Addressing Substance Misuse Research Articles

Working With Couples and Substance Abuse: Recommendations for Clinical Practice

Misuse of alcohol and drugs is widespread in modern society with the associated emotional and physical tolls on individuals, couples, and families. Yet, many therapists do not assess nor address substance misuse when clients do not identify it as a presenting problem. This article presents an overview of the literature on key aspects of couples and substance use and makes important clinical recommendations for mental health professionals who work with couples that struggle with substance use.

Reinventing the Reel: An Innovative Approach to Resident Skill-Building in Motivational Interviewing for Brief Intervention

ABSTRACT To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round “Virginia Reel” approach, supplementing 3 hours of basic MI instruction, was designed to teach and coach residents to use MI while providing ongoing medical care. SBIRT/MI-competent facilitators served as both trainers and actors at 8 carefully sequenced Objective Structured Clinical Examination (OSCE) stations, providing instruction, role-play practice, and feedback on 17 microskills in 2 successive clinical “visits”/rounds addressing alcohol misuse and diabetes management. Evaluation included OSCE checklists, overall competency assessments, and responses to open-ended questions. Three residents showed improvement between rounds. Resident evaluations were strongly positive, identifying practice of MI skills and receipt of coaching and feedback from MI experts as particularly valuable. Further study is needed to confirm effectiveness of the approach and explore the impact of fewer OSCE stations of longer duration.

The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare

Parental substance misuse places families at risk for involvement in Child Welfare Services (CWS) (Barth, Gibbons, & Guo, 2006). Furthermore, maltreated children of parents who misuse substances are more likely to misuse substances in adulthood than are maltreated children of parents who do not misuse substances (Schuck & Widom, 2001). More than 10% of all children in the United States live with a parent who misuses or is addicted to alcohol or drugs (Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2008). These children are disproportionately at risk for both poor developmental outcomes (Osborne & Berger, 2009) and being abused or neglected (Walsh, MacMillan, & Jamieson, 2003). They are also at risk for becoming involved with Child Protective Services and, potentially, for being removed from home and placed in substitute care if their home environment is deemed a threat to their safety. The child welfare system may be the locus of a vicious circle of intergenerational substance use. Maltreated children of parents who misuse substances will themselves be comparatively likely to misuse substances in adulthood (Schuck & Widom, 2001). Although CWS are intended, in part, to diminish maltreatment's negative impact on adolescents' substance use, there is evidence that receiving CWS affects adolescents' substance use adversely. Furthemore, experience in foster care or other out-of-home placement has been associated with substance misuse in adulthood (Zlomick, Tam, & Robertson, 2004). There is a dearth of literature on the extent and correlates of substance misuse among CWS-involved families, and the literature on prevention and treatment services is even more limited. Contributing to this gap in the literature is the fact that many child welfare journals fail to identify the role of substance abuse in child maltreatment. Furthermore, maltreated children continue to be a hidden population within the substance abuse literature. Scientists and practitioners interested in this area must sift through these two huge bodies of literature to find relevant studies. It is in this veritable Tower of Babel that social work can keep this crucial determinant of child safety, permanency, and well-being from becoming confounded. There is arguably no profession in the United States more closely identified with the field of child welfare than social work. Child welfare has even been referred to as a specialized field within social work, implying the professional preeminence, if not the exclusivity, of social work in delivering CWS (Lieberman, 1988). In addition, social workers play a huge role in substance abuse treatment and service delivery (Burke & Clapp, 1997). Therefore, social work may be one of the few professions to afford a comprehensive understanding of the interdisciplinary determinants, treatments, and prevention needs of families affected by substance misuse within the child welfare system. Social work has been criticized for many years as a profession that cherry picks theory and practice from allied fields, including psychology and sociology. Taking leadership in this area will allow the field of social work to demonstrate professional preeminence in an interdisciplinary area commonly overlooked by its critics. The following is an overview of the current state of the field of substance misuse and child welfare, followed by recommendations for epidemiological and social work services research inquiry. PREVALENCE OF SUBSTANCE MISUSE AND CHILD WELFARE INVOLVEMENT Although studies suggest that a sizable majority of families involved in CWS are affected by substance use, estimates of prevalence among parents and children vary widely. In its report to Congress in 1999, the U.S. Department of Health and Human Services (HHS) stated that between one-third and two-thirds of children in CWS were affected by substance misuse. To date, this is the only federally documented statistic related to substance use and CWS. …

