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Falker CG, Stefanovics EA, Rhee TG, Rosenheck RA. Women's Use of Substance Use Disorder Treatment Services: Rates, Correlates, and Comparisons to Men. Psychiatr Q 2022; 93:737-752. [PMID: 35661318 DOI: 10.1007/s11126-022-09989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
In spite of evidence of increasing prevalence of substance use disorders (SUDs) among women, there is little information on gender differences in SUD treatment use. Nationally representative survey data were used to compare specialized SUD treatment among women and men with past-year DSM-5 SUD diagnoses (N = 5,789, 42.8% women). An estimated 10.7% of women and 9.9% of men (p = 0.45) received SUD treatment. Those who received treatment among both men and women had more problems than others. Five variables were independently associated with receipt of past-year treatment in both women and men and while five others were independently associated with receipt of treatment for only one gender. Interaction analysis, however, revealed no statistically significant gender differences in any correlate of treatment receipt. Although men were more likely to have SUDs than women, there were no significant differences by gender in rates or correlates of service use.
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Affiliation(s)
- Caroline G Falker
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Taeho Greg Rhee
- Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Robert A Rosenheck
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA. .,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA. .,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
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2
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Richardson L, Minh A, McCormack D, Laing A, Barbic S, Hayashi K, Milloy MJ, Huyser KR, Leahy K, Li J. Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10456. [PMID: 36012091 PMCID: PMC9408769 DOI: 10.3390/ijerph191610456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 05/07/2023]
Abstract
The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.
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Affiliation(s)
- Lindsey Richardson
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Anita Minh
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Deb McCormack
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Allison Laing
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Providence Research, 1190 Hornby, Vancouver, BC V6Z 2K5, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Kathleen Leahy
- UBC Learning Exchange, University of British Columbia, 612 Main St., Vancouver, BC V6A 2V3, Canada
| | - Johanna Li
- EMBERS Eastside Works, 57 E Hastings St., Vancouver, BC V6A 0A7, Canada
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3
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Hunter BA, Jason LA. Correlates of employment among men in substance use recovery: The influence of discrimination and social support. J Prev Interv Community 2022; 50:163-177. [PMID: 34162309 PMCID: PMC9148586 DOI: 10.1080/10852352.2021.1940756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of the present study was to identify correlates of employment among men in substance use recovery, including recovery-related discrimination and social support. A cross-sectional sample of men (N = 164) who lived in sober living homes located across the United States participated in the present study. Data were collected online and through mailed surveys. No socio-demographic variables were associated with employment status. Discriminant Analysis (DA) was conducted to understand how recovery-related discrimination and social support contributed to group separation (employed vs. not employed). Results from this analysis suggested that recovery-related discrimination was the driving force in classification, as men who were not employed had much higher recovery-related discrimination than men who were employed. Men who were not employed also had lower social support scores than men who were employed. Stigma and discrimination may play a large role in employment among former and current substance users. Treatment providers should discuss the impact of stigma on individuals while they are in treatment. However, additional research is needed to more fully understand the relations among discrimination, social support, and employment.
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Affiliation(s)
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Lu W, Oursler J, Herrick S, Beninato J, Gao N, Brown L, Durante A. Work-Related Interview Skills Training for Persons with Substance Use Disorders. JOURNAL FOR SPECIALISTS IN GROUP WORK 2021. [DOI: 10.1080/01933922.2021.1900959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Weili Lu
- The State University of New Jersey
| | | | | | | | - Ni Gao
- The State University of New Jersey
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Greer A, Bungay V, Pauly B, Buxton J. 'Peer' work as precarious: A qualitative study of work conditions and experiences of people who use drugs engaged in harm reduction work. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102922. [PMID: 32911320 DOI: 10.1016/j.drugpo.2020.102922] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
In this study, we examine the qualitative accounts of people who use drugs engaged in 'peer' work in harm reduction settings across British Columbia, Canada. We found peer work was precarious, characterized by nonstandard or casual work arrangements, high job instability and insecurity, insufficient wages, and limited social benefits. Participants were reluctant to exercise their rights or negotiate work conditions, such as higher wages or more consistent work, out of fear of job loss. However, the flexibility of peer work was beneficial for some in that it worked within their life circumstances and provided a low-barrier entry into the labor market. If inequities in peer work are perpetuated, unrecognized and unaddressed, precarious work conditions may continue to undermine the potential benefits of harm reduction work for organizations, peer workers and the people to whom they engage with and support. This study adds people who use drugs to the many social groups that are impacted by precarious work conditions globally.
