Estimating the costs of substance abuse: implications to the estimation of the costs and benefits of gambling

This presentation describes a recently developed set of guidelines for estimating the economic costs of substance abuse, summarizes the findings from a Canadian study that utilized these guidelines, and discusses the implications to the potential development of guidelines for estimating the costs and benefits of gambling. The guidelines for estimating the costs of substance abuse present a general framework of costs to be included and discuss methodological issues such as the definition of abuse; determination of causality; comparison of the demographic and human capital approaches; the treatment of private costs; the treatment of nonworkforce mortality and morbidity; the treatment of research, education, law enforcement costs, the estimation of avoidable costs and budgetary impact of substance abuse, and the significance of intangible costs. Utilizing these guidelines, a study was undertaken to estimate the economic costs of alcohol, tobacco, and illicit drugs to Canadian society in 1992. Based on this experience, it is argued that cost/benefit research should be conducted by multidisciplinary teams, that the real value of such work lies more in the detailed findings than in the bottom line results, and that focus should be placed on developing an ongoing process for developing consensus on how to conduct studies of the costs and benefits of gambling, rather than attempting to find a precise methodology that everyone agrees upon.     

Internet gambling in relation to Internet addiction,substance use,online sexual engagement and suicidality in a Greek sample

Research has found gambling to be related to a variety of other addictive behaviours. The study objective was to evaluate the association of Internet gambling with Internet addiction, online sexual engagement, suicidality and substance use, in a sample of Greek adults. The study sample consisted of 789 military personnel. During their annual medical examination the study participants anonymously completed a series of self-reported questionnaires in relation to socio-demographic data, Internet gambling practices, online sexual engagement, Internet addiction, suicidality and psychoactive substance use. We found that Internet addiction significantly predicted engagement with online gambling, followed by substance use in general, and, in particular, the use of cocaine or heroin. Finally, two other predictive indicators were self-reported suicide attempts and engagement with online sex. Online gambling is associated with various behaviours related to impulsivity such as Internet addiction, online sexual engagement, suicidality and substance use. Future research will increase our knowledge on the contribution of new technologies and the Internet in Internet gambling dimensions, as well as on the associations with other high-risk behaviours such as substance use, pornography and suicidality.     

Problem gambling and property offences: an analysis of court files

This article outlines some of the major findings regarding criminogenic problem gambling in Crofts' (2002) analysis of New South Wales Local and District Court files. The article details firstly the advantages and disadvantages of relying upon court files as a source of information on gambling related crime. The article then outlines the personal characteristics of the subjects in the study, the relationship of gambling to the commission of their offences and judicial responses. The study provided qualitative information on when people are likely to seek treatment for problem gambling and also highlighted problem gambling as a significant motivation for employee theft. The study also suggests that the reasons for problem gambling may impact upon offending patterns.     

Prevention of problem gambling: modifying misconceptions and increasing knowledge

Research on gambling clearly demonstrates that today's youth are very much involved in gambling activities. As they take part in these activities, young people develop and entertain irrational thoughts about gambling and become at risk for developing severe gambling problems. In this study, a video specifically designed to correct misconceptions and increase knowledge about gambling was tested on 424 grade 7 and 8 students. The effectiveness of the video was evaluated using four different experimental conditions. Findings indicated that the video significantly improved subjects' knowledge about gambling and corrected their misconceptions. The implications of these results for the prevention of gambling problems are discussed.     

The case for implementing the levels of prevention model: Opiate abuse on American college campuses

Opiate abuse in the United States is on the rise among the college student population. This public health crisis requires immediate action from professionals and stakeholders who are committed to addressing the needs of prospective, current, and recovering opiate users using comprehensive prevention methods. Such approaches have been used to deliver primary, secondary, and tertiary intervention to alcohol and other drug users but are underutilized in the case of opiate abuse among college students in the United States. There is a definite need for involving college campus faculty, staff, students, and others in efforts to prevent opiate abuse at all levels. Our recommendations include specific strategies to address this imminent issue using an innovative application of the traditional Levels of Prevention Model.     

