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)

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)

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)

Research has shown that addressing and integrating the existential dimension in treatment settings reduce symptoms like anxiety, depression and substance abuse. Healthcare chaplains are key personnel in this practice. A nationwide, cross-sectional survey influenced by a mixed-methods approach was used to examine the attitudes, practices, understanding and perceptions of mental health professionals, including healthcare chaplains, regarding the value of addressing the existential dimension in treatment programmes. The existential group practice was led by the healthcare chaplains as (...) an integrated part of specialist mental health services. A positive and open attitude towards addressing the existential dimension was identified among the informants. Despite this, a small gap between attitude and practice was reported. Existential, religious and spiritual concerns are reported as part of the existential dimension and as relevant topics to be discussed in specialist mental health services. The findings indicate that the existential group practice could have a positive influence on the co-leaders’ competence to address existential, religious and spiritual concerns; however, this should be further investigated. (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)

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)

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)

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)

Ethical clinical practice requires cultural competency. In the United States, Hispanics report stronger attitudinal barriers to drug abuse treatment than any other racial/ethnic group. Hispanics report feeling that drug abuse treatment providers do not understand their unique cultural needs and are unfamiliar with their experiences of discrimination and immigration. Using this case study to explore broader ethical and policy issues, this study investigates the extent to which US universities train counselors to address the culturally specific needs (...) of Hispanic patients and how this is reflected in practice in Los Angeles County. Based on a content analysis of the required courses, syllabi, and course descriptions at 30 universities related to culture/race/racism/ethnicity/diversity at the undergraduate and graduate levels on the addiction therapist track, and thematic analysis of eight in-depth interviews with counselors working in outpatient rehabilitation centers in Los Angeles, I argue that cultural competency education for drug abuse counselors is too surface level and infrequent to adequately prepare students for a career in addiction counseling for Hispanic clients. Significant changes must be made to how cultural diversity is valued and prioritized in the field of psychology to provide better care for Hispanic people with a substance use disorder and fulfill the moral obligation to eliminate this health disparity. Although this study focuses on counselors in Los Angeles, these findings are relevant for professionals and healthcare systems across the United States and beyond who seek to provide equitable and effective care for Hispanic patients. (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 can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, (...) but are the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, (...) but are the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (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)

Essays devoted to the work of the late Neil Wilson, Canadian philosopher and contributor to the field of semantic analysis that emerged from the fusion of logic, pragmatism, and ontology. Many of the essays in this volume take their initial inspiration from Wilson's seminal work Substances Without Substrata.

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)

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)

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)

_Substance use disorders belong to the class of externalizing behaviours that are generally more common among men than women. Those women who do have substance disorders therefore deviate more from the norms of society compared with men, tend to live in an environment characterized by high risk of violence and other forms of abuse, and tend to be survivors of childhood trauma. In terms of seeking treatment, women often have difficulty acknowledging their problems with substance use (...) disorders, and professionals are reluctant to ask women about drug or alcohol use. Even when they do seek treatment, women in many countries face practical and financial barriers to access treatment. For women who do enter treatment, outcomes are generally comparable to outcomes for men, suggesting that facilitating entry into treatment can yield substantial benefits for women with addictions._. (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)

Better memory, greater motivation and concentration lead to greater productivity, efficiency and performance, all of which are features that are highly valued in a modern society focused on productivity. In the effort for better cognitive abilities, otherwise healthy individuals use cognitive enhancers, medicines for the treatment of cognitive deficits of patients with various disorders and health problems, such as Alzheimer’s disease, schizophrenia, stroke, Attention Deficit Hyperactivity Disorder or ageing. The use of these is more common in professions with emphasised (...) cognitive abilities, or in occupations that require more attention, focus and alertness. Their use is also associated with the general working population, in that they are supposed to use them to alleviate the effects of sleep deprivation and to cope with increasing workloads. In the paper, we are addressing the ethical issue and the dilemmas of the use of pharmaceutical enhancements by healthy people who have no medical reason for taking such substances, in the context of improving their cognitive functions. (shrink)

In this paper, I argue that bioethics suffers from a masculinist approach-what I call “ethical androcentrism.” Despite the genesis of other legitimate approaches to ethics (such as feminist, narrative, and communicative ethics), this masculinist tradition persists. The first part of my paper concerns the problem of ethical androcentrism, and how it is manifest in our typical ways of “doing” bioethics (as teachers, ethicists, policymakers, and medical practitioners). After arguing that bioethics suffers from a masculinist ethic, I consider the case of (...) maternal substance addiction to show how this ethic negatively affects the treatment of pregnant addicts. I argue that by treating maternal substance addiction from an androcentric approach, we fail to serve both pregnant addicts and their fetuses; furthermore, we misrepresent the intentional state of pregnant substance addicts and label them “prenatal abusers.” If maternal substance addiction is to be ethically addressed -- and if pregnant substance addicts are to be effectively treated -- we cannot tacitly accept an androcentric ethic. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the (...) power to commit pregnant women involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

Ayahuasca is a psychoactive beverage that is mostly used in ritualized settings (Santo Daime rituals, neo-shamanic rituals, and even do-it-yourself-rituals). It is a common practice in the investigated socio-cultural field to call these settings “healing rituals.” For this study, 15 people who underwent ayahuasca (self-)therapy for a particular disease like chronic pain, cancer, asthma, depression, alcohol abuse, or Hepatitis C were interviewed twice about their subjective concepts and beliefs on ayahuasca and healing. Qualitative data analysis revealed a variety of (...) motivational patterns, subjective effects, and user types. Most participants were convinced that ayahuasca had influenced their illness positively or improved their coping with their illness. More importantly, it had enhanced their well being in general. As a result, we concluded that the effects of ayahuasca should not be reduced to a pharmacological model. The substance should be conceptualized as a psychological catalyst that unfolds within different fields of sociocultural ideas. (shrink)

