"You can never work with addictions in isolation":Addressing intimate partner violence perpetration by men in substance misuse treatment

AbstractBackgroundStudies have shown rates of IPV-perpetration among men in substance misuse treatment at rates far higher than the general population. There is poor evidence for the effectiveness of IPV perpetrator programmes.MethodsAn analysis of drugs and alcohol policy documents 1998–2015 was conducted using discourse analysis to examine how English drug and alcohol policy has addressed IPV among substance misusers. Transcripts of interviews with 20 stake holders were analysed thematically.ResultsHow policy ‘frames’ IPV-perpetration among drug and alcohol misusers has implications for service provision. IPV has increasingly been framed in terms of its implications for child safeguarding, and has been ‘folded in’ to policies targeting Troubled Families. With increasing ‘localism’ in English drug and alcohol policy there has been little specification of services for substance misusing IPV-perpetrators. Policy and literature produced by IPV perpetrator and victim organisations has framed IPV-perpetration as an individual choice with intoxication as a post hoc excuse for violence with limited implications for effective service development. Interviews with stake holders indicate a range of understandings/explanations for IPV among substance misusing men. Stake holders suggest that not all staff have the confidence or skills to ask men about their relationships and that there are few referral routes for substance misusing men who seek help for their IPV perpetration.ConclusionThere are gaps and contradictions in the extent to which English drug and alcohol policy has sought to address IPV-perpetration among substance misusers. Recent National Institute for Health and Care Excellence guidance provide an opportunity to include domestic abuse training for all front line social care staff including in the substance misuse sector. There is a need for further research into effective services for substance misusing perpetrators and the development of training for front-line staff

Factors associated with discharge against medical advice from an inpatient alcohol and drug detoxification unit in Barcelona during 1993-2006

Records from 1,228 consecutively admitted patients (74.5% male) to an inpatient detoxification unit in Barcelona during 1993-2006 were examined to determine factors associated with discharge against medical advice (AMA). 21.5% of admissions were discharged AMA. In multiple logistic regression and compared to patients who were medically discharged; those discharged AMA were younger, more likely to be dependent on heroin, other opiates, cocaine or psychostimulants or be receiving suppression from methadone maintenance therapy [reference category: alcohol]. Assisting clinicians to identify patients most at risk for leaving inpatient detoxification AMA will enhance their ability to motivate such patients to remain in treatment

Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland

Aims: To compare psychiatric morbidity between 176 female drug users with lifetime involvement in prostitution (prostitutes) and 89 female drug users with no involvement (non-prostitutes) in Glasgow, Scotland. Method: The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. Results: Prostitutes were more likely to report adult physical (OR 1.8) or sexual abuse (OR 2.4), to have attempted suicide (OR 1.7) and to meet criteria for current depressive ideas (OR 1.8) than non-prostitutes. Seventy-two percent of prostitutes and sixty-seven percent of non-prostitutes met criteria for a level of current neurotic symptoms likely to need treatment (CIS-R ≥18). Being in foster care (OR 8.9), being prescribed medication for emotional problems in the last 30 days (OR 7.7), adult sexual abuse (OR 4.5), poly drug use in the last 30 days (OR 3.6) and adult physical abuse (OR 2.6) were significantly associated with a CIS-R score of ≥18 for prostitutes using multiple logistic regression. Conclusions: Higher rates of adulthood abuse among prostitutes may explain the greater proportion of prostitutes than non-prostitutes meeting criteria for current depressive ideas and lifetime suicide attempts

Staff regard towards working with patients with co-morbid depression and substance misuse : an exploratory study

Funding: Funding was received from the European Commission (contract number 2005322).Background. Patients having co-morbid mental health and substance misuse experience poorer treatment outcomes than those treated for either condition alone. Studies suggest health professionals regard towards these patients is a factor. Aims. To compare regard towards patients with co-morbid depression and substance misuse across different health professions and services, relative to independent conditions (depression, diabetes, alcohol and/or drug misuse). Methods. A cross-sectional comparative exploratory study of regard towards five patient groups conducted on multi-disciplinary staff (general practitioners, psychiatrists, psychologists, nurses and social workers. Total n=113) in three Scottish NHS board regions-NHS Fife, Tayside and Forth Valley. Services from three main treatment entry points were recruited in each region - 10 primary care services (43.5%), 7 mental health (70%) and 4 specialist addiction (100%). Descriptive statistics were calculated for regard towards each patient group. Multifactorial between subjects ANOVA examined influences on Medical Condition Regard Scale (MCRS) scores. Results. Regard towards patients with co-morbid depression and substance misuse was frequently lower than towards patients with independent conditions. Male professionals held lower regard towards these patients than female (p=0.03). Addiction services held the highest regard and general practice lowest (p >0.001). Over-45‘s held the lowest regard towards these patients (p=0.02). Health professional’s satisfaction with working with these patients was also low (mean 1.98, sd 1.22) compared to other conditions. Conclusions. Regard towards patients with co-morbid depression and substance misuse is lower than either condition independently, particularly among older, male professionals and those in general practice.Publisher PDFPeer reviewe

