Individual rights and collective obligation. Compulsory intervention towards substance abusers in Norwegian social law

This article focuses on an important duality in the modern welfare state: the will to help our fellow citizens through institutionalized welfare policies, and the danger of violating individual liberty and integrity. Individual rights of self-determination and integrity are important values of the liberal constitutional government (the Rechtstaat). Our collective ethical obligation to help those in need is an important value of the welfare state. With respect to compulsory intervention towards adult and under-age substance abusers, the possible tensions between these values are particularly visible. The legal foundation for such efforts in Norwegian social law is discussed with regard to different ethical and moral principles. The main questions are how compulsory interventions are justified and how different principles are weighted in positive law. The ethical principles of collective obligation and the moral principle of individual rights are differently balanced in the Child Care Service Act and the Social Service Act. Both acts, however, expose the problematic combination of solving social problems by the use of force and securing individual autonomy and integrity.     

Childhood maltreatment among Norwegian drug abusers in treatment

This article reports on the investigation of the correlation between the European Addiction Severity Index (EuropASI) and the Childhood Trauma Questionnaire (CTQ) among 102 Norwegian drug abusers admitted to treatment. The aim of the study is to explore how different types and levels of childhood trauma and social and psychiatric factors, medical situation and experienced family history are interrelated. The study addresses three main questions: 1) What is the prevalence of different kinds of childhood trauma among drug abusers in treatment? 2) Does type or level of maltreatment in childhood predict specific substance abuse problems as adults and/or specific social, psychiatric and medical problems as adults? 3) Do substance abuse problems and mental health problems in the primary family predict different types and levels of childhood maltreatment? Twenty‐five per cent of the total sample was included in the high‐level trauma group and 54% in the intermediate‐level group. Females had significantly higher scores than males in all types of childhood trauma. The strongest correlations were found between childhood trauma and lifetime psychiatric problems and psychiatric status during the last 30 days before admission for treatment. More research, and especially prospective studies, is needed to clarify the importance of parents' substance abuse and psychiatric problems in childhood/adolescent compared with trauma in the client's childhood and the client's current psychiatric status.     

Abscondence and duration of treatment of compulsorily committed alcoholics on a locked ward: effects of changes in the treatment program and the law

The study concerns 124 alcoholics compulsorily committed to a locked ward at Runnagården, a coercive treatment setting in mid-Sweden. Three groups are compared: 57 patients were admitted before and 29 were admitted after the implementation of an introductory Alcoholics Anonymous-oriented program on the ward. Another 38 patients were admitted after the changes in legislation, which resulted in a longer duration of compulsory care. The groups were compared as to the number of days spent on the locked unit and the number of times they absconded. With the implementation of the program, a significant reduction was observed in the time needed on the locked ward, while the number of abscondence incidents showed a weaker tendency to decrease. After the legislative changes were made, the same factors increased. Multivariate regression was used to check confounding background factors. In conclusion, the introduction of an Alcoholics Anonymous-oriented program in a coercive treatment setting reduced the time spent on a locked ward without increasing the number of times patients absconded. Increase in length of coercion increased both the time spent at the locked ward and the number of times absconded.     

Unilateral Family Therapy with the Spouses of Alcoholics

The design and development of a unilateral family therapy for alcohol abuse is reported from a study of 25 spouses. Subjects were recruited from newspaper advertisements in which spouses of partners who had a drinking problem and refused to enter treatment were solicited to receive free professional assistance. Treatment embraced treatment orientation, clinical assessment, spouse role induction, abuser-directed interventions, spouse-directed interventions, and maintenance. Results indicated that the unilateral treatment program can be implemented, the spouses of uncooperative alcohol abusers can be assisted to function as a positive rehabilitative influence with their alcoholic mates, and that important positive gains for the abusers and spouses can be achieved. It is concluded that the unilateral approach should be experimentally evaluated and, if results are favorable, applied with other populations.     

