It is useful in an article of this kind to inform the reader of the author’s background, biases, and rationale for the format and content. As a clinically trained psychiatrist and addiction specialist/researcher, my training and experience have led me to best understand the “clinical side” of alcoholism and substance abuse. A large part of my career has been devoted to treating individuals with alcohol use disorders, especially in the context of clinical trials devoted to finding new medications (...) to reduce craving, drinking, and preventing relapse. I also teach professionals about the diagnosis and treatment of alcohol and other substance abuse disorders. While my focus has been mainly on alcohol use disorders, much of what is known about the neuroscience of addiction is applicable to many, if not all, substances of abuse. I have seen the ravages of these diseases, including death, but I more commonly see the milder forms of these diseases that make people’s lives just plain miserable and/or less enjoyable or productive than they would have been without their addiction. (shrink)

Alcohol and substance abuse are prevalent in our society. Advances in neuroscience have led to a clearer understanding of the effects of abused substances on the brain. Clues are now available regarding how a person goes from a “user” to being addicted based on brain chemistry, anatomy, and genetic risk. During this process the person loses at least partial, if not complete, control, over their compulsive substance use. This article attempts to put modern notions of alcohol and (...) substance abuse and dependency into a societal and cultural context with the hope of reducing the stigma of this illness while shifting the focus a bit more away from criminal solutions to those offered by health care and treatment options. (shrink)

We examine the relation between worker substance abuse and workplace fraud in a sample of medical doctors. Relative to their peers, we observe that doctors engaging in substance abuse are between 50 and 100 times more likely to commit fraud in a given year. This result is consistent with research suggesting that substance abuse both creates financial pressures and impairs the functioning of cognitive self-regulatory mechanisms. Our results are robust in within-subject tests and between-subject (...) tests, as well as in tests using instrumental variables that exploit exogenous variation in the state-level availability of opioids, a commonly abused substance. (shrink)

This article examines the role of anecdote and casual literary criticism in the post-Tang defamation of Han Yu’s character. Several scholar-officials from the Song, Yuan, and later eras criticized Han Yu’s moral inconsistency in their collections of “miscellaneous notes” and “remarks on poetry”. Specifically, Han Yu is condemned for over-indulging in amorous relations with young female musicians and for pursuing immortality through alchemical means. I discuss the critical reception of a few key compositions authored by Han Yu and his contemporaries (...) in order to place his alleged activities in their historical context, explore the contested process by which he became a cultural icon, and clarify the various ways that later literati shaped his image and used it for their own purposes. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse (...) or child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse (...) or child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

This paper will set out in plain language the basic ontology of “Deleuze’s Spinoza”; it will then critically examine whether such a Spinoza has, or indeed could have, ever truly existed. In this, it will be shown that Deleuze’s reading of Spinoza involves the imposition of three interlocking, formal principles. These are (1) Necessitarianism, (2) Immanence, and (3) Univocity. The uncovering of Deleuze’s use of these three principles, how they relate to one another, and what they jointly imply in terms (...) of ontology, will occupy Part 1 of this paper. The critique of these principles from a Spinozist perspective, i.e. that their use by Deleuze is incompatible with Spinoza’s own metaphysics, will occupy Part 2 of this paper. (shrink)

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic event. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequalae at the neuro-behavioural level. Second, parents’ addiction often entails a childrearing environment characterised by poor parenting skills, disadvantaged contexts and adverse childhood experiences, leading to dysfunctional outcomes. Young adults born from/raised by (...) parents with drug problems and who develop a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved 3 groups each consisting of 15 young adults (aged 18-24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterised by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions; personality disorders were also common but did not differentiate them from non-exposed young people with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing executive functions and adopting a trauma-focused approach. (shrink)

