Treatment needs and experiences of Australian women with alcohol and other drug problems

Treatment Needs of Patients With Severe Alcohol Use Disorders

Background

People with alcohol use disorders (AUDs) have varied needs while they seek treatment. Understanding and focusing on the needs will improve treatment outcomes. The objective of the study is to qualitatively assess the treatment-related needs of patients with AUDs admitted to a tertiary care treatment center.

Methods

A semi-structured questionnaire with anchor questions was developed based on a literature review and key informant interviews. All the interviews were audio recorded, transcribed, and color-coded manually. Two reviewers reviewed the codes. Themes and subthemes were generated using thematic inductive analysis.

Results

Among 15 patients interviewed, all the patients had severe AUD (100%), were married (100%), were primarily males (86.6%), and more than half below the poverty line (53.4%), with a mean age of 41.1 years (SD = 9.5). Four major themes of treatment needs were identified: (a) individual, (b) family-related, (c) hospital-related, and (d) community-related. Among individual needs-medication-related, psychological, and occupational were prominent. Addressing family conflict and supporting the family are the significant subthemes for family-related needs. The behavior of the treating team, environmental needs, and diverse services were significant hospital-related needs. Awareness, accessibility, availability, and affordability of treatment services were the major community-related needs.

Conclusion

The study highlights diverse needs extending from individual to community among people with AUDs. A holistic treatment model to address these needs will improve the quality of care and treatment outcomes.

Characteristics of clients entering women-only substance use treatment services in New South Wales

BACKGROUND

Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs.

OBJECTIVES

We aim to assess characteristics of women entering treatment in these services.

DESIGN

Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry.

RESULTS

Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women's mean age was 35.4 years (standard deviation = 9.8; range = 17-67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p < 0.001). Methamphetamine (43%) and alcohol (32%) were the most reported principal drug of concern. Women (89%) reported high levels of psychological distress (median Kessler-10 scale score = 27.5, range = 10-50), highest for women reporting alcohol as their principal drug. Overall, 43% of episodes resulted in treatment completion, most commonly for women entering residential treatment (45% vs 22%, p < 0.001) and for alcohol treatment (adjusted odds ratio = 1.42; confidence interval = 1.07-1.90; p < 0.001). Women with Kessler-10 scale scores indicating anxiety or depression at treatment entry were less likely to complete treatment than those with lower scores (adjusted odds ratio = 0.56; confidence interval = 0.38-0.80; p < 0.001).

CONCLUSION

Women entering women-only residential treatment tend to be younger and report methamphetamine as principal drug of concern. Women enter treatment with high degrees of psychological distress. Women's services need to ensure their programmes can respond to diverse needs of younger women presenting with methamphetamine use disorder and older women with alcohol use disorder experiencing high levels of psychological distress.

John L, Hutton S, Palmer P, Lunsky Y. Virtual group-based mindfulness program for autistic women: A feasibility study

BACKGROUND

Autistic women experience life differently than autistic men. For example, autistic women tend to be diagnosed significantly later than autistic men, they experience a higher number of traumas, and are at increased risk for mental health conditions. Given gender-specific life experiences, autistic women may benefit from gender-specific group-based supports. Virtual mindfulness has been shown to be helpful in improving well-being among autistic adults; however, limited research has explored the impact of virtual mindfulness when it is delivered to a group of autistic women only.

OBJECTIVES

The aim of this article is to describe a preliminary evaluation of a virtual mindfulness group piloted for autistic women. Five key areas of feasibility were assessed in the current study: demand, implementation, acceptability, practicality, and limited efficacy testing.

METHODS

Twenty-eight women participated in a 6-week virtual autism-informed mindfulness program and were asked to complete measures assessing psychological distress, self-compassion, and mindfulness at pre and post. Participants were also asked to complete a satisfaction survey after the program.

RESULTS

Results showed that the program was feasible in terms of demand, implementation, practicality, and acceptability. While quantitative results showed there were no changes in psychological distress, self-compassion, and mindfulness from pre- to post-program, qualitative results showed some benefits.

CONCLUSION

Given the unique challenges that some autistic women experience, offering groups to autistic women may have some value and it would be important to continue exploring this topic area.

