Addressing excess risk of overdose among recently incarcerated people in the USA: Harm reduction interventions in correctional settings

Purpose-The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach-Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings-Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value-In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement

The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: A moderated mediation analysis

This study investigated the incidence of posttraumatic stress disorder (PTSD) and psychiatric co-morbidity following epileptic seizure, whether alexithymia mediated the relationship between self-efficacy and psychiatric outcomes, and whether the mediational effect was moderated by the severity of PTSD from other traumas. Seventy-one (M=31, F=40) people with a diagnosis of epilepsy recruited from support groups in the United Kingdom completed the Posttraumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20 and the Generalized Self-Efficacy Scale. They were compared with 71 people (M=29, F=42) without epilepsy. For people with epilepsy, 51% and 22% met the diagnostic criteria for post-epileptic seizure PTSD and for PTSD following one other traumatic life event respectively. For the control group, 24% met the diagnostic criteria for PTSD following other traumatic life events. The epilepsy group reported significantly more anxiety and depression than the control. Partial least squares (PLS) analysis showed that self-efficacy was significantly correlated with alexithymia, post-epileptic seizure PTSD and psychiatric co-morbidity. Alexithymia was also significantly correlated with post-epileptic seizure PTSD and psychiatric co-morbidity. Mediation analyses confirmed that alexithymia mediated the path between self-efficacy and post-epileptic seizure PTSD and psychiatric co-morbidity. Moderated mediation also confirmed that self-efficacy and PTSD from one other trauma moderated the effect of alexithymia on outcomes. To conclude, people can develop posttraumatic stress disorder symptoms and psychiatric co-morbidity following epileptic seizure. These psychiatric outcomes are closely linked with their belief in personal competence to deal with stressful situations and regulate their own functioning, to process rather than defend against distressing emotions, and with the degree of PTSD from other traumas. © 2013 Elsevier Ireland Ltd

Capitalizing on Place: An Investigation of the Relationships among Social Capital, Neighborhood Conditions, Maternal Depression, and Child Outcomes

In this dissertation I employ an ecological framework to understand the co-occurring influence of the individual, family, and community on child and maternal well-being. Specifically, I investigate the relationship of neighborhood socioeconomic disadvantage and social capital as it applies to child behavior problems, child academic skills, and maternal depression, while also accounting for individual and family characteristics. In all three studies, I analyze data from the Los Angles Family and Neighborhood Survey (L.A. FANS) using multilevel linear regression. In the first study, I investigate the association of neighborhood and maternal characteristics with child and adolescent behavior problems. The results showed that children and adolescents of depressed mothers, and children living in high poverty neighborhoods, had more internalizing and externalizing behavior problems. Finally, although neighborhood social capital was not directly associated with behavior, social capital did attenuate the relationship between maternal depression and higher levels of adolescent behavior problems.In the second study, I demonstrate that children of depressed mothers performed worse on measures of reading ability and math computation skills. Also, children living in neighborhoods higher in social capital performed better on the measure of math computation compared to children living in lower social capital neighborhoods. However, social capital was not associated with either of the measures of reading achievement. In addition, neighborhood socioeconomic disadvantage was not significantly associated with any of the academic outcomes. I also did not find that social capital moderated the relationship between maternal depression and child academic skills.In the third study, I focus on the importance of neighborhood characteristics as predictors of depression among Latina mothers. I also investigated how neighborhood structural characteristics - socioeconomic disadvantage, residential stability and the percent of Latinos in the community, are associated with social capital. As expected, residential stability was positively, while socioeconomic disadvantage was negatively, associated with social capital. Contrary to my hypothesis about the protective effects of living in a neighborhood with a higher percent of co-ethnics, an ethnic enclave, the percent of Latinos in the community was negatively associated with social capital. However, as predicted, neighborhood social capital was negatively associated with depression for Latinas

Capitalizing on Place: An Investigation of the Relationships among Social Capital, Neighborhood Conditions, Maternal Depression, and Child Outcomes

