Prescription drug misuse (PDM), defined as use without a prescription or solely for the feeling or experience caused by the drug, has become a popular topic among substance use researchers. While the vast majority of studies on the topic tackle epidemiological questions surrounding PDM, there is a notable lack of studies that look specifically at risk factors rooted in sociological/criminological theories. The current research seeks to bridge this gap in the literature by examining theoretically based explanations for PDM among college students utilizing three criminological theories commonly applied to other forms of substance use: Social Learning Theory, Social Bonding/Control theory, and General Strain Theory. In addition, this study also seeks to examine differences in user types characterized by motives for misuse as they relate to predictors stemming from these theories of interest. Utilizing an independently collected sample of 841 college undergraduates from a large southern university, the findings show that nearly one in four students misused prescription drugs in the past semester. Motivations for PDM were primarily instrumental in nature, with very few respondents misusing solely for recreational purposes. Furthermore, social learning based risk factors could best account for PDM within the sample with partial and indirect supports also found for strain based risk factors as well. Implications of these findings as well as theoretical and practical applications are presented.

Aboriginal young people experience a high rate of family violence, alcohol and drug misuse, suicide, sexual abuse, and socioeconomic disadvantage (Gordon, Hallahan & Henry, 2002; Hunter, 1990, 1991c; Kimberley Aboriginal Medical Services Council, 1999; Memmott, Stacy, Chambers & Keys, 2001; Swan & Raphael, 1995). Over the last decade a burgeoning array of policy, services and programs have been developed to combat the social and emotional problems in Aboriginal communities. Despite some successes, Aboriginal children and youth consistently demonstrate poorer outcomes than non-Aboriginal youngsters across most domains of living, including health, mental health, education and vocation (Zubrick et al., 2005). While the evidence-base related to problems in Aboriginal communities has expanded, there is a deficit in knowledge about practical and sustainable interventions to build strengths in remote young Aboriginal people and families, to promote youth and community wellbeing. Even less has been done on the ground to assist remote Aboriginal communities to take action in tackling the problems they face (Atkinson, Bridge & Gray, 1999; Kimberley Aboriginal Medical Services Council & Westerman, 2002; National Aboriginal Health Strategy Working Party, 1989). / This qualitative participatory action research project conducted in the West Kimberley Western Australia from 2001 to 2004 was in collaboration with agencies based in Broome and the Bardi people of Ardyaloon Community, One Arm Point. The investigation aimed to (1) identify and explain the mental health and social and emotional problems affecting Aboriginal young people and families living in remote communities in the West Kimberley; and (2) identify and describe goals and methods for intervention to promote social and emotional wellbeing and build resilience in young people and communities. The third aim was to feed back and culturally validate the research findings. The overarching goal of this project was to work in partnership with Ardyaloon Community in prioritising community-based solutions to youth problems. An Aboriginal Project Advisory Group was formed to guide the research and several local project assistants were employed to assist with the field work. The project involved three studies. Overall, 32 Broome-based youth, parents and service providers, and 59 Elders, parents, youth and service providers from One Arm Point were involved in interviews and discussion groups. The findings were discussed and validated by 101 agency and community people. The results indicate a number of risk and resilience factors operating across the individual, family, community and socio-political sphere, including cultural and historical factors influencing youth wellbeing. From the findings, a model for community-based mental health promotion intervention was developed to address youth problems and build strengths prioritised by Ardyaloon Community.

Research suggests that non-medical prescription drug (NMPD) use is becoming increasingly prevalent, particularly among adolescents. A critical step towards developing effective intervention efforts requires identifying adolescents who are at risk for NMPD use. An extensive literature suggests that both adolescents and adults with elevated anxiety sensitivity (AS) are at greater risk for problematic substance use, and a small body of work has identified similar links with NMPD use specifically among adults. However, most of this literature combines all prescription drugs into a single category, and no work has evaluated the relation between AS and NMPD use among adolescents. The current study endeavors to further this area of research by examining the relation between AS (overall and subscales) and NMPD use among adolescents. The project evaluated 276 adolescents (age 9-19 years) enrolled in a residential treatment program on level of AS, including sub-dimensions (i.e., cognitive, physical, and social), and NMPD use across three categories of drugs: analgesic (e.g., Vicodin®), anxiolytic (e.g., Xanax®), and stimulant (e.g., Adderall®). A series of logistic regression models indicated that overall AS predicted nonmedical analgesic use, but not anxiolytic/sedative or stimulant use. A closer investigation of the AS subscales demonstrated that only the AS social subscale significantly predicted nonmedical analgesic and anxiolytic/sedative use. These results suggest that AS is related to NMPD use among adolescents, highlighting the need for future work to disaggregate the assessment of NMPD use into specific drug classes and explore the subscale dimensions of AS.

Juvenile misuse of prescription drugs in the United States has continuously increased over the last few decades, especially within rural regions of the country. Despite continuous increase in rates of misuse, limited research exists on elements of socialization that may function to prevent drug use. The current study utilized the Monitoring the Future Survey data to explore prescription drug misuse between different populations of juveniles. While using Hirschi’s (1969) theory of social bonds as a theoretical framework, different elements of socialization were explored to determine whether they work to contribute or prevent prescription drug misuse among rural and urban juveniles. Results indicated that parental attachment served as the most substantial protective factor among both populations of juveniles. Additionally, socialization differed in relation to prescription drug use among rural and urban youth. These findings could be implicated in future anti-drug programs that specifically target different regions of the country.