A gender-based analysis of nonmedical prescription opioid use among people who use illicit drugs

BACKGROUND

Research investigating the unique impacts associated with engaging in nonmedical prescription opioid use (NMPOU) among males and females who also use illicit drugs is needed.

METHODS

Data were collected between 2013 and 2017 from two linked prospective cohort studies in Vancouver: the At-Risk Youth Study and Vancouver Injection Drug Users Study. Generalized estimating equations were used to identify factors associated with engaging in NMPOU among females and males separately.

RESULTS

Among 1459 participants, 534 were female (37%). Similar proportions of females (46%) and males (48%) engaged in NMPOU at their first visit during the study period. In multivariable analyses, factors associated with NMPOU among both males and females included heroin use, overdose, drug dealing, and difficulty accessing health and social services. Among females, those who engaged in NMPOU were more likely to report Caucasian or white ethnicity, cocaine use, crystal methamphetamine use, and sex work; among males, those who engaged in NMPOU were older, reported crack use and engaged in binge drug use (all p < 0.05).

CONCLUSION

The prevalence of NMPOU was similar among males and females who use illicit drugs in Vancouver, and NMPOU was independently associated with markers of vulnerability among both genders. Findings highlight the need for a comprehensive public health approach to address NMPOU that integrates overdose prevention and reversal services, employment opportunities, and better access to services for both women and men.

Team psychological safety and team performance

Purpose

The purpose of this paper is to examine the relationships between team psychological safety and team performance and to test the mediating effect of learning orientation and moderating effect of psychological empowerment on that relationship.

Design/methodology/approach

Data were collected from 50 teams and 345 team members from 20 different organizations. The moderated mediation analysis of psychological empowerment was tested using hierarchical regression analysis (PROCESS Macro) in SPSS.

Findings

The results show that higher the psychological empowerment, higher is the effect of psychological safety and learning orientation on team performance. Results supported the moderated mediation analysis of psychological empowerment.

Practical implications

Given that psychological empowerment and learning orientation of team members will effect team performance, organizational efforts to foster psychological empowerment should be rewarding. Focusing on channelizing team psychological safety to improve team members’ relationship, openness and comfort with each other will increase team performance.

Originality/value

The study incorporated learning orientation and psychological empowerment to redefine the relationship between psychological safety and team performance.

Do women with complex alcohol and other drug use histories want women-only residential treatment?

BACKGROUND

Women-only addiction services tend to be provided on a poorly evidenced assumption that women want single-sex treatment. We draw upon women's expectations and experiences of women-only residential rehabilitation to stimulate debate on this issue.

METHODS

Semi-structured interviews were undertaken with 19 women aged 25-44 years [currently in treatment (n = 9), successfully completed treatment (n = 5), left treatment prematurely (n = 5)]. All had histories of physical or sexual abuse, and relapses linked to relationships with men. Interviews were audio-recorded, transcribed verbatim, coded and analysed inductively following Iterative Categorization.

FINDINGS

Women reported routinely that they had been concerned, anxious or scared about entering women-only treatment. They attributed these feelings to previous poor relationships with women, being more accustomed to male company and negative experiences of other women-only residential settings. Few women said that they had wanted women-only treatment, although many became more positive after entering the women-only service. Once in treatment, women often explained that they felt safe, supported, relaxed, understood and able to open up and develop relationships with other female residents. However, they also described tensions, conflicts, mistrust and social distancing that undermined their treatment experiences.

CONCLUSIONS

Women who have complex histories of alcohol and other drug use do not necessarily want or perceive benefit in women-only residential treatment.

Providers' Perceptions of Gender-Specific Drug Treatment

This study examined substance abuse treatment providers' perceptions of the gender-specific service needs of women in treatment as well as the obstacles that impede the delivery of services to meet those needs. Surveys were administered to more than 100 staff members of five treatment agencies that were participating in the Chicago Practice Improvement Collaborative. These surveys were followed up with focus group discussions. Most participants reported that their treatment agencies delivered gender-specific services but also described the numerous barriers to addressing women's specific needs, such as limited resources and the psychosocial challenges experienced by women in treatment (e.g., depression, child care, and family responsibilities). We discuss these findings in light of previous studies, the strengths and limitations of our research design, and the value of collaborations between researchers and practitioners.

