Abuse Treatment Research Articles

Primary healthcare approach to substance abuse management.

Substance abuse is common amongst patients attending primary healthcare settings. Despite the substantial impact on one’s health, substance abuse is often underdiagnosed by primary care providers owing to a lack of training and time for screening. Self-reported screening tools are easy to administer and efficient to make a substance abuse diagnosis in primary care settings. Comorbid mental illness and intimate partner violence are common amongst patients presenting with substance abuse in primary care. An early diagnosis and a brief behavioural change counselling are effective in managing substance abuse before it develops into dependency. A brief motivational communication rather than a confrontation during substance abuse screening, counselling and treatment is important to achieve optimum patient outcomes.

An Exploratory Study of the Relationship Between Human Service Engagement, Recidivism and Completion of a Batterer Intervention Program

Research on intimate partner violence shows that individuals who employ abusive behaviors also often have other psychosocial health problems (e.g., substance use) that may limit their ability to engage in treatment for abuse. Limited information exists regarding the psychosocial health needs of individuals who perpetrate abuse and how those needs play a role in their ability to follow through and complete an intervention program. Administrative data from one batterer intervention program (BIP) (N = 330), the local Department of Human Services, and court records were used to explore the relationship of service involvement to post-BIP recidivism. We found that over half the sample had engagement with DHS prior to starting the BIP, and general welfare, health and medical assistance, and behavioral health services were the most accessed programs. Additionally, recidivism for any crime was significantly higher among those with prior DHS involvement. Individuals who perpetrate abuse and who have a history of contact with DHS may represent the most vulnerable population with regards to both risk for attrition from a BIP and future recidivism. Future studies should seek to understand best practices for referrals and coordinated care for individuals who perpetrate abuse and ensure access to a broad range of services to help assist in reducing violent behaviors.

Individual and family motivational intervention for treatment of alcohol abuse

Alcohol abuse is one of four non-communicable diseases that kill 70 % of the world’s population, damaging the individual and his family’s functionality. This project’s objective was to evaluate the effectiveness of family versus individual alcohol abuse intervention using a transtheoretical model and motivational interview. El abuso de alcohol es una de las cuatro enfermedades no transmisibles que matan al 70% de la población mundial y dañan al individuo y la funcionalidad des u familia.

Economic abuse and its associations with symptoms of common mental disorders among women in a cross-sectional survey in informal settlements in Mumbai, India

BackgroundDomestic violence takes a range of interconnected forms, of which economic abuse is common, but less studied than others. We examine the prevalence of economic abuse, its determinants, and its association with symptoms of depression, anxiety, and suicidal ideation.MethodsOur cross-sectional survey in informal settlement areas in Mumbai, India, asked women aged 18–49 years 15 questions about acquisition, use, and maintenance of economic resources, demographic and socioeconomic factors, and physical, sexual, and emotional violence. We administered the Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scales and asked about suicidal thinking. Determinants of economic abuse and its associations with positive screens for depression and anxiety were explored in univariable and multivariable logistic regression models.ResultsOf 4906 ever-married women respondents, 23% reported at least one form of economic abuse by either an intimate partner or another family member. The commonest were denial of property rights (10%), not being trusted with money (8%), and coercive appropriation of belongings (7%). Economic abuse was more commonly reported by widowed, separated, or divorced women than by married women (aOR 12.4; 95% CI 6.4, 24.1), and when their partners used alcohol or drugs (aOR 1.4; 95% CI 1.2–1.7). Women had greater odds of reporting economic abuse if they had suffered emotional (aOR 6.3; 95% CI 5.0–7.9), physical (aOR 1.9; 95% CI 1.4–2.6), or sexual violence (aOR 5.4; 95% CI 3.6–8.1) in the preceding 12 months. Economic abuse was independently associated with positive screens for moderate-severe depression (aOR 2.6; 95% CI 2.0–3.4), anxiety (aOR 2.7; 95% CI 1.9–3.8), and suicidal ideation (aOR 2.2; 95% CI 1.5–3.1). The odds of anxiety and depression increased with each additional form of economic abuse.DiscussionTo our knowledge, this is the first community-based study in India of the prevalence of economic abuse and its associations with symptoms of common mental disorders. It provides empirical support for the idea that economic abuse is at least as harmful to women’s mental health as physical violence. Surveys should include questions on economic abuse and prevention and intervention strategies need to help survivors to understand its forms.

