Search

Background: Mothers whose child's death is related to substance use have emerged as prominent and outspoken critics of Canadian drug policy in the news media. We examined the extent to which, and who among, the general public has seen or heard mothers bereaved by substance use in the media; predicted factors associated with exposure to such media; and explored associations with public acceptance of harm reduction. Methods: We analyzed data from a 2018 online panel survey assessing Canadian views on harm reduction, using randomly-drawn provincially representative (N = 4645) and nationally representative (n = 2002) samples of adults. Results: A majority (58.3%) of Canadians had seen or heard media featuring a mother whose child had died from an overdose. Respondents who had an increased level of familiarity with people who use drugs as well as older respondents were significantly more likely to have reported exposure to bereaved mothers' media. Respondents who had been exposed to bereaved mothers' media coverage were less likely to respond 'don't know/no opinion' of harm reduction vs. opposing harm reduction. Conclusion: Additional studies using a variety of methods are required to further evaluate the advocacy work being undertaken by mothers bereaved by substance use. [ABSTRACT FROM AUTHOR]

Background: Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables. Methods: Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables. Results: Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education. Conclusions: The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that news media which includes a sympathetic portrayal of a mother bereaved by substance use can increase public support for harm reduction initiatives. However, the extent to which such news media coverage occurs in Canada is unknown, and research has not documented how the news media in Canada covers such stories. We undertook a mixed-method secondary analyses of 5681 Canadian newspaper articles on harm reduction (2000–2016). Quantitative analyses described the volume and content of harm reduction reporting featuring a mother whose child's death was related to substance use while qualitative thematic analysis provided in-depth descriptions of the discourses underlying such news reporting. Newspaper articles featuring a mother whose child's death was related to substance use were rarely published (n = 63; 1.1% of total harm reduction media coverage during the study period). Deductive content analysis of these 63 texts revealed that coverage of naloxone distribution (42.9%) and supervised drug consumption services (28.6%) were prioritized over other harm reduction services. Although harm reduction (services or policies) were advocated by the mother in most (77.8%) of these 63 texts, inductive thematic analysis of a subset (n = 52) of those articles revealed that mothers' advocacy was diminished by newspaper reporting that emphasized their experiences of grief, prioritized individual biographies over structural factors contributing to substance use harms, and created rhetorical divisions between different groups of people who use drugs (PWUD). Bereaved mothers' advocacy in support of harm reduction programs and services may be minimized in the process of reporting their stories for newspaper readers. Finding ways to report bereaved mothers' stories in ways that are inclusive of all PWUD while highlighting the role of broad, structural determinants of substance use has the potential to shift public opinion and government support in favour of these life-saving services. [ABSTRACT FROM AUTHOR]

