Chemical Dependency Treatment Research Articles

Prevalence and Factors Associated With Criminal Behavior Among Illicit Drug Users: A Cross-Sectional Study

ABSTRACTBackground: Studies indicate high rates of criminal behavior, violent activities, and legal problems among illicit drug users (IDU) in Brazil. The aim of this study was to estimate the prevalence and factors associated with criminal behavior among IDU undergoing treatment for chemical dependency in Central Brazil. Methods: Cross-sectional study carried out with IDU undergoing treatment for chemical dependence. Data were collected by means of face-to-face interviews and analyzed using logistic regression. Results: Of the total participants (n = 274), 46.7%, 15.7%, and 10.9% reported involvement in robbery, drug trafficking and homicide, respectively. Robbery was associated with young age, withdrawal symptoms, prison record, sex work, and crack use, while drug trafficking was associated with young age, low education, and marijuana use. Homicides were associated with cocaine and marijuana use. Conclusion: The results show high rates of criminal behavior among drug users, demonstrating associations between socio-demographic and behavioral characteristics, illicit drug use, and practices of illegal activities. These variables must be considered when planning programs and policies to reduce harm related to drug use and abuse.

Special Edition: The effects of the Bonny Method of Guided Imagery and Music (GIM) on interpersonal problems, sense of coherence, and salivary Immunogloblin A of adults in chemical dependency treatment

The purpose of this study was to evaluate the effectiveness of the Bonny Method of Guided Imagery and Music (GIM) on interpersonal problems, coping measures and immune function in 19 adults in chemical dependency treatment for an average of 43 days. Psychological measures included the Inventory of Interpersonal Problems Short Circumplex Form (IIP-SC), the Sense of Coherence Scale (SOC) and physiological measure included salivary immunoglobulin A. Pre-test measures were collected at the initial interview session and post-tests at the final BMGIM session. Experimental subjects received one GIM session a week during their treatment. Results show significant decrease on the domineering, cold, and non-assertive subscales of the IIP-SC and on the manageability subscale of the SOC scale. The physiological measure of sIgA did not show a significant increase. The BMGIM appears to be effective in addressing issues underlying substance abuse, in addition showing a positive impact on physical health.

Underutilization of Pharmacotherapy for Treatment of Alcohol Use Disorders Part II-Results from a Survey of Practices among North Carolina Mental Health Providers and Brief Review of Efficacy of Available Pharmacotherapies

Introduction: Alcohol is the third leading cause of preventable death worldwide. There is substantial risk for development of alcohol use disorder among those with psychiatric disorders, complicating their care. Despite extensive evidence in support from controlled trials and from expert opinion, medication-assisted treatment has had low levels of penetration in practice. Only 3% of sufferers receive FDA-approved treatment. The goal of this survey is to explore potential causes of underutilization of evidence-based pharmacotherapeutical agents in the treatment of alcohol use. Secondary, we analyze differences in practice patterns between different academic institutions, facilities specializing in chemical dependence treatment, and general community practitioners. We are aware of no prior study that has attempted to evaluate these factors. Methods: An online questionnaire was designed in Qualtrics and distributed through the use of an anonymous link. Target participants were members of the Psychiatry departments of four academic institutions in NC, community mental health providers, prescribers from chemical dependence treatment facilities, and Veteran Affairs psychiatrists. A total of 170 participated, an 85% response rate. Data was analyzed using Qualtrics software as well as by a statistician. Results: A significant portion of psychiatric patients have comorbid alcohol use, and despite patient interest, medications are rarely utilized in both academic as well as chemical dependence facilities-20% of respondents never prescribed any. Reasons mainly include lack of provider knowledge of available medications (r=-0.277, n=136, p=0.001), prescribing guidelines (r=-0.265, n=136, p=0.002) and dosing (r=-0.245, n=136, p=0.004). Provider’s attitude towards substance use treatment also affects prescribing (r=-0.21, n=136, p=0.014). Those who do prescribe seem to favor off-label medications and avoid Naltrexone IM formulation. Providers acknowledge that the majority of those with alcohol use disorders have medical conditions caused or affected by the ongoing use. Instituting medications leads to positive experiences: patients maintain sobriety longer, have less legal problems and are better able to engage in their care. Conclusion: In the treatment of alcohol use, guidelines recommend FDA approved medications in conjunction with bio psychosocial interventions. Global assessment indicates prescribers mainly avoid pharmacotherapy due to lack of comfort and knowledge. There may also be financial barriers in a current alcohol treatment system that is traditionally non-medically oriented. Although it is recommended to start with FDA approved medications, off-label use is high. Despite positive implications noted when medications are instituted, providers’ ambivalence continues. As part of our daily practices, general psychiatrists should gain confidence in using evidence-based, FDA approved, medications in treatment of alcohol use disorders.