A universal harm-minimisation approach to preventing psychostimulant and cannabis use in adolescents: a cluster randomised controlled trial

Background

Psychostimulants and cannabis are two of the three most commonly used illicit drugs by young Australians. As such, it is important to deliver prevention for these substances to prevent their misuse and to reduce associated harms. The present study aims to evaluate the feasibility and effectiveness of the universal computer-based Climate Schools: Psychostimulant and Cannabis Module.

Methods

A cluster randomised controlled trial was conducted with 1734 Year 10 students (mean age = 15.44 years; SD = 0.41) from 21 secondary schools in Australia. Schools were randomised to receive either the six lesson computer-based Climate Schools program or their usual health classes, including drug education, over the year.

Results

The Climate Schools program was shown to increase knowledge of cannabis and psychostimulants and decrease pro-drug attitudes. In the short-term the program was effective in subduing the uptake and plateauing the frequency of ecstasy use, however there were no changes in meth/amphetamine use. In addition, females who received the program used cannabis significantly less frequently than students who received drug education as usual. Finally, the Climate Schools program was related to decreasing students’ intentions to use meth/amphetamine and ecstasy in the future, however these effects did not last over time.

Conclusions

These findings provide support for the use of a harm-minimisation approach and computer technology as an innovative platform for the delivery of prevention education for illicit drugs in schools. The current study indicated that teachers and students enjoyed the program and that it is feasible to extend the successful Climate Schools model to the prevention of other drugs, namely cannabis and psychostimulants.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12613000492752.

Contraception, punishment and women who use drugs

BACKGROUND

In light of the recent debate on the use of financial incentives to promote long-acting contraception and sterilisation among women who use illicit drugs we discuss attitudes to contraception, pregnancy and parenting among Australian women who inject drugs.

METHODS

Qualitative interviews were conducted with 90 women of reproductive age about contraceptive use, preferences, reproductive histories, attitudes to and experiences of parenting. All women were either currently, or had previously injected drugs. The in-depth, semi-structured interviews were compared and contrasted for themes relating to drug use, contraception, pregnancy and parenting.

RESULTS

Participants aspired to control their fertility, expressed individual contraceptive preferences and concerns for their children (both born and unborn). Most had tried a number of contraceptive methods interspersed by periods of non-use related to experiences of side-effects, being single or abstinent, believing that they were infertile and trying to conceive. Attitudes varied from woman to woman and in the same individual over their life course. Some believed that they were not likely to be capable, but most aspired to be successful mothers.

CONCLUSIONS

Women's drug use should not automatically be associated with an inability to make informed health care choices or to care for children. Evidence suggests that women who use drugs do not need to be paid to limit or end their fertility. Rather, programs that aim to reduce barriers to obtaining free, non-discriminating reproductive advice and parenting assistance would better utilise women's agency to improve their own reproductive health.

The role of an Aboriginal women's group in meeting the high needs of clients attending outpatient alcohol and other drug treatment

INTRODUCTION AND AIMS

Support groups are typically offered as part of specialist alcohol or other drug treatment. However, their usefulness with Indigenous Australians has not been examined. This paper provides a profile of Aboriginal women attending an inner city outpatient alcohol and other drug treatment service, insight into how effective women and staff perceive the support group to be at meeting their needs and suggestions for improvements.

DESIGN AND METHODS

Structured interviews were conducted with 24 Aboriginal female clients of an outpatient treatment service and with 21 staff from across that service and the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption and mental health risk (Indigenous Risk Impact Screen).

RESULTS

Clients reported social and health indicators illustrating disadvantage and complex needs. Most clients and staff perceived the group to be useful and easily accessible. The participants discussed positive elements including opportunities for shared experience in a non-judgemental environment, practical support and health education. Staff reported how the safe, relaxed environment of the group helped with early identification of issues and user-friendly pathways for treatment access. Suggested improvements included greater involvement from Aboriginal staff and community members and enhanced communication with other staff.

DISCUSSION AND CONCLUSIONS

Clients and staff recognised the usefulness of the group, including the opportunities it provided for socialisation and early intervention. Comprehensive research is needed to determine the types and sources of support that best assist Aboriginal women with substance use disorders.

