A Study of Readiness to Change Profiles in Alcohol and Other Drug Abusers

The purpose of the study was to measure readiness to change profiles of alcohol and other drug abusers, information which is needed in the individual tailoring of treatment. The subjects (N = 780) were Finnish alcoholics and polydrug users receiving inpatient treatment. The instrument used to measure readiness to change was the University of Rhode Island Change Assessment Scale (URICA). In the cluster analysis the subjects were placed in groups. The results revealed wide differences in readiness to change profiles, yet not between alcoholics and polydrug users. Higher education, female gender, living with minor children and marital state were consistently associated with better readiness to change. Those coming on an entirely voluntary basis and those aiming at abstinence were also more ready to change than other subjects. Abstinence in this population is generally a realistic objective, which many clients adopt after some unsuccessful attempts at controlled use. The article contemplates the significance of the findings in the light of earlier profiling studies and the treatment of substance abuse.     

实物声学密度定量的初步探讨

声学密度定量（ＡＤ）是以背向散射积分（ＩＢＳ）为基础的定量方法。在２Ｄ图像感兴趣区取样，经计算机处理提供声学定量参数。本文通过１４种实物８５个取样区检测探讨了：ＡＤ的定量方法；几种物质定量值；不同频率深度与定量值的关系。结果提示：ＩＢＳ为原理的ＡＤ检测敏感性高，对有微弱区别的液体能检出具体的参数。液体的ＡＤ测值＜１０ｄＢ，含有少或微量脂肪性有机或无机物１０～１６．３ｄＢ，实质性物体２０ｄＢ以上。频率升高声学定量值变小。实质性物质远场测值降低１６．６～６８．１％；液性则较近场增加５４．０％～１８８．６％。为人体组织声学定量提供了参考数据     

Pruritus after intrathecal baclofen withdrawal: A retrospective study

OBJECTIVES: To determine the frequency of pruritus after intrathecal baclofen (ITB) withdrawal and to study the pathophysiology of this symptom. DESIGN: Retrospective cohort study. SETTING: Rehabilitation department of a general hospital. PARTICIPANTS: Patients (N=102) implanted with an ITB pump who had been followed up since 1988. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence of pruritus after withdrawal. We studied the relation between pruritus and daily dose, concentration and mode of infusion of baclofen, and cause of the central nervous system lesion inducing spasticity. RESULTS: Pruritus was observed in 10 of 23 cases of ITB withdrawal. It never occurred during the first 3 months after pump implantation. It seems likely that the segmental spinal action of baclofen is responsible for pruritus. There was no statistically significant difference between patients with ITB deprivation who did and did not experience pruritus in their daily infused dosage or in concentration and mode of infusion. Surprisingly, no pruritus was observed in patients with multiple sclerosis. CONCLUSIONS: Pruritus is a frequent symptom after ITB withdrawal. Its occurrence is probably subsequent to chronic blocking of the liberation of substance P by baclofen at the spinal level. This symptom is a good clinical predictor of baclofen withdrawal, in contrast to an isolated increase of spasticity that may be due to drug tolerance or irritant factors. Pruritus requires investigation of a possible dysfunction of the infusion system.     

110名精神科护士3种物质滥用状况的调查分析

目的 调查精神科护士镇静安眠药、烟草、酒精3种物质滥用情况,为采取有针对性的管理措施提供参照.方法 采用自制镇静安眠药使用问卷、酒精使用障碍筛查量表及烟草依赖的HIS计算方法,对110名精神科护士进行现状调查.结果 精神科护士物质滥用阳性率为59.6%,镇静安眠药滥用率17.3%,均为女性,酒精滥用率15.5%,均为男性,烟草高度依赖率22.7%,男性高度烟草依赖率5513%.多因素分析发现性别、是否参与夜班、是否为护士长是物质滥用发生的危险因素.结论 精神科护士物质滥用率高,有必要针对危险因素采取有效措施进行干预.     

The bottle's nearly empty? Treatment of drug addiction

Treatment of drug addiction was a flagship policy of the Blair Government s crime and disorder agenda. It remains a headline issue. However the outcomes of these measures have not had the miraculous effect on crime reduction that were hoped for. Hence political enthusiasm for the half-billion pound annual investment in drug treatment may be running out. A new Prime Minister and the economic recession mean that the bubble may be about to burst for funding of the UK drug treatment services.     

