3,891 research outputs found

    Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice

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    An apparent shortage of psychiatric beds in many areas has created a situation in which involuntary commitment may be seen as a virtual entitlement—a way to prioritize intensive mental health services for individuals who would have difficulty accessing these services otherwise. Constraints on access greatly influence involuntary commitment practice and policy. Outpatient commitment, commonly termed “Assisted Outpatient Treatment” (AOT), may serve as a portal to services in some communities, using the legal leverage of commitment law. To meet these challenges in a shifting policy landscape, some guidance is needed to assist state policymakers and practitioners in reforming, implementing, and appropriately targeting commitment law and practice—both inpatient and outpatient—to the small proportion of adults who require and may benefit from its use. Part I of this report reviews the history and current status of involuntary commitment in the United States. Part II sets forth expert consensus principles to guide the optimal, ethical use of commitment. Part III provides practical tools— briefly stated guidelines and a checklist of requirements—to assist policy makers and others responsible for reforming or implementing civil commitment laws or systems

    Characteristics of facilities with specialized programming for drinking drivers and for other criminal justice involved clients: analysis of a national database

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    <p>Abstract</p> <p>Background</p> <p>Offering specialized programming at substance abuse treatment facilities can help diversify clientele and funding sources, potentially enhancing the facilities' ability to survive and/or expand. Past research has shown that facilities only offering specialized programming for driving under the influence/driving while intoxicated offenders (DUI) are predominately private-for-profit owned. As criminal justice populations, both DUI and other criminal justice offenders, comprise a large proportion of those in community-based substance abuse treatment knowing facilities' characteristics would be important for administrators and policymakers to consider when updating programming, training staff or expanding capacity to ensure efficient use of scarce resources. However, while such characteristics are known for DUI programs, they are not known for facilities offering specialized programming for other criminal justice offenders.</p> <p>Methods</p> <p>Analysis of the 2004 US National Survey of Substance Abuse Treatment Facilities.</p> <p>Results</p> <p>Almost half the facilities (48.2%) offered either DUI or other criminal justice specialized programming. These facilities were divided between those offering DUI specialized programming (17.7%), other criminal justice specialized programming (16.6%) and both types of programming (13.9%). Certain characteristics were independently associated with offering DUI specialized programming (private ownership, rural location, for profit status) or other criminal justice specialized programming (receiving public funds, urban location, region of country).</p> <p>Conclusion</p> <p>Offering specialized programming for DUI or other criminal justice offenders was common and associated with distinct characteristics. These observed associations may reflect the positioning of the facility to increase visibility, or diversify clientele and possibly funding streams or the decision of policymakers. As the criminal justice populations show no sign of decreasing and resources are scarce, the efficient use of resources demands policymakers recognize the prevalence of these specialized programming, join forces to examine them for efficacy, and explicitly incorporate these characteristics into strategies for workforce training and plans for treatment expansion.</p

    Utilisation non mĂ©dicale des mĂ©dicaments d’ordonnance chez les adolescents utilisant des drogues au QuĂ©bec

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    Abstract : OBJECTIVE: To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. METHOD: Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. RESULTS: Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. CONCLUSIONS: The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.OBJECTIF: DĂ©terminer la prĂ©valence de l’utilisation non mĂ©dicale des mĂ©dicaments d’ordonnance (UNMMO) et les facteurs qui y sont associĂ©s chez les adolescents (de 12 Ă  17 ans) qui utilisent des drogues au QuĂ©bec. MÉTHODE: Des analyses de donnĂ©es secondaires ont Ă©tĂ© exĂ©cutĂ©es avec les donnĂ©es d’une Ă©tude de 6 mois, l’EnquĂȘte quĂ©bĂ©coise sur la santĂ© des jeunes du secondaire 2010-2011, une enquĂȘte de grande envergure visant Ă  obtenir une meilleure comprĂ©hension de la santĂ© et du bien-ĂȘtre des jeunes quĂ©bĂ©cois du secondaire. Des analyses de rĂ©gression logistique bivariĂ©e et multivariĂ©e ont Ă©tĂ© menĂ©es pour Ă©tudier l’UNMMO chez les adolescents qui utilisent des drogues, selon les facteurs des caractĂ©ristiques sociodĂ©mographiques, des caractĂ©ristiques des pairs, des indicateurs de la santĂ© (anxiĂ©tĂ©, dĂ©pression, ou trouble de dĂ©ficit de l’attention [TDA] avec ou sans hyperactivitĂ©), de l’autoefficacitĂ©, de l’environnement familial, et de l’utilisation de substances (utilisation d’alcool et de drogues). RÉSULTATS: Parmi les adolescents qui avaient utilisĂ© des drogues dans les 12 mois prĂ©cĂ©dents, 5,4 % (IC Ă  95 % 4,9 % Ă  6,0 %) dĂ©claraient une UNMMO. Selon les analyses multivariĂ©es, un TDA (ratio de cotes ajustĂ© [RCC] 1,47; IC Ă  95 % 1,13 Ă  1,91), un trouble anxieux (RCC 2,14; IC Ă  95 % 1,57 Ă  2,92), une faible estime de soi (RCC 1,62; IC Ă  95 % 1,26 Ă  2,08), un faible autocontrĂŽle (RCC 1,95; IC Ă  95 % 1,55 Ă  2,45), une faible supervision parentale (RCC 1,43; IC Ă  95 % 1,11 Ă  1,83), une utilisation d’alcool rĂ©guliĂšre (RCC 1,72; IC Ă  95 % 1,36 Ă  2,16), et une utilisation de polysubstances (RCC 4,09; IC Ă  95 % 3,06 Ă  5,48) Ă©taient associĂ©s Ă  des probabilitĂ©s accrues de dĂ©clarer une UNMMO. CONCLUSIONS: La prĂ©valence observĂ©e de l’UNMMO Ă©tait plus faible que prĂ©vu. Cependant, les associations notĂ©es entre certains troubles de santĂ© mentale et l’utilisation rĂ©guliĂšre ou intensive d’autres substances psychoactives sont inquiĂ©tantes. Les implications cliniques sont discutĂ©es