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Affiliation(s)
- A Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby BC, V5A 1S6, Canada.
| | - V Bungay
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - B Pauly
- School of Nursing, University of Victoria, O Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada
| | - J Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall Vancouver, BC V6T 1Z3, Canada
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Tempalski B, Williams LD, West BS, Cooper HLF, Beane S, Ibragimov U, Friedman SR. Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:3. [PMID: 31918733 PMCID: PMC6953254 DOI: 10.1186/s13011-019-0235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, NDRI, Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Leslie D Williams
- Institute for Infectious Disease Research, NDRI, Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Stephanie Beane
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Samuel R Friedman
- Department of Population Health, New York University, New York, NY, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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7
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Bunting AM, Staton M, Winston E, Pangburn K. Beyond the Employment Dichotomy: An Examination of Recidivism and Days Remaining in the Community by Post-Release Employment Status. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:712-733. [PMID: 30362852 PMCID: PMC6387636 DOI: 10.1177/0306624x18808685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Criminological research has tended to consider employment in a dichotomy of employed versus unemployed. The current research examines a sample of individuals 1-year post-release to assess the extent to which four distinct employment categories (full-time, part-time, disabled, and unemployed) are associated with reincarceration and days remaining in the community. Findings indicate disabled individuals remain in the community longer and at a higher proportion compared with other employment categories. Furthermore, unique protective and risk factors are found to be associated with each employment category while some risk factors (e.g., homelessness) highlight the importance of addressing reentry barriers regardless as to employment status.
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8
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Boyd J, Richardson L, Anderson S, Kerr T, Small W, McNeil R. Transitions in income generation among marginalized people who use drugs: A qualitative study on recycling and vulnerability to violence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:36-43. [PMID: 29986270 PMCID: PMC6167137 DOI: 10.1016/j.drugpo.2018.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/23/2018] [Accepted: 06/11/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Income is an important determinant of health among people who use drugs (PWUD). However, understanding transitions between differing types of income generation within the formal and informal economy and how they can be shaped by vulnerability to risk and harm remain poorly understood. This study examines how transitions in income-generating activities are shaped by and influence exposure to violence among marginalised PWUD, in Vancouver, Canada's, Downtown Eastside (DTES) neighbourhood. METHODS Qualitative interviews were conducted with twenty-six individuals engaged in informal and illegal income-generating activities in the DTES. Interview transcripts were analyzed thematically, focusing on relationships between income generation and violence during the study period between January 2014 to April 2015 and drew upon concepts of social violence when interpreting these themes. RESULTS Participants' engagement in informal and illegal income-generating activities represented a means to negotiate survival given multiple barriers to formal employment and inadequate economic supports. Our findings highlight how informal and illegal income-generating activities in the DTES are characterized by structural, symbolic and everyday violence, while transitions from 'high risk' (e.g., sex work, drug dealing) to perceived 'low risk' (e.g., recycling) activities represent attempts to reduce exposure to violence. However, participants emphasized how informal income generation was nonetheless shaped by structural violence (e.g., gendered hierarchies and police harassment), experienced as everyday violence, and introduced exposure to alternate risks. CONCLUSION Our findings underscore the critical role of income generation in shaping exposure to violence, highlighting the need for low-threshold employment interventions targeting PWUD as a central component of harm reduction strategies.
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Affiliation(s)
- Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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9
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Nikoo M, Vogel M, Choi F, Song MJ, Burghardt J, Zafari Z, Tabi K, Frank A, Barbic S, Schütz C, Jang K, Krausz M. Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:18-24. [DOI: 10.1016/j.drugpo.2018.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
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10
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Linton SL, Haley DF, Hunter-Jones J, Ross Z, Cooper HLF. Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Soc Sci Med 2017; 185:81-90. [PMID: 28554162 DOI: 10.1016/j.socscimed.2017.04.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 12/20/2022]
Abstract