Cigarettes,alcohol, drugs and self-esteem: a comparison of 15-16-year-olds from France and the UK

This paper compares samples of 15-16-year-olds from the UK and France on their use of the Rosenberg Self-esteem Scale (Rosenberg 1965) and on the relationships between total self-esteem and substance use. On all 10 of the scale items French students used the extreme ratings to a far greater extent than did UK students. However, the means and standard deviations obtained on adding up the 10 item scores were similar. In both countries, boys showed higher self-esteem than girls and heavy cigarette smoking was associated with low self-esteem. There were no other significant relationships between self-esteem and substance use for the French children, but there were several such, particularly for girls, in the UK.     

Assessing substance use among Iranian healthcare students

Aims : The strict measures used to prohibit the sale and use of unlawful substances has not changed the increasing trend of substance use in Iran. The aim of this study is to assess the rate of substance use among Iranian healthcare students. Participants : Students (346) were selected randomly; 43.9% were females and 56.1% were males. Measurements : A confidential questionnaire was distributed, completed by the students and collected in the same session. Findings : Of the participants, 34.7% admitted the use of substances now or in the past: cigarettes (28%) were the most frequently used substance. The other substances used were: alcohol (15%), opium (8.4%), cannabis (4.6%), heroin (0.9%) and LSD (0.6%). Only 6.9% of the students were still using substances regularly: cigarettes (5.5%), alcohol (1.7%), opium (1.4%), cannabis (1.2%), heroin (0.3%) and LSD (0.3%). Some had used or were using more than one substance. Conclusions : Use of substance was significantly related to gender (50% of males and 15.2% of females used substances, and 11.3% of males and 1.4% of females were current regular users). Pleasurable purposes were the most common motivations both for past and current use.     

Ethnicity,patterns of substance misuse and criminality: a comparative study of White and Asian patient populations in West London

Aims To compare and evaluate patterns of substance misuse and criminality in White and Asian patient populations. Setting Outer Borough of London. Methods Retrospective case note study of 200 consecutive attendees at a Community Drug Treatment Unit. Outcome measures (1) Age at presentation; (2) sex distribution; (3) age of first use; (4) drug of choice; (5) alcohol consumption; (6) criminal record; and (7) amount spent (£ sterling) on drug habit per day. Results In the Asian group there were more opiate users and lower levels of alcohol consumption. The Asian group reported less criminal activity and a lower age of presentation to the service compared to the White group. There were very few Asian females attending the service. There was no appreciable difference in the daily amount spent on drug habit or age of first use of drugs between the two groups. Comments/clinical implications Our study provides evidence that there is need for vigorous research in this field, particularly targeting hidden populations like Asian women. This will inform service development so that it is culturally sensitive and appropriate to the needs of ethnic minorities.     

The therapeutic relationship between therapists and substance-using clients: A qualitative exploration

Objective: To explore the experiences of therapists within their therapeutic work with drug-using clients, specifically what they found helpful and hindering.

Design: Interpretative phenomenological analysis (a qualitative methodology) was used.

Method: Eight semi-structured interviews were conducted with clinical psychologists who worked with substance-using clients.

Results: Five complex and interconnecting themes emerged from the analysis: participants spoke of the need to ‘find hope’ in their work with clients. This was helped by understanding the ‘core meanings’ of substance misuse. Participants undertook significant ‘responsibilities’ with their clients and the process of assessing the risks involved in the work was linked to a sense of ‘fear’. ‘Tolerance’ of the risks and responsibilities within the work was necessary for participants to continue therapeutic work. Therapeutic work was inextricably linked to ‘keeping connected’ to clients through establishing and maintaining a strong therapeutic relationship.

Conclusions: These themes may serve as the basis for further research. Links to the existing research literature, implications for clinical practice, and the potential for future research are discussed.     

Correlates of partner and non-partner aggression among patients with substance use disorders in an urban ED

Introduction: Violence is a leading cause of morbidity and mortality among patients seeking care in urban emergency departments (EDs). Few studies have examined the relationship between substance use and violence among ED patients with substance use disorders. The urban ED is a critical location for intervening with patients with substance use disorders and violence. This study examined correlates of violence by patients with substance use disorders.