In this dissertation I employ an ecological framework to understand the co-occurring influence of the individual, family, and community on child and maternal well-being. Specifically, I investigate the relationship of neighborhood socioeconomic disadvantage and social capital as it applies to child behavior problems, child academic skills, and maternal depression, while also accounting for individual and family characteristics. In all three studies, I analyze data from the Los Angles Family and Neighborhood Survey (L.A. FANS) using multilevel linear regression. In the first study, I investigate the association of neighborhood and maternal characteristics with child and adolescent behavior problems. The results showed that children and adolescents of depressed mothers, and children living in high poverty neighborhoods, had more internalizing and externalizing behavior problems. Finally, although neighborhood social capital was not directly associated with behavior, social capital did attenuate the relationship between maternal depression and higher levels of adolescent behavior problems.In the second study, I demonstrate that children of depressed mothers performed worse on measures of reading ability and math computation skills. Also, children living in neighborhoods higher in social capital performed better on the measure of math computation compared to children living in lower social capital neighborhoods. However, social capital was not associated with either of the measures of reading achievement. In addition, neighborhood socioeconomic disadvantage was not significantly associated with any of the academic outcomes. I also did not find that social capital moderated the relationship between maternal depression and child academic skills.In the third study, I focus on the importance of neighborhood characteristics as predictors of depression among Latina mothers. I also investigated how neighborhood structural characteristics - socioeconomic disadvantage, residential stability and the percent of Latinos in the community, are associated with social capital. As expected, residential stability was positively, while socioeconomic disadvantage was negatively, associated with social capital. Contrary to my hypothesis about the protective effects of living in a neighborhood with a higher percent of co-ethnics, an ethnic enclave, the percent of Latinos in the community was negatively associated with social capital. However, as predicted, neighborhood social capital was negatively associated with depression for Latinas

A Laboratory-Based Study of the Relationship Between Childhood Abuse and Experiential Avoidance Among Inner-City Substance Users: The Role of Emotional Nonacceptance

Despite the theorized centrality of experiential avoidance in abuse-related psychopathology, empirical examinations of the relationship between childhood abuse and experiential avoidance remain limited. The present study adds to the extant literature on this relationship, providing a laboratory-based investigation of the relationships between childhood sexual, physical, and emotional abuse, experiential avoidance (indexed as unwillingness to persist on 2 psychologically distressing laboratory tasks), and self-reported emotional nonacceptance among a sample of 76 inner-city treatment-seeking substance users. As hypothesized, results provide evidence for heightened experiential avoidance and emotional nonacceptance among individuals with moderate-severe sexual, physical, and emotional abuse (compared to individuals reporting none-low abuse). However, although emotional nonacceptance was associated with increased risk for experiential avoidance, it mediated the relationship between childhood abuse and experiential avoidance only for emotional abuse. As such, results suggest that one mechanism through which emotional abuse in particular leads to experiential avoidance is emotional nonacceptance. Findings suggest the utility of interventions aimed at decreasing experiential avoidance and promoting emotional acceptance among abused individuals

Temperamental and Environmental Risk Factors for Borderline Personality Disorder Among Inner-City Substance Users in Residential Treatment

Borderline Personality Disorder (BPD) is widely considered the result of biological vulnerability and environmental adversity. Despite growing evidence for the role of several temperamental and environmental risk factors in the development of BPD, the unique contribution of each to the development of this disorder remains unclear. Furthermore, the extent to which these factors are associated with BPD among underserved and diverse populations is unknown. The current study examined the temperamental and environmental factors uniquely associated with BPD among a sample of 93 inner-city individuals receiving residential substance use treatment. Results indicate that BPD was associated with higher impulsivity and emotional instability/vulnerability, lower well-being, and several interpersonal manifestations of positive and negative temperament (i.e., greater alienation and lower achievement and social closeness). BPD was also associated with several forms of childhood maltreatment, including emotional and physical abuse and neglect. However, only emotional instability or vulnerability, impulsivity, and emotional abuse emerged as unique predictors of BPD status