Social Indicators of Substance Abuse Prevention: A Need-Based Assessment

We combine a variety of census and archival data to assess the relationships between social area characteristics and substance use. We found a substantial association between social area characteristics and substance use. We focus on intra and inter community, family, school and individual domain correlations to produce a prevention need-based score to rank communities from high to low need areas. Our analyses support the general risk and protective factor model advocated by Hawkins et al. (1992). As an important outcome of this work we suggest an objective criterion for selecting variables for the final model of the social indicators; suggest a set of weights for the selected factors and validate the selected factors with regard to substance abuse by linking the social indicator database to substance abuse outcome measures from another independent database. The selection criterion was based on intra domain correlations and proved to be robust. The weights were proportional to the information conveyed by each extracted factor. Analyses of intra-domain correlations are useful in identifying the types of prevention programs needed for each municipal area. Analyses of inter-domain correlations resulted in producing an overall need score based on social area characteristics. Many of the domains revealed more than one dimension, especially the school and the community/environment domains. Our analysis supports the use of social area characteristics in predicting the need for substance abuse prevention and treatment. It also suggests cautious and well informed decisions in selecting the indicators for a need based model.     

Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

IntroductionThe use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options — such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management — are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.ObjectiveThis research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.MethodsParticipants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.ResultsThe fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.ConclusionPregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.     

Substance abuse treatment providers' explicit and implicit attitudes regarding sexual minorities

Lesbian, gay, bisexual, and transgender (LGBT) individuals have been found to have elevated rates of substance use disorders when compared with heterosexuals. However, little is known about the challenges a sexual minority might face in presenting for substance use treatment. In this study, treatment providers' attitudes toward LGBT individuals were assessed among a sample of 46 substance abuse treatment counselors who provide publicly funded treatment. Participants completed both explicit measures of heterosexist bias and an implicit measure designed to assess for biases that exist at an automatic, uncontrolled level. Results indicate that treatment counselors' negative biases regarding LGBT individuals were stronger for heterosexual counselors and for those with few LGBT friends. However, biases among this sample were significantly less than in comparison samples. Findings were also related to a newly developed measure of cultural competence in working with LGBT substance users. Implications for provision of appropriate services and recommendations to treatment agencies are discussed.     

A clinical comparison of lesbian and heterosexual women in a psychiatric outpatient clinic

Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.     

A Clinical Comparison of Lesbian and Heterosexual Women in a Psychiatric Outpatient Clinic

ABSTRACT

Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.     

Health risk-factors for gay American Indian and Alaska Native adolescent males

Having multiple identities as a homosexual American Indian or Alaska Native adolescent male increases the likelihood for poorer health and diminished well-being. This study assessed the differences in self-perceived health status between gay adolescent males and their heterosexual counterparts. A national nonrepresentative sample of 5,602 Indian and Native adolescent males was surveyed about issues of sexual behavior, physical and sexual abuse, mental health status, substance use, attitudes about school, participation in violence, and access to health care. Results indicate that there were no real differences between gay and heterosexual male respondents for substance use or attitudes about school. Statistically significant differences were found, however, in areas of mental health, as well as physical and sexual abuse. Gay adolescents were twice as likely to have thought of or attempted suicide. Gay adolescents were twice as likely to have been physically abused and nearly six times more likely to have been sexually abused. Gay American Indian or Alaska Native adolescent males constitute a very vulnerable population and are clearly in need of targeted health and social services. Unfortunately, the benefits seen by adults of the "two-spirited" gay and lesbian American Indian movement have not been accessible to Indian and Native adolescents.     

Male street prostitution in Dublin: a psychological analysis

This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of self-esteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin.     

Male Street Prostitution in Dublin: A Psychological Analysis

This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of self-esteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin.     

Unmet mental health and substance abuse treatment needs of sexual minority elders

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.     

Exploratory Study on Drug Users’ Perspectives on Quality of Life: More than Health-Related Quality of Life?

In drug treatment outcome literature, a focus on objective and socially desirable indicators of change (e.g. no drug use) has predominated, while outcome indicators that are important for drug users themselves (e.g. quality of life, satisfaction with treatment) have largely been neglected. Nonetheless, Quality of Life (QoL) has become an important concept to evaluate effectiveness of treatment in mental health care research and disability studies. Given the almost exclusive focus on Health-related Quality of Life (HRQOL) in substance abuse research and the neglect of clients’ perspectives in this field, we explore in this study the concept of QoL as perceived by drug users. Focus group discussions (n = 9) were organised in various treatment settings and community services for drug users in the region of Ghent, Belgium to identify important dimensions of QoL and their interpretation by drug users. Data were clustered and analysed based on the theoretical framework of Robert Schalock (Quality of life. Volume 1: Conceptualization and measurement, 1996). The domains ‘personal relationships’, ‘social inclusion’ and ‘self-determination’ were discussed most frequently by the participants. They stressed the importance of a supportive social network in particular. It can be concluded that QoL is not primarily associated by drug users with health and it involves much more than the aspects typically represented in measures of HRQOL.     