    Does alcohol catch the eye? Investigating young adults’ attention to alcohol consumption

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    Many studies on young adults' motivations for drinking overlook the symbolic aspects of alcohol use. However, research indicates that young adults' alcohol consumption is also driven by signaling motivations. Although the interest of a receiver is a necessary prerequisite of a signal, no previous studies have verified whether drinking behavior indeed attracts young adults' attention. Therefore, we conducted two studies. A two-part eye-tracking study ( N1 = 135, N2 = 140) showed that both young men and young women pay special visual attention to male and female drinking behavior. Additionally, a recall experiment ( N = 321) confirmed that observed male and female drinking is better remembered than observed nonsignaling, functional behavior. Moreover, alcoholic beverages also receive special attention, as they were recalled better than other functional products, and also nonalcoholic drinks similar in color and shape. In summary, the experiments clearly showed that male and female drinking behavior can be used as a signal, as both behaviors clearly function as an attention-attracting cue. Additionally, as alcoholic beverages draw more attention than nonalcoholic drinks, this attention is clearly linked to the alcohol element of the drinking behavior

    Adolescent inhalant use, abuse and dependence

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    Aims  To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design  Cross-sectional survey with structured psychiatric interviews. Setting  Facilities ( n  = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants  Current MDYS residents ( n  = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11–20); more than one-third (38.6%, n  = 279) reported life-time inhalant use. Measurements  Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings  Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions  Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72164/1/j.1360-0443.2009.02557.x.pd

    Changes in managed care activity in outpatient substance abuse treatment organizations, 1995–2000

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    Using nationally representative data from 1995 and 2000, this study examines trends in managed care penetration and activity among outpatient drug treatment organizations in the United States. Further, it investigates how managed care activity varies across different types of treatment providers and for public and private managed care programs. Overall, managed care activity has increased, with a greater proportion of units having managed care arrangements and a larger percentage of clients covered by managed care. In general, public managed care activity has increased and private managed care activity has decreased. Treatment providers report that they have fewer managed care arrangements, which may reflect consolidation in the managed behavioral care sector. Finally, growth in managed care among outpatient substance abuse treatment units affiliated with hospitals and mental health centers may signal a preference for providers that can effectively link substance abuse treatment with medical and social service provision, or, alternatively, that linkages with such organizations may provide the size necessary to assume the risks associated with managed care contracts.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45778/1/11414_2005_Article_BF02287425.pd

    Non‐medical use of prescription opioids during the transition to adulthood: a multi‐cohort national longitudinal study

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    Aims To examine non‐medical use of prescription opioids ( NMUPO ) patterns during the transition from adolescence to adulthood, and assess individual characteristics and other substance use behaviors associated with longitudinal patterns of NMUPO . Design Nationally representative samples of high school seniors in the U nited S tates (wave 1: modal age 18 years) were followed longitudinally across three biennial follow‐up waves (waves 2, 3 and 4: modal ages 19/20, 21/22 and 23/24 years). Setting Data were collected via self‐administered questionnaires to high school seniors and young adults. Participants The longitudinal sample consisted of 27 268 individuals in 30 cohorts (high school senior years 1976–2005) who participated in all four waves. Measurements Self‐reports of NMUPO and other substance use behaviors. Findings Approximately 11.6% [95% confidence interval ( CI)  = 11.2%, 12.0%] of the sample reported past‐year NMUPO in at least one of the four waves. Among those who reported past‐year NMUPO in at least one wave, 69.0% (67.6%, 70.4%), 20.5% (19.3%, 21.7%), 7.8% (7.1%, 8.6%) and 2.7% (2.3%, 3.1%) reported NMUPO at one, two, three and four waves, respectively. Several wave 1 variables were associated with greater odds of multiple waves of NMUPO and individuals who reported more waves of NMUPO had greater odds of other substance use behaviors. Conclusions Although most non‐medical use of prescription opioids among 18‐year‐olds in the U nited S tates appears to be non‐continuing, approximately one‐third of the sample reporting non‐medical use of prescription opioids appear to continue use beyond age 18 and have elevated odds of other substance use behaviors at ages 23/24.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102152/1/add12347.pd

    Introducing a trauma-informed capability approach in youth services

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    Trauma-informed practice has been developing for decades, though much remains unknown regarding how it is understood and practised. Drawing upon focus group data from an evaluation of a trauma-informed approach (TIA) implemented by an organisation in Southeast England, this paper provides a unique perspective of 31 staff members and 18 young people. Results indicate how choice and control, key elements of a TIA, align with the Capability Approach (CA). The CA is then used as a novel analytic framework to examine the data. A ‘Trauma-Informed Capabilities Approach’ is introduced as a holistic, person-centred way of conceptualising young trauma survivors’ wellbeing
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