COMMON MENTAL DISORDER AMONG ALCOHOL AND DRUG ABUSERS: A CROSS-SECTIONAL STUDY

ABSTRACT Objective: to estimate the prevalence of the probability of common mental disorders among abusers of alcohol and other drugs. Method: a cross-sectional study. The sample was made up of 234 individuals undergoing treatment and rehabilitation for chemical dependence in private clinics and in a Psychosocial Care Center in the Southeast area of the state of Goiás, Brazil. Instruments on sociodemographic profile, use of licit and/or illicit drugs, and a questionnaire that tracks common mental suffering were applied. Results: the outcome variable was the probability of common mental disorder, with 37.2% of the total of the sample. Association between the probability of common mental disorders and the female gender (odds ratio=4.06; 95% CI 1.56-10.56), age ≤25 years old (odds ratio=3.00; 95% CCI 1.41-6.38), and use of marijuana in life (odds ratio=2.83; 95% CI 1.38-5.78) were found. Conclusion: the study showed an association between the use and abuse of drugs and risk for common mental disorders.

High rates of relapse in adolescents crack users after inpatient clinic discharge

ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge) from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge), 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge), 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

Combined use of varenicicline and cognitive behavioral treatment for nicotine dependence in patients admitted to a psychiatric clinic in Rio de Janeiro – Brazil

Objective Nicotine dependence is a worldwide health problem and the second cause of death worldwide. This article aims to present the improvement in the technique used by us. The results of the implementation of the treatment program with the use of varenicline as a specific medicine for nicotine dependence during admission to a clinic for chemical dependency treatment. We also demonstrate that this treatment is possible and safe for patients with comorbid psychiatric disorders and drug use disorders. Methods Between August 2012 and August 2013, 98 patients were evaluated in a clinic for psychiatric and drug use treatment in Rio de Janeiro, Brazil. The treatment consisted of a smoking cessation therapy concurrently with the psychiatric treatment. These patients had used pharmacological therapy associated with intensive cognitive behavioral therapy, occupational therapy and moderate physical activity. In addition to the associated therapy, smoking was limited to three cigarettes daily beginning the first day of hospitalization. The drug use disorders and psychiatric illnesses were treated as usual. Results The patients adhered to the treatment. Hundred percent of the treatment group were discharged from the clinic such as tobacco abstainers. The percentage of abstinence in patients after discharge according to previous assessments (2008–2009) with follow-up of 18 months was 51%. Results of the current study are still under evaluation. Conclusions Behavioral group therapy and physical activities can be important allies for varenicline. Behavioral changes also exert great influence in the maintenance of abstinence.

Efeitos agudos do exercício físico no tratamento da dependência química

We evaluated the effects of exercise on alertness and memory, the desire to use drugs, the perception of effort and pleasure and mood state, of 16 individuals in treatment for drug addiction. We used tests and scales to assess mood, attention, memory, perceived effort and affect related to exercise, in the situations: Control, Pre and Post completion of an exercise session (60min). We observed a significant reduction in the desire to use drugs and in the execution time of the test cancellation numbers, and an increase of the number of blocks recalled. The results support the importance of the Professional of Physical Education for treatment of chemical dependency.

Recovery-Focused Addiction Psychiatry: An Interview with Dr. Marvin Seppala

In 2012, Hazelden, the iconic exemplar of the Minnesota model of chemical dependency treatment, announced its decision to begin using naltrexone and buprenorphine as optional adjuncts in the treatment of opioid addiction. This shift in clinical philosophy at Hazelden garnered considerable professional and public attention. At the center of the ensuing debates was Dr. Marvin Seppala, chief medical officer of Hazelden Betty Ford. This interview conducted with Dr. Seppala in December 2014 explores his career as an addiction psychiatrist and discusses numerous issues related to the treatment of addiction, including the 2012 decision on medication-assisted treatment and how medications are being effectively integrated into 12-Step–oriented addiction treatment.

