Drug and Alcohol Addiction in Singapore: Issues and Challenges in Control and Treatment Strategies

SUMMARY

The problem of drug addiction in Singapore has been relatively under control over the past few years. This is a result of the strategy of controlling supply to reduce demand for drugs. Alcohol consumption in Singapore is relatively low compared to Western countries. This paper provides an overview of the drug and alcohol control and treatment strategies adopted in Singapore. While new strategies have been formulated, some issues and challenges still remain. These issues and challenges are discussed and findings of a recent study conducted by the author are described. They include the need to focus on gateway drugs like alcohol, intervention involving family members, opportunities for regular employment for drug addicts, and the role of religion in aftercare treatment.     

Effects of Family Involvement on Length of Stay and Treatment Completion Rates with Cocaine and Alcohol Abusers

SUMMARY

Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and that family involvement may influence continuation in and completion of treatment for both cocaine and alcohol abusers.

A sample of 99 primary cocaine abusers and 105 primary alcohol abusers in outpatient treatment were followed during the course of their treatment. Results indicated primary alcohol abusers were significantly more successful in completing treatment than primary cocaine abusers. Family involvement in treatment significantly increased the likelihood that cocaine and alcohol abusers would complete the full course of treatment.

It is possible that treatment could be improved and completion rates increased by coordinating the involvement of the family.     

Gambling and the family: From the stress‐coping‐support Perspective 1

Abstract

Aims: To apply the stress‐coping‐support perspective to the study of the effects of problem gambling in the family. Specifically, to examine the ways in which family members cope and the nature and sources of support they receive. To compare coping strategies of family members of gamblers with those of individuals living with other addictive behaviour in the family. Design: Cross‐sectional interview and questionnaire study of close relatives of problem gamblers. Participants: Sixteen close family members of gamblers from separate families, mainly parents and partners. Data: Semi‐structured interview; adapted version of the Coping Questionnaire (CQ). Findings: Data from the CQ and qualitative analysis of interview data suggested considerable use of ‘engaged’ (specifically controlling) ways of attempting to cope with such problems, comparable to the use of such strategies by relatives of people with alcohol or drug problems, but little use of ‘tolerant‐accepting’ and ‘withdrawal’ ways. Interview data on the support received (or not) by family members confirmed previous research showing that relatives of people with addiction problems often feel unsupported, but particularly appreciate positive emotional and practical support for themselves and their problem gambling relatives. Conclusions: The stress‐coping‐support perspective, previously applied to families with alcohol and drug problems, also offers an appropriate framework for understanding problem gambling and the family.     

Cocaine Abusing Women Who Report Sexual Abuse: Implications for Treatment

ABSTRACT

Four hundred seventy-three substance-abusing women were assessed for histories of sexual abuse. The results of bivariate analysis indicated that Sexual Abuse Survivors (SAS) had higher levels of depression, anxiety, and psychological distress. A greater number of SAS reported histories of emotional and physical abuse. They also had greater severity on ASI scales of alcohol, drug, medical, and family/social difficulty. Logistic regression analysis indicated that women who were survivors of sexual abuse were more likely to have histories of emotional and physical abuse, higher levels of addiction severity, and more family members who used drugs. Implications for research and treatment are discussed.     

Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.     

Severity of impairment in dually addicted gamblers

While much information about pathological gamblers has been gathered from clinical observations, few data exist from systematic, objective studies. Furthermore, still less is known about that subset of pathological gamblers who are also chemically dependent and/or substance abusers. Previous studies (e.g., McCormick et al., 1984) report that up to 45% pathological gamblers are substance abusers. The present study hypothesizes that inpatient chemically dependent pathological gamblers will exhibit greater impairment on a variety of life-functioning measures than a comparable group of chemically dependent psychiatric inpatient. Twelve chemically dependent pathological gamblers were matched on the basis of age, sex, alcohol/drug history and occupational status with twelve chemically dependent persons with no pathological gambling history. All study members were inpatients in an addictions program at a private psychiatric hospital. Each patient was administered the Addiction Severity Index (ASI) to assess impairment in seven problem areas: medical, employment/support, alcohol, drug, legal, family/social, and psychological/psychiatric functioning. The following findings emerged: 1) Chemically dependent (CD) gamblers report more chronic medical problems than CD psychiatric patients; 2) CD gamblers report more frequent conflicts with relatives and family members than CD psychiatric patients; 3) CD gamblers report more psychiatric symptoms both in amount and duration; Although not reaching statistical significance, 42% of the CD gamblers had made a previous suicide attempt as compared to 8% of the CD psychiatric patients; 4) CD gamblers and CD psychiatric patients appear comparable with regard to employment functioning and amount of legal problems. The clinical and theoretical implications of these findings are discussed further.     

