Substance Rehabilitation Research Articles

Schizophrenia and schizoaffective disorder: Length of stay and associated factors.

Patients with schizophrenia and schizoaffective disorder often require longer admissions. To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period. The study was conducted at Tara Hospital in Johannesburg. A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay (< 30 days), medium-stay (31-90 days) and long-stay (> 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category. Mean LOS was 128 days (median 87, interquartile range [IQR] 49-164, range 0-755 days). A significantly greater proportion had long-stay admissions (p < 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p < 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment (> 80%), comorbid substance use disorders (> 40%), medical illnesses (> 40%), antipsychotic polypharmacy (> 40%) and readmissions (> 80%) were high. Most (> 80%) were discharged. Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital. This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.

Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia

Background. Rehospitalization, treatment resistance, and impairment are all possible outcomes of a schizophrenia relapse, which has a severe impact on patients, families, and the healthcare system. However, little is known regarding the time to relapse and relapse predictors in Ethiopia and in the study settings. Therefore, the aim of this study was to determine the time to relapse and relapse predictors in patients with schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Methods. A retrospective cohort study was carried out among 273 schizophrenia patients discharged from Ayder Comprehensive and Specialty Hospital between January 2015 and January 2019. The data was taken from the patient’s medical record and was chosen using a systematic random sampling procedure. A standardized data collection checklist was employed. The survival experiences of participants were compiled using a life table. Both univariate and multivariate Cox regression models were used for variable selection. Finally, after confirming the model’s diagnosis and assumptions, factors with a p value of less than 0.05 were declared to be statistically significant predictors of schizophrenia relapse. Results. In this study, the incidence of relapse was 2.9 per 100 person-months (PMs) and the median time to relapse of 13 months (interquartile range: 6–23 months). Being divorced ( AHR = 2.50 , 95% CI: 1.18-5.28), not adhering to treatment ( AHR = 5.7 , 95% CI: 3.03-10.74), and substance abuse ( AHR = 1.8 , 95% CI: 1.01-3.22) were risk factors for increasing schizophrenia relapse. Age ( AHR = 0.65 , 95% CI: 0.34-0.88) and length of first hospitalization ( AHR = 0.69 , 95% CI: 0.57-0.86) were factors that decreased schizophrenia relapse. Conclusion and Recommendation. In this study, out of 100 patients with schizophrenia followed up for a month, three had a relapse, and the highest risk factor for relapse was treatment nonadherence, followed by being divorced and substance misuse. As a result, it is advised that all parties involved focus on early detection and taking preventive measures against schizophrenia relapse, as well as providing regular psychoeducation about the significance of treatment adherence and connecting patients with substance misuse to substance rehabilitation centers.

Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study

BackgroundThe church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse.MethodsThis was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings.ResultsThe interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support.ConclusionsAcceptance of one’s addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.

Analysis of factors influencing substance use craving among Chinese substance users.

Substance use has been a serious public safety issue. It not only affects the users' physical and mental health but is also detrimental to social stability. To improve our understanding of this issue, the present study looked to examine the factors influencing substance use craving and develop interventions to reduce craving and relapse among substance users. A total of 502 substance users were included in this study. Socio-demographic characteristics and substance use-related characteristics were recorded using self-developed forms. With regard to psychological traits, we used the self-esteem scale, the experience of shame scale, and the revised Cheek and Buss shyness scale to assess the self-esteem, shame, and shyness of substance users, respectively. The degree of substance use craving of substance users was assessed using the visual analog scale (VAS). Data were analyzed using independent samples T-test, Pearson correlation analysis, and multiple linear regression analysis, as appropriate. The majority of the substance users were unmarried, employed, and with lower education levels. For substance use-related characteristics, the age of first use was 27.52 ± 8.30 years and the duration of substance use was 12.29 ± 7.72 years. The scores of their self-esteem, shame, and shyness were 25.65 ± 3.19, 57.26 ± 7.82, and 37.8 ± 7.13, respectively. All substance users rated the intensity of their substance use cravings using the VAS, which showed that the mean score was 2.83 ± 1.87. Multiple linear regression analysis showed that substance use craving was positively associated with the frequency of substance use (β = 0.186, P < 0.001), times of substance rehabilitation (β = 0.128, P = 0.003), shyness (β = 0.211, P < 0.001), and shame (β = 0.091, P = 0.033), and negatively associated with self-esteem (β = -0.117, P = 0.008). Factors and psychological traits related to substance use are important to account for substance use craving and relapse. Thus, our findings are helpful for a better understanding of the extent of substance use cravings among users and the selection of appropriate interventions to control the craving and relapse.