Theories of social causation and social influence, which posit that neighborhood and social network characteristics are distal causes of substance use, are frequently used to interpret associations among neighborhood characteristics, social network characteristics and substance use. These associations are also hypothesized to result from selection processes, in which substance use determines where people live and who they interact with. The potential for these competing selection mechanisms to co-occur has been underexplored among adults. This study utilizes path analysis to determine the paths that relate census tract characteristics (e.g., economic deprivation), social network characteristics (i.e., having ≥ 1 illicit drug-using network member) and illicit drug use, among 172 African American adults relocated from public housing in Atlanta, Georgia and followed from 2009 to 2014 (7 waves). Individual and network-level characteristics were captured using surveys. Census tract characteristics were created using administrative data. Waves 1 (pre-relocation), 2 (1st wave post-relocation), and 7 were analyzed. When controlling for individual-level sociodemographic factors, residing in census tracts with prior economic disadvantage was significantly associated with illicit drug use at wave 1; illicit drug use at wave 1 was significantly associated with living in economically-disadvantaged census tracts at wave 2; and violent crime at wave 2 was associated with illicit drug-using social network members at wave 7. Findings from this study support theories that describe social causation and neighborhood selection processes as explaining relationships of neighborhood characteristics with illicit drug use and illicit drug-using social networks. Policies that improve local economic and social conditions of neighborhoods may discourage substance use. Future studies should further identify the barriers that prevent substance users from obtaining housing in less disadvantaged neighborhoods.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Danielle F Haley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd CB#7030, Chapel Hill, NC 27599, USA
| | - Josalin Hunter-Jones
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, 120 N Aurora Street, Suite 3A, Ithaca, NY 14850, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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11
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Ghaferi HA, Bond C, Matheson C. Does the biopsychosocial-spiritual model of addiction apply in an Islamic context? A qualitative study of Jordanian addicts in treatment. Drug Alcohol Depend 2017; 172:14-20. [PMID: 28104541 DOI: 10.1016/j.drugalcdep.2016.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a dearth of research in the published literature on substance use and addiction in the Middle East and Islamic countries. This study was the first to explore whether the biopsychosocial-spiritual model of addiction was relevant to an addicted treatment population in Jordan, an Islamic country. METHODS A qualitative study design using semi-structured, face-to-face interviews were conducted with a sample of 25 males in addiction treatment. The sample was drawn from a cohort of in-patients at a treatment centre in Amman, Jordan who had already participated in a quantitative survey. A purposive sample was selected to ensure the inclusion of a range of characteristics that might affect their experience of developing addiction and its consequences, i.e., age, marital status and educational level. Interviews were transcribed and thematic analysis conducted using verbatim quotes to illustrate themes. Themes were mapped onto the biopsychosocial-spiritual model of addiction. RESULTS This study found addiction was associated with a range of health (physical and psychological), social and spiritual factors. Unpleasant physical withdrawal effects, psychological symptoms, such as anxiety and suicide attempts, were experienced. There was breakdown in marital and family relations, loss of employment, involvement in crime and neglect of religious practices, resulting in social isolation. CONCLUSION This study found that, despite some differences in emphasis, the biopsychosocial, spiritual model of addiction fit wel,l particularly given the relative importance of religion in Islamic culture. Spirituality was not explored and further study of spirituality versus religious practice in this culture is recommended.
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Affiliation(s)
- Hamad Al Ghaferi
- National Rehabilitation Centre, P.O. Box 3873, Abu Dhabi, United Arab Emirates; University of Aberdeen, Academic Primary Care, Aberdeen AB25 2ZD, Scotland, UK
| | - Christine Bond
- University of Aberdeen, Academic Primary Care, Aberdeen AB25 2ZD, Scotland, UK
| | - Catriona Matheson
- University of Aberdeen, Academic Primary Care, Aberdeen AB25 2ZD, Scotland, UK.
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12
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Richardson L, Small W, Kerr T. Pathways linking drug use and labour market trajectories: the role of catastrophic events. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:137-52. [PMID: 26358407 PMCID: PMC4713273 DOI: 10.1111/1467-9566.12344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
People affected by substance use disorders often experience sub-optimal employment outcomes. The role of drug use in processes that produce and entrench labour market precarity among people who inject drugs (PWID) have not, however, been fully described. We recruited 22 PWID from ongoing prospective cohort studies in Vancouver, Canada, with whom we conducted semi-structured retrospective interviews and then employed a thematic analysis that drew on concepts from life course theory to explore the mechanisms and pathways linking drug use and labour market trajectories. The participants' narratives identified processes corresponding to causation, whereby suboptimal employment outcomes led to harmful drug use; direct selection, where impairment, health complications or drug-seeking activities selected individuals out of employment; and indirect selection, where external factors, such as catastrophic events, marked the initiation or intensification of substance use concurrent with sudden changes in capacities for employment. Catastrophic events linking negative transitions in both drug use and labour market trajectories were of primary importance, demarcating critical initiation and transitional events in individual risk trajectories. These results challenge conventional assumptions about the primacy of drug use in determining employment outcomes among PWID and suggest the importance of multidimensional support to mitigate the initiation, accumulation and entrenchment of labour market and drug-related disadvantage.
