Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

Life values,family support and psychosocial adaptation among older people in Taiwan: an institutional and community comparison

The purpose of this study was to investigate the psychosocial adaptation among elderly persons in institutional and community settings, and to explore factors influencing their adaptation. A cross-sectional survey was conducted with a convenience sample of 165 residents of four institutions (two assisted-living facilities and two nursing homes) and 209 community-dwelling elders served by a primary care centre, all located in middle Taiwan. A structured interview questionnaire was used to collect data. Results: community-dwelling elderly had significantly higher adaptation scores than those in institutional settings. Factors related to adaptation differed between institutional and community settings, with more variables influencing adaptation in the community than in the institution. Physical functional status was the major influence on adaptation of the elderly in institutions. Dietary support from family was negatively associated with adaptation in this group. Influencing factors for community-dwelling elders were more complicated, including perceived family emotional and economic support, personal life values and physical functional status. Implications: greater support from government, including economic resources and assistance in community care are needed to achieve the policy goal of ‘aging in place’. Further investigation of the influence of family interaction on elders' adaptation is needed.     

Eliminating the U.S. drug lag: Implications for drug safety

An increase in new drugs first launched in the U.S. and shorter lags between first global drug launch and U.S. approval indicate that the U.S. drug lag has declined. This paper examines the impact of these changes on drug safety using adverse drug reaction data for FDA-approved drugs in 1990 to 2004. Results show two different effects. First, drugs having longer U.S. launch lags (more foreign market experience) have fewer post approval drug risks compared to drugs with shorter launch lags. This result implies that foreign market experience prior to U.S. entry provides information to help alleviate drug-related risks for U.S. patients. Second, drugs that are first launched in the U.S. have fewer serious drug reactions compared to those that were first launched abroad. This result is surprising, and may suggest that first U.S. drug launch signals information about unobserved application quality, which translates into lower post approval drug risks.     

Retrospective Reflections of a Whistleblower: Opinions on Misconduct Responses

Almost 10 years ago, when I was in my fourth year of graduate school, my fellow graduate students discovered that our thesis advisor had engaged in misconduct by falsifying and fabricating data in two grant applications. We informed the university and my advisor resigned. This event was a turning point in my life. Years later, I have gathered my thoughts and reflections on the experience. I believe we must first prevent what misconduct we can. But unfortunately some misconduct will still occur and in those circumstances we must respond to protect those affected by the misconduct and to progress beyond the event. In so doing, we get the most value out of scientific research.     

Parental health and children's economic well-being

The life course perspective emphasizes that past economic experiences and stage in the life course influence a family's ability to cope with negative life events such as poor health. However, traditional analytic approaches are not well-suited to examine how the impact of negative life events differs based on a family's past economic experiences, nor do they typically account for the potentially spurious association between negative life events and family economic well-being. We use finite mixture modeling to examine how changes in parental health affect children's exposure to poverty. We find that for some children the association between family head's health and children's exposure to poverty is spurious, while for other children family head's poor health is associated with increased risk of economic deprivation. The extent to which a family head's poor health alters children's economic well-being depends on a child's family's underlying economic trajectory and past history of exposure to disadvantage.     

Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology

OBJECTIVE: In this pilot study, the authors examined the effectiveness of a 4-week resilience intervention to enhance resilience, coping strategies, and protective factors, as well as decrease symptomatology during a period of increased academic stress. PARTICIPANTS AND METHODS: College students were randomly assigned to experimental (n = 30) and wait-list control (n = 27) groups. The experimental group received a psychoeducational intervention in 4 two-hour weekly sessions. Measures of resilience, coping strategies, protective factors, and symptomatology were administered pre- and postintervention to both groups. RESULTS: Analyses indicated that the experimental group had significantly higher resilience scores, more effective coping strategies (i.e., higher problem solving, lower avoidant), higher scores on protective factors (i.e., positive affect, self-esteem, self-leadership), and lower scores on symptomatology (i.e., depressive symptoms, negative affect, perceived stress) postintervention than did the wait-list control group. CONCLUSIONS: These findings indicate that this resilience program may be useful as a stress-management and stress-prevention intervention for college students.     

The case for mandatory outpatient treatment

Research on the effectiveness of mandatory outpatient treatment, which is court-ordered mental health follow up, supports its use with individuals who have serious mental illness. Many states already have some kind of mandatory outpatient treatment in place, but it is often underused. Much of the criticism of mandatory outpatient treatment is based on the fact that research demonstrating its efficacy is limited and that its implementation infringes on individuals' rights. However, sufficient evidence can be found in the literature to support its use for some individuals with chronic mental illness living in the community. In addition, the ethical principles of beneficence, utilitarianism, and communitarianism support its use in some situations. Mandatory outpatient treatment is an ethical and effective method shown to be helpful with individuals who have mental illness and are nonadherent to treatment. Expanding its use in appropriate situations is in the best interest of those with serious mental illness and society in general.     

Conservation and family planning in Tanzania: the TACARE experience

Community-based distribution (CBD) programs present an alternative way of effectively reaching people in rural areas of developing countries where conventional methods of delivery do not exist or fail. This paper reviews the experience and findings from the Jane Goodall Institute’s (JGI) TACARE program in the Kigoma region of Tanzania. It focuses on the family planning CBD program and its integration within the TACARE program to meet the broader mission of JGI’s conservation efforts. Both qualitative and survey data suggest that the CBD program meets the needs for contraception in participating rural communities and is a complementary and acceptable strategy to ultimately contribute to reduce population pressure on the villages around Gombe National Park.     

Marital relations and fertility control decisions among lebanese couples

This study examines how marital relations affect fertility control decisions among couples who want no further pregnancies. Marital relations studied include the degree of communication between husbands and wives, the extent that couples report marital tension, conflict, and separation, and the amount of intimacy and mutuality achieved in their sexual relations. Findings are based upon the responses of 530 Middle Eastern women who used the facilities of the University Hospital Family Planning Program of the American University of Beirut, Lebanon; 257 women were interviewed in their homes throughout Lebanon, and the remaining 273 were interviewed at the clinic. Three decisions were studied: (1) IUD/pill use; (2) tubal sterilization use; and (3) consideration of and refusal to use tubal sterilization. Women were interviewed using a standardized questionnaire prepared in colloquial Arabic. The decision to choose a reversible versus a permanent method was primarily sociodemographically determined. Among women who considered a permanent method, however, differences in their decisions were mainly attributable to their marital relations rather than to their demographic characteristics. Wife's attitude toward marriage and educational attainment were important and interactive components in the explanation of the association between marital relations and tubal sterilization use.I appreciate the assistance and critical comments offered by Drs. Joseph Veroff and George Simmons of the University of Michigan, and Dr. Joseph Chamie of Population Division, UN, New York. This article is a modified section of my doctoral dissertation which was recently completed at the University of Michigan. The anonymous reviewers' comments on the organization of this paper are greatly appreciated.