Abstract
This article explores the emotional experiences of drug- and/or alcohol-using parents who have child protective Social Services involvement. Research suggests that protective processes can ...reduce children’s experience of poor outcomes whilst parents undergo treatment for substance misuse. Semi-structured interviews combined with photovoice and journal writing were used to generate data. Eight UK-based parents participated. Each was accessing drug or alcohol treatment and had a child who was the subject of a child protection intervention. The resulting data from the seventeen interviews were analysed using Interpretative Phenomenological Analysis (IPA). Key findings are presented within four themes. The first two outline parents’ perceptions of themselves and how they felt they were viewed by others. Themes 3 and 4 focus on specific emotions: anger and frustration; fear and guilt. The research identifies the complex nature of parental emotions surrounding drug/alcohol misuse when social care services are involved. Parents conceptualised their experience as psychological trauma. They discussed the emotional roller-coaster of the effects of having combined interventions. The research provides insights into how drug/alcohol use can influence parenting. It also highlights issues for professional practice, including developing successful treatment models for substance-using parents.
In this article, we demonstrate how the parents included in this research, who were all subject to child protection interventions, experienced a range of conflicting emotions in negotiating these interventions. We present a novel methodological approach, where including a variety of methods of data generation over an extended period enhanced understanding of the longer-term emotional effects of child protection interventions on the experience of parenting. These parents’ views of themselves, and their perception of others’ assessments of them, are often related to self-blame and feelings of worthlessness. They conceptualised their experience of the involvement of child protection services as psychological trauma. We argue that there is a need for more appropriate treatment models, including further exploration of family interventions, for drug/alcohol-using parents.
Cognitive processing therapy (CPT), an evidence-based treatment for posttraumatic stress disorder (PTSD), has not been tested as an individual treatment among active-duty military. Group CPT may be ...an efficient way to deliver treatment.
To determine the effects of CPT on PTSD and co-occurring symptoms and whether they differ when administered in an individual or a group format.
In this randomized clinical trial, 268 active-duty servicemembers consented to assessment at an army medical center from March 8, 2012, to September 23, 2014, and were randomized to group or individual CPT. Inclusion criteria were PTSD after military deployment and stable medication therapy. Exclusion criteria consisted of suicidal or homicidal intent or psychosis. Data collection was completed on June 15, 2015. Analysis was based on intention to treat.
Participants received CPT (the version excluding written accounts) in 90-minute group sessions of 8 to 10 participants (15 cohorts total; 133 participants) or 60-minute individual sessions (135 participants) twice weekly for 6 weeks. The 12 group and individual sessions were conducted concurrently.
Primary measures were scores on the Posttraumatic Symptom Scale-Interview Version (PSS-I) and the stressor-specific Posttraumatic Stress Disorder Checklist (PCL-S); secondary measures were scores on the Beck Depression Inventory-II (BDI-II) and the Beck Scale for Suicidal Ideation (BSSI). Assessments were completed by independent evaluators masked to treatment condition at baseline and 2 weeks and 6 months after treatment.
Among the 268 participants (244 men 91.0%; 24 women 9.0%; mean SD age, 33.2 7.4 years), improvement in PTSD severity at posttreatment was greater when CPT was administered individually compared with the group format (mean SE difference on the PSS-I, -3.7 1.4; Cohen d = 0.6; P = .006). Significant improvements were maintained with the individual (mean SE PSS-I, -7.8 1.0; Cohen d = 1.3; mean SE PCL-S, -12.6 1.4; Cohen d = 1.2) and group (mean SE PSS-I, -4.0 0.97; Cohen d = 0.7; mean SE PCL-S, -6.3 1.4; Cohen d = 0.6) formats, with no differences in remission or severity of PTSD at the 6-month follow-up. Symptoms of depression and suicidal ideation did not differ significantly between formats.
Individual treatment resulted in greater improvement in PTSD severity than group treatment. Depression and suicidal ideation improved equally with both formats. However, even among those receiving individual CPT, approximately 50% still had PTSD and clinically significant symptoms. In the military population, improving existing treatments such as CPT or developing new treatments is needed.
clinicaltrials.gov identifier: NCT02173561.
Background: Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over ...the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001–2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991–1992 and 2001–2002.
Methods: Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC:
n=43,093) and NIAAA’s 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES:
n=42,862).
Results: Prevalences of DSM-IV alcohol abuse and dependence in 2001–2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991–1992 and 2001–2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males.
Conclusions: This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.
•Chronic alcohol exposure profoundly modifies lipidome profiling in PFC and striatum.•Three lipid classes, GP, GL and FA, take the most proportion of those modified lipidome.•The majority of altered ...lipids are synthesized in ER.•ER stress may account for the neurotoxicity of chronic alcohol caused disorders.
