Perceived harms and benefits of parental cannabis use, and parents’ reports regarding harm-reduction strategies

This research focussed on families in which at least one parent was a long-term cannabis user; I explored family members’ perceptions of the benefits and harms of cannabis use and the strategies parents used to minimise cannabis-related harm to themselves and their children. In depth, semi-structured interviews were undertaken with 43 individuals from 13 families, producing a series of family case studies that enabled examination of multiple perspectives within each family. In Study 1, I used an interpretive framework guided by Miles and Huberman’s (1994) thematic content analysis technique to analyse interview data, while study 2 yielded detailed descriptive vignettes that examined how the use of cannabis played out in particular families. Cannabis users have been portrayed as stereotypically lazy, unhealthy, deviant, and criminal. However, this was not the case with the current sample, whose lifestyles revolved around employment and family life. Parents claimed to use cannabis in a responsible way that minimised harm to self and family. Few reported personal experiences of harm and most did not believe that their children had been adversely affected by their use of cannabis. Nonetheless, children’s awareness of parental cannabis use, and access to the parent’s cannabis supply, occurred at a younger age than parents suspected. Parents reported harm reduction strategies that targeted five broad areas: (1) Dosage control; (2) Dependency; (3) Acute risk; (4) Long-term harm; and (5) Harm to children. The current study points to common-sense ways of reducing harm, such as being discreet about cannabis use; using less potent strains; prioritising family and work responsibilities; being careful about where cannabis was obtained; not mixing cannabis with tobacco; and limiting any financial outlay. The harm reduction strategies identified in this research might be helpful in the forensic evaluation, safety planning, and treatment of parental cannabis use. The validity of the current findings was enhanced by having independent data on the same topic from each family member’s point of view, including non-using partners and children, and by including both convergent and divergent data

Family influences on adolescent alcohol use

The thesis explores influences of the alcohol-specific (e.g. alcohol use, attitudes) and nonalcohol-specific (e.g. relationship quality) family environment on similarity and differences in adolescent siblings' alcohol use. Previous research has shown the importance of siblings for adolescent adjustment (Plomin & Daniels, 1987; Rowe & Gulley, 1992). However, research exploring family influences on siblings' alcohol use is scarce in the UK. Using a variety of theoretical perspectives, this thesis attempts to make a comprehensive account of family influence. Social learning principles (Bandura, 1977) such as modelling-imitation and reinforcement (via attitudes, norms) are considered as alcohol-specific mechanisms within families, accounting for similarity in parent-child dyads and sibling pairs. Regarding the influence of the non-alcohol-specific family environment, it is drawn on family systems theory (Minuchin, 1985), stresses and strains on parenting, and differential parenting approaches. This explores interrelations between marital, parent-child, and sibling relationships, and adolescent alcohol use (Hetherington et ah, 1999) within which models of siblings' differential intrafamilial experiences are integrated. Particular attention is given to the role of gender throughout this thesis.The study reported here used a cross-sectional design. It included 116 intact families, applying a multiple informant approach. During home visits, each parent and two siblings (younger siblings: 11-15 years, older siblings: 14-19 years) completed standardised questionnaires on demographics, alcohol/substance use, attitudes, family relationships, and other aspects of adolescents' life, combining self-reports and perceptions of others. The analysis is divided into three results sections and employs a variety of statistical methods (descriptive statistics, correlational and regression analyses, analysis of variance).Descriptive results (Chapter 5) of the level of family members' alcohol/substance use indicate that both parental and adolescents' use was lower than national surveys suggest. Differences in individual family members' self-reports and perceptions of the family environment support the use of self-reports of alcohol use and repeated analysis employing parent and child reports of family relationships.Findings on the alcohol-specific environment (Chapter 6) confirmed social learning processes. Male adolescents' alcohol use was related to parental and brothers' modelling, with parental norms being influential for older males' consumption. No such associations emerged for females regarding their parents or sisters. Older siblings' supply of alcohol was significantly associated with younger siblings' (excessive) alcohol use, but only among same-sex siblings. Neither parental alcohol norms nor perceived sanctions of adolescent alcohol use varied as a function of sibling gender similarity, but same-sex siblings experienced stricter parental alcohol norms than mixed-sex pairs.In relation to the non-alcohol-specific family environment (Chapter 7), parental alcohol use showed few disruptive effects on parenting behaviour. Marital quality affected the parent-child relationships of both siblings which in turn predicted sibling relationship quality, suggesting congruence in the quality among these family subsystems. Parenting toward each adolescent influenced this child's alcohol involvement. Younger adolescents showed lower alcohol use when their older sibling was exposed to marital discord. Generally, receiving the more favourable treatment relative to one's sibling resulted in lower alcohol involvement relative to this sibling. Sibling gender similarity moderated the siblings' level of monitoring and associations within the difference score models.Overall, the findings demonstrate the importance of the wider family environment for siblings' alcohol use and the role of gender in processes of social influence. Both parents and siblings provide opportunities for social learning of alcohol use. Child-specific experiences were the best predictors of adolescent alcohol use. However, the similarity in the climate of various family relationships reflects the importance of shared, family-level influences. Implications for alcohol education and prevention and recommendations for further research are discussed

