No description available.

Introduction: A range of factors including individual, socio-cognitive, political and those relating to geographical location provide important contexts for understanding influences on drinking behaviour. The relationship between these factors is an area that has been under-researched, so too are comparisons between the drinking behaviour of people in different cultural contexts. This is important when national rates of average alcohol suggest that lessons can be learned from countries with relatively low levels of alcohol consumption. The research reported in this thesis provides an in-depth exploratory analysis of individuals’ experiences of drinking in Italy and England, and investigates a range of motivations to drink alcohol, including, motives to drink, alcohol outcome expectancies and factors which promote drinking in moderation or abstention. Methods and participants: This research adopted a mixed methods design comprised of two studies. In the first study, a qualitative approach was adopted to explore the experience of n=24 social drinkers based in Italy and England. The second study used a quantitative approach and involved an overall total of n=403 (inclusive of abstainers) participants in Italy and England, who were asked to complete a battery of questionnaires to assess alcohol intake and a range of measures related to drinking behaviour. Findings: National differences were demonstrated for Italian and English respondents. Key findings were that English respondents were more likely to associate drinking with positive outcome expectancies, and were more likely to see drinking as a means of coping. Findings for the Italian sample suggested that drinking was linked to positive perceived parental attitude, self-perception / monitoring expectancies, and conformity; all these factors appeared to reduce levels of alcohol intake. Abstention and limiting factors suggested that ‘indifference towards’ alcohol was important for Italian abstainers when compared to limiters and to heavier drinkers. Additionally, outcomes for English abstainers suggested that indifference towards alcohol, family constraint, and religious constraint, were deciding factors that play a part in an individuals’ decision not to drink alcohol. Conclusion: The differences between the drinking patterns of Italian and English drinkers is complex and context specific. However, emerging from this research are key areas for informing policy which seek to promote levels and patterns of safe drinking. Following findings on the relationship between the “drinking to cope” motive and rising unitary intake in the English sample, it is suggested that further lines of research could explore using mindfulness techniques to enhance coping strategies in people who drink excessively.

The need for cultural competence in making services more responsive to the diverse needs of patients has been highlighted by many authors (NCCC, 2004b; Geiger,2001; Philleo and Brisbane, 1997; Ehrmin, 2005). Philleo and Brisbane (1997)argued that at a time of increasing globalisation and international communication,cultural competency is as important as computer literacy. This means that to be considered a competent professional, such as a nurse, drug worker, youth worker or social worker, one needs to take into account the wider cultural context of the person who is coming for help. A cultural dialogue, where the healthcare worker is able to communicate with people from a different cultural group, should be part of professional approach. With regard to the treatment of substance use problems,Philleo and Brisbane (1997) pointed out that a competent professional must know more than the harm alcohol and drugs can do to the body. Substance problems call for cultural solutions and a cultural dialogue, otherwise professionals are unlikely to achieve a change in their patients' behaviour. The need for better quality services for people from different cultural backgrounds has been recognised in a number of UK government policies, for example the Race Relations (Amendment) Act 2000 (RR(A)A 2000) (The Home Office (HO), 2000). These policies have pressurised organisations into promoting anti-racism and equal opportunities for both service users and staff, and to provide more accessible and culturally competent services. There has been much debate since the 1980s about how to make services more culturally aware and many training initiatives have been developed. Yet, there has been much confusion abuiot the focus of training such as, what needs to be addressed more: racism, discrimination, equal opportunity or diversity? There has been little discussion on the effectiveness of these training activities. Few have been evaluated to measure their impact, such as change in knowledge, attitude and behaviour of those trained, or their organisation's performance towards clients (Papadopoulos et al., 2004; Bhui et al., 2007). Consequently there is little evidence concerning the success of these educational activities. This PhD wants to make an original contribution to the debate surrounding cultural competence and educational practice by evaluating the effectiveness of an educational module to enhance the cultural competence of staff dealing with people with drug and alcohol problems. This study also includes an evaluation of the teaching and learning strategy used.