Magnitude and predictors of common mental disorders among residents in south Gondar Zone, Northwest Ethiopia: a community-based, cross-sectional study

BackgroundCommon mental disorders such as depression, anxiety, and somatic symptoms are a major public health concern because it is prevalent and chronic, and its impact on physical health, psychological and economic consequences is very serious. Evidence on the prevalence and predictors of common mental disorders is very limited in Ethiopia. This study aims to determine the prevalence and associated factors with common mental disorders.MethodsA community-based cross-sectional study was conducted among 731 south Gondar zone residents recruited with a multistage sampling method. Data were collected by face-to-face interviews on socio-demographic, clinical, and psychosocial factors. Common mental disorders (CMD) were assessed using a self-reporting questionnaire (SRQ-20). A-List of Threatening Experiences and the Oslo social support instruments were used to identify the factors. We used bivariate and multivariable binary logistic regressions to identify factors associated with common mental disorders. Statistical significance was declared at P-value < 0.05.ResultsThe prevalence of common mental disorders over the last four weeks was found to be 29.7% with 95% of confidence interval (CI) (26.4–33.1). After adjusting possible confounders, female sex, [AOR = 2.47, 95% CI (1.68, 3.62)], poor social support [AOR = 2.34, 95% CI (1.50, 3.64)], family history of mental illness [AOR = 2.15, (1.32–3.51)], rural resident [AOR = 2.01, 95% CI (1.35, 3.01)], current use of khat [AOR = 1.69, 95% CI (1 0.07, 2.64)] current use of tobacco (AOR = 1.71, 95% CI (1.04–2.84) and unemployment [AOR = 1.762, 95% CI; 1.193, 2.602)] were significantly associated with common mental disorders.ConclusionThe prevalence of common mental disorders was high, especially in Female sex, current substance use (khat chewing (leaves) and tobacco smoking), unemployment, rural residence, family history mental illness, and poor social support are the main determinants of common mental disorders. Early detection and appropriate intervention for common mental disorders in the community level should be promoted. Governmental strategies should be focused on implementing substance rehabilitation centers to treat Khat and tobacco might be helpful to minimize the burden of CMD in Ethiopia.

Challenges Faced by Rehabilitation Centres in Management of Drug and Substance Abuse in Uasin Gishu, Kenya