A big hole with the wind blowing through it: Aboriginal women's experiences of trauma and problem gambling

Although studies have shown a link between social trauma and problem gambling (PG), there is little research involving Aboriginal women in this area, despite Aboriginal women being potentially at higher risk for both social trauma and problem gambling. This article describes the results of a qualitative phenomenology study asking seven Aboriginal women living in Western Canada to describe their experiences of social trauma and gambling problems. Results suggest four main themes, describing: (1) the Aboriginal women's experiences of social trauma (‘the three tigers’); (2) their use of gambling to cope with these experiences (‘a big hole with the wind blowing through it’); (3) their experience of problem gambling (‘I'm somebody today’); and (4) their process of healing from social trauma and gambling problems (‘a letter to John’). Participants described what they felt was a clear link between social trauma and problems with gambling, and how gambling helped to change their mood and block out the past. The results raise the possibility that Aboriginal women with gambling problems may need support to heal from social trauma – including racism and colonization – and that upstream initiatives to reduce the incidence of social traumas may be an important response to problem gambling among Aboriginal women.     

Child sexual abuse: from prevention to self‐protection

There are a growing number of child abuse prevention and education programmes, including primarily group‐based parent and child education, which are taught by teachers within the school system. This article reviews some of the existing sexual abuse education and/or body safety programmes, as well as the research surrounding them. Advantages as well as criticisms of such programmes are reviewed. Issues such as target populations (i.e. children, teachers, parents), programme components and methodological limitations are addressed. Major findings include: children as young as three can be effectively taught self‐protection skills, parental and family involvement in training is important, and repeated exposure helps children maintain knowledge gains. The components of successful programmes include teaching children to identify and resist inappropriate touching, reassuring children that it is not their fault and learning the proper names of their genitals. Finally, future directions for programme development, research and policy are explored. Copyright © 2008 John Wiley & Sons, Ltd.     

State of the science on prevention of elder abuse and lessons learned from child abuse and domestic violence prevention: Toward a conceptual framework for research

ABSTRACT

The goal of this review is to discuss the state of the science in elder abuse prevention. Findings from evidence-based programs to reduce elder abuse are discussed, drawing from findings and insights from evidence-based programs for child maltreatment and domestic/intimate partner violence. A conceptual measurement model for the study of elder abuse is presented and linked to possible measures of risk factors and outcomes. Advances in neuroscience in child maltreatment and novel measurement strategies for outcome assessment are presented.     

Treatment outcomes among adolescents with substance abuse problems: the relationship between comorbidities and post-treatment substance involvement

This study examines comorbid mental disorders in relation to post-treatment outcomes (12 months post-intake) among adolescents (N=419) who entered three residential drug treatment programs. When contrasted with youths who had no comorbid mental disorders or youths with a single comorbid condition, those with combined internalizing and externalizing disorders (mixed comorbidity) had higher levels of substance-related problems and poly-drug use at entry to treatment, and poorer outcomes, e.g. relapse, particularly evident for drugs other than alcohol or marijuana. A significantly higher proportion of those with mixed comorbidity were admitted to short term residential treatment, as compared to long term residential care. However, the effects of comorbidity were independent of both planned and actual length of stay, suggesting that comorbidities can negatively impact treatment outcome in multiple ways, apart from length of stay. Since co-occurring problems appear to profoundly limit treatment effectiveness, treatment strategies that address comorbidity are needed to improve outcomes.     

Associations between gambling,substance misuse and recidivism among Canadian offenders: a multifaceted exploration of poor impulse control traits and behaviours

Moderate correlations among gambling, substance use and crime suggest these three behaviours may each be indicators of a single underlying problem trait, such as poor impulse control. We tested whether self-reported traits prospectively predicted future criminal recidivism, when accounting for incarcerated adult offenders' past criminal behaviour, substance use and gambling behaviour. We took a multi-construct approach to measuring components of impulse control, utilizing three questionnaires that assess sensation seeking, poor premeditation, and reward sensitivity. Male participants incarcerated in two federal institutions were invited to complete self-report booklets; participation was self-selected and fully voluntary. Results indicated moderate correlations between measures of trait impulse control, self-reported drug use, and official criminal history (N = 140). Gambling problems prospectively predicted post-release criminal recidivism (n = 83), even when accounting for past criminal behaviour, impulse control traits and substance misuse. Although they represent a small percentage of this sample, results suggest offenders with high gambling problems represent a particularly at-risk group for future crime, who were more than four times likely to reoffend compared to offenders without problem gambling. These results suggest there may be mutual impact of problem behaviours on life outcomes above the contribution of poor impulse control.     