Substance-abusing women are vulnerable to specific kinds of epistemic injustice, including stigmatization and discrimination. This article examines the development of the epistemic agency of female substance abusers by asking: How does the use of a formal discussion protocol in community rehabilitation interaction alleviate epistemic injustice and strengthen the epistemic agency of substance abusers? The data were collected in a Finnish rehabilitation center by videotaping six group discussions between social workers, peer support workers, and rehabilitation clients with (...) class='Hi'>substance abuse problems. Of these data, one recorded group discussion between four female participants—two rehabilitation clients, a peer support worker, and a social adviser—was used in this paper. Using conversational analysis, the findings indicate that, through the collaborative activities of sharing experiential knowledge about substance abuse and discussing the experiences of abuse in the rehabilitation interaction, substance abusers can develop novel ways to strengthen their epistemic agency by enhanced self-awareness. The discussion protocol is an epistemic tool that professionals and clients can learn to use in ethically and epistemologically successful ways in interaction. The use of a discussion protocol is an example of social professionals’ clinical knowledge of intensifying collaboration and sharing experiential knowledge in community rehabilitation and other substance abuse services. (shrink)

This article examines 17 substance-abusing women's perceptions of their mothering practices in the context of a residential substance-abuse treatment program for women with children and pregnant women. Using in-depth semistructured interviews and observations of treatment groups, the participants' cultural knowledge about mothering is explored. Although the women in this study described how their substance-abusing lifestyle had a negative impact on their children, they also detailed practices that illustrated that they felt capable as parents. The women were (...) silent about how race, gender, or class arrangements affected their lives; their stories, however, showed active avoidance and manipulation of the contemporary ideology of mothering. (shrink)

Older people enter the final phases of their lives with well‐established habits and rituals, some of which might be or become substance abuse. This inquiry focused on the relationship between habits, rituals, and the compulsive addictive behaviours evident in older persons' substance abuse. Habits and rituals, examined as adaptive and limiting functions in older persons, revealed changes in autonomy, social inclusion, and emotional responses to such changes as older persons experience declining energy reserves and physical debilities. (...) Older persons' ebbing sense of control and passionate responses to change illustrate the perennial struggle between the will and emotions when habits and rituals transform to compulsive addictive behaviours. Two concepts, germane to this struggle both in older persons' addictive behaviours and nurses' response, emerged from this inquiry: temperance, a balance between the will's freely chosen actions and passionate desire, and discipline, the means to achieve such balance. The focused attention demanded in discipline can be realized in spiritual exercises and daily care of the soul. Disciplined actions engage the older persons' imaginative capacities to manage and abandon the self in goals consistent with end‐of‐life issues: meaningful fulfillment of human potential and the need for daily joy and pleasure in living the final years. (shrink)

A great deal has been learned in the past fifteen years from the study of pain mechanisms. More recently, the relief of pain has begun to receive much needed attention as well. Although most, if not all, acute and cancer pain can be relieved, recent evidence shows that inadequate treatment of pain is still common among the general population—even for pain due to cancer. Inadequate treatment of cancer pain is even more likely if the patient is a member of an (...) ethnic minority, female, elderly, or a child. Evidence also suggests that substance abusers are at risk for poor pain treatment.A number of barriers which involve problems of knowledge, attitudes, and laws and regulations affect health care professionals, patients, and the health care system; collectively, they contribute to the inadequate treatment of pain. (shrink)

A great deal has been learned in the past fifteen years from the study of pain mechanisms. More recently, the relief of pain has begun to receive much needed attention as well. Although most, if not all, acute and cancer pain can be relieved, recent evidence shows that inadequate treatment of pain is still common among the general population—even for pain due to cancer. Inadequate treatment of cancer pain is even more likely if the patient is a member of an (...) ethnic minority, female, elderly, or a child. Evidence also suggests that substance abusers are at risk for poor pain treatment.A number of barriers which involve problems of knowledge, attitudes, and laws and regulations affect health care professionals, patients, and the health care system; collectively, they contribute to the inadequate treatment of pain. (shrink)

There is no empirical research exploring how substance abuse therapists perceive and manage their professional role or privacy boundaries. This study explores their attitudes associated with self-disclosure and dual relationships. Ten therapists, five who had recovered and five who had never been substance dependent, shared their work experiences during semi-structured, in-depth interviews, which have been subjected to interpretative phenomenological analysis. While nonneophytes were generally reluctant to share personal information or establish alternative forms of relationship with current or (...) former clients, neophytes were more open to using self-disclosure and admitted changing professional relationships into friendships. These findings are discussed in relation to ethical codes, training and supervision in substance abuse treatment. (shrink)