The World Drug Report notes that globally, one in twenty adults between the ages of 15 and 64 years abused at least one type of drug. Every year in Kenya misuse of drugs costs the country lots of money and sometimes the misuse has led to deaths. Due to the impact of abuse of substances on individual’s health and the socio-economic consequences, there are several efforts towards alleviating or reducing drug abuse in Kenya. With all these challenges and strategies put in place by the government and other concerned parties, drug and substance abuse in Kenya is still on the rise. This calls for drug abuse treatment whose goal is to stop drug use. The objective of this study was to determine the challenges faced by rehabilitation centers in the management of drug and substance abuse. To achieve the purpose of this study, three specific research objectives were addressed i.e., to determine the Challenges of the rehabilitation centres in management of drug and substance abuse in Uasin Gishu as attested by the management, to determine the challenges of the rehabilitation centres in management of drug and substance abuse in Uasin Gishu as attested by the rehabilitees and to establish the ways of improving the effectiveness of the existing rehabilitation centers. The target population came from the drug rehabilitation centers in Uasin Gishu County. It comprised all the drug and substance addicts and their instructors. Purposive sampling technique was used to select the drug and substance rehabilitation centers in Uasin Gishu County while stratified random sampling was used to sample the management and staff members within the rehabilitation centers. Data was collected through questionnaires and focus group discussions. Data was analyzed using descriptive statistics . Findings as attested by the management and rehabilitees showed poor rehabilitees participation, inadequate resources, poor implementation methods, negative attitude, lack of medication, irregular follow ups, rehabilitees abandonment, high client relapse, inadequate support services being the major challenges to effective implementation. It is recommended that rehabilitation management should recruit clients in references to the infrastructures in some of the rehabilitation centers to avoid congestion and the strained resources observed in some of the rehabilitation centers during the study.

The Role of the Church in Curbing Drug Addiction Problems: A Case Study of Nairobi Chapel

Drug and substance abuse is considered a worldwide menace. Kenya being part of the globe experiences its effects. The Church, being a tool that helps society live godly lives, should take part in the fight against drug and substance abuse. This study sought to identify the role of the Church in curbing drug addiction problems. A descriptive case study and qualitative research approach were employed. 50 churches under the Nairobi Chapel umbrella of Churches were targeted. Questionnaires were employed to collect data from lead pastors in charge of drug addicts’ recovery programs within Nairobi Chapel. Data was analyzed and presented using tables and charts. From the study majority of the churches that took part in the research, only 40% had ministries to help in combating drug abuse, none of the churches had financial allocation for the same, on the human resource set aside; lead pastors comprised 85%, staff members 9%, while drug and substance rehabilitation pastors were 6%, on involvement in advocacy only 20% of the churches were participating, on the other hand, 61% of the churches took part in partnerships with drug addiction and rehabilitation and prevention programs.

Implementing cognitive remediation in substance use treatment: The impact of staff perceptions

Cognitive remediation (CR) programs are new to substance treatment and research needs to evaluate their implementation. The context of implementation, specifically staff perceptions, is critical to changing practice. The aim of this study was to identify treatment staff members' perceptions about the benefits and challenges of a new CR intervention in their workplace. The study conducted semi-structured interviews with staff at a residential substance treatment center when the CR program was first being implemented and again six months later. The study interviewed eight staff members in each round (>50% of staff members in the unit) from all role designations. A critical perspective shaped a thematic analysis of challenges to implementation. The study identified benefits of the CR program to clients and staff. However, only one staff member participated in training to deliver the program. In principle, staff members support the program, but this does not necessarily translate into active involvement, even when the study conducted staff engagement activities. CR programs are likely to improve functional outcomes for people in substance rehabilitation programs. However, this study suggests that staff accepting and valuing a new intervention is not enough to sustain it. For CR programs to be feasible, management should schedule and support staff training, and facilitate staff participation in that training. Organizational factors are likely to play a significant role in implementation success or failure, and further research should explore how the organizational culture of alcohol and other drug services impacts the implementation of CR therapy.

Occupational justice health questionnaire: reflections on its application

ABSTRACT Introduction Occupational justice concept is defined as the equal access and participation in all occupations, including the resources required for participation and opportunities for social inclusion. Occupational justice not only remains conceptually ambiguous for occupational therapy practice but also lacks critical examination of its applicability to non-Western cultures. Objective This article describes the reflexive process exercised by the researchers during and after using the Occupational Justice Health Questionnaire (OJHQ) as an occupational therapy tool in a substance addiction rehabilitation setting in the Philippines. Method This qualitative study gathered transcriptions from field notes and focus group discussions of the authors. These transcriptions were characterized by the authors’ reflections on their experiences using the OJHQ on four distinct periods: 1) OJHQ translation, 2) pilot testing, 3) OJHQ-Filipino version administration, and 4) project conclusion. Data were analyzed through thematic analysis. Results Qualitative data revealed four themes: tool usefulness; administration guidelines; contextualized use of the tool; and nuances of occupational injustices in substance addiction and rehabilitation setting. Conclusion Findings expanded OJHQ’s purpose to enhance clinical reasoning, promote justice-oriented health care, activate reflective practice, and recognize the interweaving and evolving nature of injustices. This article offers an understanding of how reflections can facilitate cultural adaptation of practice tools used in occupational therapy and justice practice.