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Affiliation(s)
- Lindsey Richardson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
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13
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Smith MJ, Bell MD, Wright MA, Humm LB, Olsen D, Fleming MF. Virtual Reality Job Interview Training and 6-Month Employment Outcomes for Individuals with Substance Use Disorders Seeking Employment. JOURNAL OF VOCATIONAL REHABILITATION 2016; 44:323-332. [PMID: 31656389 DOI: 10.3233/jvr-160802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) have low employment rates and job interviewing is a critical barrier to employment for them. Virtual reality training is efficacious at improving interview skills and vocational outcomes for several clinical populations. OBJECTIVE This study evaluated the acceptability and efficacy of virtual reality job interview training (VR-JIT) at improving interview skills and vocational outcomes among individuals with SUDs via a small randomized controlled trial (n=14 VR-JIT trainees, n=11 treatment-as-usual (TAU) controls). METHODS Trainees completed up to 10 hours of virtual interviews, while controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews and vocational outcomes at six-month follow-up. RESULTS Trainees reported that the intervention was easy-to-use and helped prepared them for future interviews. While co-varying for pre-test role-play performance, trainees had higher post-test role-play scores than controls at the trend level (p<0.10). At 6-month follow-up, trainees were more likely than controls to attain a competitive position (78.6% vs. 44.4%, p<0.05, respectively). Trainees had greater odds of attaining a competitive position by 6 month follow-up compared to controls (OR: 5.67, p<0.05). VR-JIT participation was associated with fewer weeks searching for a position (r= -0.36, p<0.05). CONCLUSIONS There is preliminary evidence that VR-JIT is acceptable to trainees. Moreover, VR-JIT led to better vocational outcomes with trainees having greater odds of attaining a competitive position by 6-month follow-up. Future studies could evaluate the effectiveness of VR-JIT within community-based services.
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Affiliation(s)
- Matthew J Smith
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Warren Wright Adolescent Center, Chicago, IL USA
| | - Morris D Bell
- Yale School of Medicine, Department of Psychiatry, Department of Veteran Affairs, West Haven, CT USA
| | - Michael A Wright
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA
| | | | | | - Michael F Fleming
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Department of Family Medicine, Chicago, IL USA
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Henriques S, Candeias P. Socio-demographic characteristics and consumption patterns of drug users – synthesis of outcome research at a TC for a 10 year range. THERAPEUTIC COMMUNITIES 2015. [DOI: 10.1108/tc-03-2014-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Therapeutic communities (TCs) are one of the existent social responses in helping drug users overcome addiction and pursue social reintegration. The purpose of this paper is to present and discuss the general characteristics of about 200 drug users and their addiction and those of addicts abroad treated in a TC and clinically discharged. The analysis now presented is the first empirical approach to capture social regularities and singularities that are present in these individuals’ reintegration strategies.
Design/methodology/approach
– The data have a ten-year range – from 1999 to 2009 – and were statically analysed.
Findings
– They show a group of individuals with low qualifications reflected in their professional occupation, from which family is an essential support. These data also show a significant prevalence of heroin, alcohol, cocaine and polydrug uses, highlighting the need to consider new use patterns and new synthetic substances.
Originality/value
– TC have been little studied, mainly in Portugal.
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15
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Keyser-Marcus L, Alvanzo A, Rieckmann T, Thacker L, Sepulveda A, Forcehimes A, Islam LZ, Leisey M, Stitzer M, Svikis DS. Trauma, gender, and mental health symptoms in individuals with substance use disorders. JOURNAL OF INTERPERSONAL VIOLENCE 2015; 30:3-24. [PMID: 24811286 PMCID: PMC4766974 DOI: 10.1177/0886260514532523] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. The goal of the current study was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment. Study participants (N = 625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study conducted through the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). Study measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite [ASI-Lite]). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.
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Affiliation(s)
| | - Anika Alvanzo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Alyssa Forcehimes
- University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, USA
| | | | | | - Maxine Stitzer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Long C, DeBeck K, Feng C, Montaner J, Wood E, Kerr T. Income level and drug related harm among people who use injection drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:458-64. [PMID: 24380808 PMCID: PMC4040344 DOI: 10.1016/j.drugpo.2013.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/12/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Higher income is generally associated with better health outcomes; however, among people who inject drugs (IDU) income generation frequently involves activities, such as sex work and drug dealing, which pose significant health risks. Therefore, we sought to examine the relationship between level of income and specific drug use patterns and related health risks. METHODS This study involved IDU participating in a prospective cohort study in Vancouver, Canada. Monthly income was categorized based on non-fixed quartiles at each follow-up with the lowest level serving as the reference category in generalized linear mixed-effects regression. RESULTS Among our sample of 1032 IDU, the median average monthly income over the study follow-up was $1050 [interquartile range=785-2000]. In multivariate analysis, the highest income category was significantly associated with sex work (adjusted odds ratio [AOR]=7.65), drug dealing (AOR=5.06), daily heroin injection (AOR=2.97), daily cocaine injection (AOR=1.65), daily crack smoking (AOR=2.48), binge drug use (AOR=1.57) and unstable housing (AOR=1.67). The high income category was negatively associated with being female (AOR=0.61) and accessing addiction treatment (AOR=0.64), (all p<0.05). In addition, higher income was strongly associated with higher monthly expenditure on drugs (>$400) (OR=97.8). CONCLUSION Among IDU in Vancouver, average monthly income levels were low and higher total monthly income was linked to high-risk income generation strategies as well as a range of drug use patterns characteristic of higher intensity addiction and HIV risk. These findings underscore the need for interventions that provide economic empowerment and address high intensity addiction, especially for female IDU.