Proceeding from a phenomenological perspective, the present study investigated the experiences of seven homeless women who had lived through childhood trauma and subsequent substance abuse, with specific focus on the recovery process experienced by each. Applying the analytical protocol of Giorgi to the written accounts obtained from the participants, 15 constituent themes of the recovery process were identified. In order to illuminate the participants’ experiences with minimal influence of any possible researcher bias, the researcher refrained from labelling, judging (...) or diagnosing the women’s life circumstances. Consequently, no treatment paradigm was applied to help explain, predict or judge the behaviour of the participants during the course of this research. (shrink)

In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mental illness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community mental (...) health centers toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)

As part of an ethics course, health professions students were asked to identify ethical issues and to propose resolutions before and after a class discussion of a case involving confidentiality and substance abuse. Students listed an average of 2.4 issues before and 3.6 issues after the discussion. After discussion 50 per cent of students made explicit changes in their proposed resolution. Opinions varied widely on breaching confidentiality and the responsibility for protecting the patient's health. After the discussion almost (...) 20 per cent of the class felt it was acceptable to breach confidentiality as long as the patient was unaware. Many students identified more with the health care provider than with the patient. The presence of substance abuse altered many students' views on confidentiality. In this experience students were less rigorous in their application of principles, creating an excellent opportunity for teaching through exploration of the complexity of ethical decision-making in a specific case. (shrink)

This study examined the efficacy of corrected feedback for improving consent recall throughout the course of an ongoing longitudinal study. Participants were randomly assigned to either a corrected feedback or a no-feedback control condition. Participants completed a consent quiz 2 weeks after consenting to the host study and at months 1, 2, and 3. The corrected feedback group received corrections to erroneous responses and the no-feedback control group did not. The feedback group displayed significantly greater recall overall and in specific (...) content areas. Results support the use of corrected feedback for improving consent recall. (shrink)

Genetic intervention is on the near horizon for the treatment of substance abu se. Genetic intervention involves a reprogramming of a person’s own genetic instructions so that that person will no longer have the physical craving for the drug of choice. Unlike pharmacologic intervention, genetic intervention will change the genetic identity of the person, albeit slightly. The legal issue is whether one has a fundamental right to this medical procedure. A fundamental right is one that the government cannot deny (...) without a compelling interest. The case law indicates that the right o f medical necessity applies when the person’s affliction is serious, there are no reasonable or effective alternatives, the person did not intentionally cause the condition, and the treatment is effective for the long term. Unlike the medical marijuana ph enomenon, genetic intervention is per se anti - drug, unrelated to illegal, recreational drug use, and on its face has a medical use. Legal doctrines to date though not directly on point are conceptually compatible with the existence of a fundamental right of medical necessity for genetic intervention. (shrink)

We examined the efficacy of including a research intermediary (RI) during the consent process in reducing participants' perceptions of coercion to enroll in a research study. Eighty-four drug court clients being recruited into an ongoing study were randomized to receive a standard informed consent process alone (standard condition) or with an RI (intermediary condition). Before obtaining consent, RIs met with clients individually to discuss remaining concerns. Findings provided preliminary evidence that RIs reduced client perceptions that their participation might influence how (...) clinical and judicial staff view them. This suggests that using RIs may improve participant autonomy in clinical studies. (shrink)

Ethical frameworks can support professionals’ decision‐making. Here, we identify two ethical frameworks to analyse the best support for families that struggle with parental substance or alcohol abuse. The first framework, which we call ‘the framework of conflicting interests’, is most prominent in the literature. Here, the interests of parents and children are weighed against each other using the medical ethical principles of respect for autonomy, justice, beneficence, and non‐maleficence. The second framework is most prominent in a series of (...) interviews we conducted with alcohol‐dependent parents and professionals working in addiction care and youth care. This framework aligns more with an ethics of care, and starts with the assumption that the interests of people who are close to each other are often intertwined. This framework does not so much look at conflicting interests, but at relationships and vulnerability. We label this the ethics of care framework. In this article, we show the value of both frameworks and how they can support ethical decision‐making. (shrink)

