Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.     

The Efron dice voting system

About 50?years ago, Efron noted some counterintuitive properties of the long-term behavior of contests involving dice. For instance, consider the 6-sided dice whose sides are labeled (4,4,4,4,0,0), (3,3,3,3,3,3), (6,6,2,2,2,2), and (5,5,5,1,1,1). Each die has a 2/3 probability of rolling a higher number than the next one in the list and the last has the same 2/3 probability of rolling a higher number than the first. The non-transitivity of games involving non-identical dice was popularized by Gardner (Sci Am, 223:110–114, 1970). Although Gardner and other authors have observed that non-transitive dice serve to illustrate the complexities of the theory of voting, it does not seem that much attention has been paid to the corresponding voting system. Our purpose in this article is to present this voting system and compare its properties with those of other voting systems. One of the most interesting properties is the fact that cancellation with respect to the Efron dice voting system can replace cancellation with respect to pairwise preferences in Young’s characterization of the social choice function associated with the Borda Count.     

Exploring the relationship between employment-based social capital, job stress, burnout, and intent to leave among child protection workers: An age-based path analysis model

Research suggests that age and organizational factors are consistently linked with job stress, burnout, and intent to leave among child protection workers. However, no study has contextualized how age matters with regards to these adverse employee outcomes. We conducted a theory driven path analysis that identifies sources of employment-based social capital, job stress, burnout, and intent to leave among two age groups. We used a statewide purposive sample of 209 respondents from a public child welfare organization in a New England state in the United States. Results suggest that the paths to job stress, burnout and intent to leave differed by age group. Social capital dimensions were more influential in safeguarding against job stress for older workers compared to younger workers. Our results justify creating workplace interventions for younger workers that target areas of the organization where relational support could enhance the quality of social interactions within the organization. Organizations may need to establish intervention efforts aimed at younger workers by creating different structures of support that can assist them to better deal with the pressures and demands of child protection work.     

Screening for pediatric bipolar disorder in primary care

A child or adolescent with pediatric bipolar disorder (PBD) is at higher risk for suicide, violence, and impaired psychosocial functioning. The prevalence of diagnosed PBD has increased 40-fold in less than 2 decades, leading some to believe that PBD is inaccurately diagnosed. Complicating this issue, disagreements exist among clinicians as to the utility of current screening methods. The assessment picture is further muddied by the high rate of comorbid psychiatric conditions. A literature review was performed to describe the present understanding of PBD and identify current practices of screening for the disorder. Although screening tools are available, the literature suggests they lack validity. Awareness, a thorough interview, and expedient referral may assist clinicians in making a correct diagnosis. Accurate assessment will help ease the psychological and economic burden of PBD.     

Off-label medication use

Prescribing medications for off-label uses is not illegal. Off-label prescribing includes using medications for unapproved indications; using a drug outside of the recommended dosage range or duration of use; using a drug in certain unapproved patient populations, such as those defined by age, sex, or particular clinical parameters; or intentionally using a medication in a patient who has a known contraindication. Medications would be considered appropriate for off-label use based on their known clinical pharmacology, evidence from clinical studies, and sometimes from the personal experience of the prescriber. The decision to use a drug off label should be based on a careful assessment of the patient's treatment history and the drug's potential risks and benefits. Patients should be given adequate informed consent about how the drug is being used off label and why, along with appropriate information about known risks and side effects.     

Understanding the relationship between social change and its impacts: The experience of rural land use change in south-eastern Australia

This study investigated socio-economic impacts of land use change, giving explicit attention to the relationships between independently observed land use change and associated socio-economic changes, perceived land use change and socio-economic change, attributed cause of change, and experienced impacts of change. Using a case study region in south-east Australia, we examined the impacts of growth in use of land for dairy farming, cropping, blue gum plantations and rural residential development on (i) rural population trends, and (ii) the amount and nature of employment available in the study region. Perceptions and impacts of change were assessed using multiple qualitative and quantitative methods. Results demonstrate that local residents were not always aware of the extent and nature of land use change, and had difficulty attributing social changes and their impacts to the land use changes that underlie them. Furthermore, the felt impacts of land use change appeared dependent on a person's awareness of that change, and on their beliefs about the causes of social change. These findings highlight avenues for theoretical development to better specify the processes by which social change processes are experienced as human impacts. The findings also have implications for land use policy and social impact assessment, illustrating the importance of understanding both perceived and actual social change.     

The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges

Abstract Objective: The authors examine the dynamics and the impact of all-campus events on pH1N1 spread at Bates College in fall 2009, with comparisons to 3 other campuses. Participants: Students (N = 285) presented or called in to the Bates Health Center with symptoms consistent with influenza-like illness. Methods: Health Center staff at Bates collected data on the outbreak; data from other colleges are from Web sites and journal articles. Data were analyzed using a mathematical model for influenza. Results: Bates held 2 vaccine clinics mid-outbreak. The data are consistent with the hypothesis that the vaccine clinics may have altered routine student interactions, facilitating transmission of pH1N1 among students who otherwise might not have encountered each other. Conclusion: The vaccine clinics, held when vaccine became available, were too late to halt transmission. The disruptions to campus rhythms due to the vaccine clinics may instead have contributed to pH1N1 spread.