Pharmaceutical opioid analgesic and heroin dependence: how do treatment-seeking clients differ in Australia?

INTRODUCTION AND AIMS

Non-prescribed use of pharmaceutical opioid analgesics (POA) has been escalating internationally. In Australia, few studies have examined if POA users have similar characteristics and treatment needs to heroin users. The aim of this study was to compare those presenting for treatment where heroin versus POA were the primary drugs of concern.

DESIGN AND METHODS

A convenience sample of 192 treatment entrants were recruited from alcohol and drug treatment services in four Australian jurisdictions. A structured interview collected data on demographic characteristics, substance use, self-perceived mental and physical health, crime and harms resulting from drug use. Multivariate analyses were performed to identify characteristics which may differentiate those seeking treatment for heroin compared with POA.

RESULTS

Most treatment entrants sampled reported a history of injection drug use and use of both heroin and POA. However, those with primary POA problems were less likely to report an overdose history (adjusted odds ratio 0.90, 95% confidence interval 0.81-0.99) and more likely to initiate opioid use for pain (adjusted odds ratio 2.52, 95% confidence interval 1.04-6.12) than those with primary heroin problems. Latent Class Analysis found that, while most of the POA group were similar to heroin users in demographics, health and injecting drug use, there was a small, distinct group of primary POA problem users that did not typically inject and who commonly initiated opioid use for pain and also experienced elevated physical and mental health disability.

DISCUSSION AND CONCLUSIONS

While some differences existed, this study of Australian treatment seekers found many similar characteristics between those with primary problems with heroin and POA. Few non-injecting POA were recruited in this sample. This finding contrasts with reports of a growing population of opioid-dependent people with characteristics that are distinct from traditional opioid-dependent populations, which may reflect the orientation of current treatment systems in Australia towards injection drug users.

Improving access to hard-to-reach services: a soft entry approach to drug and alcohol services for rural Australian Aboriginal communities

Australian Aboriginal communities are concerned about drug- and alcohol-related harms in their communities. There are a significantly higher proportion of substance problems experienced by Aboriginal Australians than non-Indigenous Australians. Ways to address these problems are limited by racial barriers to mainstream services, especially in the rural context. Soft entry was an approach designed to increase Aboriginal Australians' access to Drug & Alcohol (D&A) services. The approach was designed to put control over when and how D&A interventions were delivered in the hands of the community and individuals within it by giving them ready access to a human services worker with specialist knowledge. Quantitative and qualitative evaluation methods found that soft entry substantially increased the number of Aboriginal and non-Aboriginal women accessing drug and alcohol services. It fundamentally shifted the power relationship between counselors and community, providing opportunities to develop a non-stigmatizing trustful rapport to facilitate discussion of harmful substance use. The challenges for drug and alcohol counselors were the slow unpredictability of the approach and the need for highly skilled and responsive communication techniques. However, the factor most likely to improve access to services, once trust is developed, is regular and frequent attendance at the service delivery site.

Inability to access addiction treatment and risk of HIV infection among injection drug users recruited from a supervised injection facility

BACKGROUND

Treatment for drug addiction is effective in reducing the harms of injection drug use, including infection with HIV and/or hepatitis C. We sought to examine the prevalence and correlates of being unable to access addiction treatment in a representative sample of injection drug users randomly recruited from a supervised injection facility.

METHODS

Using generalized estimating equations, we determined the prevalence and factors associated with being unable to access addiction treatment.

RESULTS

Between 1 July 2004 and 30 June 2006, 889 individuals completed at least one interview and were included in this analysis. At each interview, approximately 20% of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months. Being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. In a secondary question, the majority of individuals reported waiting lists were the reason for being unable to access treatment.

CONCLUSION

Given the independent association between inability to access addiction treatment and elevated HIV risk behavior, these results suggest expanding addiction treatment may contribute significantly to HIV prevention efforts in this population.

