Counseling for the Family: The Neglected Aspect of Addiction Treatment in Canada

ABSTRACT

There has been a historic neglect of both research and practice in the area of counselling for the family members of alcohol or other drug abusers by the addiction field in Canada. As a result, treatment for individual family members affected by alcoholism and other drug addiction remains a neglected component of the majority of Canadian addiction programs. When family involvement is incorporated, the tendency has been to concentrate on orientation and education rather than on the provision of counseling for the family members. This dearth of programming exists despite the knowledge that an active alcohol or drug abuser's behaviour disrupts the entire family system, including the functioning and development of children. Each family member is uniquely affected with negative outcomes ranging from economic hardship to violence being perpetrated against them to an increased risk among children of becoming alcohol or drug abusers themselves. Thus, treating only the active alcohol or other drug abuser is limiting and an overly narrow orientation for the enhancement of both family and community health.     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

University Binge Drinking Patterns and Changes in Patterns of Alcohol Consumption Among Chinese Undergraduates in a Hong Kong University

Abstract

Objective: To examine patterns of binge drinking and changes in drinking patterns among Chinese university students. Participants and Methods: Responses to an anonymous questionnaire were compared between a random sample of 411 second year Chinese undergraduate students in 2006 and 2,630 first year students from the previous year. Students reporting any symptoms of alcohol abuse were classified as alcohol abusers whereas those reporting repeated inability to curtail use were categorized as alcohol dependent. Results: After 1 year of university, greatly increased rates of past-month drinking of different degrees were found in both genders. Binge drinking among second year undergraduates was significantly correlated with male gender, living in a student residence hall, smoking, drinking to relieve stress, and having friends who frequently drank. Conclusions: Alcohol misuse is a health hazard to Chinese students in a university environment. Proactive policies aimed at preventing harmful alcohol use should be considered by university authorities.     

Collaborative Family Work in Youth Justice

ABSTRACT

A number of studies have found that working with family groups can be successful in improving outcomes for young people and their families. This article reports on a study in New South Wales in which juvenile justice staff offered collaborative family work interventions to young people as part of the routine offerings of a juvenile justice service. The primary objective of this study was to examine the extent to which young people who completed the family work had lower recidivism rates compared to three control groups. The methods included a comparison of recidivism rates between young people who completed the intervention, those who failed to complete, those who declined, and a matched sample of young people who were not offered the intervention. The results of the study indicated that many young people and their families were agreeable to be involved in the intervention and the completion rates were high, particularly if the work was undertaken in the family home. The young people who completed the intervention also had lower recidivism rates than young people in each of the control groups.

IMPLICATIONS

• Collaborative family work can be offered successfully by juvenile justice services to young offenders and their families.

• Collaborative family work can reduce recidivism rates for those who complete the intervention.

• It is preferable to conduct the work in the family home where completion rates are likely to be higher.

     

Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse

ABSTRACT

Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

Antecedents and correlates of alcohol, cocaine, and alcohol-cocaine abuse in early adulthood

We used a fourfold substance abuse typology consisting of non-abusers, alcohol abusers, cocaine abusers, and joint alcohol and cocaine abusers with a nationally representative sample of young adults (aged 19-26 years) to investigate issues related to prevalence, antecedents, and correlates of substance abuse. The prevalence data indicate higher alcohol abuse among white males, but approximately equal proportions of cocaine abuse and joint alcohol and cocaine abuse across gender and ethnic/racial groups. A simplex-like ordering was found for the four abuse groups with regard to the degree of problem severity associated with most of the antecedents and correlates. Joint alcohol and cocaine abusers demonstrated the highest levels of previous thirty-day and lifetime drug use, high levels of delinquent activity, and the highest rates of unemployment and marital instability. Cocaine abusers demonstrated the second highest levels of problem severity, alcohol abusers the third highest levels, and non-abusers the lowest levels. An exception to the simplex-like pattern was found with respect to educational attainment and verbal intelligence. Joint alcohol and cocaine abusers reported the lowest high school dropout rate and scored the highest on a measure of verbal intelligence. We suggest that joint alcohol and cocaine abusers may be characterized as "non-strivers" or "underachievers," quite possibly as a consequence of substance abuse.     

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.     

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.     

Beyond Performance Enhancement: Polypharmacy among Collegiate Users of Steroids

Abstract

The extremely low prevalence of steroid use among college students makes it virtually impossible to conduct analyses on any single college campus. By studying a cohort of 58,625 college students from 78 institutions that administered the Core Alcohol and Drug Survey in 1990 and 1991, a critical mass of 175 users on which it was possible to conduct statistical analyses was identified. Compared with a randomly selected group of nonusers, the steroid users reported consuming dramatically more alcohol and demonstrated higher rates of binge drinking. In addition, a significantly higher percentage of steroid users reported using tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, and designer drugs. A higher percentage of steroid users than nonusers also reported experiencing negative consequences as a result of substance abuse, and a greater percentage of the steroid users reported family histories of abuse of alcohol and other drugs. Implications from the standpoint of student development are discussed.     

Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care

ABSTRACT

Objective: Research is needed to establish the psychometric properties of brief screens in university primary care settings. This study aimed to assess the construct validity of one such screen, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), for detecting at-risk drinking among students who have utilized on-campus primary care.

