Detecting a signal in the noise : Monitoring the global spread of novel psychoactive substances using media and other open source information

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Date of Acceptance: 16/02/2015To determine the feasibility and utility of using media reports and other open-source information collected by the Global Public Health Intelligence Network (GPHIN), an event-based surveillance system operated by the Public Health Agency of Canada, to rapidly detect clusters of adverse drug events associated with ‘novel psychoactive substances’ (NPS) at the international levelPeer reviewedFinal Published versio

Epidemiology of Co-morbid Substance Use Disorders and Major Depression

Background. Many patients with mental disorders receiving treatment in mental health centres are using illicit drugs while a large proportion of those in addiction care programs have significant mental health issues. Substance use disorder and major depression are highly prevalent in the general population. They frequently co-exist, share common biological, psychological and social risk factors and affect one another in clinically significant ways. Comorbid substance use disorder and major depression represent a major health problem globally. The primary goal of this thesis is to further our understanding of the relationship between substance use disorders and co-occurring major depressive disorder by applying different epidemiological methods. Methods. The study designs used in this thesis were cross-sectional design (Chapters 3,4 and 5), population cohort design (Chapter 6) and systematic review with meta-analysis (Chapter7). Existing datasets from Statistics Canada were used for Chapters 3,4,5 and 6 while the systematic review collected data via a computerized search for original studies. Trend (Chapter 3), multilevel logistics regression (Chapter 4), Multinomial logistics regression (Chapter 5), Poisson regression (Chapter 6) and meta-analysis (Chapter 7) were done. Descriptive analysis was also done for all chapters. Results. The pooled prevalence of substance use disorder comorbid with major depression is 3.2%. The prevalence of comorbid alcohol dependence and major depression increased from 1996 to 2012 in females, those 30 years and older, who had a household income of less than $50,000 and no post-secondary graduate level education. Individuals with substance dependence and cannabis dependence were about three times (pooled OR (95%CI): 3.62 (95%CI 2.82-4.63)) and five times (pooled OR (95%CI): 5.77 (95%CI 3.8-8.77)) more likely to have comorbid major depression. Alcohol dependence increased the risk of persistent or recurrent major depression by three-fold. Comorbid substance use disorder with major depression was significantly associated with increased disability and suicide ideation. Conclusion. Given the significant overlap in comorbid substance use disorder and major depression, it is crucial that co-occurring disorders are managed proactively and concurrently. The consensus of research evidence and clinical expertise is that the treatment of comorbid substance use and mental health disorders is insufficient if they are solely psychiatric focused or addiction focused. It is recommended that an integrated treatment approach should be adopted

A national snapshot of substance misuse among child and adolescent psychiatric inpatients in Malta

This paper reports on a patient record survey that was undertaken with the central aim of establishing reliable, baseline information to inform strategic planning and organisation of future CAMHS in Malta. The records of the total population of children and adolescents admitted into the psychiatric hospital over a five year period were surveyed. Results showed that the characteristics and circumstances of children and adolescents with mental disorder and comorbid substance misuse in Malta are similar to those described in international studies. The survey emphasized the pressing need for further research into this sub group and also highlighted gaps in reliable data systems locally.peer-reviewe

Cannabis Use: Insights from Social Control Theory and the Canadian Alcohol and Drug Use Monitoring Survey

Social control theory focuses on why some people do not commit deviant behaviours, such as illicit drug use. It proposes that bonding to conventional society constrains deviant conduct. In the book Causes of Delinquency, Hirschi distinguished four elements of social bonds: attachment, commitment, involvement, and belief. This study draws upon data from the 2012 Canadian Alcohol and Drug Monitor Survey to examine the effect of social control theory, specifically the element of attachment, on controlling cannabis use. This study also uses the element of attachment to interpret gender and rural/non-rural area differences in cannabis use. Two hypotheses are offered: (1) females are less likely to use cannabis than males because females have greater attachment to others; (2) rural residents are less likely to use cannabis than non-rural residents because rural residents have greater attachment to others. The research methods in the study are cross-tabulation analysis and binary logistic regression. The statistical analysis results support both hypotheses: females have a significantly lower rate of cannabis use than males and rural residents have a significantly lower rate of cannabis use than non-rural residents. Having greater attachment to others may be associated with a decreased rate of cannabis use. Policy and further research recommendations are made

A NATIONAL SNAPSHOT OF SUBSTANCE MISUSE AMONG CHILD AND ADOLESCENT PSYCHIATRIC INPATIENTS IN MALTA

This paper reports on a patient record survey that was undertaken with the central aim of establishing reliable, baseline information to inform strategic planning and organisation of future CAMHS in Malta. The records of the total population of children and adolescents admitted into the psychatric hospital over a five year period were surveyed. Results showed that the characteristics and circumstances of children and adolescents with mental disorder and comorbid substance misuse in Malta are similar to those described in international studies. The survey emphasised the pressing need for further research into this sub group and also highlighted gaps in reliable data systems locally

A Phenomenological Study of Prescription Drug Abuse Among Children and Youth

Prescription drugs ranked as the third highest substance used/abused among Canadian youth (Health Canada, 2014). This research is a retrospective phenomenological study on child and youth prescription drug abuse. Currently, there is a lack of qualitative research in this area. The primary goal of this study is to understand the lived experiences of child and youth prescription drug abuse in order to provide greater depth and breadth into the complexities of this behaviour. Based on the aim of this study, I developed the following research question: what are the lived experiences of prescription drug abuse during childhood and adolescence? Six participants were recruited from Narcotics Anonymous. Most of the participants were interviewed twice, in a face-to-face, semi-structured format. Participants were asked questions about their prescription drug abuse experiences. Two themes emerged as a result of thematic analysis: ‘risk factors’ and ‘lived experiences of prescription drug abuse.’ The socialization and normalization of prescription drugs emerged as key risk factors for the facilitation of prescription drug abuse. Prescription drug abuse provided temporary health benefits, but also produced a number of serious health detriments for some of the participants in this study. As such, the participants perceived their abuse of these drugs as either unproblematic, or as an addiction. More importantly, some of the participants struggled with determining whether or not they were actually addicted to these drugs. Ultimately, this study expands our current knowledge and understanding of child and youth prescription drug abuse

SYMBOLIC POLICY AND ALCOHOL ABUSE PREVENTION IN YOUTH

In Canada, the prevalence of alcohol use among school-age students has emerged as a leading public health issue. Though governments at all levels have called for inter-organizational collaboration to address the issue, the representation of youth interests by key community groups is critical to the efficacy of those initiatives. This article describes the case of a community project supported by provincial and local governments in which an integrated community centre (ICC) was combined with a new high school. The ICC included a soccer centre, a track, and a licensed beverage room on the premises that opened on a daily basis. Government support for the ICC policy and related values is examined from the perspective of symbolic policy. The point is argued that the best interests of youth (the main interest group associated with the ICC) must be defined, represented and mobilized materially and symbolically in policy related to their well-being.