Engaging primary health care workers in drug and alcohol and mental health interventions: challenges for service delivery in rural and remote Australia

Access to drug and alcohol treatment services is a particularly salient issue for Australia. The nation is paying considerable attention to risky drug and alcohol use. Indigenous Australians are particularly concerned about drug and alcohol related harms in their communities. Access to treatment is the most effective way of reducing drug related harm for disadvantaged populations. Primary health care is the optimal site for delivering drug and alcohol treatment. Semi-structured in-depth interviews with 47 primary health care, drug and alcohol and other health and welfare workers in rural and remote locations were conducted. Thematic analysis of interview data identified divergent perspectives according to a participant's work role about drug and alcohol treatment, client needs and problems and service delivery approaches. Primary health care workers were conceptualised as locals. They tended to perceive that drug and alcohol interventions should quickly prevent individuals from on-going problematic use. Drug and alcohol workers were conceptualised as insiders. Most did not have knowledge or experience of the primary health care setting. Therefore they could not assist primary health care workers to integrate drug and alcohol interventions into their interactions with clients. Professional and organisational barriers constrain the primary health care worker role and limit the application of specialist interventions. Drug and alcohol work is only one of many competing demands in the primary health setting. The lack of understanding of the primary health care worker role and responsibilities is the most significant barrier to implementing specialist interventions in this role. Primary health care workers' perceptions of substance misuse are more consistent with the individual moral or personal deficit philosophy of drug and alcohol treatment than harm minimisation approaches. This is a challenge for a specialist agency that is promoting harm minimisation and an adaptive approach to treatment within the primary care setting. Building the capacity of primary health care workers to do more varied tasks requires a good understanding of the pragmatic and practical realities of their day to day practice and the philosophies that underpin these.

Women injecting drug users in London: the extent and nature of their contact with drug and health services

Improved access to drug treatment and other health services remains central to HIV prevention and other harm reduction strategies among injecting drug users (IDUs) in the UK. Efforts have therefore been focused upon making such services more accessible and 'user friendly'. Women who use drugs are considered a 'hard to reach' population. This is largely based on data from a variety of official sources which have suggested that women are under-represented as clients of drug services. While current literature provides numerous explanations for this, there have been few empirical studies exploring the nature and extent of women's contact with such services. This paper presents findings from an European Community funded survey of women IDUs in London. Data from this survey suggest that women IDUs have surprisingly high levels of contact with a range of specialist and generic health services in relation to their drug use.

Treatment needs of women with alcohol and other drug problems: experiences and views of Australian treatment personnel

One hundred treatment personnel completed a structured interview as part of an Australian national study of the treatment needs of women with alcohol and other drug problems. The aim of the survey was to ascertain personnel's experiences of, and beliefs about providing services to women. Respondents had a broad range of qualifications and experience, and were generally supportive of provision of gender-sensitive services to women. The interview addressed a number of issues, including: barriers to treatment access, ability to provide gender-sensitive services, appropriateness of women-only services, and addressing sexual abuse issues. It is concluded that while many agencies attempted to provide appropriate services for women, many experienced difficulties, such as a lack of resources and funding. There is a continuing need for research into the best method of service delivery for women.

Access to drug and alcohol treatment among a cohort of street-involved youth

BACKGROUND

A number of options for treatment are available to young drug users, but little is known about the youth who actually attempt to access such services. Here we identify characteristics of a cohort of street-involved youth and highlight commonly encountered barriers.

METHODS

From September 2005 to July 2007, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort of 529 drug users aged 14-26 living in Vancouver, Canada. Participants who attempted to access any addiction services in the 6 months prior to enrollment were compared in univariate analyses and multiple logistic regression modeling of socio-demographic and drug-related factors.

RESULTS

Factors positively associated with attempting to access services included Aboriginal ethnicity (adjusted odds ratio [AOR]=1.66 [1.05-2.62]), high school education (AOR=1.66 [1.09-2.55]), mental illness (AOR=2.25 [1.50-3.38]), non-injection crack use (AOR=2.93 [1.76-4.89]), and spending >$50 on drugs per day (AOR=2.13 [1.41-3.22]). Among those who experienced difficulty-accessing services, the most commonly identified barrier was excessively long waiting lists. In a subgroup analysis comparing those who tried to access services but were unsuccessful to those who were successful, risk factors positively associated with failure included drug bingeing (odds ratio [OR]=2.86 [1.22-6.76]) and homelessness (OR=3.86 [1.11-13.4]).

CONCLUSIONS

In light of accumulating evidence that drug use among street youth is associated with risky health-related behaviors, improving access to treatment and other addiction services should remain an important public health priority.

