to fill prescriptions, limiting treatment duration, or imposing other requirements, such as drug screening before prescription can be reauthorized. A group of Massachusetts researchers recently sought to determine whether such restrictions are justified. "The evidence does not support rationing buprenorphine to save money or ensure safety," wrote Robin Clark, Ph.D., a senior director with the Center for Health Policy and Research and an associate professor of family medicine and community health and quantitative health sciences at the University of Massachusetts Medical School, and his colleagues in the August Health Affairs.The researchers came to that conclusion after they compared spending, the use of services related to drug-use relapses, and mortality for 33,923 Massachusetts Medicaid beneficiaries receiving either buprenorphine, methadone, drug-free treatment, or no treatment during the period 2003 to 2007. They found that buprenorphine offered several attractive features as an opioid-dependence treatment. For example, buprenorphine can be prescribed by a physician and taken at home without the stigma and daily demands of acquiring methadone injections, which must by law be administered at an approved clinic. "Enrollment patterns suggest that buprenorphine has expanded treatment access," they said. Despite concerns about safety, mortality rates were similar for buprenorphine and methadone. In contrast, mortality rates were 75 percent higher among those receiving drug-free treatment, and more than twice as high among those receiving no treatment, compared with those receiving buprenorphine. Buprenorphine carries a lower risk of overdose than the stronger opioid methadone and is formulated with naloxone to prevent the practice of crushing and injecting the drug to achieve a greater opioid effect. "Buprenorphine is also more tightly bound to the opioid receptor than other opioids and therefore may protect patients by blocking out other drugs," said Clark and colleagues. But the idea among some health officials that buprenorphine is more costly than methadone turns out to be mistaken: "After adjustments for confounding factors, total health care spending for patients using buprenorphine treatment were slightly lower than for methadone, despite more frequent relapse events for buprenorphine. Longer and more expensive hospital stays among methadone patients accounted for the largest portion of the difference," the researchers pointed out. They expressed their concern that significant reductions in buprenorphine use could have the unintended effect of increasing costs and reducing the overall use of opioid substitution therapy, perhaps even contributing to "higher mortality among Medicaid beneficiaries with opioid addiction." "This analysis shows the importance of considering a broad range of costs and outcomes when attempting to implement targeted cost reductions," they said. "Failing to consider the impact of medications or other expensive treatments on total health care spending and outcomes could have the unintended effect of increasing costs and placing patients at greater risk." Funding for this study was provided by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program.An abstract of "The Evidence Doesn't Justify Steps by State Medicaid Programs to Restrict Opioid Addiction Treatment With Buprenorphine" is posted at <http://content.healthaffairs.org/content/30/8/1425.abstract#xref-corresp-1-1>. ISSUES NewArchived

Presidential Politics and the Problem of Drugs in America

This study explores the relationship between the president, public opinion, and the media in regard to drug abuse policy in America from 1969 through 2004. The theory of presidential influence over public opinion is used to test the hypothesis that presidents influence public opinion of drug abuse. Using vector auto regression time-series analysis, the study finds that while presidents do not appear to influence the public directly, they influence the media which influences public opinion. These findings are different from previous findings regarding crime control policy, but are similar to past findings for drug policy. Reasons for these findings are discussed and future research proposed.

Don’t ask don’t tell: substance abuse and addiction among nurses

The purpose of this manuscript is to illustrate the challenges faced by nurses who abuse substances and to promote international dialogue about what practitioners, administrators, health care providers and students can do when they suspect someone in the profession is abusing substances, or they may themselves be suffering from addiction. Addiction among nurses has been recognised by professionals in the field for over 100 years, and current estimates place rates of substance misuse, abuse and addiction rates as high as 20% among practicing nurses. Unfortunately, fear of punishment and discipline may keep nurses or students from asking for help for themselves or from reporting a colleague or friend who is in need of help. Discursive paper. This paper synthesises the results of three previous papers conducted on substance abuse policies in the nursing profession. In the first paper, the authors reviewed the history of addiction in nursing and compared disciplinary and alternative-to-discipline policies. The second focused on the development of an alternative-to-dismissal policy for substance abuse in a school of nursing and using telephone and email interviews, and the final paper reported findings of what types of policies seem to be working to retain and rehabilitate nurses who suffer from addiction in the USA. Lastly, this paper introduces international policy for nurses with addictions. Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions. Recognition of a colleague's need of treatment is the important first step in the rehabilitation process. Early intervention and assistance are essential for helping colleagues and students to recover from an addictive disorder and providing a confidential, non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care.