The Effects of Honesty and Openness About Sexual Orientation on Gay and Bisexual Clients in Substance Abuse Programs

A convenience sample of 183 gay, lesbian, and bisexual participants who were previously treated in substance abuse programs, completed surveys that included questions regarding their honesty and openness about their sexual orientation with counselors and clients in their programs, as well as in their personal lives. It was found that levels of honesty and openness in treatment positively correlated with reported program completion, satisfaction with treatment, feelings of therapeutic support, and feelings of connection to the program. However, there were no correlations between honesty and openness and reported abstinence from substances at the end of treatment and at the time of survey completion.     

The Influence of Campus Experiences on the Level of Outness Among Trans-Spectrum and Queer-Spectrum Students

This study utilized MANOVA and hierarchical multiple regression to examine the relationships between campus experiences and coming-out decisions among trans- and queer-spectrum undergraduates. Findings revealed higher levels of outness/disclosure for cisgender LGBQ women, and more negative perceptions of campus climate, classroom climate, and curriculum inclusivity and higher use of campus resources for trans-spectrum students. Results also revealed that higher levels of outness significantly related to poorer perceptions of campus responses and campus resources. Implications address the need to foster an encouraging and supportive campus and classroom climate and to improve the relationships with LGBTQ resource centers for trans- and queer-spectrum students.     

Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization

To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population.     

Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research

BackgroundPrevious studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth.AimThis study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy.MethodsA systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women’s experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis.FindingsTwenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals.DiscussionPerceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women’s behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use.ConclusionIncreased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.     

Personal Well-Being and Family Quality of Life of Early Adolescents in Hong Kong: Do Economic Disadvantage and Time Matter?

Differences in personal well-being and family quality of life in Chinese adolescents with and without economic disadvantage as well as the related developmental trends were examined in a longitudinal study. Over three consecutive years, Chinese junior secondary school students responded to validated measures of positive youth development, risk behaviors and perceived family functioning. Consistent with our hypotheses, results showed that poor adolescents had poorer positive youth development and perceived family functioning than did non-poor adolescents. Although there was no difference between the poor and non-poor groups on substance abuse, significant interaction effect of poverty and time on substance abuse was observed. While there was a general drop in positive youth development and perceived family functioning over the years, adolescent risk behaviors gradually increased during the junior secondary school years in Hong Kong.     

Exploring Shame,Guilt, and Risky Substance Use Among Sexual Minority Men and Women

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.     

Impact of Mentors During Adolescence on Outcomes Among Gay Young Adults

ABSTRACT

Using the National Longitudinal Study of Adolescent Health and the Adolescent Health and Academic Achievement study datasets, this study examined whether natural mentoring relationships during adolescence were associated with young adult outcomes among lesbian, gay, and bisexual (LGB) persons. Outcomes in three domains were investigated: education and employment, psychological wellbeing, and substance use and abuse. Results indicated that LGB persons reporting natural mentors during adolescence were about three times as likely to graduate from high school as those without. Discussion surrounds strategies to foster mentoring relationships within the school environment or community.     

Self-Identified Heterosexual Clients in Substance Abuse Treatment With a History of Same-Gender Sexual Contact

There is virtually no literature concerning the experiences of self-identified heterosexual clients in substance abuse treatment who have a history of same-gender sexual contact (HSGS). In a U.S. urban inpatient program in 2009–2010, 99 HSGS clients were compared to 681 other heterosexual and 86 lesbian, gay, and bisexual clients regarding background factors, program completion rates, and feelings about treatment. Male HSGS participants had lower completion rates than other male heterosexual participants. Qualitative data indicated that most male HSGS participants experienced difficult emotions regarding same-gender sexual encounters, particularly those involving trading sex for money or drugs. Implications for treatment are discussed.     

Creating coherent perinatal care journeys: An ethnographic study of the role of continuity of care for Danish parents in a vulnerable position

BackgroundWhile continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period.AimTo explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period.MethodsAn ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences.FindingsThree key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services.ConclusionAll forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.