Adolescent cannabis users at 24 years: trajectories to regular weekly use and dependence in young adulthood

AIMS

To examine the association between cannabis use by 18 years and problematic cannabis use at 24 years, considering possible mediating and confounding factors.

DESIGN

Ten-year representative prospective study with data from six time-points in adolescence (mean age 14.9-17.4 years) and two in young adulthood (mean age 20.7 and 24.1 years)

SETTING

Victoria, Australia.

PARTICIPANTS

Inception cohort of 1943 secondary school students (95.6% response rate), with 1520 (78% of adolescent participants) interviewed in the final wave.

MEASUREMENTS

Participants reported frequency of cannabis use for the past 6 months at each time-point in adolescence (age 14-17 years). Cannabis exposure was defined as: maximum frequency of use (occasional, weekly, daily), number of waves of use (1 or 2; 3-6) and first wave of use (early use: first waves 1-3). Young adult (24 years) outcomes were: weekly+ cannabis use and DSM-IV cannabis dependence, referred to collectively as problematic use.

FINDINGS

Of those interviewed at age 24 (wave 8), 34% had reported cannabis use in adolescence (waves 1-6), 12% at a level of weekly or more frequent use; 37% of these adolescent cannabis users were using at least weekly at wave 8, with 20% exhibiting dependence. Persistent adolescent cannabis and tobacco use as well as persistent mental health problems were associated strongly with problematic cannabis use at 24 years, after adjustment for potential confounding factors.

CONCLUSIONS

Heavy, persistent and early-onset cannabis use were all strongly predictive of later cannabis problems. Even so, occasional use was not free of later problems. Where there was co-occurring tobacco use or persistent mental health problems, risks for later problem cannabis use was higher.

Barriers to accessing generic health and social care services: a qualitative study of injecting drug users

While research has clearly documented the difficulties injectors encounter in accessing specialist addiction services, there is less evidence of the problems they face when securing general health care and non-substance-misuse-specific support. This paper seeks to fill some of these knowledge gaps. Between January and May 2006, 75 current injectors were recruited and interviewed through three needle exchange programmes located in diverse geographical areas of West Yorkshire. Interview data were transcribed verbatim and analysed using Framework. Findings showed that injectors were often positive about the help they received from generic health and social care services. Nonetheless, they identified a range of barriers relating to inability to access desired assistance, the burden of appointments, travel to services, stigma and negative staff attitudes, personal ill-health, lack of material resources, and anxieties about accessing support. Although some types of barriers were more evident at some services than at others and/or affected particular subgroups of injector more than others, the impact of any barrier was contingent on a range of factors. These included the attitudes of individual professionals, the circumstances and needs of individual injectors, the local availability of suitable alternative services, and the frequency with which a service needed to be accessed. In order to better understand and potentially reduce service barriers, findings are linked to broader conceptual and theoretical debates relating to social exclusion and Foucault's analyses of power and knowledge.

High psychiatric symptom severity is a moderator of substance abuse treatment outcomes among women in single vs. mixed gender group treatment

OBJECTIVE

This exploratory study examined psychiatric symptom severity as a moderator of outcomes among women receiving either the Women's Recovery Group (WRG), a new manualized group treatment for substance use disorders combining single-gender group composition and women-focused content, or Group Drug Counseling (GDC), an empirically supported mixed-gender group treatment.

METHODS

We used a mixed model analysis of variance.

RESULTS

We found a significant 3-way interaction effect of treatment condition, time, and baseline Brief Symptom Inventory scores as well as Beck Depression Inventory scores.

CONCLUSION

Single-gender group treatment may confer added benefit for women with substance abuse and high psychiatric symptom severity than mixed-gender treatment.

Factors that help injecting drug users to access and benefit from services: A qualitative study

BACKGROUND

International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help.

METHODS

Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework.

RESULTS

Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support); better operation of existing services (including better communication systems and more flexibility around individual needs); and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes). Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members); personal circumstances/life events (especially becoming a parent); and an injector's state of mind (such as feeling motivated and positive).

CONCLUSION

A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.