Nutritional status of breast cancer patients and the related factors at Vietnam National Cancer hospital in 2019-2020

A cross-sectional study on 170 breast cancer patients to describe nutritional status of breast cancer patients and the related factors at Vietnam National Cancer hospital in 2019-2020. The results revealed that overweight and obesity were the most common problem among breast cancer survivors. Up to 38% of studied patients are diagnosed as overweight or obesity using BMI classification; 84.71% are overweight while 80% of the studied subjects had central obesity. Alcohol abuse and surgery treatment were the factors worsening the risk of malnutrition of the study subjects (OR = 8.2 and 13.6, respectively). Low frequency of meat consumption (<1-3 times/week) has a higher risk of malnutrition than those who used meat daily (OR = 88.6). In addition, the age group, physical activities, chemotherapy and menopausal status affected the overweight and obesity status of breast cancer survivors (OR= 2.5, 10.7, 20.3 and 4.1, respectively). Low frequency consumption of vegetables increased the risk of overweight (OR=3.2). It is necessary to assess and screen the nutritional status for hospitalized patients immediately before treatment. Food intake and nutritional status of patients should also be paid attention in order to improve general health status and treatment outcome of breastcancer patients.

Enhancing Permanency in Children and Families (EPIC): a child welfare intervention for parental substance abuse

BackgroundAcross Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse.MethodsEPIC is a quasi-experimental study. Under the program, child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults (N = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system.DiscussionThis intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG).Trial registrationNCT04700696. Registered January 7, 2021-retrospectively registered.

Presuming the status quo? The impact of the statutory presumption of parental involvement

ABSTRACT The courts’ treatment of domestic abuse within private law child arrangements disputes has attracted significant concern for many years, most recently culminating in the call for major reform by the Ministry of Justice’s expert review into the courts’ practice. The Ministry of Justice has since committed to a follow-up review into the operation of the statutory presumption of parental involvement (Children Act 1989, section 1(2A)). This paper provides timely insight into the impact of this presumption in cases involving domestic abuse, presenting the findings from the first empirical study to explore its impact on the lower courts. Forty-one semi-structured interviews were conducted with judges, barristers, solicitors, Cafcass practitioners and representatives from domestic abuse organisations. It also explores perceptions of whether the statutory presumption ought to be reversed to introduce a presumption against contact in domestic abuse cases. It is argued that whilst the statutory presumption does not appear to be changing the courts’ practice, its harm lies in the reinforcement of a dominant narrative that children ‘need’ contact. Whilst a presumption against contact might not hold the answer to changing this narrative, there remains an urgent need to reappraise the approach taken to the resolution of cases involving domestic abuse.

Association between Work-Related Trauma Exposure and Posttraumatic Stress Symptoms among Child Welfare Workers in Japan: A Cross-Sectional Study.

Child welfare workers often experience work-related traumatic events and may be at risk of post-traumatic stress disorder (PTSD), which can hinder early interventions for child abuse. This study examined the association between each single work-related traumatic event experienced by child welfare workers and the cumulative number of traumatic event types with PTSD symptoms. A checklist of traumatic events was used to investigate work-related traumatic events. The PTSD checklist for DSM-5 (PCL-5) was used to screen for PTSD symptoms. Two multivariate analyses were performed. A total of 140 workers were included in the analyses. In the first multivariate analysis, the event, “Witnessed a parent violently beating, hitting, kicking, or otherwise injuring a child or the other parent during work” (β = 11.96; 95% CI, 2.11–21.80; p < 0.05) and resilience (β = −0.60; 95% CI, −0.84 to −0.36; p < 0.01) were significantly associated with PTSD symptoms, as was resilience in the second multivariate analysis (β = −0.60; 95% CI, −0.84 to −0.36; p < 0.01). The association between the cumulative number of event types and PTSD symptoms was not significant, but it was stronger when the cumulative number was four or more. The findings suggest the importance of reducing child welfare worker exposure to traumatic events.

Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement

ABSTRACT The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research – two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.

\u201cGuboow\u201d\u2014child abuse or traditional medical treatment? a case report

The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions.

