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Background: Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. Methods: We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results: Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. Conclusion: This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.

Objectives: 1) To examine associations between racial discrimination and drug problems among urban-based Aboriginal adults; and 2) to determine whether these associations are best explained by symptoms of psychological stress, distress or post-traumatic stress disorder (PTSD).

The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents.

Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs.

Objective: To present epidemiologic information on adolescent use of prescription drugs to get high, and not for medical purposes, in Canada.Methods: Data were obtained from 44 344 adolescents in grades 7 to 12 living across Canada's 10 provinces who completed the Youth Smoking Survey in 2008/2009.Results: Nationally, 5.9% of adolescents in grades 7 to 12 reported the use of prescription drugs to get high in the past 12 months in 2008/2009. Females were more likely to report use of pain relievers, sedatives, or tranquilizers to get high, while males were more likely to report the use of prescription stimulants for this purpose. The use of prescription drugs to get high was elevated among older youth, those living in British Columbia, and those who identified as First Nations, Métis, or Inuit. School connectedness was associated with a reduction in this form of prescription drug misuse for all adolescents; however, this protective effect was particularly strong for Aboriginal youth, and may be an important preventative factor for this population.Conclusions: Use of prescription drugs to get high was prevalent among adolescents in Canada in 2008/2009. Findings highlight the need for clinicians to include questions about prescription drugs when screening adolescents for substance abuse in Canada. Findings also highlight the need for evidence-informed strategies to reduce prescription drug misuse among Aboriginal youth living outside First Nations communities in Canada. The results of this study suggest school connectedness may be a particularly important target for these interventions.

Objectives: Racial discrimination is an established life course social determinant of health associated with adverse psychological outcomes among minority populations. However, little is known about the extent to which Aboriginal people in Canada may experience racial discrimination and consequent adverse psychological effects. This study sought to measure the extent to which Aboriginal university students living in an urban area of Canada experienced racism, to triangulate this evidence with US data and qualitative findings, and to examine the impact of these experiences on mental health.Methods: Data for this mixed method study were collected via in-person surveys with a volunteer sample of Aboriginal university students (n= 60) living in a mid-sized city in central Canada in 2008–2009.Results: Results indicate Aboriginal university students experienced more frequent racism across a greater number of life situations than African- and Latino-American adults in the United States. Student reactions to these experiences were symptomatic of what has been termed racial battle fatigue in the United States. Students who considered themselves traditional or cultural Aboriginal persons were significantly more likely to experience discrimination.Conclusions: Results underline the need for policies aimed at reducing racism directed at Aboriginal people in urban areas and the growth of services to help Aboriginal people cope with these experiences. Results highlight the need for further research to determine the potential pathogenic consequences of racial discrimination for Aboriginal people in Canada.

Objective: To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada.Methods: Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students (n= 60) in 2008/2009.Results: Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards.Conclusions: This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting.

Objective: We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta.Methods: Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%.Results: The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not.Conclusions: Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.

Objective: Population health surveys around the world have studied the epidemiology of comorbid substance use disorders (SUDs) and other mental disorders as part of larger efforts to assess needs and direct integrated planning and delivery of services. This study presents the first national assessment in Canada of the prevalence of co-occurring SUDs and other mental disorders, with attention to differences by substance problem severity, sex, age, and region.Methods: This work is a secondary analysis of data from the 2002 Canadian Community Health Survey: Mental Health and Well-Being. The sample was obtained using a multistage stratified cluster design (n= 36 984, response rate = 77%).Results: The 12-month population prevalence of co-occurring disorders was 1.7%. The 12-month prevalence of other mental disorders was higher among those with illicit drug, relative to alcohol, problems and among those with dependence, compared with those with less severe problems. Sex and age differences mirrored population differences in pure disorders. Salient regional differences included the higher rate of co-occurring disorders in British Columbia and the lower rates in Quebec.Conclusions: Cross-study comparisons are hampered by methodological differences; however, these Canadian rates are at the lower end of the range reported internationally. This might have resulted from the exclusion of several disorders known to be highly comorbid with SUDs. Nonetheless, prevalence is high in certain subgroups, and efforts under way to improve Canada's substance abuse and mental health services should continue to ensure that adequate attention is directed to the needs of people with co-occurring disorders.

