AIMS: This study set out to identify any undesirable consequences of legislative change in the organization of the treatment of problem drug users (PDUs), which aimed to combine their social and medical care. METHOD: The method used was a register-based three-year follow-up prevalent cohort study. RESULTS: On 1 January 1996, the law was changed to allocate unambiguous and undivided responsibility for the combined social and medical care of PDUs in Denmark. The main objective of the legislative change was to move PDUs from treatment by general practitioners (GPs) and at private clinics to treatment institutions under the control of the counties. The possibility remained that medical treatment could, however, continue to be given by GPs or private clinics, based on specific agreements. The study showed that at the end of the period, 31 December 1998, two-thirds remained in treatment at private clinics or at GP surgeries. During the period only 8% of users were at some time without methadone treatment; 2% remained without methadone treatment throughout the study period. CONCLUSION: The transition from GPs and private clinics to the county treatment centres went smoothly. The number of PDUs in MMT (methadone maintenance treatment) in the city of Copenhagen increased in the period 1995 to 1998. The average quantity of methadone given to the cohort increased during these years from 72 mg per day to 92 mg per day. The legislative change therefore did not result in a higher threshold for treatment or a more restrictive prescription of methadone. No adverse effect on crime, hospital admissions, or death could be attributed to the legislative change in treatment organization.
To demonstrate the link between gambling, alcohol and drug problems among Ontario adults and to present information on the relationship between expenditures on gambling and type of gambling with gambling problems.
Using data collected in a 1994 telephone survey of 2,016 randomly chosen Ontario adults, gambling problems are related to the CAGE scale of alcohol problems and the ICD-10 measure of alcohol dependence, as well as smoking, other drug use, and demographic variables. Descriptive tables based on crosstabulations and means are provided, as well as a series of 9 logistic regression models.
The most significant predictor of gambling problems was the amount spent on gambling in the preceding 30 days, with alcohol dependence on the ICD-10 scale and age also important predictors. Lottery players, compared to other gamblers, are more likely to be male, relatively less affluent, older on average, more likely to report alcohol problems (but not dependence) and be currently smoking.
The results make clear that heavy drinking and drinking problems are associated with higher levels of spending on gambling and reports of gambling problems. This leads to the suggestion that treatment programs for those with gambling, alcohol or other drug problems should assess that possibility of comorbidity, since the presence of more than one of these problems can significantly affect the success of treatment and contribute to relapse.
This study aimed to examine whether variations among regions in Quebec existed after we controlled for individual characteristics in the prevalence of 1) alcohol, cannabis, and gambling behaviours and 2) substance-related disorders and pathological gambling.
Using data derived from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), we nested 5332 respondents from the province of Quebec within 374 regions equivalent to census subdivisions (CSDs). Outcome variables included 1) drinking status (past 12 months), alcohol consumption (last week), and 12-month diagnosis of alcohol dependence; 2) cannabis use (past 12 months and lifetime) and diagnosis of illicit drug dependence; and 3) gambling status, severity of gambling problems, and number of reported gambling activities (past 12 months). Multilevel regression models with individuals (Level 1) nested in regions (CSDs, Level 2) assessed the variations among regions in the prevalence of various outcomes and disorders when individual characteristics were controlled for.
Variance component models revealed that all alcohol-related variables, the prevalence of cannabis use (12 months), and problem gambling did not vary among areas. Gambling rates and the average number of reported gambling activities varied among areas, even when individual-level variables were accounted for in the models, whereas for lifetime cannabis use, variations among areas became nonsignificant.
Intervention programs may need to address the environment as a relevant determinant of health-related behaviours and lifestyles.
According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.
Illicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use.
We carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients' first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems.
The mean age of the clients was 25 years, 21% (n?=?519) were homeless, 54% (n?=?1363) were unemployed and 7% (n?=?183) had experienced threats of violence. Half of the clients (50%, n?=?1258) were self-referred and 31% (n?=?788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n?=?630) was more prevalent than other infectious diseases and depressive symptoms (59%, n?=?1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR?=?1.86; 95% CI?=?1.50-2.30) and psychological problems (AOR?=?1.51; 95% CI?=?1.23-1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR?=?3.89; 95% CI?=?1.32-11.46) and for reporting a combination of social and health problems (AOR?=?3.24; 95% CI?=?1.58-6.65).
The existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients' treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.
The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.
From a health services perspective, peer-based resources merit special attention. Participation in self-help fellowships, like the Twelve Step Groups (TSGs), have been shown to improve outcomes of patients with substance use disorder (SUD) and they represent a valuable adjunct to the SUD treatment system. This study investigated the relationship between patient perceptions of TSGs and the intent to participate in TSGs after receiving detoxification treatment.
We included 139 patients that entered a detoxification unit (detox) in Kristiansand, Norway. We analyzed factors associated with the intention to participate in TSGs post-discharge with contingency tables and ordinal regression analysis.
Forty-eight percent of patients had participated in TSGs before entering detox. Respondents saw more advantages than disadvantages in TSG participation, but only 40% of patients showed high intentions of participating in TSGs post-discharge. A high intention to participate in TSGs was most strongly correlated with the notion that participation in TSGs could instill the courage to change. In a multivariate analysis, the perception that TSGs were beneficial was the strongest factor related to a high intention of TSG participation after treatment.
Our findings increased the understanding of factors most likely to influence decisions to attend TSGs in SUD treatment contexts with uncommon TSG participation. Our results suggested that the majority of patients may be sufficiently influenced by highlighting the potential gains of TSG participation. Treatment programs that do not focus on self-help group attendance during and after treatment should consider implementing facilitative measures to enhance utilization of these fellowships.