The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and other relevant areas, which may remedy this gap. Particular advances include the use of elder abuse severity measures and goal attainment scaling, and the application of restorative justice theory to intervention. Elder abuse research also may benefit from advances in biomedical clinical trial methodology, including characterizing and following up with subjects excluded from trials or those who drop out, estimating numbers needed to treat to assess cost-effectiveness, and a priori stopping rules for when an intervention proves quickly beneficial or harmful. In this article, we argue these advances can and should inform elder abuse intervention research, propose a theoretical framework to guide such efforts, and demonstrate how this framework can inform practice, using elder abuse multidisciplinary teams and nursing home shelters as examples.

Exploratory Analyses for Missing Data in Meta-Analyses and Meta-Regression: A Tutorial

AbstractObjectivesIn this tutorial, we examine methods for exploring missingness in a dataset in ways that can help to identify the sources and extent of missingness, as well as clarify gaps in evidence.MethodsUsing raw data from a meta-analysis of substance abuse interventions, we demonstrate the use of exploratory missingness analysis (EMA) including techniques for numerical summaries and visual displays of missing data.ResultsThese techniques examine the patterns of missing covariates in meta-analysis data and the relationships among variables with missing data and observed variables including the effect size. The case study shows complex relationships among missingness and other potential covariates in meta-regression, highlighting gaps in the evidence base.ConclusionMeta-analysts could often benefit by employing some form of EMA as they encounter missing data.

Racial and Ethnic Disparities in Pain Management

Pain is subjective, which makes its management a complicated task. The challenge of medical decision-making associated with pain often requires health care providers to rely heavily on their individual discretion and experience. This often creates an avenue for biases to play a role in the selection of the best available and most appropriate pain management interventions. Therefore, the overall purpose of this review is to summarize the current literature related to racial and ethnic disparities in pain management. Electronic searches of four databases revealed 2,112 articles; however, only six studies met criteria for inclusion in this review. Even when the source of pain is the same, research indicates management may differ between racial or ethnic groups. While the treatment of objectively painful conditions remains relatively constant among races and ethnicities, inequities in pain management become more apparent in the treatment of conditions characterized by only subjective pain indicators. Further disparities were identified in the dosage, dosage reduction, and oversight of opioid analgesics between groups. Inequities in prescribing patterns widen existing healthcare disparities by contributing to undertreatment of pain in ethnic minorities and overtreatment of pain and subsequent risk of opioid abuse in Whites. Health care providers must use a patient-centered and evidence-based approach to combat the ambiguity of clinical decision-making regarding pain. When knowledgeable of appropriate standard of care for pain management, athletic trainers can identify when a patient’s pain needs are unmet or when substance abuse interventions may be necessary.

Association between Caregiver Neurotic Personality Trait and Elder Abuse: Investigating the Moderating Role of Change in the Level of Caregiver Perceived Burden

Objectives: To investigate whether caregiver neuroticism affects the level of elder abuse and whether changes of caregiver perceived burden alter this relationship. Methods: Using 2-year longitudinal data, a consecutive sample of 800 Chinese family caregivers and their care recipients with dementia were recruited from the geriatric and neurological departments of 3 grade-A hospitals in the People’s Republic of China. All the participatory dyads were assessed between September 2015 and February 2016 and followed up for 2 years. Results: Significant increase in the prevalence was found for physical abuse, psychological abuse, and caregiver neglect. Caregiver neuroticism was associated with an increased level of physical and psychological abuse over the 2-year observation period; however, change in the level of caregiver perceived burden altered this association. Specifically, the absence and decrease of perceived care burden prevented an increase in the level of physical and psychological abuse among caregivers high in neuroticism. Although caregiver neuroticism was also associated with an increased level of caregiver neglect, caregiver perceived burden did not appear to have an impact on this relationship. Discussion: This study provided evidence that caregiver neuroticism was associated with an increased level of physical and psychological abuse, while changes in the level of caregiver perceived burden may alter this trajectory. These findings suggest the importance of implementing caregiver-centered intervention and prevention programs for elder abuse by specifically targeting caregivers’ behaviors related to their neurotic personality trait and cognitive appraisal of caregiving stressors associated with such personality traits.