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Affiliation(s)
- Cathy Long
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada.
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17
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Calcaterra SL, Beaty B, Mueller SR, Min SJ, Binswanger IA. The association between social stressors and drug use/hazardous drinking among former prison inmates. J Subst Abuse Treat 2014; 47:41-9. [PMID: 24642070 DOI: 10.1016/j.jsat.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
Social stressors are associated with relapse to substance use among people receiving addiction treatment and people with substance use risk behaviors. The relationship between social stressors and drug use/hazardous drinking in former prisoners has not been studied. We interviewed former prisoners at baseline, 1 to 3 weeks post prison release, and follow up, between 2 and 9 months following the baseline interview. Social stressors were characterized by unemployment, homelessness, unstable housing, problems with family, friends, and/or significant others, being single, or major symptoms of depression. Associations between baseline social stressors and follow-up drug use and hazardous drinking were analyzed using multivariable logistic regression. Problems with family, friends, and/or significant others were associated with reported drug use (AOR 3.01, 95% CI 1.18-7.67) and hazardous drinking (AOR 2.69, 95% CI 1.05-6.87) post release. Further research may determine whether interventions and policies targeting social stressors can reduce relapse among former inmates.
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Affiliation(s)
- Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO.
| | - Brenda Beaty
- Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado
| | - Shane R Mueller
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Sung-Joon Min
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO; Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado; Division of Substance Dependence, University of Colorado School of Medicine, Aurora, CO
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18
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Laudet AB. Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery. J Addict Dis 2012; 31:288-302. [PMID: 22873190 DOI: 10.1080/10550887.2012.694604] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Employment is a key functioning index in addiction services and consistently emerges as a goal among individuals in recovery. Research on the employment status in the addiction field has focused on treatment populations or welfare recipients; little is known of employment rates or their predictors among individuals in recovery. This study seeks to fill this gap, capitalizing on a sample (N = 311) of urban individuals at various stages of recovery. Fewer than half (44.5%) of participants were employed; in logistic regressions, male gender and Caucasian race enhanced the odds of employment, whereas having a comorbid chronic physical or mental health condition decreased the odds by half. Implications center on the need to identify effective strategies to enhance employability among women and minorities and for integrated care for individuals with multiple chronic conditions.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc., New York, New York 10010, USA.
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19
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Richardson L, Wood E, Kerr T. The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs. Soc Sci Med 2012; 76:126-33. [PMID: 23157930 DOI: 10.1016/j.socscimed.2012.10.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/24/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
Despite growing awareness of the importance of context for the health of people who use drugs, studies examining labour market outcomes have rarely considered the role that physical, social and structural factors play in shaping labour market participation among drug users. Using discrete time event history analyses, we assessed associations between high-intensity substance use, individual drug use-related risk and features of inner-city drug use scenes with transitions into regular employment. Data were derived from a community-recruited cohort of people who inject drugs in Vancouver, Canada (n = 1579) spanning the period of May 1996-May 2005. Results demonstrate that systematic socio-demographic differences in labour market outcomes in this context generally correspond to dimensions of demographic disadvantage. Additionally, in initial analyses, high-intensity substance use is negatively associated with transitions into employment. However, this negative association loses significance when indicators measuring exposure to physical, social and structural features of the broader risk environment are considered. These findings indicate that interventions designed to improve employment outcomes among drug users should address these social, structural and physical components of the risk environment as well as promote the cessation of drug use.
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20
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German D, Latkin CA. Boredom, depressive symptoms, and HIV risk behaviors among urban injection drug users. AIDS Behav 2012; 16:2244-50. [PMID: 22760741 DOI: 10.1007/s10461-012-0247-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Boredom is closely aligned with depression, but is understood to be conceptually distinct. Little is known about boredom among active drug users and the potential association with depression and HIV risk. Current IDUs (n = 845) completed a baseline behavioral survey including socio-demographic characteristics, self-reported boredom, depressive symptoms (CESD score), and HIV risk behaviors. One-third of the sample reported high boredom in the past week. In multivariate analysis, those who reported boredom were less likely to be older, African-American, have a main partner, and to be employed at least part-time. Controlling for covariates, those with high boredom were almost five times as likely to report high depressive symptoms. Co-occurrence of boredom and depressive symptoms (28 %) was strongly and independently associated with a range of injection risk behaviors and sex exchange. This study demonstrates the need for more thorough understanding of mental health and HIV risk among urban drug users.