Chronic Disease and Chemical Dependency Treatment in Primary Care Patients With Problem Drug Use

This article examines whether chronic disease is associated with chemical dependency treatment in primary care patients with problem drug use. Chronic disease was common in 781 disadvantaged individuals who had problem drug use and were seen in primary care clinics affiliated with a public safety-net hospital. Individuals had, on average, 5.4 chronic medical conditions, and overall 57% had low severity chronic disease. In the year following enrollment, 14% had chemical dependency treatment. Severity of chronic disease was not associated with chemical dependency treatment (p = .26). In summary, chronic disease neither hindered chemical dependency treatment, nor did it facilitate such treatment.

Risk behaviors for sexually transmitted diseases among crack users.

Objectives: to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users. Method: cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0. Results: of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases. Conclusion: the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.

Mental Illness Drives Hospitalizations for Detained California Youth

PurposeThe purpose of the study was to describe inpatient hospitalization patterns among detained and nondetained youth in a large, total population of hospitalized adolescents in California. MethodsWe examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997 to 2011. We considered hospitalized youth aged 11–18 years “detained” if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay between detained youth and their nondetained counterparts in the general population. ResultsThere were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus nondetained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared with 19.8% of nondetained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median length of stay compared with nondetained inpatient youth with mental illness (≥6 days vs. 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥43 days). ConclusionsDetained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention.

Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics

IntroductionThe present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. MethodData were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. ResultsIn the 2years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30days. ConclusionsAdditional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems.

A Changed Life: Becoming True to Who I am.

A Changed Life: Becoming True to Who I am Jay Kyle Petersen I was born intersex in 1952 in the county hospital of a very small, ultraconservative town in rural Southwestern Minnesota. My biological parents and paternal grandparents raised me on a small family farm nearby. I knew by age four I was a boy. No one told me. There was nothing to decide. I have always known I am male. My parents never discussed my unusual condition with me and died having never accepted me. They denied my true identity and instead chose to give me a girl’s name and raise me as a girl. My paternal grandmother knew I was different. She lived on the farm with us and, as she explained to me later on in life, changed my diapers and helped take care of me as an infant and toddler. She also was a Certified Nurse’s Aide in the pediatric ward of the county hospital where I was born and could see that anatomically I was different from other infants. She remained my lifelong ally and friend until her death in 1993. She and Grandpa provided an oasis in their farmhouse where I felt accepted. I felt relaxed and comfortable in their company, and could just be myself. Grandpa took me fishing. Grandma drove me to 4–H State Fair demonstrations and supported me in the audience for which she had helped prepare me. My grandmother taught me good humor, excellence and how it was okay to make mistakes. Much later, in 1977, she drove four hours alone to Minneapolis in blizzard conditions to be my “concerned family person” during chemical dependency treatment, when my mother and dad refused and she also celebrated with me after my successful completion of the program. I loved her and she loved me and she showed it. With her I found refuge away from the pressure and abuse in our farmhouse. But my grandparents and parents did not show me affection physically. The only touch I felt from my family, except my paternal grandparents, was abusive including certain religious figures outside our family. Farm animals and pets provided warmth, love, acceptance, and companionship. I loved riding around the farm on the back of my pet pig, Lucy. Nature, especially trees, wild weather, and local lakes provided rest for my stretched, weary nerves and stimulation for my imagination. There was something about the vivid and contrasting colors, even the sounds and livingness about it all—rich deep moist greens, clean pure vast open blues, dark warm earth which I laid upon and felt in my hands. These and the soothing sounds of the wind gently moving through tree leaves and corn leaves and the lake water lapping calmly upon sandy shores, as Grandpa cast out his line: all this I found both relaxing and energizing and allowed for me the safety and environment to rest, let go and expand so my natural inclinations to express myself creatively could open up. Otherwise, I had a very lonely, frustrated, painful, humiliating childhood and adolescence filled with mounting anger and a sense of futility because I could not be or express my real male self—including my attraction to girls. The cultural and religious pressure I felt, the increased abuse and social lies I was forced to live with—including being forced to wear girls’ clothing against my will—became unbearable. I sought [End Page 106] refuge in addiction early on—food for comfort, nicotine for mood alteration, alcohol given to me by my dad, and more. I became suicidal, and remained for a long time terribly depressed. The geneticist I have consulted for the last four years says that physicians who examined me prior to my genital surgeries described my genitals as “male structures formed without enough testosterone,” rather than female structures formed in the presence of excess androgen. She told me that the features recorded in my medical records, and that she had observed, indicate androgen exposure in utero along with an inherited genetic condition such that she says my condition began at conception. I was born with XX karyotype and testing for usual causes for androgen excess with someone...