Background: A history of complex trauma alters basic self-structure, attachment system and core areas of interpersonal functioning and relationships. There is increasing recognition of the high proportions of complex trauma histories within substance misusers and limited research into the sequelae of complex trauma, particularly in relation to comorbid complex trauma and substance misuse. There is a distinct lack of adequate theory and guidelines for treatment. Research Aim: to explore psychologist’s experiences of and perspectives about their work with substance misusers with a history of complex trauma. Complex trauma is a term used to describe experience’s which arise from severe, prolonged and repeated trauma which is often interpersonal in nature. Courtois & Ford (2009) have defined complex trauma as “involving stressors that: are repetitive or prolonged, involve direct harm and/or neglect and abandonment by ostensibly responsible adults, occur at developmentally vulnerable times in the victim’s life, such as early childhood, have great potential to compromise severely a child’s development.” (p1). The prototype trauma that was first described under the term complex trauma was child abuse and neglect. Method: Semi-structured interviews were conducted with eleven clinical and counselling substance misuse psychologists working across four health boards in Central Scotland. The data was analysed using Interpretative Phenomenological Analysis (IPA). Results: Six main superordinate themes emerged from the data: 1. Challenges in negotiating therapeutic relationship; 2. Balancing relational forces; 3. Walking the tightrope of comorbidity; 4. Conceptual dearth (surrounding complex trauma); 5. Emotional impact of Work, and, 6. Core role of therapeutic relationship (in treatment and recovery). Discussion: Participants accounts suggest there are many risks to balance as well as paradoxes inherent in this type of work. The nature of a history of complex trauma means that often clients have difficulties with attachment and relational aspects in their lives, which in turn affect their engagement in the therapeutic relationship. The findings of this study suggest that it is precisely because relationships seem so threatening and challenging for these clients, that the therapeutic relationship appears to form such a vital role in the therapeutic treatment and recovery process for these client.

No description available.

Those who misuse alcohol in the United States do not regularly seek treatment on their own to reduce use and avoid consequences of misuse. Because of the association between alcohol misuse, alcohol-related risk behaviors, and injury; alcohol misuse in the United States has serious societal and individual repercussions. To alleviate these problems, health care professionals; including doctors, nurses, and social workers; have an opportunity to screen injured patients for alcohol misuse and provide brief interventions. Although some brief intervention research has demonstrated reductions in alcohol misuse and other injury-related behaviors, other evidence indicates that brief alcohol interventions are not equally effective for all injured patients. Moreover, screening and brief alcohol interventions are not reimbursed in most states, leaving providers and medical centers uncompensated for providing services. A possible way to address these challenges is to target intervention services to patients who are most likely to make positive changes. Therefore, this dissertation used mixture modeling to identify subclasses of injured patients based on their past injury-related consequences and risks of alcohol misuse in order to describe which subgroups made the greatest reductions in drinking in the year following discharge from a Level-1 trauma center. This dissertation also identified which subclasses of patients made the greatest behavioral improvements for injury-related consequences and risks of alcohol misuse during the year following discharge from the trauma center. Patients with profiles that contained high probabilities of multiple consequences and risks and those with histories of alcohol-related accidents and injuries reported some of the largest improvements in drinking and injury-related consequences and risks following discharge. Those classes that made the fewest changes had profiles that consisted of fighting and taking foolish risks while drinking or that consisted of low probabilities of risks or consequences of alcohol misuse. This dissertation provides tentative evidence for targeting intervention services to injured patients. Further research should verify which subclasses of patients are most likely to reduce alcohol misuse and other alcohol-related risk behaviors in order to more effectively target brief alcohol interventions, increase cost savings, and improve the health and behavioral health outcomes for injured patients who misuse alcohol. / text