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21
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Holwerda A, Groothoff JW, de Boer MR, van der Klink JJL, Brouwer S. Work-ability assessment in young adults with disabilities applying for disability benefits. Disabil Rehabil 2012; 35:498-505. [PMID: 22823955 DOI: 10.3109/09638288.2012.702846] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate the impact of diagnosis, co-morbidity, secondary conditions (e.g. learning problems, subclinical mental and somatic complaints, addictions, and socio-emotional and behavioral problems) and problems in social context on work ability as assessed by Insurance Physicians (IPs) in young adults applying for a disability benefit. METHOD IPs of the Social Security Institute assessed young adults with disabilities (aged 15-27) applying for a disability benefit (n = 1755). Data were analyzed with multilevel ordinal regression techniques. RESULTS Primary diagnosis, co-morbidity and subclinical mental complaints were associated with IP-assessed work ability. Persons with mental health conditions as primary diagnosis were less likely to reach a higher work ability than persons with somatic diseases. Young adults with two or more co-morbid conditions and those with psychiatric or developmental co-morbidity were less likely to reach a higher work ability level than persons without co-morbidity. Young adults with subclinical mental complaints were half as likely to reach a higher IP-assessed work ability than young adults without this condition. CONCLUSION Primary diagnosis, type and number of co-morbid conditions and subclinical mental complaints are associated with IP-assessed work ability. Work-ability assessments among adolescents with disabilities applying for disability benefits still focus mainly on medical factors.
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Affiliation(s)
- Anja Holwerda
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.
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22
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The Mediating Role of Parent–Child Bonding to Prevent Adolescent Alcohol Abuse Among Asian American Families. J Immigr Minor Health 2012; 14:831-40. [DOI: 10.1007/s10903-012-9593-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Sigurdsson SO, Ring BM, O'Reilly K, Silverman K. Barriers to employment among unemployed drug users: age predicts severity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:580-7. [PMID: 22242680 DOI: 10.3109/00952990.2011.643976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Drug users in treatment or exiting treatment face many barriers to employment when entering the job market, such as low levels of education and technical skills, and low levels of interpersonal skills. As a result of these and other barriers, employment rates in these groups are generally low. OBJECTIVE This article examines the existence and possible predictors of specific barriers to employment related to interpersonal and technical skills in a sample of participants enrolled in a therapeutic workplace intervention for substance abuse. METHODS In Study I (N = 77), we characterized and examined predictors of participant scores on a staff-rated scale of interpersonal skills (Work Behavior Inventory). In Study II (N = 29), we examined whether participants had lower levels of computer knowledge than job seekers in the general population, and investigated possible predictors of computer knowledge in the sample. RESULTS In general, participants in Study I displayed low levels of interpersonal skills, and participants in Study II scored lower on the computer knowledge test than job seekers in the general population. Older participants tended to have lower levels of interpersonal skills and lower levels of computer knowledge. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These results suggest that providers of workforce development services for drug users in treatment or exiting treatment should attend to these specific barriers to employment, which may also be more pronounced among older clients.
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Affiliation(s)
- Sigurdur Oli Sigurdsson
- Department of Psychology, University of Maryland-Baltimore County, Baltimore, MD 21250, USA.
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24
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Svikis DS, Keyser-Marcus L, Stitzer M, Rieckmann T, Safford L, Loeb P, Allen T, Luna-Anderson C, Back SE, Cohen J, DeBernardi MA, Dillard B, Forcehimes A, Jaffee W, Killeen T, Kolodner K, Levy M, Pallas D, Perl HI, Potter JS, Provost S, Reese K, Sampson RR, Sepulveda A, Snead N, Wong CJ, Zweben J. Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders. Drug Alcohol Depend 2012; 120:55-64. [PMID: 21802222 PMCID: PMC3579551 DOI: 10.1016/j.drugalcdep.2011.06.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 06/25/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job. METHOD Study participants were recruited through the NIDA Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring. RESULTS JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with "obtaining a new taxed job" accounting for the majority of cases. CONCLUSION JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well.
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Affiliation(s)
- Dace S Svikis
- Department of Psychology, AWHARE (Addiction & Women's Health: Advancing Research and Evaluation), Virginia Commonwealth University, Old City Hall, Room 350A, 1001 East Broad Street, PO Box 980343, Richmond, VA 23298-0343, USA.
