Employees' reactions to an interactive website assessing alcohol use and risk for alcohol dependence,stress level and coping

Objective We assessed employee's reactions to using a website‐based intervention designed to identify moderate and high‐risk drinkers and to reduce their problematic drinking.

Methods One hundred and eighty‐seven participants completed a prewebsite‐intervention survey, website intervention, and a follow‐up survey assessing participants' reactions to the website. The website provided feedback regarding participants' alcohol use, risk of lifetime or current alcohol dependence, stress level, and coping style. Participants identified as at ‘low’ or ‘moderate’ risk for alcohol‐related problems were randomly assigned to receive either ‘limited individualized feedback’ or ‘full individualized feedback’. High‐risk participants were given the full individualized feedback intervention.

Results Twenty‐three per cent were identified to be at high risk of having alcohol‐related problems, and 17% were at moderate risk. Most participants viewed the site information as interesting and easy to use. High‐risk participants were more interested in alcohol‐related information than were other participants. Eight per cent of the respondents reported a change in their drinking with this brief intervention.

Conclusion These findings demonstrate the potential of the Internet to attract and engage persons who are high‐ or moderate‐risk for alcohol‐related problems in learning more about their risk as well as about their stress and their strategies for coping.     

A descriptive study on emergency department doctors’ and nurses’ knowledge and attitudes concerning substance use and substance users

AimThe aim of this study was to determine emergency department doctors’ and nurses’ knowledge and attitudes regarding problematic substance use and substance users.MethodsData were collected using an adapted survey questionnaire and the Substance Abuse Attitude Survey (SAAS). By means of convenience/opportunistic sampling all emergency department doctors and nurses (N = 145) working in three university teaching hospitals in Ireland were asked to fill out the knowledge and attitudes questionnaire.ResultsA response rate of 46%, N = 66 was achieved. Results indicate that participants’ current level of knowledge about alcohol and drug misuse in general, is satisfactory. A particular knowledge deficit in relation to intervention strategies, and other substances was identified. The majority of participants have never received any specific training regarding substance use and this suggests that substance using patients are managed inadequately. The SAAS results indicate that participants exhibited near-optimal attitudes for constructive working with substance using patients.ConclusionThere is an urgent need for further in-service training programmes and the development of standard protocols/guidelines for the identification and management of substance using patients who present in the emergency department.     

Participation in decision‐making about medication: A qualitative analysis of medication adherence

Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18–64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients’ views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.     

Impact of nurse‐led behavioural counselling to improve metabolic health and physical activity among adults with mental illness

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non‐communicable disease. This repeated‐measures, single‐group intervention trial evaluated the effects of a 19‐week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face‐to‐face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self‐report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically‐significant changes were demonstrated between baseline and post intervention for participants’ waist circumference (P = 0.035) and waist‐to‐height ratio (P = 0.037). Non‐significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse‐led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an ‘open door’ policy to allow for attendance interruptions, such as hospitalization.     

Infectious risk of biological drugs vs. traditional systemic treatments in moderate‐to‐severe psoriasis: a cohort analysis in the French insurance database

The aim of this study was to compare the infectious risk between a group of psoriasis patients treated by biological drugs (BD) and a group treated by traditional systemic treatments (TST). We built a retrospective observational cohort study from the French health insurance database in the Midi‐Pyrénées area (2.9 million inhabitants, southwest of France) using data from 01/01/2010 to 12/31/2013. We compared the infectious risk between ‘exposed’ patients treated with BD (adalimumab, etanercept, infliximab, or ustekinumab) and ‘unexposed’ patients treated by TST (phototherapy, acitretin, methotrexate, or cyclosporine). We realized a survival analysis on the first infectious event, defined as an anti‐infective drug delivery or a hospital diagnosis of infection. We selected 101 ‘exposed’ and 788 ‘unexposed’ patients. In our multivariate Cox model, ‘exposure’ did not seem to decrease the time frame of the first infectious event compared with ‘nonexposure’ (HR = 0.94, P = 0.62). Among all treatment, the safest seemed to be ustekinumab while the least safe was etanercept. We found factors statistically associated with the risk of infection: gender (female vs. male), economic deprivation, chronic hepatitis B or C, history of cancer, at least one infectious event, and the number of different drugs during the 6‐month period before the study. We did not find any difference of infective risk between the BD and the TST. This result enhances the recent PSONET registries conclusions.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.     