This thesis portfolio includes two studies, a qualitative grounded theory of treatment adherence in people who inject drugs (PWID) and a systematic review of staff turnover in substance misuse services. The empirical paper is presented first, the findings of which led to the systematic review. The qualitative interview study arose from observations made within a clinical trial for the treatment of chronic Hepatitis C (HCV). The Chief Investigator of the ERADICATE trial team initially approached the Adult Psychological Therapies Service to investigate what seemed to be an anomaly – patient engagement with HCV treatment had far exceeded expectations. Indeed, positive treatment adherence is not common among PWID. What is more remarkable is participants continued the trial while experiencing the highly aversive side-effects of interferon, a medication known to mimic opioid withdrawal. It is important, if not crucial, to acknowledge the wider socio-cultural context in which this thesis portfolio was produced; the political landscape changed significantly over the course of writing. Divisive judgements about what characteristics make a person worthy and deserving of resources, became more dominant in public discourse and heightened the author’s awareness to these aspects in the data. PWID are among the most marginalised, and stigmatised groups in society. Several of the participants interviewed were homeless and all were at various points on a relapsing trajectory of injecting drug use. Perhaps positive treatment adherence in this population is counter-intuitive because intuition is often based on assumptions derived from implicit biases. Indeed, until 2008, Scottish policy systematically denied HCV treatment to PWID. Due to the assumption that re-infection was inevitable, treatment was seen to be wasteful. Epidemiological studies now show is that public health is significantly improved when PWID are treated, as population prevalence goes down. Completing this thesis led to an examination of fundamental assumptions, not just relating to the participants or the data, but also relating to the question of what Clinical Psychology is. What can we contribute to the science of human behaviour? How does a self-aware mind arise and become autonomous? What leads adults to mentalize and enact their intentionality through particular behaviours, like taking medication? In grappling with these questions, the reader will detect the influence of developmental theorists, Vygotsky, Erikson and Bowlby. Seminal experiments, such as Tronick’s still face (Tronick, 1989)1 and Harlow’s monkeys (Harlow and Zimmerman, 1958)2, alongside newer fields of interpersonal neurobiology and developmental trauma have supplied the soil in which to ground the data gathered in this study. From our earliest days we are designed to absorb stimuli and integrate our perception into a gestalt. When PWID are characterised as “chaotic”, there is a failure to appreciate what this may really reflect: difficulty making sense of internal experience resulting in the absence of order, coherence and meaning. Therefore, the ontological presupposition underlying both the empirical paper and systematic review, is that humans are resilient, relational beings. When the correct conditions and contingencies are in place, our innate propensity to learn and grow can manifest in positive, adaptive behaviour. Narratives are not only ways of seeing the world, but ways of constructing it; we live through and are created by the stories told by others and ourselves (Murray, 2003)3. The public narrative of scepticism that has emerged around scientific endeavour, makes it all the more incumbent upon researchers to carry out their work with personal conviction, integrity and transparency (Rea, 2017, February 22)4. This qualitative analysis was completed with a high level of scientific rigour. Indicators of quality were employed throughout, for example, particular attention was paid to preserving the colloquial expression of participants in transcription and substantiates the authentic representation of their voice. The resultant grounded theory shows that the interpersonal context is a key part of adherence behaviour among PWID. This finding precipitated another question, if good quality relationships are important for patient engagement, how do staff stay engaged in the task of providing consistent, sensitive care on a sustained basis? The current evidence base on supporting and preserving compassion did not substantiate a systematic review, however, the opposite phenomenon, people leaving their jobs has been explored. As Clinical Psychologists we are able to connect with and influence different audiences by skilfully adapting our language. In order to appeal to managers and team leaders, the most pragmatic way of framing staff disengagement, was to examine actual staff turnover as a ‘hard’, concrete outcome. The methodological quality of studies included for review was reasonable in the context of methodological limitations. Findings point to the importance of collective support, good quality relationships and job satisfaction in mitigating against turnover in substance misuse services. This thesis portfolio is a sensitive and pragmatic understanding of engagement in both PWID and staff with the respective systems within which they are embedded. The results are contextualised and oriented toward medical colleagues working in HCV treatment, service leaders and fellow applied psychologists.

Background: When a family encounters the problem of adolescent substance misuse, the burden of managing it often falls primarily on the mother. Objective and methods: This research was conducted in two phases to explore the experiences of mothers of adolescents who misuse substances. Phase one was a systematic qualitative evidence synthesis of qualitative studies on the experiences of mothers of adolescents who misused substances. In this phase, conventional content analysis was used to create a narrative synthesis of themes and categories. Phase two was a qualitative study using thematic analysis to describe mothers’ experiences of parenting an adolescent who misused drugs. Findings: Eleven qualitative studies were included in the literature review. New categories regarding mothers’ experiences emerged from the review and synthesis: 1) I love you and we can talk no matter what; 2) So this is really happening . . . My kid’s on drugs; 3) What have I done?; 4) My family is shattered: a) I can’t believe what you’re doing, b) I can’t face this, c) I’ve lost my baby; and 5) It’s not my addiction. Four mothers were interviewed for the qualitative study. Mothers described their realities and the challenges they faced parenting an adolescent who misused drugs. Their experiences were represented in the following categories:1) recognition, 2) punishment/surveillance, 3) negative emotions, 4) relationships, 5) escalating effects, 6) strategies, and 7) home–a safe place. Conclusions: The findings from this research contribute to our understanding of the everyday lives and struggles that mothers face with their adolescents’ substances misuse. Nurses, by implementing early targeted interventions, will meet the needs of these mothers and assist themselves and ultimately their adolescents to attain optimal wellbeing.