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25
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Storti CC, De Grauwe P, Sabadash A, Montanari L. Unemployment and drug treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:366-73. [DOI: 10.1016/j.drugpo.2011.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 10/17/2022]
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26
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Debeck K, Wood E, Zhang R, Buxton J, Montaner J, Kerr T. A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs. J Urban Health 2011; 88:724-35. [PMID: 21533961 PMCID: PMC3157498 DOI: 10.1007/s11524-011-9575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2-6, 6-15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36-14.20); daily crack use (AOR = 2.70; 95% CI, 2.07-3.52); encounters with police (AOR = 2.11; 95% CI, 1.62-2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14-1.95). Regular employment (AOR = 0.50; 95% CI, 0.38-0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45-0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.
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Affiliation(s)
- Kora Debeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Debeck K, Wood E, Qi J, Fu E, McArthur D, Montaner J, Kerr T. Interest in low-threshold employment among people who inject illicit drugs: implications for street disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:376-84. [PMID: 21684142 DOI: 10.1016/j.drugpo.2011.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/11/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Income generation opportunities available to people who use illicit drugs have been associated with street disorder. Among a cohort of injection drug users (IDU) we sought to examine street-based income generation practices and willingness to forgo these sources of income if other low-threshold work opportunities were made available. METHODS Data were derived from a prospective community recruited cohort of IDU. We assessed the prevalence of engaging in disorderly street-based income generation activities, including sex work, drug dealing, panhandling, and recycling/salvaging/vending. Using multivariate logistic regressions based on Akaike information criterion and the best subset selection procedure, we identified factors associated with disorderly income generation activities, and assessed willingness to forgo these sources of income during the period of November 2008 to July 2009. RESULTS Among our sample of 874 IDU, 418 (48%) reported engaging in a disorderly income generation activity in the previous six months. In multivariate analyses, engaging in disorderly income generation activities was independently associated with high intensity stimulant use, as well as binge drug use, having encounters with police, being a victim of violence, sharing used syringes, and injecting in public areas. Among those engaged in disorderly income generation, 198 (47%) reported a willingness to forgo these income sources if given opportunities for low-threshold employment, with sex workers being most willing to engage in alternative employment. CONCLUSION Engagement in disorderly street-based income generation activities was associated with high intensity stimulant drug use and various markers of risk. We found that a high proportion of illicit drug users were willing to cease engagement in these activities if they had options for causal low-threshold employment. These findings indicate that there is a high demand for low-threshold employment that may offer important opportunities to reduce drug-related street disorder and associated harms.
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Affiliation(s)
- Kora Debeck
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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28
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Sigurdsson SO, DeFulio A, Long L, Silverman K. Propensity to work among chronically unemployed adult drug users. Subst Use Misuse 2011; 46:599-607. [PMID: 20964531 PMCID: PMC3985271 DOI: 10.3109/10826084.2010.526982] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Analyses were conducted to compare rates of employment before, during, and after employment at the therapeutic workplace, which is a novel employment-based treatment for drug misuse. Participants in two clinical trials attended the therapeutic workplace at higher rates than they worked before intake and six months after discharge. These data suggest that unemployed chronic drug misusers will attend work at higher rates at the therapeutic workplace than in the community when paid modest wages, and that the failure of chronic drug misusers to obtain employment in the community may not result from lack of interest in work.
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Affiliation(s)
- Sigurdur Oli Sigurdsson
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
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29
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Sung HE, Chu D. The impact of substance user treatment participation on legal employment and income among probationers and parolees. Subst Use Misuse 2011; 46:1523-35. [PMID: 21428743 DOI: 10.3109/10826084.2010.537007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Employment is essential for recovery. But treatment could conflict with work schedules, and employment gains could be short lived. This study examined how employment and income varied during and after treatment, what aspects of treatment impacted on employment, and whether treatment improved income. Baseline and follow-up data were analyzed for 760 probationers and parolees in 11 US cities that participated in the 1992-1995 Drug Abuse Treatment Outcomes Study. Results showed that only residential/inpatient treatment was associated, temporarily, with employment. Retention, compliance, and self-efficacy were correlated to posttreatment employment. However, treatment had no impact on income, which was determined by education and work history.
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Affiliation(s)
- Hung-En Sung
- Department of Criminal Justice, John Jay College of Criminal Justice, New York, New York 10019, USA.