Assenting to exposedness – meanings of receiving assisted bodily care in a nursing home as narrated by older persons

Most older persons moving to a nursing home need to receive assisted bodily care, which means being in a position of vulnerability. However, few studies have explicitly focused on the meanings of receiving assisted bodily care from the older persons’ perspective. This study aimed to elucidate meanings of receiving assisted bodily care, as narrated by older persons living in a nursing home. Twelve men and women, aged 80 or older, living in a Swedish nursing home, participated in the study. Data were generated by narrative interviews and analysed with a phenomenological‐hermeneutical method. The regional ethics committee approved the study. In the analysis, one main theme emerged: ‘Assenting to exposedness’. This theme comprised five themes, ‘To have hope in hopelessness’, ‘To relinquish one's body into others’ hands’, ‘To be between power and powerlessness’, ‘To oscillate between one's own responsibility and demands’, ‘To be in an ongoing interaction’, and ten subthemes. In conclusion, receiving assisted bodily care means to be exposed, but not passively. Rather, it means to be self‐determinant for as long as possible, to perceive the body as lived. When the body must be relinquished to others, it might be objectified, leading to care‐suffering. To avoid this, the older persons use a certain competence, acquired through life, to decide when to take action or when to assent. However, this is but one of the several possible interpretations, which may be considered a limitation.     

Affected family member coping with a relative with alcohol and/or other drug misuse: A cross‐sectional survey questionnaire

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members’ coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support‐giving experience. A cross‐sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that ‘Other’ family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant‐inactive maladaptive coping strategies had a significantly greater adverse influence on family members’ physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support‐giving role and to sustain them in this crucial support‐giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.     

Maturing out,natural recovery,and dual diagnosis: What are the implications for older adult mental health services?

In 1962, Charles Winick proposed that addiction was a self‐limiting process, whereby individuals stopped using substances once the stresses of life transitions ceased. The notion of maturing out, as labelled by Winick, often forms the basis of the natural recovery movement in alcohol and other drug (AOD) research, aiding the notion that older individuals either cease their substance use or fall victim to the higher mortality rates prevalent in substance‐using populations. As more consumers present to adult mental health treatment settings with co‐occurring substance use disorders, the idea that individuals will simply cease using AOD is outdated. Given the future challenges of an ageing population, it is prudent to explore those who fail to mature out of substance use, as well as challenge the notion that older adult mental health services rarely encounter substance‐using individuals. The present study explores Winick's research in the context of an ageing population and older adult mental health services. It also ponders the proposition put forth in subsequent research that older individuals with lifelong substance use switch to substances that are easier to obtain and better tolerated by their ageing bodies.     

Alcohol and substance use in civilian chronic PTSD patients seeking psychological treatment

Alcohol and substance use in patients suffering from chronic posttraumatic stress disorder (PTSD) were investigated. Those with alcohol‐ or substance‐abuse disorders that pre‐dated their trauma were excluded from the study. Participants were assessed by interview and with questionnaires. Information on 120 participants was obtained. The mean number of units of alcohol consumed per week was 11.96 with a median of 6. Twenty‐eight per cent of the sample claimed to be abstinent, whereas 23 (19%) consumed units in excess of the recommended limit and eight (7%) suffered from alcohol‐abuse disorder. Twenty‐three (19%) participants also admitted to substance use, the majority cannabis. Of these, 10 were also hazardous drinkers. Two participants suffered from substance‐abuse disorder. Comorbidity of anxiety and mood disorders was high, with depression (48.7%), generalized anxiety disorder (36.5%), panic attack disorder (13.2%) and specific phobias (6.1%) being the most common. Other than a significant association between depression and substance use, comorbid disorders were not associated with alcohol consumption or substance use. Gender, the severity of threat to life during the trauma, age and arousal symptoms were significantly associated with the units of alcohol consumed. Age, life impairment and depression were significantly associated with substance use. The use of alcohol in this PTSD sample overall did not appear to differ from the general population. In a relatively small proportion of chronic civilian PTSD patients, alcohol and substance use may be problematic; however, the extent of this problem appears limited.     