Discovery Under § 1782 in International Commercial Arbitration: Recent Developments From A ‎Comparative Perspective

Title 28 U.S.C. § 1782 empowers American federal courts to order persons in the United States ‎to give testimony or to produce documents “for use in a proceeding in a foreign or international ‎tribunal.” However, disagreement persists, both in the courts and among commentators, as to ‎whether the phrase “international tribunal” in § 1782 includes “private” international commercial ‎arbitral tribunals, and the issue is now before the United States Supreme Court. The circuit split ‎that has emerged in this regard and the lack of a uniform approach across the United States have ‎created uncertainty and unpredictability in international commercial arbitration practice, which ‎are not conducive to orderly international commercial transactions and dispute resolution. In this ‎article, I approach the debate from a comparative perspective that has thus far been underutilized ‎in the literature. Given that one of the main purposes of § 1782 is to promote comity and ‎cooperation among nations, I undertake a detailed examination of recent jurisprudential and ‎legislative developments in two jurisdictions — the United Kingdom and New Zealand — with ‎respect to judicial assistance in the taking of evidence from persons located in their territory for ‎use in private international commercial arbitration. Notwithstanding differences in their general ‎approach to discovery, these, and other, jurisdictions are increasingly allowing for such judicial ‎assistance. Therefore, I argue that American courts should similarly interpret § 1782 to allow, in ‎principle, discovery in relation to private international commercial arbitrations. Courts should ‎then exercise their discretion in enforcing the provision in accordance with clear and uniform ‎criteria that will promote the goals of both § 1782 and international commercial arbitration and ‎prevent abuse and unnecessary judicial intervention. ‎

Inconvenient topic: laxative abuse. review and clinical case

Annotation. Laxatives are drugs with different mechanism of action that are used to treat or prevent constipation. Use of laxatives to control body weight is considered a dangerous tendency, especially among young women with eating disorders. Natural or synthetic stimulant purgatives are the most commonly used for weight loss because they are cost-effective, have rapid onset of action, and available in various dosage forms. Excessive use of laxatives results in a gradual efficacy decrease causes specific damage of the gastrointestinal tract, other organs and systems. This condition is known as "laxative abuse". The purpose of this review is to summarize the available scientific data on behavioral characteristics, clinical and diagnostic criteria and tactics of treatment of laxative abuse with a clinical case description. Laxatives abuse should be suspected in case of eating disorders, clinical, laboratory, endoscopic and histological changes in the gastrointestinal tract. Treatment of laxative abuse requires gradual laxatives withdrawal, potassium replacement therapy and mandatory training in the healthy eating principles. The clinical case describes a young woman who tried to stop taking laxatives, but she started to use diuretics due to peripheral swelling. At the time of examination, the daily dose of furosemide was 600 mg (15 tablets a day). Laxative abuse is relatively common among young women and requires monitoring by physicians of various specialties.

Caregiver Neurotic Personality Trait and Elder Abuse—The Moderating Role of Change in the Level of Caregiver Burden

Objectives: To investigate whether caregiver neuroticism has an effect on subsequent occurrence of elder abuse and whether change in the level of caregiver perceived burden alters this relationship. Methods: Using two-year longitudinal data, we analyzed a consecutive sample of 800 Chinese family caregivers and their care recipients with dementia recruited from the geriatric and neurological departments of three Grade-A hospitals in People’s Republic of China (PRC). All the participatory dyads were assessed between September 2015 and February 2016 and followed for two years. Results: Significant increase in the prevalence was found for physical and psychological abuse, caregiver neglect, and financial exploitation. Caregivers high in neuroticism were more likely to engage in subsequent physical and psychological abuse, however, change in the level of caregiver perceived burden altered this association. Specifically, absence and alleviation of care burden during the two-year observation prevented the subsequent occurrence of physical and psychological abuse. Although caregiver neuroticism was also associated with subsequent caregiver neglect, caregiver perceived burden did not appear to have an impact on this relationship. Discussion: This study provided evidence that caregiver neuroticism was associated with subsequent physical and psychological abuse, while change in the level of caregiver perceived burden may alter this trajectory. These findings suggest the importance of implementing caregiver-centered intervention and prevention programs for elder abuse by specifically targeting at caregivers’ behaviors related to their neurotic personality trait and cognitive appraisal of caregiving stressors associated with such personality trait.