Undergraduate medical education in substance use in Ireland: a review of the literature and discussion paper

Medical complications of substance use are a considerable cause of morbidity and the role of the physician in the care of such problems has consistently been demonstrated. Appropriate knowledge and skills are necessary to carry out this role. To review the literature on training undergraduate medical students in identifying and managing substance misuse and to discuss the implications of this literature for Irish medical education. A search of the literature was performed using keywords; "substance-related disorders", "undergraduate" and "curriculum". All abstracts were reviewed and the full text of relevant abstracts was studied and references reviewed for further articles. Despite an increase in prevalence of the problem of drug and alcohol use in Ireland and the UK, this has not been reflected in undergraduate medical curricula. In the UK, minimal time is devoted to formal teaching of medical undergraduates in the area of substance misuse and many doctors do not have the appropriate knowledge, skills, attitudes and confidence to treat patients with such problems. In Ireland, no data has reported formal undergraduate teaching hours in the area of drug and alcohol misuse. Internationally, substance abuse curricula have been developed and implemented in medical schools in the United States and Australia. While substance misuse is increasing in prevalence, this is not reflected in the composition of medical curricula, especially in Ireland. International best practice whereby undergraduate curricula that adequately address substance misuse and related issues are systematically developed and implemented, is recommended for adoption by Irish medical schools.

Violent, nonviolent, and substance-related offending over the life course in a cohort of males and females treated for substance misuse as youths

Most studies on adolescent offending heterogeneity are based on general population samples, and few include individuals with substance misuse or look specifically at substance-related offending. It is also unclear how offender subtypes develop after young adulthood or how offending heterogeneity varies between genders. This study aimed to identify subgroups of offending among adolescents with misuse problems and to examine associations with offending in adulthood. The study included 1,992 females and males that consulted a clinic for adolescents with misuse problems between 1968 and 1971. Latent Class Analyses were conducted to identify subgroups based on violent and nonviolent offending before age 20. Participants were then followed until age 50 and reexamined regarding violent, nonviolent, and substance-related crimes. Associations between subgroups before age 20 and subgroups age 21-50 were examined. Before age 20, three subgroups were identified among the females and six among the males. Males were more specialized in their offending and demonstrated higher levels of offending. Results pointed to both stability and decrease of violent and nonviolent offending, and to the emergence of substance-related offending in adulthood in both genders. The connection between substance-related crimes and general delinquency in adulthood among individuals treated for substance misuse suggests that interventions should also address substance misuse for reducing the overall volume of crime. This study also highlights the importance of including females in research on offending heterogeneity.

An evaluation of group work as an intervention to reduce the impact of substance misuse for offender patients in a high security hospital

Despite established epidemiological links between substance misuse, mental illness, and violent behaviour, the impact of interventions for offender patients is not well understood. The high security hospital is a unique environment which restricts access to substances while attempting to address substance misuse behaviours. In this study, 22 high secure patients with a history of substance misuse participated in a CBT group-work programme. They were assessed pre and post with the Stages of Change Readiness and Treatment Eagerness Scale, and the Psychological Inventory of Drug-Based Thinking Styles. A small number also engaged in a qualitative review of the impact of participation. Treatment had a positive significant effect on patients' perceptions and awareness of substance misuse behaviours and associated problems. Some patients reported particular benefits from engaging in psycho-drama relapse prevention skills training. One of the patients who refused the group subsequently tested positive for a urine drug screen test. Overall, results indicate some positive aspects of a substance misuse intervention with male high secure patients. However, acknowledged limitations highlight the need for further research to support these findings, to monitor the behaviours in high security of former substance misusers, and for maintenance/ongoing work for those transferred to conditions of lower security.