Much efforts have been tried to clarify the molecular mechanism of alcohol-induced brain damage from the perspective of genome and protein; however, the effect of chronic alcohol exposure on global lipid profiling of brain is unclear. In the present study, by using Q-TOF/MS-based lipidomics approach, we investigated the comprehensive lipidome profiling of brain from the rats orally administrated with alcohol daily, continuously for one year. Through systematically analysis of all lipids in prefrontal cortex (PFC) and striatum region, we found that long-term alcohol exposure profoundly modified brain lipidome profiling. Notably, three kinds of lipid classes, glycerophospholipid (GP), glycerolipid (GL) and fatty acyls (FA), were significantly increased in these two brain regions. Interestingly, most of the modified lipids were involved in synthetic pathways of endoplasmic reticulum (ER), which may result in ER stress-related metabolic disruption. Moreover, alcohol-modified lipid species displayed long length of carbon chain with high degree of unsaturation. Taken together, our results firstly present that chronic alcohol exposure markedly modifies brain lipidomic profiling, which may activate ER stress and eventually result in neurotoxicity. These findings provide a new insight into the mechanism of alcohol-related brain damage.
Abstract This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11–18) and young adults (age 19–30). We identified 185 ...eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents ( g ¯ = 0.27 and g ¯ = 0.19) and young adults ( g ¯ = 0.17 and g ¯ = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.
Objective: Behavioral economic theory suggests that a reduction in alcohol use is most likely when there is an increase in rewarding substance-free activities. Anxiety has also been linked to heavy ...drinking, and strategies to reduce anxiety may enhance alcohol interventions. The goal of this 2-site randomized controlled clinical trial was to evaluate the efficacy of a brief alcohol intervention that was supplemented with either a behavioral economic substance-free activity session (SFAS) or a relaxation training (Relaxation training RT) session. Method: Participants were 393 college students (61% female, mean age = 18.77 years) who reported 2 or more past-month heavy drinking episodes. Participants were randomized to 1 of 3 conditions: (a) assessment; (b) alcohol brief motivational intervention (BMI) plus SFAS; or (c) BMI plus RT. Both treatment conditions included 2 in-person sessions plus a phone booster session. Outcomes were evaluated 1-, 6-, 12-, and 16-months postintervention. Results: Generalized linear mixed models indicated that the combination of a BMI plus either the SFAS or RT was associated with significant reductions in alcohol use and problems across the 16-month follow-up compared with assessment only. There were no significant differences between the two active treatment conditions. Changes in proportional reinforcement from substance-related activities, and protective behavioral strategies mediated treatment effects. Conclusion: Two-session (plus booster) interventions that combine BMI and either substance-free activity enhancement or RT can result in enduring reductions in alcohol misuse among college drinkers.
What is the public health significance of this article?
Heavy drinking among college students is a significant public health concern. Brief alcohol interventions are effective, but drinking reductions are generally small, suggesting the need for additional intervention elements. The results of this randomized clinical trial suggest that brief alcohol interventions that are supplemented with either relaxation training or a behavioral economic session focused on increasing substance-free activities are associated with reductions in alcohol misuse over a 16-month follow-up period.
Both bullies and victims of bullying are at risk for psychiatric problems in childhood, but it is unclear if this elevated risk extends into early adulthood.
To test whether bullying and/or being ...bullied in childhood predicts psychiatric problems and suicidality in young adulthood after accounting for childhood psychiatric problems and family hardships.
Prospective, population-based study.
Community sample from 11 counties in Western North Carolina.
A total of 1420 participants who had being bullied and bullying assessed 4 to 6 times between the ages of 9 and 16 years. Participants were categorized as bullies only, victims only, bullies and victims (hereafter referred to as bullies/victims), or neither.
Psychiatric outcomes, which included depression, anxiety, antisocial personality disorder, substance use disorders, and suicidality (including recurrent thoughts of death, suicidal ideation, or a suicide attempt), were assessed in young adulthood (19, 21, and 24-26 years) by use of structured diagnostic interviews. RESULTS Victims and bullies/victims had elevated rates of young adult psychiatric disorders, but also elevated rates of childhood psychiatric disorders and family hardships. After controlling for childhood psychiatric problems or family hardships, we found that victims continued to have a higher prevalence of agoraphobia (odds ratio OR, 4.6 95% CI, 1.7-12.5; P < .01), generalized anxiety (OR, 2.7 95% CI, 1.1-6.3; P < .001), and panic disorder (OR, 3.1 95% CI, 1.5-6.5; P < .01) and that bullies/victims were at increased risk of young adult depression (OR, 4.8 95% CI, 1.2-19.4; P < .05), panic disorder (OR, 14.5 95% CI, 5.7-36.6; P < .001), agoraphobia (females only; OR, 26.7 95% CI, 4.3-52.5; P < .001), and suicidality (males only; OR, 18.5 95% CI, 6.2-55.1; P < .001). Bullies were at risk for antisocial personality disorder only (OR, 4.1 95% CI, 1.1-15.8; P < .04).
The effects of being bullied are direct, pleiotropic, and long-lasting, with the worst effects for those who are both victims and bullies.
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, ...making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%–100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
•This is the first systematic review on the correlates and consequences of cannabis use in military veterans.•The literature predominantly comprises cross-sectional studies; few studies have used longitudinal or RCT study designs.•Cannabis use is consistently associated other substance use, greater psychiatric severity, and self-harm/suicidality.•Few studies have examined the efficacy of medical cannabis in veterans; those that have are methodologically of low quality.
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