This study examines characteristics of work sites related to the establishment of Employee Assistance Programs (EAPs) and drug testing programs. A sample of 633 human resources managers at work sites with 100 or more employees across Canada completed a questionnaire on their work site characteristics and the types of programs available (response rate = 77.8%). Work sites with EAPs had significantly (p< .01) fewer visible minorities, were more likely to be unionized (p< .0001), and had less hierarchical management styles (p< .00001) than work sites without EAPs. For drug testing programs, significant differences were found across provinces (p< .00001) for work sites that delivered goods to the United States (p< .01), and for those in the safety-sensitive work sectors (p< .00001). Results suggest that the presence of an EAP is an indication of an employee benefit and is more likely to exist in work sites with nonhierarchical management styles, and that drug testing programs are linked to geopolitical issues and safety concerns.

Objectives: This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression.Method: Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression.Results: Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05).Conclusions: Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population.

AbstractThe aim of this study was to examine the relationship between an objective and perceived measure of the physical environment related to physical activity within a school setting. A self‐report questionnaire to assess the perceived physical environment was completed by 850 male and female students in four high schools in rural Alberta, Canada. Two researchers completed objective observations in the same four schools. The students were grouped as perceiving the school environment (a) accurately, (b) affording greater opportunities, or (c) providing fewer opportunities. Discriminant analysis revealed two significant functions which differentiated between the three groups based on variables associated with physical activity in youth (i.e., age, self‐efficacy, peer network, family network, and teacher relationship) and on activity level. The first discriminant function's canonical correlations showed that teacher relationship (.91) and activity level (.42) were most predictive of individuals who perceived more opportunities than assessed in the objective measure. The second function's canonical correlations found that peer network (.63), self‐efficacy (.41), and activity level (‐.37) were the best at predicting individuals who perceived inaccurately. When examined by gender the discriminant analysis revealed only one significant function. For both females and males, this function's strongest predictors included teacher relationship and energy expenditure, while for males only, self‐efficacy and family network were also highly correlated. The discriminant analysis's model equation correctly classified 68.0% of the cases, 16.6% more cases than would be predicted by chance alone. Overall, the small mean difference score (0.37) between the three groups directs researchers to use either objective or perceived measures of the physical environment, as both should provide similar results.

Objective: To clarify “continuity of care” (COC), a construct associated with the delivery of services for persons suffering from severe and persistent mental illness (SPMI), with attention to the service recipient's perception of COC.Method: The study involved a systematic appraisal of the literature on COC, supplemented by interviews with 36 SPMI patients and their families. Statements highlighting attributes of COC were extracted from both sources.Results: Comments by patients and families corresponded to descriptions of COC in the mental health literature. Attribute classifications by independent teams of judges showed good consistency. The following 4 attribute domains of the COC construct were identified: service delivery, accessibility, relationship base, and individualized care.Conclusions: Service recipients' perceptions of COC overlapped with representations of the construct in the mental health literature. The qualitative inquiry resulted in a draft, 47-item, self-report questionnaire for use in studies of interventions designed to facilitate COC.

Background: We quantified the prevalence of alcohol problems among Alberta adults and determined relationships between sociodemographic characteristics, problem drinking status, and interest in self-help materials to reduce alcohol use. Methods: A computer-aided telephone interview was administered to a stratified random sample of 10,014 Albertans, 18 years of age or older (5,621 women and 4,393 men; M age = 43.3 years, SD = 16.0), with a response rate of 65.4%. Measures included: 1) current drinking status, 2) prior alcohol treatment, 3) problem drinking status (using the Alcohol Use Disorders Identification Test; AUDIT), and 4) interest in receiving free selfhelp materials to encourage safe drinking. Data were weighted to reflect age, sex, and regional Alberta population. Results: Of the total sample, 19.3% abstained from drinking in the past year, 4.2% had received treatment for alcohol problems at some point in their lives, and 80.7% were current drinkers (i.e., consumed alcohol in the previous year). Some 15.2% (n=1,193) of current drinkers were classified as having a drinking problem. Logistic regression analyses showed that problem drinkers had 3.5 times greater odds of being male and 2.3 times greater odds of being interested in self-help interventions, compared to other current drinkers. Being single, of younger age, and not being exposed to post-secondary education also significantly predicted problem drinking status. Interpretation: Alcohol misuse is common among Alberta drinkers, but many of them are interested in receiving brief public health interventions designed to help them assert control over their behaviour.