Coercion and justice: a critical analysis of compulsory intervention towards adult substance abusers in Scandinavian social law

Compulsory interventions towards adult substance abusers have a long tradition in the Scandinavian countries. Attitudes towards such controversial measures have changed during the last decades, and currently all three countries (Denmark, Norway and Sweden) emphasise individual autonomy and integrity as the basic principle in social law. In this article justifications of compulsory interventions are analysed on the basis of three general principles of justice: the liberal Principle of Autonomy, the Principle of Care and the utilitarian Harm Principle. A critical approach towards the weighting of these principles is applied in the discussion of the legal foundation of compulsory measures in the Norwegian, Swedish and Danish social laws.     

Young Men Living Through and with Child Sexual Abuse: A Practitioner Research Study

to andrewdurham{at}warwickshire.gov.uk Summary This paper uses a post-structural framework to examine the experienceand impact of child sexual abuse on the lives of seven youngmen aged between 15 and 24. The study highlights the importanceof survivors' perspectives and of allowing children and youngpeople to speak for themselves and theorize their own experiences.The study's sensitive methodology allowed the young men to besupported throughout the research and feel able to impart hiddenfeelings and anxieties which they had held on to for significantperiods of time. The research showed how the perpetrators tookextensive measures in targeting and gaining access to and silencingthe boys they sexually abused. Through purposefully constructedrelationships, the boys were made to feel responsible and guiltyabout being abused and therefore found it extremely difficultto tell. A social context of patriarchal relations, with genderconstructions characterized by compulsory heterosexism and homophobiasignificantly exacerbated the experiences of the young men.This context was shown to create circumstances and ‘normal’power relationships that allowed the abuse to happen, creatingmany opportunities for the abusers to justify their actionsand further silence their victims.     

Marital Problems of the "Old" Elderly as They Present to a Mental Health Clinic

This work examines the mental health problems faced by “old” elderly couples, and explores various interventions aimed at helping this group. The authors observe that although almost every couple that enters treatment appears to be in a state of crisis, problems tend to have a rather chronic underlay. This will be analyzed from several theoretical perspectives, with emphasis being placed upon how couples “negotiated” earlier life stages, transitions, and experiences. The authors' own practice style and objectives for treatment will be discussed; interventions outlined, Critical attention will be given to why therapy with this group is challenging, and where failures occurred. Suggestions will be offered as to how this therapy can be made more effective. Case examples will be used to highlight the points that are made.     

The role of social support when giving up drug abuse: a female perspective

This article contains a presentation and analysis of the results from two qualitative studies, which examined female drug abusers' everyday lives and the social support available to them within their close relationships. Both studies concerned women who were participating in work-training or treatment programmes and who were in the process of giving up drug abuse. The two main questions concerned the supply of social support from the women's social networks and whether the amount of support available or lack of support had any impact on the exit process. Social support within different relationships of the women's social networks is presented, as well as different types of professional social support and treatment. The results in relation to previous research about female drug abusers and social support from gender and class perspectives are discussed. Conclusions about three important factors when creating a new life after drug abuse are drawn.     

Women and men – same problems, different treatment

The focus on difference between men and women has been important in the development of gender-specific treatment for alcohol and drug problems. The aim of this article is to examine the views of alcohol and drug treatment staff on differences between men and women in treatment and compare men and women in treatment on issues related to staff attitudes. One data set consists of questionnaires sent to staff working with alcohol and drug problems in Stockholm County (n = 918). Another data set consists of interviews with women and men in treatment for alcohol and drug problems in Stockholm (n = 1865). The results show that staff experience differences between men and women both in their problems and in how they should be treated. Some of these differences are supported by the comparison of women and men in the client-data, but mostly the differences are relatively small or even non-existent.     

Dilemmas when working with substance abusers with multiple and complex problems: the case manager's perspective

Since the 1990s, case management has been implemented in the USA and Canada – and recently also in various European countries – to support substance abusers with multiple and complex needs. Although this intervention is often presented as a set of standardised functions, its application is often a subjective task involving various dilemmas, which may influence case management outcomes significantly. Based on a comparison of case managers' experiences in Denmark and Belgium, we focus on several core dilemmas in case management for substance abusers with complex problems. Case management practices vary from one project to the next and even within the same project. Such differences are apparently related to the way in which case managers approach dilemmas such as those existing between control versus self-determination, or between systematic versus ad-hoc planning. The conclusion is that it is vital to discuss these dilemmas during training courses and supervision meetings in order to ensure that the intended form of intervention is actually delivered on the ground.     