Drinking,other substance use and suicidal ideation in middle adolescence: a population study

Aims To assess the relationship between self-reported suicidal ideation and alcohol and other substance use among 14-16-year-olds. Design, setting, participants A cross sectional school survey of 16 464 subjects aged 14-16 years in two Finnish regions. Findings Alcohol use frequency and any use of substances other than alcohol were significantly associated with suicidal ideation. Of girls (boys) who reported drinking weekly, 8% (7%) reported severe suicidal ideation compared with 1% (0.7%) of those not drinking. Of girls (boys) who reported use of substances other than alcohol five times or more, 13% (21%) reported severe suicidal ideation, compared with 1.3% (1.1%) of those who had no use of substances other than possibly alcohol. These associations persisted in multivariate analyses controlling for depressive symptoms and sociodemographic background. Conclusions Frequent alcohol use and use of substances other than alcohol independently indicate a risk for adolescent suicidal ideation and may thus represent an early warning signal for attempted suicides. School and health service personnel should pay attention to adolescents who drink frequently or experiment with or use drugs to improve the identification of suicidality and the possibilities for early intervention.     

Substance use by adolescents in the Western Developmental Region of Nepal

The health and well-being of adolescents is threatened by the use of psychoactive substances, such as tobacco, alcohol or other intoxicating substances. This study, carried out in 2011, explored substance use among 12–18-years-olds in the Western Developmental Region of Nepal, with 408 participants drawn from one urban school and two rural schools. Our aim was to identify the prevalence of psychoactive substance use, describe the related reasons, exposures and consequences and to discover the associations between substance use and various background factors. We evaluated the adolescents’ substance use with the Adolescents’ Substance Use Measurement and this showed that 10.5% of the adolescents used tobacco and 22.3% used alcohol and other intoxicants. Smoking and tobacco use was associated with gender, age and whether the fathers and grandparents smoked or drank and the use of intoxicants was associated with living in an urban area, the mother’s occupation and the father’s use of intoxicants. The adolescents at highest risk were older males and there was an association with the mother’s substance use. Our findings suggest that prevention programmes that tackle substance use among adolescents should focus on such factors as gender, age, living in urban areas and exposure at home.     

Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France

Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15–44 years included in the ‘Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey’, an annual cross‐sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005–2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58–0.88]) and with lower medication misuse (0.66 [0.49–0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio‐economic environment.     

Prevalent cord-stump care practices among mothers of infants: Against the backdrop of chlorhexidine digluconate gel scale-up

Within the context of Chlorhexidine scale-up, this cross-sectional study explores umbilical cord-stump care practices of mothers of infants in Enugu-North, and their perspectives on specific issues fueling unhygienic cord-stump care practices. Quantitative data were collected from 397 participants using a structured questionnaire. Cumulatively, 29.2% of the respondents resorted to unhygienic substances for cord-stump-care, and 11.3% of them used Chlorhexidine for care. Compared to mothers within the ‘22-26-year-old’ category, mothers within the ‘17-21-year-old’ category were more likely to desire a short time-to-cord-separation (OR = 2.1; 95% CI = 1.0–4.5). First-time mothers (OR = 5.9; 95% CI = 3.5–10.2) and younger mothers (OR = 152.8; 95% CI = 36.2–891.1) were more likely to yield to gatekeepers' opinions on newborn-care compared to non-first-time mothers and older mothers (32-40-year-old category), respectively. This study identifies putative predictors of newborn-care decisions within the context of Chlorhexidine scale-up. Further, the prevalence of Chlorhexidine use was low, and the use of unhygienic substances was significant.     