Parents of children at risk—a multi‐agency initiative to address substance misuse amongst parents whose children are at risk of neglect

Child Abuse ReviewVolume 17, Issue 6 p. 454-462 Short Report Parents of children at risk—a multi-agency initiative to address substance misuse amongst parents whose children are at risk of neglect Jo-Anne Welsh, Corresponding Author Jo-Anne Welsh jo-anne.welsh@brightonoasisproject.co.uk Brighton Oasis Project, Brighton, UKBrighton Oasis Project, 11 Richmond Place, Brighton BN2 9NA, UK.Search for more papers by this authorGretchen Precey, Gretchen Precey Independent Social Worker, Brighton, UKSearch for more papers by this authorPauline Lambert, Pauline Lambert Primary Care Trust, Southdowns PCT NHS Trust, Brighton, UKSearch for more papers by this author Jo-Anne Welsh, Corresponding Author Jo-Anne Welsh jo-anne.welsh@brightonoasisproject.co.uk Brighton Oasis Project, Brighton, UKBrighton Oasis Project, 11 Richmond Place, Brighton BN2 9NA, UK.Search for more papers by this authorGretchen Precey, Gretchen Precey Independent Social Worker, Brighton, UKSearch for more papers by this authorPauline Lambert, Pauline Lambert Primary Care Trust, Southdowns PCT NHS Trust, Brighton, UKSearch for more papers by this author First published: 24 November 2008 https://doi.org/10.1002/car.1050Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume17, Issue6Special Issue: Parental and Young People's Substance MisuseNovember/December 2008Pages 454-462 RelatedInformation

Addressing substance misuse in a medium secure unit

Individuals diagnosed with severe mental illness have higher rates of alcohol and substance misuse than the general population. This can present the client and the care team with a variety of issues around physical and psychological well‐being, as well as social and occupational functioning. In forensic psychiatry, the effect of comorbid substance misuse on offending behaviour is particularly pertinent. There have, however, been few studies examining the treatment of alcohol and substance misuse within this particular patient group.At a regional secure unit in North Wales, a group for inpatients was set up to provide education on alcohol and substance misuse over a course of six informal meetings, and to then evaluate participants' attitudes towards substance misuse. Of the six participants, five reported that their knowledge of substances had increased, and that they had no intention to use drugs again after discharge. Staff and client participants also suggested useful future topics for the group.

‘Researching ourselves back to life’: new ways of conducting Aboriginal alcohol research

This paper highlights the importance--and provides an example--of Aboriginal control over research. It describes how Aboriginal people from Tangentyere Council conducted a survey of the attitudes of people who reside in Town Camps to a trial of liquor licensing restrictions in Alice Springs; how the results of the survey were used; and how the project led to the establishment of a permanent 'Research Hub' within Tangentyere Council. The paper provides a model of conducting research for other Aboriginal community-controlled organisations and can inform non-Aboriginal researchers about ways of working with Aboriginal community organisations to address substance misuse and other health problems.

Prisoners’ views of injecting drug use and harm reduction in Irish prisons

Drug misuse and hepatitis C are known to be endemic in Irish prisons. Using a grounded theory approach, this qualitative study sought to examine prisoners’ views of drug injecting practices and harm reduction interventions in Dublin prisons. Thirty-one male prisoners were interviewed (16 injecting drug users and 15 non-injectors). Two themes relevant to drug use practices emerged. Respondents described increased health risks related to injecting drug use during detention and associated with a prison environment. These included: the low availability of heroin which encouraged a shift from smoking to injecting; the scarcity of injecting equipment which fostered sharing networks far wider than outside prison; inadequate injecting equipment cleaning practices; and the rent of needles and syringes in exchange for the drugs. Both non-injectors and injectors interviewed supported harm reduction interventions in prison and felt that the range of drug services available in prison should mirror those currently available in the community, although half opposed or had reservations about syringe exchange in prison. Prisoners’ viewed their time in prison as an opportunity to address substance misuse related problems; health professionals should not miss this opportunity.