Intensive family preservation services: an examination of critical service components

A treatment programme for child victims of sexual abuse within the family has been evaluated in terms of psychological and behavioural outcomes for the young people two years after beginning therapy. The Canadian programme was based on principles established by Giarretto in his Child Sexual Abuse Treatment Program (CSATP). Screening by child protection workers selected potential candidates. However, because of limited resources, referral of less than half of the originally screened families was made, even though they were judged suitable for participation. This made available an untreated comparison group ( n  = 30), similar in many ways to the treated families ( n  = 27). After two years the treated adolescents had largely recovered levels of self-esteem obtained in normative samples, and depressive affect had diminished markedly, as had problem behaviours. By contrast, the untreated adolescents had retained low levels of self-esteem, and high levels of depression. Negative behaviours (delinquency, running away from home, acts of deliberate self-harm) had deteriorated after two years. This was linked both to further within-family abuse (in a fifth), followed by a drift in some into street life. Despite its apparent success, the CSATP could not be continued because of lack of funding, and problems in maintaining a community development model for supporting a humanistic programme.     

'School was just a nightmare': childhood abuse and neglect and school experiences

Children who have experienced abuse display significant difficulties in dealing with all aspects of the school environment. This paper examines the experiences at school of a group of respondents who had been subject to abuse and neglect during their childhood and adolescence. A qualitative research approach, utilizing in-depth interviews, was used to explore their perspectives and insights in relation to their experiences. The findings of this study show how the various forms of abuse and neglect experienced in their families had consequences for them in the school setting. A further important finding was a lack of professional student welfare support for the interviewees at school. Implications for prevention and intervention approaches in relation to both policy and service delivery are outlined.     

Validating a Korean Version of the Drug Abuse Screening Test-10 (DAST-10)

ABSTRACT

There are no screening instruments for adults in the Korean language that are specific to drugs other than alcohol and tobacco. The purpose of this study is to validate the Korean version of the Drug Abuse Screening Test-10 (DAST-10). The Korean version of the DAST-10 was validated with 1,000 adults including general adults and at-risk adults. The results indicated that the Korean version of the DAST-10 was unidimensional similar to its English-language counterpart and showed satisfactory internal consistency reliability and convergent validity. The results also showed that the Korean version demonstrated optimal performance at a cutoff score of 2, which is the same as that of its English-language counterpart. It is expected that as the development of Korean-language instruments measuring alcohol problems contributes to the expansion of related research, the development of the Korean version of the DAST-10 will facilitate research on various topics related to substance abuse in Korea. Validation with Korean adults identified as substance abusers is needed to improve the ability of the Korean version to correctly identify substance-abusing adults.     

Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town

The article reports on an exploratory study that examined access to alcohol and other drug treatment for historically disadvantaged communities in the Cape Town metropole. In-depth interviews were conducted with 20 key informants from various sectors of the alcohol and drug treatment system, including treatment service providers, members of local drug action committees and social workers from district social service offices. Findings highlighted three structural barriers to service delivery: (i) difficulties in developing and implementing a strategic plan relating to alcohol and drug problems due to poor capacity and other infrastructural issues, such as a lack of information, poor intersectoral collaboration and limited consultation with service providers; (ii) limited allocation of resources to alcohol and drug treatment which has restricted the availability of affordable services as well as the capacity of established services to meet increased demand for services in this area; and (iii) fragmented service delivery. The study highlighted the need for further transformation of the South African social welfare system responsible for alcohol and drug treatment service delivery through public–private partnership development and the introduction of a management information system.     

Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Substance abuse

Alcohol abuse poses special risks for increased morbidity and mortality among older adults, contributing to the heightened use of medical resources and the related increase in medical costs. Although the prevalance of alcohol use disorders in the older adults is generally less than that found in younger groups, it is expected to increase with the aging of the "baby-boom" generation. In spite of this, little attention has focused on developing, and evaluating the efficacy of, treatment programs for older adults with alcohol related disorders. This article discusses the availability of effective treatment strategies for older alcohol abusers and reviews the epidemiological and outcomes research literatures related to alcohol abuse and older adults. The few empirical studies that examine outcomes associated with the treatment of older substance abusers reveal positive outcomes, especially when "age-specific," cognitive-behavioral, and less confrontational treatment approaches are employed.     