Background: Referral from the Criminal Justice System (CJS) is a key, common route into drug misuse treatment. It is important to know whether, and how, it impinges on treatment outcome, particularly in relation to motivational states that may influence behaviour change.Aim: To assess the association between motivational state and level of treatment coercion, and the effects of these on treatment engagement and outcome, among a sample of drug misuse treatment seekers in England.Setting: Patients were sampled from 342 community and residential drug misuse treatment services within 94 (of 149) commissioning areas in England during 2006-07. All patients seeking drug misuse treatment at these services were eligible for inclusion. Methods: The Circumstances, Motivation, and Readiness scale provided measures of propensity for treatment including specific sub-scores for circumstances, motivation and readiness for treatment. The degree of referral coercion was categorised according to the level of CJS involvement: CJS referral with a condition of attendance; voluntary CJS (no attendance condition); non-CJS. Predictors of propensity were examined using linear regression, with particular emphasis on level of coercion. The predictive nature of coercion and propensity in relation to treatment uptake and threshold points for duration of treatment retention was examined using logistic regression models. Cox proportional hazard models examined associations with linear measures of treatment duration. Analysis of treatment outcome focussed on changes in: the value of drugs used; severity of dependence score; and level of offending. Relationships between these measures and coercion and propensity were examined using quantile, linear and logistic regression models. These were further supported by longitudinal models, incorporating instrumental variables for continuous outcomes to account for potential time related confounding. Results: No negative association was observed between level of coercive referral and levels of motivation or readiness for treatment and conditional referral was positively associated with motivation at the point of treatment entry. Both readiness for treatment and coercion predicted treatment retention for three months, although previous treatment experience treatment and use of heroin were the most consistent predictors of retention. Increasing pre-treatment motivation predicted greater reduction in the value of drugs used but not changes in the level of offending. Neither propensity sub-scores nor coercive referral predicted change in dependence severity. However, coercion was associated with cessation of offending among opiate /crack users. Conclusions: Propensity and coercion have mutually exclusive effects on different aspects of behaviour change. Coercion can positively affect treatment retention but changes in drug taking behaviour are more strongly associated with level of intrinsic motivation. Assessment of propensity, including its motivational components, at treatment entry could inform treatment delivery but its importance should not overshadow that of other factors, which may exert more important effects. Coercive CJS referral is not detrimental to treatment success and may have particular benefits for specific populations, but the cost effectiveness of diversionary schemes should be considered.

Title: Drug Related Crimes and Overdoses during the COVID-19 Pandemic Format: Poster Authors: Janaya Colbert, Kristin Mahan, MA, Jill D. Stinson, PhD Department of Psychology, College of Arts & Sciences, East Tennessee State University, Johnson City, TN The COVID-19 pandemic affected many aspects of life, including restricting many people to their homes. During the lockdown, more people were isolated inside, which may have resulted in varying levels of drug and substance-related crimes, as well as overdose deaths. Increases in substance misuse may be associated with stress regarding COVID-19, but these events may be less often officially reported during the lockdown. An increase in substance use may also be associated with an increase in overdose deaths. In the present study, we will compare trends of drug and substance related outcomes before and during the pandemic in Tennessee, and differentiate effects between rural and urban counties. Data for this project were obtained from the Tennessee Bureau of Investigation’s (TBI) online incident-based reporting system and the County Health Rankings and Roadmaps online database. Variables of interest include all 95 Tennessee counties, number of driving under the influence (DUI) cases, number of drug/narcotic violation cases, and number of overdose deaths. In 2019, there were 19,556 reported DUI cases and in 2020, there were 17,578 reported DUI cases in Tennessee. In 2019, there were 50,618 reported drug/narcotic violations and in 2020, there were 49,875 reported drug/narcotic violations. In 2019 there were 4,776 reported overdose deaths and 5,097 reported overdose deaths in 2020. Utilizing 2x2 factorial ANOVAs, we will analyze the relationships between county type (i.e., urban vs. rural) and report year (i.e., 2019 vs. 2020) for each outcome of interest. Our hypotheses include: (a) there will be differences between urban and rural counties on the rates of drug and substance related outcomes (i.e., DUI cases, drug/narcotic violation cases, overdose deaths) pre- and mid-pandemic; (b) drug-related crimes and DUI cases decreased during the pandemic when compared to the previous year due to lockdown procedures and decreased ability to access substances; and (c) overdose deaths increased from pre- to mid- pandemic. Anticipated results will help examine how the COVID-19 pandemic has affected rates of drug and substance related crimes, which can help inform prevention and treatment strategies in the future. Additionally, potential discrepancies between rural and urban counties may highlight prevention and treatment disparities for those struggling with substance misuse, which can inform resource allocation within Tennessee.