Estado nutricional e hábitos alimentares de dependentes químicos em tratamento ambulatorial

Objetivo Identificar o estado nutricional e hábitos alimentares de pacientes masculinos em recuperação de dependência química em acompanhamento ambulatorial de uma unidade de adição. Métodos Estudo transversal com 25 pacientes adultos em tratamento ambulatorial para dependência química. Foram aferidos parâmetros antropométricos (peso, estatura, circunferência da cintura e índice de massa corporal) e de composição corporal (bioimpedância elétrica), e foram investigados hábitos alimentares (Questionário de Frequência Alimentar – QFA). As variáveis categóricas são apresentadas como frequências e percentuais e as variáveis contínuas, como média e desvio-padrão ou como mediana e intervalo interquartil. Resultados Observou-se índice de massa corporal médio de 27,73 ± 4,15 kg/m2, com prevalência de sobrepeso de 80% e obesidade de 8%. A média da circunferência da cintura foi de 96,60 ± 9,84 cm e a de percentual de gordura corporal, de 23,24 ± 6,44. A maior parte da amostra estudada [20 (80%)] refere realizar quatro ou mais refeições por dia e 72% referiram aumento do consumo alimentar no período de abstinência. A preferência por alimentos específicos no período de abstinência foi relatada por 12 (48%) pacientes. Em relação ao consumo de alimentos ultraprocessados, destaca-se o consumo diário de pão francês (68%), pães brancos de forma (16%), sucos artificiais (48%), refrigerantes (32%), queijo amarelo (36%), embutidos com alto teor de gordura (36%) e balas e chicletes (32%). Conclusão Os resultados mostram prevalência elevada de sobrepeso e obesidade, além de medida de circunferência da cintura alterada, relato de aumento da ingestão alimentar e consumo diário e semanal elevado de alimentos ultraprocessados.

Combined Use of Varenicline and Cognitive Behavioral Treatment for Nicotine Dependence in Patients Admitted to a Psychiatric Clinic in Rio De Janeiro, Brazil-improved Technique.

Objective Nicotine dependence is a worldwide health problem. The results of the implementation of a treatment program using Varenicline as a specific medicine for nicotine dependence during admission in a clinic for chemical dependency treatment are demonstrated, and also that this treatment is possible and safe for patients with comorbid psychiatric disorders and drug abuse disorders. Methods Between August 2012 and August 2013, 122 patients were evaluated in a clinic for psychiatric and drug abuse tratment in Rio de Janeiro, Brazil. The treatment consisted of a smoking cessation therapy concurrently with the psychiatric treatment. These patients had used pharmacological therapy associated with intensive cognitive behavioral therapy, occupational therapy and moderate physical activity. Smoking was limited to three cigarretes daily since the first day of hospitalization. The medicine used for treatment was Varenicline. Results despite the drastic reduction to three cigarretes daily, 100% of the patients adhered to treatment e are discharged from the clinic as tobacco abstainers. Only 67,21% answered the questionnaire after 12 month of follow-up, and 52,43% were still in abstinence. Conclusions A high number of patients accepted the treatment. Behavioral group therapy and physical activities can be important allies for Varenicline. The use of Varenicline was safe in patients with psychiatric disordes, with no cases of suicide.

Theories and treatment of drug dependency: a neurochemical perspective.