Sexual abuse in sport: a model to prevent and protect athletes

Several studies clearly show that sexual abuse exists in sport. Currently, very few studies have examined the prevention and management of this problem in sports organisations. This article explores the measures used to prevent sexual abuse in sports organisations as well as the perceptions of the sports actors affected by these measures (parents, athletes, administrators and coaches). The results demonstrate that several factors affect the implementation of measures and the management of this problem in sports organisations. Moreover, few measures exist to prevent and manage cases of sexual abuse in these organisations, thus jeopardising the protection of athletes. Copyright © 2010 John Wiley & Sons, Ltd.     

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.     

The Triple P‐Positive Parenting Programme: a universal population‐level approach to the prevention of child abuse

The Triple P‐Positive Parenting Programme is described as an example of an evidence‐based universal parenting initiative that provides a tiered continuum of interventions of increasing strength but narrowing reach in an effort to make parenting programmes more accessible to parents. Interventions within the system range from the use of the media and brief messages to intensive family interventions for parents where parenting problems are complicated by multiple additional sources of family adversity. Several issues concerning the role of training and organizational factors that influence the successful uptake and implementation of the programme are discussed. Copyright © 2003 John Wiley & Sons, Ltd.     

Prevention validation and accounting platform: a framework for establishing accountability and performance measures of substance abuse prevention programs

The field of substance abuse prevention has neither an overarching conceptual framework nor a set of shared terminologies for establishing the accountability and performance outcome measures of substance abuse prevention services rendered. Hence, there is a wide gap between what we currently have as data on one hand and information that are required to meet the performance goals and accountability measures set by the Government Performance and Results Act of 1993 on the other. The task before us is: How can we establish the accountability and performance measures of substance abuse prevention programs and transform the field of prevention into prevention science? The intent of this volume is to serve that purpose and accelerate the processes of this transformation by identifying the requisite components of the transformation (i.e., theory, methodology, convention on terms, and data) and by introducing an open forum called, Prevention Validation and Accounting (PREVA) Platform. The entire PREVA Platform (for short, the Platform) is designed as an analytic framework, which is formulated by a collectivity of common concepts, terminologies, accounting units, protocols for counting the units, data elements, and operationalizations of various constructs, and other summary measures intended to bring about an efficient and effective measurement of process input, program capacity, process output, performance outcome, and societal impact of substance abuse prevention programs. The measurement units and summary data elements are designed to be measured across time and across jurisdictions, i.e., from local to regional to state to national levels. In the Platform, the process input is captured by two dimensions of time and capital. Time is conceptualized in terms of service delivery time and time spent for research and development. Capital is measured by the monies expended for the delivery of program activities during a fiscal or reporting period. Program capacity is captured by fourteen measurement units, tapping into the dimensions of staff resources and community assets. Staff resources are, in turn, operationalized in terms of staff size, staff certification status, staff turnover rate, and the accreditation status of a provider agency. Community assets are operationalized by the number of community centers accessible to the funded agency, number of formalized teams or antidrug coalitions active in the catchment area, and other social/human services providers with whom the prevention agency has formalized networks. The totality of process output from all sources of program activities is reduced to eighteen classes of measures. These are operationalized by thirty-three summary measures. Some of these include: total count of events facilitated; total number of clients served; average number of clients served per event; clients served by single and multiple program sessions; classification of target population in terms of the severity of risk as defined by the Institute of Medicine; age groups and race/ethnicity of clients served; number of program participants retained by recurring programs; number of clients who have completed the program; penetration rates to the target population; client attrition rates; average referral rates per provider per time interval; referral success rates; and so on. All process output measures specified in the Platform are derived from two broad classes of events classified as either products or services. The collectivity of these measures is expected to present a cost-effective, parsimonious, yet comprehensive picture of the entire spectrum of the process output, i.e., "what came out of the program as program activities". For the measurement of performance outcomes, two types of data are incorporated into the Platform: outcome data from individuals and the behavior (or performance) of social indicators from aggregated data bases. Individual data are used to evaluate the outcome of substance abuse programs     