Substance use and associated emotional and behavioral problems in Nepalese adolescents

Background: Research has demonstrated that problem behavior has been associated with substance use, but knowledge is lacking on such associations in a low-income country like Nepal. Aims: This study aimed to find associations between emotional and behavioral problems and substance use among Nepalese adolescents. Method: A cross-sectional study was conducted at the end of 2011, with participants from three schools in the Province 4 of Nepal. We selected 408 adolescents aged 12 to 18 (mean 15.2 years, 54% boys) at one urban and two rural schools. The data were collected using the Youth Self-Report and Adolescents’ Substance Use Measurement. Results: Higher scores on withdrawn/depressed symptoms, thought problems, attention problems, delinquent or aggressive behavior or internalizing or externalizing problems were associated with the use of tobacco, alcohol or other substances. In the broadband scales, only internalizing problems predicted the use of intoxicants. Higher scores for attention problems predicted the use of tobacco, any intoxicants, and high-risk user. Conclusion: Our findings indicated that problem behavior among Nepalese adolescents was associated with substance use. Future studies should explore the association between problem behavior and substance use, including causal factors, so that risky behavior among Nepalese adolescents can be prevented.     

'Take my hand, help me out': mental health service recipients' experience of the therapeutic relationship

ABSTRACT: The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was ‘what is therapeutic about the therapeutic relationship?’ This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community‐dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health‐care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: ‘relate to me’, ‘know me as a person’, and ‘get to the solution’. The ways in which these participants described therapeutic relationships challenge some long‐held beliefs, such as the use of touch, self‐disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in‐depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.     

The prevalence of use,dependency and harms of legal ‘party pills’ containing benzylpiperazine (BZP) and trifluorophenylmethylpiperazine (TFMPP) in New Zealand

Piperazine‐based ‘party pills’ containing 1‐benzylpiperazine (BZP) and 1‐(m‐trifluorophenylmethylphenyl)piperazine (TFMPP) have become increasingly popular in New Zealand and many other countries. The aim of this study was to collect data on the population prevalence and related harm from legal party pill use in New Zealand. A national household sample of 2010 people aged 13–45 years old was collected using a computer‐assisted telephone interviewing (CATI) facility. Twenty per cent of the sample had tried legal party pills and 15% had used them in the previous year. Approximately 40% of males aged 18–24 years old had used legal party pills in the past year. While most users reported fairly minor problems from use, such as insomnia (50% of last year users), some users reported potentially more serious physical problems, such as ‘vomiting’ (12%), ‘inability to urinate’ (10%), ‘chest pains’ (4%) and ‘seizures’ (0.8%). Users also reported a range of psychological problems from use such as visual hallucinations (9%), paranoia (8%) and depression (8%). Two per cent of last year users were classified as dependent on legal party pills using a short dependency scale. The extent of harms and incidences of more serious problems, suggest that stricter regulation of the sale and use of legal party pills in New Zealand may be appropriate.     

Perceived risks of alcohol and illicit drugs: relation to prevalence of use on individual and country level

Background: Individual experience with substance use is considered as one of the principal factors influencing risk perception and attitudes of young people towards substance use. The aim of this article is to show the relationship between self‐reported prevalence and the subjectively perceived risks of substance use, both for individuals and at the country level.

Methodology: The relationships were analysed on a sample of students participating in the ESPAD survey in eight European countries. The sample of 22,899 students was divided into five groups: abstainers (9.3%), experimental alcohol consumers (52.0%), regular alcohol consumers (14.2%), experimental drug users (12.3%), and regular drug users (12.2%).

Findings: Significant differences were observed in the risk perception of use of selected substances among five types of users. The percentage of students perceiving moderate or great risks of substance use tends to fall across the groups with increasing prevalence of more risky patterns of substance use. Highest perceived risks of alcohol and illicit drugs use were found among abstainers and experimental alcohol consumers, while both experimental and regular drug users tend to perceive lower risks. Regular alcohol consumers perceive relatively high risks of illicit drug use, but they under‐estimate the risks of alcohol consumption. Country differences were observed in the level of perceived risks. These differences correspond to a different distribution of types of users and to the overall prevalence of substance use in individual countries.