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Background: Prescription drug abuse is a public health problem in the United States and the region of Appalachia, specifically. Primary care and addiction medicine—as possible points of access for prescription drugs with abuse potential and points of intervention for prescription drug abuse—are among the medical fields at its forefront. Little is known, however, about perceptions of prescription drug abuse across the two patient populations. Objectives: The objective of this qualitative analysis was to explore perceptions of the scale and context of prescription drug abuse among primary care and addiction medicine patients in Appalachia. Methods: As part of a mixed methods study, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine in Central and South Central Appalachia from 2014 to 2015. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes. Results: Three themes were identified: (1) pervasiveness of prescription drug abuse, describing perceptions of its high prevalence and negative consequences; (2) routes and routine practices for prescription drug acquisition and distribution, describing perceptions of routes of access to prescription drugs and behaviors exhibited to acquire and distribute prescription drugs; and (3) rationales for prescription drug acquisition and distribution, describing perceptions of the two underlying reasons for these processes—tolerance/addiction and revenue source. Conclusions/Importance: Perceptions of prescription drug abuse among primary care and addiction medicine patients in Appalachia are multifaceted, especially regarding prescription drug acquisition and distribution. Clinical practice implications for mitigating prescription drug abuse are discussed.

Background: Provider–patient communication underpins many initiatives aimed at reducing the public health burden associated with prescription drug abuse in the United States. The purpose of this qualitative analysis was to examine the characteristics of provider–patient communication about prescription drug abuse from the perspective of prescribers. Methods:From 2014 to 2015, 10 semi-structured interviews were conducted with a purposive sample of prescribers from multiple professions and medical fields in Central and South Central Appalachia. The interviews were conducted using a guide informed by Social Cognitive Theory and community theory research, audio-recorded, and transcribed verbatim. Thematic analysis, facilitated by NVivo 10 software, was used to generate themes.Results:Prescribers described 3 primary communication patterns with patients related to prescription drug abuse—informative, counteractive, and supportive. Prescribers also reported multiple factors—personal (e.g., education, experiences, and feelings of tension) and environmental (e.g., relationship with a patient, clinical resources, and policies on controlled prescription drugs)—that affect provider–patient communication and, by association, delivery of patient care related to prescription drug abuse.Conclusions:The findings suggest that provider–patient communication about prescription drug abuse is multidimensional and dynamic, characterized by multiple communication patterns and contributory factors. They have implications for (1) research aimed at advancing theoretical understanding of prescriber prescription drug abuse communication behaviors with patients and (2) interventions aimed at strengthening prescriber prescription drug abuse communication behaviors with patients.

La toxicomanie a des répercussions importantes tant pour les individus qui en souffrent que pour la société en général (MSSS, 2007). L’efficacité des traitements offerts aux toxicomanes est toutefois affaiblie par la difficulté à maintenir et à engager en traitement cette clientèle (Meier et al., 2006). Dans ce contexte, et puisque la qualité de l’alliance thérapeutique est associée aux résultats et à la persévérance en traitement (Martin et al., 2000; Meier et al., 2005a), l’alliance qui se développe entre le client et le thérapeute en cours de thérapie peut être vue comme une piste de solution prometteuse pour améliorer l’efficacité des traitements de la toxicomanie. La présente étude se propose d’identifier les facteurs associés à l’alliance thérapeutique développée par une clientèle toxicomane en traitement (n = 269). L’étude s’intéresse également à l’influence de doubles problématiques (toxico-justice, toxico-santé mentale) sur les relations existantes entre l’alliance et ces facteurs (effets modérateurs). Les liens entre l’alliance thérapeutique et différentes variables (santé mentale, consommation, satisfaction envers les services, motivation, soutien social, pressions légales) ont été examinés à l’aide d’analyses de régression hiérarchique. Les résultats indiquent que le profil de consommation évalué avant l’entrée en traitement covarie avec l’alliance thérapeutique. Les troubles cognitifs et la satisfaction envers les services sont les deux principales variables évaluées lors de la thérapie de groupe qui sont associées à l’alliance. Des effets modérateurs de la présence de problématiques associées à la toxicomanie (justice, santé mentale) sur la relation entre certaines variables indépendantes et l’alliance ont finalement été observés. / Drug misuse has a major negative impact on individuals and on society as a whole (MSSS, 2007). The efficiency of drug treatments is however weakened by the difficulty retaining and engaging this clientele in treatment (Meier et al., 2006). In this context, and because the quality of the therapeutic alliance is associated with treatment outcome and treatment retention (Martin et al., 2000; Meier et al., 2005a), the alliance which develops between the client and therapist in the course of therapy appeared to be a promising solution to improve the efficiency of the treatments of drug addiction. The present study focus on the factors associated to the therapeutic alliance developed by drug addicts recruited in a drug rehabilitation programme (n = 269). The study is also interested in the influence of problems associated with addiction (justice and mental health) on the existing relations between the alliance and independents variables (moderating effects). The links between the therapeutic alliance and a range of factors (mental health, drug use, satisfaction with services, motivation, social support, legal pressures) are examined. The findings demonstrate that pretreatment drug use covarie with the therapeutic alliance. Cognitive disorders and satisfaction with services are two main variables assess during the group therapy which are associated with the alliance. The moderating effect of problems associated with addiction (justice, mental health) on therapeutic alliance is finally supported.

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