Treatment of chemical dependence ("addiction") requires an understanding of its effects on the brain. To guide research in the area of chemical dependence, several foundational theories have been developed. These include the incentive salience, receptor down-regulation, opponent process, and psychomotor stimulant theories. These have been important both in summarizing and in guiding investigations. However, the extant theories do not provide a single unified framework nor have they yielded all of the guidance necessary for effective chemical dependence treatment. The present paper summarizes and then integrates these theories and suggests some implications for the treatment followed by this integration.

Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care

The use of drugs other than alcohol is a leading cause of fatal injury in the United States, accounting for more than 40 000 deathsperyear.1 Increases intherateofdrug-attributabledeaths over the past 2 decades have beenfueledbyoverdosesof illicitlyusedprescriptiondrugs (such as opioids and sedatives, sometimes in combination with alcohol). In 2011, an estimated 1 280 134 hospitalizations were related to drug overdosesnationwide,ofwhich1 021 563 (80%) involveddrugsonly and258 571 (20%) involveddrugs incombinationwithalcohol.2 National roadside research surveys have detected more drivers on roads after using drugs than alcohol,3 and severalmetaanalyses indicate that fatal trafficcrashrisksofdriverswhohave simultaneously used drugs and alcohol exceed the fatal crash risk of driving after either alone.4,5 In addition, marijuana use has increased in the past decade,6,7 perhaps accelerated by legalizationofmedicalmarijuanain22statesandWashington,DC, and legalization of recreational use by Colorado andWashington State. These public health trends underscore the need for continuing research to develop effective interventions for unhealthy drug use, and the emphasis on primary care in health care system reforms suggests that approaches to identify and effectively intervenewith patients exhibiting risky patterns of drug use should be evaluated in a variety of clinical settings. A substantial number of experimental studies have indicated that screeningandbriefnegotiated intervention (BNI) are effective inadultprimarycare inreducingriskyalcoholmisuse.8 Other research, such as a study of illicit drug screening and intervention for adults in anurgent care setting9 andanobservational study of screening and interventions in a broad array of generalmedical settings,10havesuggested thatBNImayalsobe effective in helping patients reduce their use of illicit drugs. A large multicenter international study showed overall significanteffects inprimarycare,althoughnosignificanteffectswere identifiedwhentheUSsiteswereexaminedseparately.11 Buildingonthesestudies, this issueofJAMA includesreports12,13 from 2well-designedandimplementedrandomizedclinical trials that foundscreeningandbrief interventions ingeneralmedical settings were not effective for reducing drug use. In a 3-group randomized trial, Saitz et al12 tested the efficacyof2briefcounseling interventions for illicitdruguseorprescription drug misuse. Adult primary care patients with Alcohol,Smoking,andSubstanceInvolvementScreeningTestscores of 4 or greaterwere studied (N = 528). The authors compared a 15-minute BNI and a 30to 45-minute adaption of motivational interviewing (MOTIV) and a booster with no brief intervention. The BNI included motivational interviewing feedback, review of “pros” and “cons” of use, and development of plans forchange.TheMOTIVinterventionelicitedpossible links betweendruguseandhealth concerns, highlighteddiscrepanciesbetweennegativedruguseoutcomesandvaluedgoals, enhanced self-efficacy about behavior change, and provided options for change. At intake, the reported main drug use was marijuana (63%), cocaine (19%), andopioids (17%), andboth interventionsaddressedalcohol in the15%forwhomitwasaconcern. In addition, all patients received a written list of substance use disorder treatment andmutual help resources. At the6-month follow-up, therewereno significantdifferences between groups inmeanmain drug use days in the past month, inanydruguse,or in riskofdrugdependence.Norwere there significant differences in drug use consequences, injectiondruguse, unsafe sex, hospitalizations, emergencydepartmentvisits, ormutualhelp attendance. Lackof effectwas consistent regardless of drug used, severity, alcohol use, and substance-relatedhealthcondition.Theauthorsconcludedthat if other trials yield consistent results, widespread implementation of drug screening and brief interventionwith referral to treatment should be reconsidered. Of note, contrary to many studies on alcohol screening and brief intervention, there was notareduction inheavydrinking.This raises thepossibility that drugandalcohol-using, single, low-incomepatientswithhigh unemployment and comorbidities may benefit less from BNI. In another study in this issue, Roy-Byrne et al13 randomized 868 adult (age ≥18 years) primary care patients in 7 safetynet clinics to receive enhanced care as usual or a brief 30minute intervention and booster within 2 weeks providing feedback on drug use, discussing pros and cons of use, raising participant confidence in being able to change, and presenting options for change. Patients in both groups received a handout depicting their drug problem, severity score, and a list of substance abuse treatment resources. The authors identified and trackedpast30-dayuseof themost frequentlyuseddrug,aswell as chemicaldependence treatment records, statealcohol arrest records,andin-patienthospitalizationanddeathrecords. Inboth groups, follow-up at 3, 6, 9, and 12monthswasmore than87%. During follow-up, therewerenosignificantdifferencesbetween the2 studygroupsondaysofdruguse,AddictionSeverity Indexdruguse,oranysecondaryoutcomesoradmissions to chemicaldependency.Bothgroupsreduceddrugusefrequency Related articles pages 492 and 502 Opinion