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30
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Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev 2010; 29:293-300. [PMID: 20565522 DOI: 10.1111/j.1465-3362.2009.00141.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS One of the most substantial costs of drug use is lost productivity and social functioning, including holding of a regular job. However, little is known about employment patterns of injection drug users (IDU). We sought to identify factors that were associated with legal employment among IDU. DESIGN AND METHODS We describe the employment patterns of participants of a longitudinal cohort study of IDU in Vancouver, Canada. We then use generalised estimating equations (GEE) to determine statistical associations between legal employment and various intrinsic, acquired, behavioural and circumstantial factors. RESULTS From 1 June 1999 to 30 November 2003, 330 (27.7%) of 1190 participants reported having a job at some point during follow up. Employment rates remain somewhat stable throughout the study period (9-12.4%). Factors positively and significantly associated with legal employment in multivariate analysis were male gender (adjusted odds ratio [AOR] = 2.78) and living outside the Downtown Eastside (AOR = 1.85). Factors negatively and significantly associated with legal employment included older age (AOR = 0.97); Aboriginal ethnicity (AOR = 0.72); HIV-positive serostatus (AOR = 0.32); HCV-positive serostatus (AOR = 0.46); daily heroin injection (AOR = 0.73); daily crack use (AOR = 0.77); public injecting (AOR = 0.50); sex trade involvement (AOR = 0.49); recent incarceration (AOR = 0.56); and unstable housing (AOR = 0.57). DISCUSSION AND CONCLUSIONS Our results suggest a stabilising effect of employment for IDU and socio-demographic, drug use and risk-related barriers to employment. There is a strong case to address these barriers and to develop innovative employment programming for high-risk drug users.
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Affiliation(s)
- Lindsey Richardson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Foley K, Pallas D, Forcehimes AA, Houck JM, Bogenschutz MP, Keyser-Marcus L, Svikis D. EFFECT OF JOB SKILLS TRAINING ON EMPLOYMENT AND JOB SEEKING BEHAVIORS IN AN AMERICAN INDIAN SUBSTANCE ABUSE TREATMENT SAMPLE. JOURNAL OF VOCATIONAL REHABILITATION 2010; 33:181-192. [PMID: 21818173 DOI: 10.3233/jvr-2010-0526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Employment difficulties are common among American Indian individuals in substance abuse treatment. To address this problem, the Southwest Node of NIDA's Clinical Trials Network conducted a single-site adaptation of its national Job Seekers Workshop study in an American Indian treatment program, Na'Nizhoozhi Center (NCI). 102 (80% men, 100% American Indian) participants who were in residential treatment and currently unemployed were randomized to (1) a three session, manualized program (Job seekers workshop: JSW) or (2) a 40-minute Job Interviewing Video: JIV). Outcomes were assessed at 3-month follow up: 1) number of days to a new taxed job or enrollment in a job-training program, and 2) total hours working or enrolled in a job-training program. No significant differences were found between the two groups for time to a new taxed job or enrollment in a job-training program. There were no significant differences between groups in substance use frequency at 3-month follow-up. These results do not support the use of the costly and time-consuming JSW intervention in this population and setting. Despite of the lack of a demonstrable treatment effect, this study established the feasibility of including a rural American Indian site in a rigorous CTN trial through a community-based participatory research approach.
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Affiliation(s)
- K Foley
- Na'Nizhoozhi Center Incorporated
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Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry 2009; 50:245-50. [PMID: 19374969 PMCID: PMC2743957 DOI: 10.1016/j.comppsych.2008.07.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Psychotic symptoms (delusions and hallucinations) are reported to be increased among persons using illicit substances, but little is known about the comparative frequency with which the symptoms occur with abuse of different substances. To establish this, we interviewed individuals who had wide experience of commonly used drugs. METHODS Four hundred seventy-six intravenous drug users, crack-cocaine users, and heroin snorters recruited via street outreach were interviewed using the Composite International Diagnostic Interview-Substance Abuse Model to assess dependence on a number of substances including amphetamines, cannabis, cocaine, and opioids. As a part of this assessment, we assessed a history of delusions and hallucinations in the context of use of, or withdrawal from, these specific substances. RESULTS From 27.8% to 79.6% users of amphetamine, cannabis, cocaine, and opiates met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, dependence for that specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (5.2%-100%), cannabis (12.4%-80.0%), cocaine (6.7%-80.7%), and opiates (6.7%-58.2%). The risk of psychotic symptoms increased for respondents who abused (odds ratio [OR], 12.2) or had mild (OR, 17.1), moderate (OR, 47.0), or severe dependence (OR, 114.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users. CONCLUSIONS Most users dependent on illicit substances experience psychotic symptoms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the substance use disorders for all 4 substances. These findings emphasize the importance of developing services to target this population as they are at a heightened risk for developing psychotic symptoms.
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