Addictions

Addiction, increasingly perceived as a heterogeneous brain disorder, is one of the most peculiar psychiatric pathologies in that its management involves various, often non-overlapping, resources from the biological, psychological, medical, economical, social, and legal realms. Despite extensive efforts from the players of these various fields, to date there are no reliably effective treatments of addiction. This may stem from a lack of understanding of the etiology and pathophysiology of this disorder as well as from the lack of interest into the potential differences among patients in the way they interact compulsively with their drug. This book offers an overview of the psychobiology of addiction and its current management strategies from pharmacological, social, behavioural, and psychiatric points of view

Opioid and stimulant use among a sample of corrections-involved drug users : seeking an understanding of high-risk drug decisions within a system of constraint.

In the United States, high-risk drug use remains a significant social problem. Opioids and stimulants are two drug classes that have contributed to substantial recent increases in drug-related arrests, overdose, and mortality. Kentucky has been particularly devastated by high rates of opioid and stimulant use. Opioid and stimulant effects, while highly rewarding, can result in adverse consequences. Still, some people choose to use these drugs, and choose to continue using even after experiencing adverse consequences, such as incarceration. The aim of this study was to explore high-risk drug use among a sample of corrections-involved adults in Kentucky and to identify endogenous and exogenous factors with the potential to have influenced drug-related decision-making prior and subsequent to incarceration. Attention was paid to understanding concomitant opioid and stimulant use and heroin use. Survey data collected as part of an ongoing corrections-based substance use treatment program outcomes study were examined. The final sample (N=1,563) included adults released into Kentucky counties between 2012-2017. Non-parametric statistical tests and multinomial logistic regression were used to identify factors associated with opioid, stimulant, and concomitant use; binary logistic regression was used to identify factors associated with heroin use. Results indicate that opioid and stimulant use was endemic in this sample, though rates of use subsequent to incarceration were lower than pre-incarceration rates. During the 30-day period prior to incarceration, 29.0% of participants reported concomitant use, 28.5% reported opioid use, and 18.0% reported stimulant use. During the one-year post-release period, 11.9% of participants reported concomitant use, 12.5% reported opioid use, and 8.3% reported stimulant use. During this post-release period, 10.7% reported heroin use. Concomitant and heroin use positively correlated with many factors with the potential to adversely influence cognition and constrain choice. Similar relationships between many of these factors and outcomes involving other drug or no drug use were not observed. Behavioral economics, a molar view of choice and behavior, was used to conceptualize how factors in the lives of participants had the potential to influence and constrain decision-making in respect to high-risk drugs. Findings are discussed in light of how they may inform future research, policy, and practice

Essential Notes in Psychiatry

Psychiatry is one of the major specialties of medicine, and is concerned with the study and treatment of mental disorders. In recent times the field is growing with the discovery of effective therapies and interventions that alleviate suffering in people with mental disorders. This book of psychiatry is concise and clearly written so that it is usable for doctors in training, students and clinicians dealing with psychiatric illness in everyday practice. The book is a primer for those beginning to learn about emotional disorders and psychosocial consequences of severe physical and psychological trauma; and violence. Emphasis is placed on effective therapies and interventions for selected conditions such as dementia and suicide among others and the consequences of stress in the workplace. The book also highlights important causes of mental disorders in children

Evidence-based screening, brief intervention and referral to treatment for substance-using adolescents with delinquent-type behaviours