Participants: 389 students recently seen in university primary care completed a confidential online survey in December 2014.

Methods: Bivariate correlations between the AUDIT-C and measures of alcohol consumption and negative drinking consequences provided concurrent evidence for construct validity. Receiver Operating Characteristic curve analyses determined optimal cut-off scores for at-risk drinking.

Results: The AUDIT-C significantly correlated with measures of alcohol consumption and negative drinking consequences (p < .001). Analyses support optimal AUDIT-C cut-off scores of 5 for females and 7 for males.

Conclusions: The AUDIT-C is a valid screen for at-risk drinking among students who utilize university primary care.     

Assessing Social Work's Contribution to Controlled Outcome Studies in the Alcohol Dependence Treatment Literature

ABSTRACT

Alcohol use disorders are among the most prevalent and disabling conditions encountered by social work practitioners. Although a substantial body of research findings has accrued evaluating the effectiveness of available alcohol dependence treatments, few efforts have been made to assess the contribution that social work has made to this database. Thus, this study examined the contribution of social work to the alcohol dependence treatment outcome research literature over the past half-century. Controlled investigations of alcohol dependence treatments published between 1950 and 2000 were analyzed by publication outlet type and primary author's professional affiliation. Computerized bibliographic searches of medical and social science databases were conducted and a manual search of 13 core social work journals to identify controlled studies of alcohol dependence interventions. Results indicate that researchers affiliated with schools or departments of social work as well as studies contained within core social work journals have contributed little to knowledge development, with respect to controlled studies, in the alcohol dependence treatment literature. Greater social work involvement in chemical dependency research would contribute much to current efforts to promote evidence-based practice and clinical guideline development in this important practice area.     

The Role of Social Workers in the Treatment of Addictions

Abstract

This article describes the history of social workers' involvement in the treatment of addictions in the United States. Beginning with Mary Richmond, the “mother of social casework,” social workers have played an increasingly important role in the treatment of individuals with alcohol and other drug problems and of their family members. Today, social workers are important players not only in program development, administration, and treatment of chemical addictions, but also in “process” addictions, such as eating disorders and gambling. Moreover, social workers are increasingly involved in addictions research and policy arenas.     

Victims’ Retrospective Explanations of Sibling Sexual Violence

ABSTRACT

While sibling sexual abuse may be the most common form of sexual violence within the family, relatively few studies have been conducted on this topic. The current study addresses this gap in the literature through analyses of thematic categories in narratives gathered from an online survey of sibling sexual violence. Survivors were asked to report why they believed their siblings had become sexually abusive toward them. Participants believed that their abusers had learned to be abusive due to their own victimization or exposure to pornography, were abusive to establish dominance over them, or had some undisclosed mental illness. While the study does not claim to test these explanations or include abusers’ own narratives, it offers insight as to how sibling sexual violence survivors make sense of their experiences and assign blame to abusers and their families. It also offers insights into future inquiries about sibling sexual abuse.     

Systemic Barriers to the Employment of Social Workers in Alcohol and Other Drug Treatment Agencies

Abstract

Literature suggests a low number of social workers employed in the field of alcohol and other drug (AOD) treatment. This study shows that social workers with undergraduate degrees (BSWs) have higher rates of employment in AOD than bachelor's degree holders from other disciplines. Master's level social workers (MSWs), however, have a much lower involvement than their counterparts with counseling degrees. Six factors are inferred to partially explain MSWs' low involvement in the field: (1) low education requirements; (2) low pay; (3) absence of “social worker” positions; (4) competition among different disciplines; (5) lack of MSW interns; and (6) state certification requirement. Suggestions to increase the employment of social workers in the AOD field are offered.     

Dropout and completion of treatment among spouse abusers

This study examines a population of spouse abusers undertaking a treatment program. Its purpose was to identify the variables associated with dropout and completion of treatment and to build a predictive model. Data were collected on 286 men who began group treatment in one of eight community programs in the province of Quebec, Canada. Results show that men who complete treatment are older, better educated and have better economic conditions than men who drop out. They also have a more stable family life, have been in a relationship for a longer period of time and have more children with their actual spouse. Men who completed treatment showed more commitment, better working capacities and a higher level of agreement with their therapists, thus developing a stronger therapeutic alliance. Support provided by people in the environment was significantly related to treatment completion. Social and judicial pressures were not related to completion.     

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students

Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.     

Powerlessness and Abuse and Neglect of Older Adults

ABSTRACT

This article is a qualitative study which addresses the interacting relationship between the environmental context of care giving and abuse and neglect of older adults. These are examined through a thematic content analysis of risk factors identified in sixteen ‘in depth’ interviews of abused and neglected victims including two of their abusers. The interviews provide a portrait of their past and present situations, their roles and relationships and the process through which the interviewees move into their described process of powerlessness.

The interviewees are analysed through a critical, systemic, ecological analysis of the historical, gender and cultural perspectives of the interviewees. Through the relationships of the victims and their abusers in the macro, meso, exo and micro systems, questions are raised about the growing debate regarding changes in family patterns and demographics that affect how societies define the provision of care to their dependent adults. They demonstrate that violence is produced by complex interacting systems and significant events, that impact on the life courses of some older adults and some care givers leading them into powerless positions and resulting in abuse and neglect.