Prevalence and clinical correlates of substance use amongst acute psychiatric inpatients in Gauteng, South Africa.

BackgroundMental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes. The diagnosis of substance use is often inadequate when comorbidity is present. It is vital to understand the prevalence of substance use amongst psychiatric patients to inform both clinical practice and service development in South Africa.AimTo ascertain the prevalence and clinical correlates of SUD amongst acute psychiatric inpatients.SettingThe setting for this study was Helen Joseph Hospital acute psychiatric ward.MethodsA cross-sectional study was conducted whereby consecutively admitted patients were invited to participate in a structured clinical interview utilising the alcohol use disorders identification test (AUDIT) and drug use disorders identification test (DUDIT) questionnaires. Statistical comparisons were made between those with and without SUD.ResultsOf 150 participants, 100 (67%) were identified with a SUD. Those with SUD were younger (p = 0.0010), more often male (p = 0.012), less likely to have a disability grant (p = 0.015) and more likely to be brought to hospital by police, ambulance or self than by a family member (p = 0.025). Almost half of people with bipolar disorder (47.3%) and schizophrenia (41.4%) had comorbid SUD. Twenty-three (15%) participants identified with SUD on questionnaire had been missed clinically. Only two participants were referred for inpatient substance rehabilitation on discharge.ConclusionSubstance use disorders are highly prevalent amongst psychiatric inpatients. The AUDIT and DUDIT are potentially useful screening tools in routine clinical practice. Greater collaboration between psychiatric and substance rehabilitation services is recommended.

The role of barriers to care on the propensity for hepatitis C virus nonreferral among people living with HIV.

: Twenty-five percent of HIV/hepatitis C virus (HCV) coinfected patients were not referred for HCV treatment despite unrestricted access in California to direct-acting antivirals (DAA) in 2018. Having unstable housing and ongoing drug use directly affected HCV treatment nonreferral. However, psychiatric history and alcohol use impacted HCV treatment nonreferral through the mediation of not being engaged in HIV care. Achieving HCV elimination requires DAA treatment outside conventional health settings, including substance rehabilitation centers, mental health crisis houses, and homeless shelters.

Associations of deviant peer affiliation with youths’ substance use disorder abstention motivation: The mediating role of perceived social support and the moderating role of collective identity

The aim of the current study is to explore the mechanism by which deviant peer affiliation affects substance abusers’ substance abstention motivation and the mediating role of perceived social support in the relationship between these concepts. Moreover, we also investigated whether collective identity moderates the relations among deviant peer affiliation, perceived social support, and substance rehabilitation. The participants were 430 male substance abstainers who completed a battery of questionnaires. The Chinese versions of the Deviant Peer Affiliation Questionnaire, Motivation for Abstention Scale, Perceived Social Support Scale and Identity Orientation Scale were used. The results showed that all the dimensions of deviant peer affiliation were negatively associated with the dimensions of substance abstention motivation. Moreover, perceived social support partially mediated the relations between deviant peer affiliation and substance abstention motivation. Additionally, collective identity was a significant moderator of the relations between perceived social support and substance abstention motivation. These findings provide a clearer understanding regarding the impact of deviant peer affiliation and perceived social support on substance abstention motivation in individuals with substance use disorder.

Clinical characteristics and treatment outcomes of women with heroin dependence in Johannesburg, South Africa.