Method: For this cross-sectional study, 1215 patients (64.7% males, average age 34.1 years, SD = 10.58) in an ED, with substance use disorder, completed Substance Abuse Outcome Module (Smith et al., 1996, Psychiatric outcomes module: Substance Abuse Outcomes Module (SOAM). Baltimore, MD: Williams & Wilkins), Addiction Severity Index (McLellan et al., 2006, The Addiction Severity Index at 25: Origins, contributions and transitions. American Journal on Addictions, 15(2), 113–124), Conflict Tactics Scale (Straus, 1979, Measuring intrafamily conflict and violence: The conflict tactics (CT) scales. Journal of Marriage and Family, 41(1), 75–88) and Social Support Scale (Smith et al., 2006, Reliability and validity of the substance abuse outcomes module. Psychiatric Services, 57(10), 1452–1460). Participants were coded into groups based on aggression: participants who are not aggressive (n = 675), participants aggressive towards a partner (n = 249) and participants aggressive towards a non-partner (n = 291).

Results: Logistic regression analysis examined variables associated with participants aggressive towards a partner and participants aggressive towards a non-partner with participants who are not aggressive as the reference group. Participants aggressive towards a partner were related to female gender, antisocial traits and lower level of social support; participants aggressive towards a non-partner were related to younger age, male gender, history of physical abuse, alcohol intoxication, drug problems and antisocial traits.

Conclusion: Screening and brief intervention in urban EDs should focus on substance use and aggression, with tailoring needed to address the unique factors associated with partner and non-partner aggression.     

Caught in the middle: receptionists and their dealings with substance misusing patients

The management of substance misusing patients in primary care has been repeatedly advocated. The receptionist is an integral part of the primary healthcare team, however, the role of the receptionist with substance misusing patients has not previously been examined. Questionnaires were given to 72 receptionists in general practices in southeast London, of which 57 (76%) responded. Almost half had experienced difficulties with substance misusing patients and thought they were the most difficult sort of patients. About a quarter of the receptionists thought that these patients should not be treated in general practice and just over half wanted some form of training or support. If substance misusing patients are to be treated in general practice, further consideration needs to be given to receptionists, who may benefit from training, support and a fuller appreciation of their contribution in the management of patients.     

A Therapeutic Day Programme for problem substance users in Cardiff and the Vale of Glamorgan: development and client-centred evaluation

As a result of the on-going evaluation of mental health service provision for problematic substance users, the Community Addiction Unit set up a structured day programme focusing on key psychosocial elements relevant to preventing relapse in this client group. We provide here an overview of the process involved in the development of this new service and details of a client-orientated service evaluation (rather than an outcome-orientated assessment) performed since its inception. Results of the evaluation indicate an overall improvement in the relevance of the sessions to these clients, an increased perception of service quality and an enhanced atmosphere conducive to participation within the programme sessions. Key areas for future development are identified as issues of client preparation prior to commencing the programme. Further, attracting and retaining male and female drug clients has been shown to be an area that warrants attention. The Therapeutic Day Programme offers problematic substance users a research-based and effective service, worthy of continuation, further development and outcome evaluation.     

First use of multiple substances: Identification of meaningful patterns

Context: Understanding the process through which adolescents and young adults are trying legal and illegal substances is a crucial point for the development of tailored prevention and treatment programs. However, patterns of substance first use can be very complex when multiple substances are considered, requiring reduction into a few meaningful number of categories.

Data: We used data from a survey on adolescent and young adult health conducted in 2002 in Switzerland. Answers from 2212 subjects aged 19 and 20 were included. The first consumption ever of 10 substances (tobacco, cannabis, medicine to get high, sniff (volatile substances, and inhalants), ecstasy, GHB, LSD, cocaine, methadone, and heroin) was considered for a grand total of 516 different patterns.

Methods: In a first step, automatic clustering was used to decrease the number of patterns to 50. Then, two groups of substance use experts, three social field workers, and three toxicologists and health professionals, were asked to reduce them into a maximum of 10 meaningful categories.