Includes bibliographical references.Background: Both substance use and delinquent-type behaviours are prevalent among adolescents in Cape Town, South Africa. However, early interventions in developed countries for adolescents with similar problems are not available in many low and middle income countries, including South Africa. This is a concern as providing evidence-based interventions that address these dual behavioural problems may prevent their progression. There is thus a need for identifying and understanding the kinds of interventions that would be able to address both of these problems Aim: The aim of this thesis is to identify an evidence-based intervention for reducing adolescent substance use and delinquent-type behaviours and adapt it for use among adolescents in Cape Town, South Africa. Method: This study comprised six parts. Study I utilised a longitudinal data set to examine the association between substance use and delinquent-type behaviours, as well as the trajectory of these behaviours among school-going adolescents in Cape Town. As one needs to know how to identify adolescents who would benefit from such an intervention, Study II identified suitable screening tools for identifying these adolescents. While screening tools are generally brief instruments to identify problems with substance use, assessment instruments for those adolescents who screen positive would more comprehensively assist in the further evaluation of their problem behaviours, as well as measure other risk factors for substance use and delinquent-type behaviour. Study III therefore tested and adapted assessment tools for those adolescents who screen positive for substance use and delinquent-type behaviour. The next step was to identify a suitable evidence-based brief intervention that addressed substance use and delinquent-type behaviours in an integrated manner. Study IV consisted of a systematic review and meta-analysis to identify such an intervention. As only studies from developed countries were included in the review, the final two studies concentrated on adapting the intervention identified in Study IV with service providers and adolescents in focus groups 6. Study V consisted of a cultural adaptation which tested the ecological validity of the identified brief intervention in Cape Town communities. Study VI was a content adaptation that modified the brief intervention for adolescents in this context, and to include a focus on delinquent-type behaviours. Results: The final result is a screening, brief intervention and referral to treatment (SBIRT) package that is ready to be tested for efficacy on substance use and delinquent type behavioural outcomes. Each study contributes to the different components that make up this package. The results from the longitudinal study indicated that while substance use is not predictive of delinquent-type behaviours, these two behaviours co-occur at different stages of adolescence. In addition, adolescents that smoked and were delinquent were at significantly higher risk of engaging in later delinquent-type behaviour. This suggests that it would be efficient to address the two risk behaviours simultaneously using an integrated intervention. The GAIN-SS was identified as an easy-to-use and psychometrically sound short screener for identifying adolescents with both problems who may benefit from a brief intervention. The comprehensive assessment tool developed for use if an adolescent screens positive and may therefore be eligible for such a brief intervention, measured the following core domains: substance use, delinquency, parenting practices, peer substance use and readiness to change. These were modified based on both adolescent participants’ and experts’ recommendations. Following assessment, Teen Intervene was identified as the brief intervention which was the most effective in reducing early adolescent substance use and consequences related to substance use. While this promising intervention addresses substance use and behavioural outcomes broadly, it did not do so in an integrated and comprehensive manner. Teen Intervene was also only tested in one population, and the results of the qualitative studies (V and VI) were therefore helpful in the adaptation of the intervention. Qualitative work found that the context that adolescents in the study have been exposed to within their home setting, school and community, as well as their relationships with people within these settings, influence their engagement in risk behaviours. Therefore ensuring ecological validity is important when modifying the identified intervention for use in Cape Town. The intervention was expanded to include a focus on delinquent-type behaviours and a handbook was developed for adolescents that contained information from the, skills-building exercises, as well as goal setting from the original intervention for the individual adolescent. Recommendations for the implementation of this intervention showed that the types of recruitment strategies in place may affect the uptake of services, and organisational factors (organisational readiness, staff issues, available resources) may affect the delivery of intervention services. Such issues should be taken into account before implementation takes place. Conclusion: This thesis is one of the first to investigate the relationship between substance use and delinquent-type behaviours in a developing country setting. It describes the identification of an SBIRT package for substance use and delinquent type behaviours among adolescents, and how these were adapted to develop an integrated intervention that addresses both of these problems. This adapted intervention may provide an option of tailor-made services for adolescents in disadvantaged communities in Cape Town, where adolescents are often affected by a host of social problems but where a lack of resources are available to address these problems. The contextual and content-based adaptation processes highlighted the importance of working with adolescents directly to ensure that the intervention adequately addressed the local context as well as the specific issues that they face, at their level of understanding. The engagement of service providers, who may be trained to deliver this integrated intervention package, was also important to address possible challenges that could occur while delivering the intervention. The next steps in the process would be to implement the adapted version of the intervention to iron out some of the potential implementation issues that were alluded to above, and ultimately to assess its efficacy in addressing the very real social conditions described in Chapter 1

Technologies for Understanding and Preventing Substance Abuse and Addiction

This report has four parts. The first part focuses on several factors that are necessary for substance abuse and addiction to occur, including an examination of the biological research regarding the phenomenon of addiction to a variety of substances. The second part describes individual risk and protective factors that contribute to the abuse of, and addiction to, alcohol and drugs. The third part, looks at how risk and protective factors play out in subcultures and in major activity settings (home, school, workplace, and recreation), and assesses the effectiveness of various substance abuse prevention initiatives. The fourth section, addresses a range of legislative issues and options for Congress arising from an understanding of the factors leading to substance abuse and addiction

Textbook of Psychiatry First Edition, Draft 2

This multi-authored collaborative textbook on psychiatry, originally created on Wikibooks, discusses a range of psychiatric disorders, including psychotic, mood and and anxiety disorders, amongst many others. It covers other aspects of psychiatric care such as diagnosis, neurobiology, psychopharmacology, treatment methods, and dealing with agitated or violent patients