There has been a steady increase in the number of women with heroin dependence in South Africa (SA). Data from developed countries suggest that women with substance use disorder have unique treatment needs. There are limited SA data on women with heroin dependence and their response to treatment. To describe the clinical and psychosocial characteristics of women entering inpatient rehabilitation for heroin dependence, determine the outcomes of treatment 3 and 9 months after rehabilitation, and compare these findings with male heroin users. We conducted a longitudinal study of 44 women with heroin dependence who were admitted to a rehabilitation facility in the West Rand Municipality of Gauteng Province, SA. The participants were assessed during admission and 3 and 9 months after leaving inpatient rehabilitation. Structured interviews measured changes in drug use, psychopathology, social functioning, injecting and sexual behaviour, criminality and general health. Statistical analysis of these outcomes and comparison between women and men at 3 months and 9 months was performed by a generalised estimating equation. Fixed and time-varying covariates were included in the models. At baseline, 40% of female participants were HIV-positive, 50% engaged in sex work, 27% were injecting heroin users, and 75% were diagnosed with a comorbid mental illness. Thirty-seven (84%) and 30 (68%) were re-interviewed at the 3- and 9-month follow-up points, respectively. Of these, 6 were abstinent from all substances at 3 months and 2 at 9 months. Compared with males, females had a higher prevalence of HIV infection (p=0.006) and mental illness (p=0.0002) at enrolment. At 9 months, women had similar levels of drug use and criminality to men but scored significantly worse in terms of general health, social function and risky sexual behaviour. Women with heroin dependence in Johannesburg have high rates of HIV infection and comorbid mental illness and low rates of abstinence after inpatient detoxification and psychosocial therapy. Women fared worse than men in many domains of treatment outcome. This study builds evidence for the need for gender-sensitive substance rehabilitation facilities in SA.

Factors associated with the successful completion of a substance rehabilitation programme at a psychiatric training hospital.

BackgroundComorbid psychiatric and substance use disorders are common and present several treatment challenges.AimThe aim of this study was to determine which patient and substance factors are associated with the completion of a substance rehabilitation programme in psychiatric inpatients.SettingThe study was conducted at the Substance Rehabilitation Unit (SRU) at Weskoppies Hospital, a psychiatric training hospital in South Africa, which offers a 6-week programme at the hospital for psychiatric inpatients.MethodsThis descriptive, retrospective hospital-based study was carried out comparing completers and non-completers of the SRU programme with respect to patient and substance factors. All patients accepted into the SRU during 2013–2014 were included (n = 119). Data were collected over a year (2016–2017) from the clinical files, SRU referral forms, SRU attendance register, hospital computerised demographic records, nursing notes and administration files using a data collection sheet designed by the researchers for this study. Comparison between completers and non-completers was performed using Chi-Square or Fisher’s Exact tests.ResultsThe SRU accepted 119 patients from January 2013 to December 2014. The majority of the sample were involuntary patients (n = 39), 30–49 years old (n = 57), male (n = 89), unmarried (n = 112), never having received a disability grant (n = 27), unemployed (n = 96) and with a Grade 8–11 education (n = 49). Substance-induced psychotic disorders (n = 39), schizophrenia (n = 29) and bipolar disorders (n = 22) were found to be common. Frequent medical comorbidities included head injury (n = 27), cardiovascular disease (n = 18) and HIV reactivity (n = 7). Cannabis (n = 98), alcohol (n = 94) and nicotine (n = 90) were the most frequently used substances. Level of education (p = 0.004), disability grant status (p = 0.004), Nyaope use (p = 0.001) and nicotine use (p = 0.049) were statistically seen to be significantly associated with completion. Psychiatric diagnoses and general medical comorbidity were not associated with completion.ConclusionsThis study has yielded several results in areas that have not yet been well researched in South Africa. Risk factors for non-completion may include lower levels of education, being on a disability grant and using Nyaope or nicotine, but may vary in different settings. Future research should focus on identifying further factors that may affect completion of substance rehabilitation in psychiatric inpatients, the role of disability grants in patients with co-occurring disorders and the effect of Nyaope and nicotine use on treatment outcomes in this population. Effective and accessible interventions to assist vulnerable patients also need to be identified.