Compulsory treatment potentially offers a cost-effective and rehabilitative alternative to incarceration for substance-user offenders. However, the compatibility of harm-reduction principles and compulsory substance-user treatment initiatives is unclear. First, the historical record suggests that policy and legislative changes promoting diversion to treatment are typically not followed up by administrative, fiscal, and evaluative support. Moreover, cost-saving arguments underlying past programs may be inadequate to cope with concerns about civil liberties raised by compulsory treatment practices. Second, empirical evidence suggests that there may be a fundamental incompatibility between attitudes endorsing compulsory treatment and attitudes endorsing harm reduction. Finally, empirical claims about the relative efficacy of mandated versus nomandated substance-user treatment are plagued by conceptual and methodological problems. These arguments suggest that compulsory substance-user treatment and harm reduction may not be as compatible as is commonly believed. Consequently, caution is warranted in moving toward a widespread adoption of compulsory treatment policies. [Translations are provided in the International Abstracts Section of this issue.]

Musically naive students were taught a piano lesson. In a paid teaching condition, the teacher was portrayed as being extrinsically motivated by a $25 payment. In a second condition, the teacher was portrayed as an intrinsically motivated volunteer The confederate teacher was blind to conditions and gave the same standardized lesson to all students. Students in the volunteer condition perceived the teacher as exhibiting greater enjoy-mast, enthusiasm, and innovation relative to those in the paid condition hey also enjoyed the lesson more, reported a more positive mood, and were more interested in further learning. During a free-play interval, students in the volunteer condition exhibited greater exploratory activity than those in the paid condition

In a household survey, 882 respondents provided information on (1) weekly alcohol consumption, (2) perceptions of job security, pressures exerted by co-workers and friends to use alcohol and other drugs, social isolation on the job, and (3) alcohol-related problems. At a bivariate level, consumption was positively related to alcohol problems (r = .45, p < .001). However, perceived pressure to use alcohol and other drugs exacerbated the effects of consumption on social and legal problems among drinkers reporting low (three or fewer drinks per week) and high (nine or more drinks per week) levels of alcohol use. In addition, workplace variables improved the predictability of alcohol problems, after effects of alcohol consumption were controlled. These results suggest that future work should examine perceived characteristics of the workplace as moderators of consumption effects, and as direct effects on alcohol-related problems, independently of consumption levels.

Empirical-phenomenological methods were used to assess effects of aesthetic attitude on variations in aesthetic response. Immediately before viewing a painting, thirty participants were randomly assigned to conditions in which they either attempted to physically relax or attempted to physically relax andpsychically distance themselves from practical concerns. Then, participants: 1) provided verbal accounts of their experiences during three one-minute viewings of Raphael's La Fornaria, 2) completed a version of Gardner's painting style identification task [1], and 3) rated the target painting, the experimental procedures, and their background in art. Numerically aided phenomenological methods [2] revealed five distinct types of reported experience: tentative psychological interpretation, stereotyped rejection, quiet encounter, impatient overfamiliarity, and positive painterly evaluation. Analyses of the style identification data and of participants' ratings provided convergent validation for these types of aesthetic response. Although the manipulation of aesthetic attitude was not optimal, numerical phenomenological methods allowed assessment of subtly differentiated types of aesthetic response. These types of reported experience argue against a rigid dichotomy between aesthetic and nonaesthetic responses.