Data from multiple sources point to the desire for revenge in response to grievances or perceived injustices as a root cause of violence, including firearm violence. Neuroscience and behavioral studies are beginning to reveal that the desire for revenge in response to grievances activates the same neural reward-processing circuitry as that of substance addiction, suggesting that grievances trigger powerful cravings for revenge in anticipation of experiencing pleasure. Based on this evidence, the authors argue that a behavioral addiction framework may (...) be appropriate for understanding and addressing violent behavior. Such an approach could yield significant benefits by leveraging scientific and public health-oriented drug abuse prevention and treatment strategies that target drug cravings to spur development of scientific and public-health-oriented “gun abuse” prevention and treatment strategies targeting the revenge cravings that lead to violence. An example of one such “motive control” strategy is discussed. Approaching revenge-seeking, violence, and gun abuse from the perspective of compulsion and addiction would have the added benefit of avoiding the stigmatization as violent of individuals with mental illness while also acknowledging the systemic, social, and cultural factors contributing to grievances that lead to violent acts. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the (...) power to commit pregnant women involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the (...) power to commit pregnant women involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

In recent years, anthropologists have built a rich body of ethnography on the experience of addiction, including important cultural critiques of treatment systems. Yet little has been written from the perspective of those who work in the everyday to help others recover from substance abuse. In this article, I reflect on my labor as a clinical social worker providing therapy for homeless women and men who struggle with addiction. Building on the eloquence of those who seek to (...) recover, recovery poets, I demonstrate how the work of a team of frontline workers operates in a particular intersubjective realm that creates different conditions for understanding addiction and recovery than does anthropological fieldwork. By detailing the labor of recovery as I performed it using different evidence-based therapies to permit the emergence of a new consciousness, I aim to bring to center stage the complex labor of frontline workers so that their working conditions will be taken into account more often in anthropological work on addiction and treatment. (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)

Guilherme Messas is a Brazilian psychiatrist, founding member of the Brazilian Society for Phenomeno-Structural Psychopathology and author of many peer-reviewed articles in the field of psychopathology. His book entitled 'The Existential Structure of Substance Misuse' is an important and comprehensive phenomenological analysis of psychoactive substance abuse behaviour, considering a field still partially explored by clinical and psychopathological research. The contents provided by the author in this work are not only of great theoretical relevance, but also of clinical (...) utility in the rehabilitation of these patients. It would be important to deepen the field of phenomenological research in addictions, exploring the contents proposed with the aim of providing tools and knowledge that would be of concrete help in the treatment pathway of substance abuse. (shrink)

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Adolescence methamphetamine use is an issue of considerable concern due to its correlation with later delinquency, divorce, unemployment and health problems. Understanding how adolescents initiate methamphetamine abuse is important in developing effective prevention programs. We formulate a mathematical model for the spread of methamphetamine abuse using nonlinear ordinary differential equations. It is assumed that susceptibles are recruited into methamphetamine use through imitation. An epidemic threshold value, Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document}, termed the (...) abuse reproduction number, is proposed and defined herein in the drug-using context. The model is shown to exhibit the phenomenon of backward bifurcation. This means that methamphetamine problems may persist in the population even if Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document} is less than one. Sensitivity analysis of Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document} was performed to determine the relative importance of different parameters in methamphetamine abuse initiation. The model is then fitted to data on methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse in the treatment centres of Cape Town and parameter values that give the best fit are chosen. Results show that the proportion of methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse will continue to decrease in Cape Town of South Africa. The results suggest that intervention programs targeted at reducing adolescence methamphetamine abuse, are positively impacting methamphetamine abuse. (shrink)

Traditionally the doping debate has been dominated by those who want to see doping forbidden (the prohibitionist view) and those who want to see it permitted (the ban abolitionist view). In this article, the authors analyse a third position starting from the assertion that doping use is a symptom of the paradigm of highly competitive elite sports, in the same way as addictions reflect current social paradigms in wider society. Based upon a conceptual distinction between occasional use, habitual use and (...) addiction, and focusing on the physical and/or mental dependency caused by the addictive use of a certain drug, we argue that marihuana, stimulants and anabolic steroid abuse—the most frequently detected substances in doping tests—satisfies at least one, often both, of these conditions. A conclusion to be drawn from the authors' arguments is that the prohibitionist view is inappropriate for dealing with doping, as the severe sanctions attached to it will cut the doper off her/his social and professional environment, thereby risking reinforcing her/his addictive conduct. But the ban abolitionist view seems inappropriate as well. At first sight, it seems neither rational nor humane not to intervene when confronted with conduct which is highly harmful for the individual and upon which she has reduced or no control whatsoever. Instead the authors' proposal will be to contextualise dopers' conduct within sport healthcare and see it strictly in relation to each athlete's personal background. Developing preventive programmes—implemented through person-tailored counselling and eventually treatment, rather than severe sanctions or the mere lifting of the ban—seems to be a more reasonable, and probably more efficient, way of conducting ‘the war against doping’. (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)

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)