Factors associated with successful completion of a substance rehabilitation programme at a psychiatric training hospital

IntroductionComorbid psychiatric and substance use disorders are common globally. Management of either condition is influenced by comprehensive management of the other.AimThe aim of this study was to determine which patient and substance factors are associated with completion of a substance rehabilitation programme in psychiatric inpatients.MethodsThe study was conducted at the Substance Rehabilitation Unit (SRU) of Weskoppies Hospital, a psychiatric training hospital in South Africa. It was a hospital-based two-group cross-sectional study comparing clinical files of completers and non-completers of the SRU programme with respect to patient and substance factors.ResultsMost of the patients referred to the SRU were involuntarily admitted, between the ages of 30 and 49 years, male, black or African origin, South African, single, unemployed, never having received a disability grant and with a highest level of education between Grades 8 and 11. Substance-induced disorders, psychotic disorders and Cluster B personality traits were common. Cannabis, alcohol and tobacco were the most frequently used substances. Patients with a lower level of education, who receive a disability grant or who use Nyaope or tobacco, were statistically significantly less likely to complete the SRU programme than those without these factors. Psychiatric diagnosis and general medical comorbidity were not associated with completion.ConclusionCompletion rates were comparable to those in general substance rehabilitation centres. The association of tobacco smoking and non-completion was in keeping with other research. Low educational level may be a predictive factor of non-completion in this population. This study has yielded several recommendations for substance rehabilitation services in this population and filled a number of research gaps. Further research is still needed, especially with regard to substance rehabilitation in Nyaope-users and the role of disability grants. Creative approaches will be necessary in order to support patients at risk of dropout, in light of resource limitations and the drive towards individualised care.

Factors related to methamphetamine relapse risk among clients in the substance rehabilitation center of National Narcotics Board in West Java, Indonesia

Purpose This purpose of this paper is to describe methamphetamine relapse risk, examine the relationship between factors in the dynamic model of relapse and methamphetamine relapse risk. Design/methodology/approach A total of 165 clients from the Substance Rehabilitation Center of National Narcotics Board in West Java, Indonesia were recruited. The research instruments included a demographic characteristic questionnaire and eight different tests: Drug Taking Confidence Questionnaire; Stimulant Effect Expectancy Questionnaire; Stage of Change Readiness and Treatment Eagerness Scale version 8.0 for Drug; Coping Strategies Inventory Short Form; Positive Affect and Negative Affect Schedule; Desire for Speed Questionnaire; Social Support Questionnaire; and the Stimulant Relapse Risk Scale. Descriptive statistics were used to analyze the data. Pearson’s product moment correlation was used to test the relationship among variables. Findings Clients (63 percent) were at a moderate level of methamphetamine relapse risk (mean=56.33, SD=10.54). Outcome expectancy, positive emotional state, negative emotional state and craving were positive and had a significant correlation with relapse risk (r=0.261, r=0.380, r=0.370, r=0.509, p&lt;0.01, respectively). Self-efficacy was negative and had a significant correlation with relapse risk (r=−0.316, p&lt;0.01). Motivation, coping and social support had no correlation with relapse risk. Originality/value Two-thirds of the clients in a rehabilitation center have a tendency to relapse following treatment. Nursing intervention for early detection of methamphetamine relapse risk during treatment by using standardized instruments should be implemented.