Social ecology of substance use by tertiary students: Preliminary findings

AbstractThis study investigated the social ecology of substance use among 162 tertiary students studying at Northern Territory University in April 2000. The sample was predominantly female (69.6%), Australian born (70%), non-Indigenous (77.2%), not active in the labour market (58.8%) and intending to complete an undergraduate degree (62.7%). Substance use was prevalent, and 77.6% of students were current drinkers, 59.4% currently smoked tobacco and 28.5% used other drugs. Polydrug use was evident, with 24.8% of students using more than one substance on the same occasion in the previous month. Substance use tended to be associated with relaxing, socialising and wanting to feel good. Most students were not concerned about their alcohol use and their perceptions of normal drinking behaviour highlight the challenges in addressing substance misuse patterns in this population.

What are personality disorders and are they treatable?

The recent report of the Fallon inquiry has reopened the debate on how best to treat people with personality disorders. Currently treatment varies depending on the patient's location. There is some consensus about what constitutes effective treatment, including behavioural therapy, cognitive behavioural therapy, psychopharmacology, a programme addressing substance misuse, interpersonal training and team nursing,.

What are personality disorders and are they treatable?

The recently published report of the Fallon inquiry (Fallon et al, 1999) has reopened the debate on how best to treat people with personality disorders. Currently, the treatment varies depending on whether patients are in an NHS setting or inpatient psychotherapeutic unit, a special hospital or the penal system. Personality disorder is prevalent in approximately 10% of the population and some evidence suggests a 50% prevalence rate for all psychiatric patients. It is a heterogeneous disorder that is often misunderstood by professionals. There is some consensus within the literature about what constitutes effective treatment. Treatment includes behavioural therapy, cognitive behavioural therapy, psychopharmacological treatment, the development of a therapeutic programme including offence-focused work, addressing substance misuse, interpersonal training and a triumvirate/collegiate method of team nursing, where nurses share the responsibility for patients.

Development of community based Alcohol and Other Drug (AOD) workers in remote Indigenous communities in the Northern Territory

AbstractThe aim of this paper is to document community development initiatives undertaken to address substance misuse issues in remote Indigenous communities in the Northern Territory (NT). This paper is describing work in progress that primarily focuses on the early stage of an evolving community development process to provide alcohol and drug services, particularly in the “treatment” domain, in remote NT communities. Treatment in this context refers to counselling and various support and caring activities, which can take place in a variety of settings, such as a residential facility, a health clinic, a women's or community drop-in centre. The context is community development as the paper explores options to address a community defined need to have effective alcohol and other drug programs available to people living in remote communities.

Substance misuse education in social work practice

A study of substance misuse education in social work is described. Social work courses do not always address substance misuse education, even though there have been many attempts to highlight the importance of social workers being equipped to deal with issues relating to alcohol or other drug use. This paper describes the importance of the inclusion of substance misuse in social workers' education and describes the development of a substance misuse module on the MSc, Diploma in Social Work programme at the University of Wales Swansea. The module is evaluated in three stages: (1) from the conclusion of the module; (2) at the end of the second social work practice placement; and (3) 9 months after the commencement of practice. The conclusions emphasize the students' use of the contents of the course, and their positive attitudes towards intervention. Suggestions for future research are included.

Substance misuse in individuals with spinal cord injury.

The literature addressing substance misuse in spinal cord injury (SCI) is reviewed with special attention paid to differences in substance misuse in the spinal cord injury and general populations. Studies examining epidemiology indicate that while substance misuse often is present when spinal cord injuries occur, the exact prevalence of it in the SCI population has yet to be determined. The literature also suggests that risk factors unique to SCI predispose substance misuse in this population in addition to risk factors commonly present in the general population. Articles examining issues relevant to substance misuse in SCI identify some concerns specific to this population. Although treatment outcome literature for substance misuse in SCI is scarce, it is clear that treatment facilities must be adapted to suit the needs of the spinal cord injured. However, it has yet to be determined how treatment content should differ.