The Women's Recovery Group Study: a Stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling

The aim of this Stage I Behavioral Development Trial was to develop a manual-based 12-session Women's Recovery Group (WRG) and to pilot test this new treatment in a randomized controlled trial against a mixed-gender Group Drug Counseling (GDC), an effective manual-based treatment for substance use disorders. After initial manual development, two pre-pilot groups of WRG were conducted to determine feasibility and initial acceptability of the treatment among subjects and therapists. In the pilot stage, women were randomized to either WRG or GDC. No significant differences in substance use outcomes were found between WRG and GDC during the 12-week group treatment. However, during the 6-month post-treatment follow-up, WRG members demonstrated a pattern of continued reductions in substance use while GDC women did not. In addition, pilot WRG women with alcohol dependence had significantly greater reductions in average drinks/drinking day than GDC women 6 months post-treatment (p<.03, effect size=0.81). While satisfaction with both groups was high, women were significantly more satisfied with WRG than GDC (p<.009, effect size=1.11). In this study, the newly developed 12-session women-focused WRG was feasible with high satisfaction among participants. It was equally effective as mixed-gender GDC in reducing substance use during the 12-week in-treatment phase, but demonstrated significantly greater improvement in reductions in drug and alcohol use over the post-treatment follow-up phase compared with GDC. A women-focused single-gender group treatment may enhance longer-term clinical outcomes among women with substance use disorders.

Substance abuse treatment entry, retention, and outcome in women: a review of the literature

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran

AIM

This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran.

METHODS

Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined.

RESULTS

292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison.

CONCLUSION

This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.

Suicide in alcohol-dependent individuals: epidemiology and management

The association of alcohol dependence with suicidal behaviour is well established although complex. On the basis of epidemiological and clinical evidence, alcohol dependence is known to increase the risk for suicidal ideation, suicide attempts and completed suicide. However, this risk is modulated by a wide variety of factors including sociodemographic, clinical, treatment-related and life situational characteristics as well as current drinking status and the effect of inebriation. Treatment and management of patients with alcohol dependence and concomitant suicidal communication or suicide attempts is crucial, as is the recognition of these patients in emergency and other healthcare service contacts. The treatment strategies cannot be based on evidence derived from randomised clinical trials as such data do not exist. They must rather be based on current knowledge of risk factors for suicidal behaviour, efficacy of treatment for alcohol dependence or relevant co-morbid conditions and problems known to be common in treatment settings. In this article, we review the essential literature on the epidemiological and clinical research in the areas of alcohol dependence and suicidal behaviour. On the basis of current data and clinical experience, we suggest the following principles be followed in the management of alcohol-dependent individuals: (i) suicidal threats or communication by alcohol-dependent individuals in emergency and other contacts should be taken seriously; (ii) other mental disorders should be well evaluated, a consequent treatment plan initiated and follow-up arranged; (iii) appropriate and up-to-date pharmacological treatment should focus on both reducing the amount of drinking and treating symptoms of other mental disorders; (iv) psychotherapeutic efforts should be focused on emerging symptoms of both alcohol use and other mental disorders; and (v) known epidemiological and clinical risk factors, adverse life events in particular, should be recognised and taken into account.

Alcohol and drug treatment for women: clinicians' beliefs and practice

The present paper reports on the results of a telephone survey of 217 alcohol and drug treatment clinicians on their beliefs and practice, in relation to service provision for women. Nurses comprised the second largest professional group surveyed. Seventy-eight percent of clinicians believed that women's treatment needs differed from men's and 74% reported a range of approaches and interventions, such as assisting with parenting issues and referral to women-only programmes. Several differences emerged in relation to approaches and interventions used, depending on clinician gender, work setting and proportion of women on clinicians' caseload. Implications for mental health nursing include the need to more systematically incorporate gender-based treatment needs into practice and undergraduate and postgraduate education and training programmes.

Women-specific alcohol use(r) intervention programs: a preliminary dimension analysis based on specialized services in Western New York State

Women-specific models have been proposed as a means for achieving the best service user-treatment match for women who experience alcohol use related problems. To better understand how theoretical and empirical knowledge are being applied in real world programs, interviews were conducted at seven programs in Western New York State where specialized women's alcohol use(r) services have been developed. A preliminary analytical model of women's services is proposed, consisting of the following three dimensions: 1) level of orthodoxy, 2) population specificity, and 3) change target.