Results: Classifications obtained through our methodology are of practical interest by revealing associations invisible to purely automatic algorithms. The article includes a detailed analysis of both final classifications, and a discussion on the advantages and limitations of our approach.     

Poster 11: Increasing substance use disorder treatment compliance for persons with traumatic brain injury

Objective: To compare the effectiveness of 3 interventions for increasing compliance during the initial phase of substance use disorder treatment. Design: Randomized controlled trial. Setting: 2 community-based programs for persons diagnosed with traumatic brain injury (TBI) and substance use disorder. Participants: 195 new clients (n=124, n=71) of 2 programs. Participants were randomly assigned to 1 of 4 treatment conditions, and stratified by race, gender, facility, and interviewer. Interventions: Reduction of logistical barriers to attending appointments; brief motivational interviewing to increase motivation for treatment; provision of financial incentives to participate in treatment; and attention control. Main Outcome Measures: Signed Individualized Service Plan (ISP) within 30 days of intake. Secondary outcomes included days to signing the ISP, premature termination, and missed appointments. Results: The sample was comprised of 70% men, and 31% of participants were of minority status. TBI onset occurred an average of 8 years before study entry. The barrier reduction and financial incentive interventions resulted in higher rates of signing the ISP within 30 days (P<.001). Significant differences between conditions were also found for days to signing ISP and premature termination. Conclusions: Initial participation in treatment can be improved by reducing barriers to participation or by providing financial incentives.     

塞来昔布对骨关节炎大鼠疼痛评分和SP表达的影响

目的：探讨佐剂性诱导骨关节炎大鼠模型血清和脊髓背根神经节中SP表达变化,及其与痛觉评分的相关性和塞来昔布的干预效应。方法将40只SD大鼠随机分为4组：A组（正常组10只）、B组（正常＋塞来昔布组10只）、C组（骨关节炎组10只）、D组（骨关节炎＋塞来昔布组10只）,C和D组予以左膝和尾部皮内分别注射完全弗氏佐剂（CFA）诱导骨关节炎模型,通过酶联免疫吸附测定（ELISA）塞来昔布对于血浆和脊髓背根神经节内SP含量的影响,采用痛觉评分分析塞来昔布对骨关节炎后疼痛行为的影响。结果与对照组比较（A和B组）,骨关节炎大鼠模型（C和D组）脊髓和脊髓背根神经节内SP含量明显升高（P＜0.01）,且 SP 含量与疼痛疼痛评分呈正相关（r＝0.83,P＜0.01;r＝0.61,P＜0.01）;并且塞来昔布治疗组（D组）SP含量较C组显著降低（P＜0.05）。结论 SP在骨关节炎痛的发生中具有重要作用,塞来昔布抑制SP的合成或释放,从而缓解疼痛。     

Spa treatments as a potential tool in the rehabilitation of people with alcohol and drug problems: a personal perspective

There is a lack of non‐pharmacological options for the treatment of people with substance misuse problems. However, service users often mention their use of steam rooms and home baths to help aid their problem of detoxification and aid relaxation of muscle cramps. These anecdotes prompted this current review, to establish whether spa bathing is used for this purpose and whether there is any evidence of its effectiveness. The review was carried out in 2003 and includes a literature review together with written and oral responses from individuals and organizations. The review provided an overview of the extent of uses of spa bathing and describes a variety of examples.     

The alcohol industry in developing countries

Although the alcohol industry takes many different forms in the wide diversity of developing countries, recent trends in alcohol production and worldwide trade show that globalized alcoholic beverages are playing a leading role in developing societies. Although most alcohol is produced and consumed locally, and the headquarters of most of the largest alcohol manufacturers are in developed countries, the production structure of these commodities explains their influence. Looking at the production of globalized alcohol as a commodity chain suggests the importance of the last two links in the chain, namely marketing and advertising. Heavy reliance on these links raises high entry barriers, increases profitability, and puts the global transnationals increasingly in charge of creating the imagery of drinking. This export of brands and brand images rather than actual products in turn influences how alcohol and what alcohol is being consumed. While global companies use the sophisticated marketing technologies honed in the developed countries, governments and other public health authorities in most developing countries have little technology at their disposal for monitoring, preventing or treating alcohol-related problems. International leadership is needed to counter the influence of the global alcohol companies in developing societies.