According to the Institute of Medicine, chronic pain affects at least 116 million adults in the United States, which is more than the total affected by heart disease, cancer, and diabetes combined. Pain costs the nation up to $635 billion each year in medical treatment and lost productivity. It has been conceptualized as a public health problem due to its prevalence, seriousness, disparities, vulnerable populations, the utility of population health strategies, and the importance of prevention at both the population and (...) individual levels. For many patients, treatment of pain is inadequate due to uncertain diagnoses, societal stigma, the lack of effective treatments, and inadequate patient and clinician knowledge about the best ways to manage pain. This article explores the inadequate treatment of pain in the U.S. and the subsequent rise of prescription painkiller abuse, misuse, and overdoses. This is followed by a review of the actions taken by states to regulate the prescribing of controlled substances. (shrink)

There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues, were exploited during the first wave (...) of psychedelic research in the USA. To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies. All data relevant to the study are included in the article. (shrink)

Access to students’ perspectives on substance abuse is essential for effective youth intervention projects development. This study aimed to explore students’ perspectives on abuse of drugs and alcohol with probable development of student-led intervention strategies. The study was conducted at public universities in Zambia. Student’s perspectives on drugs and alcohol abuse were documented using a mixed method design that employed purposive and snowball sampling to select 200 respondents to questionnaires and 10 to in-depth interviews. A humanistic (...) theory approach was applied in the interpretation and analysis of the data collected. The findings showed that cannabis (30%) and codeine contained in Benylin (17%) were commonly abused. Further findings showed that students’ academic pressure was the leading cause of substance abuse (27%), followed by peer pressure (20%). Students knew that abuse of drugs and alcohol led to low academic performance, violence and theft, risks of contracting sexually transmitted infections (STIs), and other social maladjustments. The study recommends that institutions of learning increase student-led awareness campaigns, security surveillance on campus, and collaboration with government drug enforcement agencies. Institutions of learning should involve students in the planning of programmes to deal with drug and alcohol abuse. Contribution: The study will inform amendment of drug and alcohol abuse policies in institutions of learning. The study will contribute towards the UNESCO O3 PLUS project goal of making campuses safe and inclusive, and overall, the Sustainable Development Goal 3 and 4. The study serves as basis for scholars in the field of biblical theology engaged with justice, health and human development. The article is a contribution to the research project Biblical Theology and Hermeneutics. The results of this research can especially be utilised by scholars in the field of psychology of religion, the sociology of religion and practical theologians focusing on youth ministry. (shrink)

Pharmacists, physicians, and other health care personnel practice within an integrated system of laws and regulations that influence many treatment modalities. Capitation, managed care, and other controls strain these relationships by mandating greater oversight of how health care is delivered. From a pharmacists’s perspective, any use of medication requites knowledge of three omnipresent factors: regulatory control, formularies, and economic decision making. My objective is to raise awareness of these issues as they relate to the prescription of pain medication and to (...) pain management generally.All practice-oriented drug law and regulation is based on the federal Controlled Substances Act of 1970. The Act, also known as Title II, is part of a much larger piece of legislation, the Comprehensive Drug Abuse Prevention and Control Act of 1970. CSA was enacted to regulate the manufacturing, distribution, dispensing, and delivery of drugs or substances that are subject to, or have the potential for, abuse or physical or psychological dependence. (shrink)

Pharmacists, physicians, and other health care personnel practice within an integrated system of laws and regulations that influence many treatment modalities. Capitation, managed care, and other controls strain these relationships by mandating greater oversight of how health care is delivered. From a pharmacists’s perspective, any use of medication requites knowledge of three omnipresent factors: regulatory control, formularies, and economic decision making. My objective is to raise awareness of these issues as they relate to the prescription of pain medication and to (...) pain management generally.All practice-oriented drug law and regulation is based on the federal Controlled Substances Act of 1970. The Act, also known as Title II, is part of a much larger piece of legislation, the Comprehensive Drug Abuse Prevention and Control Act of 1970. CSA was enacted to regulate the manufacturing, distribution, dispensing, and delivery of drugs or substances that are subject to, or have the potential for, abuse or physical or psychological dependence. (shrink)

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature (...) and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)