‘I make use of my precious experience,and help others. It's a kind of blessing.’ Does public sharing of past experiences help in the rehabilitation of former offenders or drug abusers?

The Community Education Service (CES) of The Society of Rehabilitation and Crime Prevention (SRACP) has pioneered the adoption of life education in crime prevention education in Hong Kong since 1977. Under this programme, former offenders and drug abusers are recruited to share their experiences with community audiences. Through such sharing, it is hoped that the former offenders and drug abusers will gain a deeper insight into the consequences of committing crime or abusing drugs, have the courage to admit their failings and find the way to lead a more fulfilling and law-abiding life.

In the past, different organizations have employed former offenders and drug abusers in educational programmes, particularly in relation to the prevention of juvenile delinquency. A number of studies demonstrate the educational effectiveness of sharing past deviant behaviours with audiences. Moreover, the mission of SRACP is to help the reintegration into society of former offenders and drug abusers. Consequently, employing former offenders and drug abusers to share their experiences serves another important function; to facilitate the transformation of their past histories into valuable assets and help with their own rehabilitation during the process of serving others, as suggested by ‘helper therapy’ and ‘professional ex-s’ (Brown 1991). A successful rehabilitation means success in reducing recidivism.

This paper examines whether sharing one's real-life experiences with others can influence the rehabilitation process, and provides recommendations for improving service delivery to benefit both audience and the speakers themselves. Fifteen individuals who were formerly either offenders or drug abusers, aged between 18 and 45 years, and who had led a ‘clean’ life for the previous six months, took part in in-depth interviews in order to investigate their perceptions of the function of real-life experience sharing in their own rehabilitation. Concepts of labelling theory (Becker 1963) and self-fulfilling prophecy (Wilkins 1976) provided the framework for these interviews.

The study concludes that respondents are normally able to help themselves to resist crime and drugs, given that the internal and external factors affecting sharing are well addressed. The results identify practical implications and directions for future involvement of former offenders and drug abusers in community-based crime prevention education programmes.     

How do substance abusers and their significant others experience the re‐entry phase of therapeutic community treatment: a qualitative study1

Transition to re‐entry (aftercare) is a stressful event for therapeutic community residents. While several authors agree on the importance of social support during reintegration, few studies have focused on the experiences of re‐entry clients themselves and their significant others during this period. Using a case‐study design, the present study examines the re‐entry process of four TC‐residents and three of their social network members during a six‐month period, starting at the time of their transfer to the halfway house. Clients and their significant others have mixed feelings about the reintegration period, although both are mainly positive. Clients report difficulties in leaving behind the TC‐mentality and building up a stable social network; they are surprised about the frequent contacts with substance (ab)use in mainstream society. Significant others misjudge clients’ feelings about transition and relapse. Many significant others have a positive attitude towards the use of substances. The tendency in mainstream society to increasingly accept the use of substances intensifies clients’ need for early guidance in building up stable supportive networks. Significant others need well‐grounded information on the reintegration process and on relapse.     

Understanding and working with adolescent neglect: perspectives from research,young people and professionals

This paper provides an overview of research about adolescent neglect funded by the Department of Children, Schools and Families (now the Department for Education) and the Department of Health. The paper examines what is known from literature about the causes of adolescent neglect, together with its potential consequences for well‐being. Drawing on qualitative data, the concept of neglect is explored from the perspectives of young people themselves and the professionals who work with them. Consideration is given to examples of interventions and preventative models geared towards addressing adolescent neglect. Key findings indicate that there is a need for both a re‐examination of current definitions of neglect in the light of age‐related distinctions and perspectives, and a fuller understanding of the particular needs of adolescents who are experiencing neglect. Additionally, the research highlights that there is a lack of research knowledge about neglectful parenting and the behaviour of young people, as well as limited understanding of interventions with neglected adolescents. Key themes from the research are discussed in terms of their implications for future practice, policy and research in relation to working to improve the welfare of neglected young people.