Preliminary evaluation of contingent meals and telephone use to improve evidence-supported family therapy session attendance in mothers referred by Child Protective Services for substance abuse

Persons referred by Child Protective Services (CPS) for substance abuse evidence high rates of nonattendance to therapy sessions, taxing systems of care and exacerbating outcomes. This study examined the influence of two telephone-based incentive programs on therapy session attendance in mothers who were referred by CPS for substance abuse. After baseline therapy session attendance was established in an evidence-based clinic that incorporated a telephone engagement intervention (Phase I), participants were provided free cellular telephones with limited minutes and permitted to order free meals delivered by the therapist during upcoming sessions (Phase II). The third phase was similar to Phase II, but participants were provided unlimited minutes. Results indicated that participants’ attendance was significantly improved when meals and cellular telephone minutes were contingent on attendance. Although the percentage of sessions attended by participants during Phase III was higher than Phase II, unlimited minutes and meals did not significantly enhance attendance relative to limited minutes and meals. Session attendance for significant others of these participants was significantly higher during Phase III as compared with Phase I. Session attendance of significant others was statistically similar between Phase I and II and between Phase II and Phase III. Study implications and recommendations for future research and practice are discussed in light of the findings.     

An ecological approach to child abuse: a creative use of scientific models in research and practice

Over the past 40 years, considerable progress has been made in our understanding of the aetiology and processes of child abuse. This understanding has been based within two scientific paradigms: the psychodynamic and sociological models. More recently, both strands have been incorporated in a more comprehensive ‘ecological’ paradigm. This presents child abuse as occurring within the context of the child's environment at different, nested levels. The ecological paradigm is currently the most comprehensive model we have for understanding child abuse, providing a systematic framework in which to conduct both research and child protection practice. This paper begins by describing the nature and use of scientific models in both research and practice. Three levels of models are outlined: working models, paradigms and worldviews. The paper then goes on to consider how models are used in our understanding of child abuse, focusing on three major paradigms (sociological, psychodynamic, ecological). The ecological model or paradigm is then described in detail, expounding the four different levels within it. The uses and limitations of the ecological model are discussed in relation to both research and practice. Finally, some practical suggestions are provided for the reader to creatively apply this understanding at a personal and professional level. Copyright © 2001 John Wiley & Sons, Ltd.     

Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control.A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth.More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08.Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.     

Digital crime,trauma, and abuse: Internet safety and cyber risks for adolescents and emerging adults in the 21st century

ABSTRACT

The shift in the technology landscape has altered the technology ecosystem of adolescents and emerging adults in the 21^st century. Yet, with greater use of digital gadgets comes greater mental health risks that technological advancement brings. This study provides a narrative review of contemporary cyber risks faced by adolescents and emerging adults. In particular, this review will cover dangers and effects of cyber-bullying, social media, cyber-dating violence, sextortion, sexting, revenge porn, online dating, catfishing, and scammers, with an emphasis to raise awareness and encourage proactive efforts dedicated to address these social concerns as the digital era continues to evolve.     

An analysis of children and young people's calls to ChildLine about abuse and neglect: a study for the Scottish Child Protection Review

In 2001 a young child, who was known to child protection agencies, was murdered by her stepfather. Following a recommendation of an inquiry into her death, a ministerial multidisciplinary review of child protection across Scotland was carried out. The review aimed to promote the reduction of abuse or neglect of children and to improve the services for children who experience abuse or neglect. It was carried out by a multidisciplinary team and the report made 16 recommendations. The review was informed by a series of sub‐projects. This paper describes one sub‐project that aimed to collect the views of children and young people who might have been abused but might not have had contact with child protection agencies. The study was carried out in conjunction with ChildLine Scotland. Call data for one year were made available for quantitative analysis. Qualitative analysis was carried out on the counsellors' notes on all calls relating to abuse and neglect taken during a 2‐week period. Children described signi?cant levels of abuse and neglect. Many had told no‐one of the abuse and in particular had not contacted child protection agencies. The paper considers the implications of the ?ndings for the child protection system. Copyright © 2004 John Wiley & Sons, Ltd.