Psychosocial distress,physical illness,and social behaviour of close relatives to people with substance use disorders

ABSTRACT

This study explores how a family member with substance use disorder (SUD) affects the psychosocial, behavioral, and physical states of other family members. Sixteen in-depth interviews with relatives of Icelandic individuals afflicted with SUD were performed. The interviewees were selected from a pool of Icelandic families whose members included one or more chronic SUD users. They represented different relations to the user (spouses, parents, children, and siblings) and both genders. All participants except for siblings expressed that SUD had negatively affected their mental health by inducing depression, anxiety, and stress-related physical illness. All had experienced physical violence, mental abuse and financial loss. Parents indicated that the SUD of the family member had isolating psychosocial impacts on their children and caused a loss of connection among their family members. All participants, except the siblings, regarded their workplace as a shelter. The study’s findings can help social professionals to better understand the effects of SUD on families, family systems, and public health in general.     

Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options

This review examines the results from 19 outcome studies, involving 1,501 cases, within 10 different clinical approaches to getting alcohol or drug abusers to engage in treatment or self-help. Each approach is summarized and its "success rate(s)" presented. Comparisons are made across various subcategories, such as alcohol vs. drug abusers, adolescents vs. adults, and experimental conditions vs. controls. A distinction is drawn between "Dual-Purpose" approaches, which combine engagement with counseling of the concerned person who originally sought help for the substance abuser, and "Engagement-Primary" approaches, which generally confine their efforts (through working with family members and others) to getting the substance abuser into treatment/self-help. "Best bet" clinical options are presented in terms of which particular approach appears to have the edge with which kind of substance abuser.     

Addiction Treatment with Deaf and Hard of Hearing People: An Application of the CENAPS Model

ABSTRACT

Alcohol and drug addiction is a significant problem among deaf and hard of hearing people. Looking through a Deaf culture lens, treatment for alcohol and drug addiction is key for providing care for deaf and hard of hearing clients. Using the CENAPS model, an applied cognitive-behavioral therapy program is recommended for addiction treatment. The CENAPS model provides clinicians with tools for stabilizing deaf and hard of hearing clients, supporting their transition to early recovery. Educating the client about the stages of relapse and the stages of recovery, clinicians using this model can better treat and prepare deaf and hard of hearing clients for long-term recovery.     

Growing Up in a “WE” Family

SUMMARY

When couples choose to parent as a unit (the couple as WE) rather than as autonomous individuals, they and their children both benefit. The current article details some ways that parents can further expand their “couple as WE” into a “family as WE” with active parents and socially perceptive children. The article also discusses ways that family members can start and maintain a family dialogue.     

Drug trafficking and addiction among low-income urban youths: An ecological perspective

Drug addiction and drug trafficking continue to be a major problem during adolescence and a primary cause of significant problems in adulthood. For low-income, urban, African American youths, these problems are compounded by environmental factors-such as communities that are depleted of resources, schools that are inadequately funded, family members who are unemployed-and other physical, legal, spiritual, social and psychological factors. These ecological factors have the potential to impinge significantly on the lives of those who become involved with drug use and sales. The problems resulting from these issues not only affect the individual but also family members, communities and the nation.

This paper examines the patterns of drug addiction and trafficking among African American youths in poverty, with an eye toward answering the following questions: What is drug trafficking? What is the youths perception of drug addiction? What role does drug trafficking play in subsequent drug use? What is the nature and role of ecological factors, such as poverty, in the interaction between drug addiction and drug trafficking? How do these issues reflect on developmental theories of addiction?     

Whole in Body,Mind & Spirit: Wholistic Health and the Limits of Medicine

Abstract

Use of the Substance Abuse Subtle Screening Inventory (SASSI), a new instrument for assessing the presence of chemical dependency, was tested on a college population. In tests with 376 subjects, the SASSI showed significant promise in discriminating between nonabusers, moderate abusers, and severe abusers. Further, results of the SASSI obvious attributes scale were correlated in the expected directions with indicators of level of chemical use. The particular need for an alcohol and drug abuse assessment instrument that is relatively impervious to social desirability effects is discussed in light of the history of assessment problems in this area.     

The Logical Difference Between Prevention and Treatment

The authors have spent 2 1/2 years investigating the process of change in family systems presenting with addictive symptoms in one or more of their members. The context of this research has been the systemic family therapy of more than 36 families in a hospital based drug and alcohol service. Emergent from this research is evidence of potentially destructive effects upon families and addicts who present requesting help, by referring them to programmes which are educative or preventative in nature. The case will be put for a clear distinction to be made between the functions of ‘prevention’ and ‘treatment’ in multi-disciplinary teams in addiction services (and by implication other community health services); and for establishing a more rigorous intake system based upon such a distinction and designed to respond more appropriately to presenting requests by potential users of such a service.     