The Challenges of Conducting Qualitative Research on "couples" in Abusive Intimate Partner Relationships Involving Substance Use

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual “couples” that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females’ relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings

Substance use and Intimate Partner Abuse (IPA):A descriptive model of the pathways between substance use and IPA perpetration for men

Intimate partner abuse (IPA) is a pervasive public health and human rights issue disproportionately affecting women. There is a complex link between IPA and substance use; substance use can increase both the frequency and severity of IPA. Pathway models have been applied to explore heterogeneous trajectories into other behaviours and to identify areas for intervention. This approach has not previously been applied in the area of substance use and IPA. Inductive thematic analysis of 37 interviews with heterosexual men aged 28-52 who had reported previous IPA perpetration was conducted. Men were recruited from alcohol and drug services across two areas of England. Three groupings of pathways into substance use-related IPA were generated: 1) Rule Breaking Pathway (n = 11); 2) Entrenched Substance Use Pathway (n = 13); and 3) Relationship Insecurity Pathway (n = 13). Across the three groupings of pathways, the men's childhood and early experiences led to different journeys into SU-related IPA (abuse that was associated with intoxication, withdrawal, acquisition and substance use lifestyle). Each pathway presented differently with varying core features, for example core features of generalised violence, mental health or jealousy, and different predisposing background factors, including types and timing of childhood abuse and trauma. Adopting a pathways approach drawing on principles of equifinality and multifinality can improve understanding of heterogeneity in men who perpetrate IPA and use substances and propose treatment/intervention targets

Motivational strategies in interventions for intimate partner violence offenders: A systematic review and meta-analysis of randomized controlled trials

Previous research suggests that the inclusion of motivational strategies in interventions for intimate partner violence (IPV) offenders could increase their effectiveness. This review evaluated the effectiveness of interventions for IPV offenders that includes motivational strategies to reduce physical and psychological IPV, treatment dropout, official recidivism to IPV offending, and to increase intervention attendance dose. The present systematic review and meta-analysis were conducted using PRISMA guidelines. The following databases were searched from 1983 to 2018 for randomized controlled trials (RCTs) of interventions for IPV offenders that incorporated motivational strategies for adult participants that included men and included IPV behaviors as outcomes: Cochrane Collaboration, MEDLINE, EMBASE, PsycINFO and CINAHL. A total 1,134 studies were identified, 12 RCTs were included in the narrative review and 7 in the meta-analysis. Results indicated that IPV interventions that incorporated motivational strategies were significantly more effective in increasing the intervention dose and reducing dropout than interventions without motivational strategies. IPV offenders receiving interventions with motivational strategies were 1.73 times less likely to intervention dropout compared to those in interventions without such strategies. For physical and psychological IPV and official recidivism (e.g., rearrests, police record), evidence favored interventions with motivational strategies, although not significantly. These findings have important practical implications, especially considering the high dropout rates in IPV offender programs and the link between dropout and higher rates of recidivism

Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review.

Drug-related harms, including harms from sexualised drug use (SDU), are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Chemsex, a type of SDU practiced mainly by MSM, is associated with methamphetamine use and increased HIV seropositivity or risk of acquisition. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. The impact of coronavirus disease 2019 (COVID-19) on chemsex is unknown. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use (and factors associated with these changes) following the onset of the COVID-19 pandemic. This report presents findings related to SDU/chemsex among MSM. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Decreased chemsex practice was associated with COVID-19-related fear. This synthesis suggests that chemsex practice continued, and for some MSM increased, throughout COVID-19 pandemic 'lockdowns'. This may have increased COVID-19 transmission and severity among potentially vulnerable MSM