The Role of Filipino Occupational Therapists in Substance Addiction and Rehabilitation: A Q-Methodology

ABSTRACTMore than the shortage of manpower, occupational therapists (OTs) in substance addiction and rehabilitation (SAR) practice have remained underused and misunderstood in the Philippines. This study aimed to identify the role of Filipino OTs in people with SUD based on the perspectives of OTs, mental health professionals, and former service users and carers in the community. Using Q-Methodology (QM), this research revealed a tripartite role for Filipino OTs in SAR: (a) “Promoter of occupational participation,” (b) “Collaborator to enhance participation and well-being,” and (c) “Facilitator of environmental supports for occupational participation.”

Philanthropy and dentistry

A look at BrushUpUK's mission to improve the oral health education provided to substance and alcohol misuse rehabilitation projects in South West England

Accountable or not accountable: A profile comparison of alleged offenders referred to the Free State Psychiatric Complex Forensic Observation Ward in Bloemfontein from 2009 to 2012.

BackgroundThe crime rate in South Africa is extraordinarily high. The problem of crime is further complicated when a person, who suffers from a mental illness, becomes involved in a crime. Furthermore, the forensic evaluation of a person suspected of having a mental illness involved in alleged criminal behaviour can be challenging. However, a dearth of information exists in South African literature regarding the link between crime and mental illness.AimTo determine the percentage of alleged offenders, referred to the Free State Psychiatric Complex (FSPC) for observation, found accountable and not accountable, and to compare the biographical, diagnosis and offence profiles of these two groups. The analysis of differences can contribute to a better understanding of the complex process of forensic assessments.SettingForensic Observation Ward, FSPC, Bloemfontein.MethodsIn this comparative, retrospective study, all 505 trial-awaiting alleged offenders (observati) referred from 2009 to 2012 for a 30-day observation period, according to Sections 77 and/or 78 of the Criminal Procedures Act, were included. Results were summarised as frequencies and percentages, and means or percentiles. Significant differences between the groups were determined by sample t-tests or chi-squared tests.ResultsObservati found not accountable were in the majority (64.5%). Significant differences were found regarding marital and employment status, substance abuse, type of offence and diagnoses between the two groups. Almost all of the observati found to be not accountable were diagnosed with mental illness at the time of the assessment, whereas most observati found to be accountable for their actions at the time of the alleged offence were not found to be mentally ill. Observati found not accountable were significantly more likely to be diagnosed with schizophrenia, intellectual disability and substance-induced psychotic disorder, and committed mostly assault, murder and vandalism. Observati found accountable committed mostly rape, murder and theft.ConclusionThe majority of observati were found not accountable, with significant differences found between the two groups regarding demographic characteristics, type of diagnosis and offences committed. The identified differences can be used to assist in establishing criteria for the appropriate referral of alleged offenders by courts. Unnecessary referrals have a serious financial impact on the Department of Health. Furthermore, the high incidence of substance abuse among persons referred to the FSPC highlights the need for more substance rehabilitation centres in the Free State Province.

The acute effect of pleasurable music on craving for alcohol: A pilot crossover study

Chronic administration of drugs of abuse leads to a dopamine deficient state in the mesolimbic system, causing dysphoria in abstinence and contributing to craving and return to use. Recent functional imaging studies have shown that listening to personally pleasing music activates the mesolimbic reward system in a fashion similar to drugs of abuse. It has been proposed that such activation could ameliorate the dysphoria and craving of the hypodopaminergic state. The present study sought to evaluate the efficacy of listening to personally pleasing or moving music on reducing craving in abstinent alcoholics using a single-blind, within-subject randomized block design, with three randomly determined presentations of each condition. Twelve participants with Alcohol Use Disorder on a residential substance rehabilitation unit reported their level of craving with a Visual Analog Scale before and after listening to either the participant-selected song or white noise. Using a mixed model to analyze the crossover design, the music intervention was found to have a statistically significant advantage in craving reduction compared to the noise control. Our results indicate that personally pleasing music might have a role in augmenting substance use disorder treatment via craving reduction. Further study is warranted to elucidate factors which predict the most robust response from this intervention.