The Impact of Traumatic Brain Injury on Prison Health Services and Offender Management.

A large percentage of incarcerated offenders report a history of traumatic brain injury (TBI) with concomitant neuropsychiatric and social sequelae. However, research looking at the relationship between TBI and delivery of correctional health services and offender management is limited. In this study, the relationships between TBI and use of correctional medical/psychological services, chemical dependency (CD) treatment completion rates, in-prison rule infractions, and recidivism were investigated. Findings indicated that TBI history has a statistically significant association with increased usage of correctional medical/psychological services, including crisis interventions services, and with higher recidivism rates. Results also showed a trend toward offenders with TBI incurring higher rates of in-prison rule infractions and lower rates of CD treatment completion. Implications and future directions for correctional systems are discussed.

Measuring chronic pain intensity among veterans in a residential rehabilitation treatment program.

The purpose of this study was to identify whether veterans with chronic pain, substance abuse, and posttraumatic stress disorder (PTSD) diagnoses residing in a Residential Rehabilitation Treatment Program (RRTP) perceived a higher level of pain than those veterans who had chronic pain but did not have active substance abuse issues or PTSD. A sample of veterans (n = 200) with chronic pain undergoing treatment for either chemical dependency and/or PTSD in an RRTP and a Surgical Specialty Care outpatient clinic at a Department of Veterans Affairs medical center took part in the study. Multiple analysis of variance and further univariate statistics were examined to determine the association between groups on the different scales. There was a considerable difference in terms of which group of veterans perceived a higher rate of pain even with the use of the same four pain assessment scales (i.e., Numeric Rating, Visual Analog, Faces, and Mankoski). Scores were significantly higher for the RRTP group than the Surgical Specialty Care group on all screening measures (p < .001). Veterans with chronic pain, substance abuse, and/or PTSD diagnoses residing in an RRTP tended to have a higher perception of chronic pain compared to those without substance abuse or PTSD diagnoses.

Drug addictions and sexual violence in childhood and adolescence: analyzing life stories

The sexual violence (SV) suffered in childhood and adolescence significantly affects the physical and mental health of the victims who are subjected to pain, shame and guilt, requiring them to adopt coping strategies of these feelings. The use of alcohol and drugs is a recognized way of dealing with the pain of living. This work of narrative feature analyzes and discusses through the life story of eight people, chemical dependency as a result of VS suffered in childhood or adolescence. The participants of this study are male and have suffered sexual violence in this age period of life. Their ages range from 23 to 39 years, and all are admitted to a therapeutic community in a city in the interior of Sao Paulo state, in Brazil, for treatment of chemical dependency, being met by the department of Psychology. Seven participants cited the violence suffered in childhood (between 7 and 9 years), and adolescence (age 14). The attackers were people closed to the victims. All patients claim that violence suffered influenced their entry into the world of drugs. Six participants declare themselves as homosexuals, a participant claims to have ceased to be gay and the other is not stated as a homosexual, but presents difficulties regarding sexuality. The participants see the drugs as an anesthetic of heartaches. Was noted that the patients have a double stigma in society: the issue of drugs addiction and the orientation of sexual desire, because the majority of participants are homosexual. The results reinforce the need for effective action geared to accommodate the victims of sexual violence and effective preventive measures to prevent them, as well as preventing the use of alcohol by adolescents victimized.