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Objective: Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers. Methods: Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD. Results: Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations. Conclusions: Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment. [ABSTRACT FROM AUTHOR]

The study aims to map the treatment perspectives of international experts on treating mentally ill offenders (MIO) in a forensic psychiatric centre (FPC) using the Delphi method. The four-round Delphi study reveals high conformity on the proposed treatment-related issues. However, some points of divergence remain. Three controversies underpinning these disagreements are discussed. The first regards the treatment and control debate, the second concerns the dual role of assessment in forensic mental health care and the third describes potential entry conditions for treatment in a FPC. Further research is needed to scientifically underpin the above mentioned debates. In this regard, the study suggests a close collaboration between practitioners and researchers. [ABSTRACT FROM AUTHOR]

Objective:Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers. Methods:Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD. Results:Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations. Conclusions:Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment. [ABSTRACT FROM AUTHOR]

Although Synanon has been extensively studied, attention has seldom been paid to the question of how the many ex-members who left Synanon before or at its dissolution 'survived' their community and indoctrination, and how they now evaluate their involvement. This article explores how ex-members react to their previous affiliation to Synanon, the cradle of the therapeutic community (TC) for addiction. A series of critical incidents, following Synanon's public proclamation restyling itself as a religion, which led to the dismantlement of Synanon, are highlighted and contrasted with the achievements of the movement. For this research study, we used a social constructivist methodology. Following qualitative snowball targeted sampling, open interviews and text analysis, 14 statements, representing the main reactions, were retained. These served as the basis for a web-based survey. It was found that ex-Synanon members still believe in the positive realizations of their experience. On the other hand, they are not blind to the negative aspects of this time but tend to deny, or perhaps do not know, that the proclamation to become a religion was in fact initiated by the inner circle and that this was the start of the dismantling of the organization's value system and the introduction of strange and inappropriate behaviour. The article emphazises the potential powerful and long-lasting effects of 'community as method' as a means of indoctrination of values. It endorses the opinion that the drug-free concept-based TC operates within the framework of an effective belief system that encourages and reinforces behavioural change. It is therefore critically important to ensure that present-day TCs remain open to the views and expectations of society. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether European and American therapeutic communities (TCs) for addiction, both traditional and modified, share a common perspective on what is essential in treatment using the Survey of Essential Elements Questionnaire (SEEQ). The European sample ( N == 19) was gathered in 2009. For the American sample ( N == 19), we used previously published research data. Despite comparable perspectives, European traditional TCs ( N == 11) scored significantly higher than their American predecessors ( N == 11) on four SEEQ domains. Cluster differences were more pronounced in Europe than in America. [ABSTRACT FROM AUTHOR]

This paper describes experiences of implementing different standardized assessment tools for research and treatment needs in 29 residential treatment centres in nine countries in Europe, within the IPTRP (Improving Psychiatric Treatment in Residential Programs for emerging dependency groups). Four instruments were obligatory for all centres participating: the EuropASI, the SCID, the Maastricht Social Network Analysis MSNA and the BioMAPS. The implementation process was prolonged, since extensive and repeated training was needed and the instruments had to be translated and adapted, and comparability in data discussed. The data collection had to deal with both coding and language problems before any analysis could be made. The experiences show several prerequisites for the success of this kind of project: an understanding of the treatment framework as a system, to anticipate and plan for problems and blockages; active involvement of staff in the project and intensive training, consultancy and support. [ABSTRACT FROM AUTHOR]

In 1981, a "research-practice" breakthrough was realized through the foundation of the European Federation of Therapeutic Communities (EFTC). Since its foundation EFTC regularly organized conferences and symposia. A few years later (in 1983), the European Workshop On Drug policy Oriented Research (EWODOR) was established at the Erasmus University in Rotterdam, including a special section devoted to the therapeutic community (TC). The authors examined the proceedings of all meetings organized by EFTC and EWODOR. The major topics presented throughout the last 20 years are highlighted in a chronological selection and these presentations largely focus on the challenges of the TC and the state of the art regarding scientific knowledge. In this overview only those authors who published articles in scientific journals indexed in the "Web of Science" (Institute for Scientific Information—ISI) were retained. Although research has never been the primary consideration in TCs, it played a far from negligible role in its development. Research findings prompted innovations and thus often provoked resistance, but on the other hand they functioned as a catalyst between the necessity of a belief system and the reality of society. The role of "grey" literature and the availability of information through the Internet will become more and more important in the communication between researchers and practitioners. [ABSTRACT FROM AUTHOR]