The alcohol contexts of consent,wanted sex,sexual pleasure,and sexual assault: Results from a probability survey of undergraduate students

Objective: To examine, in a probability sample of undergraduate students, characteristics of students’ most recent sexual experiences (including alcohol use) as well as their experiences with nonconsensual sex. Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%). Methods: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime). Results: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police. Conclusions: Implications for campus policy and health education are addressed.     

Risk Factors for Suicidal Behavior Among Alcoholics

Abstract

Four risk factors for parasuicide and suicide ideation in 197 male and female alcoholism inpatients were investigated: addiction severity, family addiction history, psychiatric symptomatology, and inadequate social support. Risk factors for suicide ideation were psychiatric symptom severity and social dysfunction; those for parasuicide were younger alcohol problem onset, more alcoholism symptoms, greater social dysfunction, and greater psychiatric symptom severity. Logistic regression was utilized to assess the independent effects of risk factors on both suicide ideation and parasuicide. The most efficient model for parasuicide prediction consisted of psychiatric severity, controlling for gender; the most efficient model for ideation was psychiatric severity.     

Coping Behaviors of Cocaine Dependent Women

Abstract

Four-hundred and forty-nine cocaine dependent women from three treatment programs were assessed for level of addiction severity, family difficulty, medical problems, and types of coping strategies at treatment entry. Results indicate that the women utilized more problem-focused coping at treatment entry than emotion-focused. And, findings also revealed that most women used similar coping strategies regardless of intensity or philosophy of the treatment program. ANOVA analysis revealed differences between groups in the use of express emotion and social withdrawal. Findings that reveal an association between social support and the utilization of more positive coping strategies have implications for engaging family members and support network persons in the treatment process. Relationships between social withdrawal and other emotion focused coping strategies have implications for aggressive outreach to engage women in treatment.     

Child Welfare and Alcohol and Other Drug Treatment (AOD): Bridging the Gap to Comprehensive Services

ABSTRACT

Chemical addiction is a significant factor in child abuse and neglect (U.S. Department of Health and Human Services [DHHS], 1999). Although research has indicated that an alliance between the child welfare and alcohol and other drugs (AOD) treatment fields is the best way to effectively address chemical addiction within families, collaboration has not generally been established. The lack of collaborative relationships between the child welfare and AOD fields can be attributed to a number of different factors. Similarities in proposed interventions for collaborative efforts between AOD treatment and child welfare agencies can be found throughout the literature. The establishment of a truly collaborative partnership between AOD treatment and the child welfare system is a necessary step towards achievement of functional and healthy families, a goal common to both disciplines.     

Oyate Ptayela: Rebuilding the Lakota Nation Through Addressing Historical Trauma Among Lakota Parents

SUMMARY

This article presents evidence to suggest that historical trauma has affected Lakota parents and children by changing parenting behavior and placing children at risk for alcohol and other substance abuse. The theoretical explanation of the Lakota historical trauma response is described and used as a framework for the design of a parenting skills curriculum. This intervention focuses on (1) facilitating parental awareness of life span and communal trauma across generations and (2) a re-cathexis or re-attachment to traditional Lakota values.

The experimental curriculum intervention was delivered to a group of ten Lakota parents and two Lakota parent facilitators on a Lakota reservation. Qualitative study results revealed that parents experienced the curriculum as effective, particularly the focus on both historical trauma and the reconnection with traditional Lakota mores. The curriculum's emphasis on traditional protective factors for alcohol and other substance abuse prevention for Lakota children presents implications for other parenting curricula. The article concludes with recommendations for future research in the area of Indian parenting and historical trauma.     

Incorporating Spirituality and the Strengths Perspective into Social Work Practice with Addicted Individuals

Abstract

In the last two decades, the social work profession began to confront the professional avoidance of alcoholics and other drug addicts, and discussions of spirituality. While acknowledging the importance of 12-Step Programs of Alcoholics/Narcotics Anonymous, we also acknowledge that spirituality is a major aspect of addiction and recovery from an addiction. The authors present the Strengths Perspective and apply key concepts to Steps 1-3 of the 12-Steps to increase our understanding of addiction and recovery from alcoholism and other drug addiction. The article concludes that social workers must continue to increase their understanding of the recovery and spiritual issues of alcoholics and other drug addicts.