The Critical Help-Seeking Role of Family, Friends, and Neighbors in the Lives of Elder Abuse Victims

Elder abuse prevention and intervention is a complex puzzle. We focus on examining the typically invisible role, experience, and impact of nonabusing family, friends, and neighbors, or “concerned persons” in stopping elder abuse. Given the reality that most elder abuse goes unreported and unaddressed, it seems essential to understand if and how concerned persons can play a role in help-seeking for older victims, and to also understand the needs and issues faced by concerned persons as a consequence. First. Breckman presents evidence of the significant distress concerned person’s experience from knowing about elder abuse and trying to assist victims, and shares experience developing and implementing the first Elder Abuse Helpline for Concerned Persons in the U.S. Second, Fraga Dominguez et.al. present an important international perspective highlighting findings about concerned persons as users of a UK elder abuse helpline, their profile, the impact of helping, and variables relating to help-seeking. Third, Stum shares findings from a qualitative study of elder family financial exploitation related to what concerned family members were trying to accomplish by getting involved (motivating goals) and the resulting continuum of outcomes. Fourth, Kilaberia also explores the help-seeking experiences of concerned family members in elder family financial exploitation situations, specifically the range of tasks involved, and the impacts on the concerned family member’s individual health and well- The discussion led by Burnes will focus on understanding contributions of the research presented given the current state of the field, and offer suggestions for future research and intervention directions.

Substance Use Is Common in Elder Abuse Cases: Qualitative Findings From a Multi-Disciplinary Team

Elder abuse is mistreatment of an older adult by a caregiver or another person in a position with an expectation of trust. Adversely affecting as many as 10% of community-dwelling older adults in the US, it may include physical abuse, sexual abuse, psychological abuse, financial exploitation and neglect. Mental illness and substance use by caregivers, family members and victims themselves have been described as risk factors for multiple forms of elder abuse in prior cross-sectional analyses but the impact on these cases is poorly understood. To explore this association we conducted a focus group using a semi-structured format involving an inter-disciplinary group of elder abuse professionals that are part of the New York City Elder Abuse Center enhanced multi-disciplinary team (EMDT) in Staten Island, New York. Focus group participants reported that opioid, cocaine, cannabis and alcohol use is common among perpetrators of elder abuse, especially in cases of financial mistreatment, verbal and physical abuse. Other potential consequences included eviction of the older adult victim, co-dependency and involvement of the older adult in the procurement of illicit substances, and substance use by the older adult. Respondents specifically expressed concerns that the opioid epidemic, including rising heroin use, may be changing the frequency and nature of elder abuse, and that case investigations offer an opportunity to facilitate referrals for formal substance use disorder assessment and treatment. Future work includes additional focus groups and quantitative analysis to clarify the intersection between substance use and elder abuse and inform intervention and prevention strategies.

What Are the Most Distressing Aspects of Experiencing Elder Abuse? Findings From a Qualitative Study With Victims

Adult protective services and other community-based agencies respond to hundreds of thousands of elder abuse cases annually in the United States; however, few studies include elder abuse victims’ voices. This study explored the most distressing aspects of elder abuse, as identified by victims themselves; to date, this is the first known study on this topic. Guided by a phenomenological qualitative methodology, this study conducted in-person, semi-structured interviews with a sample of elder abuse victims (n = 30) recruited from a community-based elder abuse social service program in New York City. To enhance trustworthiness, two researchers independently analyzed transcript data to identify key transcript codes/themes. Distressing aspects of elder abuse were identified across three key domains, related to feelings of loss (50% of codes), threats/negative consequences (55%), and client-needs/system incongruity (14%). Specifically, the first theme represented outcomes related to loss of relationships (19% of ‘loss’ codes), personhood (16%), credibility (19%), faith/trust in others (38%), and finances (8%). The second theme looked at threats to physical self (34% of ‘threat’ codes), psyche (39%), and others, including the perpetrator (27%). The third theme focused on mismatches in client/system goals (50% of ‘incongruity’ codes) and legal system involvement (50%). The findings in this study provide a comprehensive and conceptually organized range of aspects to serve as infrastructure for the development of meaningful interventions to address the needs of victims. This study represents one of the largest efforts to understand and integrate the perspectives and needs of victims into elder abuse intervention practice/research to date.