Background and aims: Fentanyl is primarily responsible for the current phase of the overdose epidemic in North America. Despite the benefits of treatment with medications for opioid use disorder (MOUD), there are limited data on the association between fentanyl, MOUD type and treatment engagement. The objectives of this analysis were to measure the impact of baseline fentanyl exposure on initiation and discontinuation of MOUD among individuals with prescription‐type opioid use disorder (POUD). Design, setting and participants: Secondary analysis of a Canadian multi‐site randomized pragmatic trial conducted between 2017 and 2020. Of the 269 randomized participants, 65.4% were male, 67.3% self‐identified as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. Fentanyl‐exposed participants were more likely to be younger, to self‐identify as non‐white, to be unemployed or homeless and to be currently using stimulants than non‐fentanyl‐exposed participants. Interventions: Flexible take‐home dosing buprenorphine/naloxone or supervised methadone models of care for 24 weeks. Measurements: Outcomes were (1) MOUD initiation and (2) time to (a) assigned and (b) overall MOUD discontinuation. Independent variables were baseline fentanyl UDT (predictor) and assigned MOUD (effect modifier). Findings Overall, 209 participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure was associated with reduced likelihood of treatment initiation [odds ratio (OR) = 0.18, 95% confidence interval (CI) = 0.08–0.36] and shorter median times in assigned [20 versus 168 days, hazard ratio (HR) = 3.61, 95% CI = 2.52–5.17] and any MOUD (27 versus 168 days, HR = 3.32, 95% CI = 2.30–4.80). The negative effects were no longer statistically significant in adjusted models, and no interaction between fentanyl and MOUD was observed for any of the outcomes (all P > 0.05). Conclusions: Both buprenorphine/naloxone and methadone may be appropriate treatment options for people with prescription‐type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl‐exposed individuals appear to be driving the association with poorer treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: Extensive exposure to prescription-type opioids has resulted in major harm worldwide, calling for better-adapted approaches to opioid agonist therapy. The authors aimed to determine whether flexible take-home buprenorphine/naloxone is as effective as supervised methadone in reducing opioid use in prescription-type opioid consumers with opioid use disorder.Methods: This seven-site, pan-Canadian, 24-week, pragmatic, open-label, noninferiority, two-arm parallel randomized controlled trial involved treatment-seeking adults with prescription-type opioid use disorder. Participants were randomized in a 1:1 ratio to treatment with sublingual buprenorphine/naloxone (target dosage, 8 mg/2 mg to 24 mg/6 mg per day; flexible take-home dosing) or oral methadone (≈60-120 mg/day; closely supervised). The primary outcome was the proportion of opioid-free urine drug screens over 24 weeks (noninferiority margin, 15%). All randomized participants were analyzed, excluding one who died shortly after randomization, for the primary analysis (modified intention-to-treat analysis).Results: Of 272 participants recruited (mean age, 39 years [SD=11]; 34.2% female), 138 were randomized to buprenorphine/naloxone and 134 to methadone. The mean proportion of opioid-free urine drug screens was 24.0% (SD=34.4) in the buprenorphine/naloxone group and 18.5% (SD=30.5) in the methadone group, with a 5.6% adjusted mean difference (95% CI=-0.3, +∞). Participants in the buprenorphine/naloxone group had 0.47 times the odds (95% CI=0.24, 0.90) of being retained in the assigned treatment compared with those in the methadone group. Overall, 24 drug-related adverse events were reported (12 in the buprenorphine/naloxone group [N=8/138; 5.7%] and 12 in the methadone group [N=12/134; 9.0%]) and mostly included withdrawal, hypogonadism, and overdose.Conclusions: The buprenorphine/naloxone flexible model of care was safe and noninferior to methadone in reducing opioid use among people with prescription-type opioid use disorder. This flexibility could help expand access to opioid agonist therapy and reduce harms in the context of the opioid overdose crisis. [ABSTRACT FROM AUTHOR]

Introduction: The perceived unmet service needs of acute care‐seeking people who use illegal drugs (PWUD) have been poorly documented, despite evidence of frequent hospital utilisation. This study applies the Behavioral Model for Vulnerable Populations to investigate correlates of unmet service needs in this subpopulation. Methods: Survey data from 285 PWUD at three urban Canadian acute care centres were examined. The survey included the Perceived Need for Care Questionnaire, which measured service seeking and care satisfaction for mental health and substance use concerns across seven types of services, as well as barriers to having care needs met. The Behavioral Model for Vulnerable Populations was applied in hierarchical setwise logistic regression to examine associations between high unmet service need and socio‐structural predictors (i.e. predisposing, enabling and need factors). Results: Almost half (46%) of participants reported a high level of unmet service need, despite seeking services during the past year. Participants reporting recent criminal activity, adverse childhood experiences, transitory sleeping, having no community support worker, and meeting screening criteria for depression were more likely to report a high level of unmet service needs. Structural barriers to care (57%) were more commonly reported than motivational barriers (43%). Discussion and Conclusions: Acute care‐seeking PWUD experience high rates of unmet service needs for their mental health and substance use problems. Strategies that can help overcome structural barriers to care are necessary to help address the service needs of this population. [ABSTRACT FROM AUTHOR]

The Brief Screener for Substance and Behavioral Addictions (SSBAs) was developed to assess a common addiction construct across four substances (alcohol, tobacco, cannabis, and cocaine), and six behaviors (gambling, shopping, videogaming, eating, sexual activity, and working) using a lay epidemiology perspective. This paper extends our previous work by examining the predictive utility of the SSBA to identify self-attributed addiction problems. Participants (N = 6,000) were recruited in Canada using quota sampling methods. Receiver Operating Characteristics (ROCs) analyses were conducted, and thresholds established for each target behavior's subscale to predict self-attributed problems with these substances and behaviors. For each substance and behavior, regression models compared overall classification accuracy and model fit when lay epidemiologic indicators assessed using the SSBA were compared with validated screening measures to predict selfattributed problems. ROC analyses indicted moderate to high diagnostic accuracy (Area under the curves (AUCs) 0.73–0.94) across SSBA subscales. Thresholds for identifying self-attributed problems were 3 for six of the subscales (alcohol, tobacco, cannabis, cocaine, shopping, and gaming), and 2 for the remaining four behaviors (gambling, eating, sexual activity, and working). Compared to other instruments assessing addiction problems, models using the SSBA provided equivalent or better model fit, and overall had higher classification accuracy in the prediction of self-attributed problems. The SSBA is a viable screening tool for problematic engagement across ten potentially addictive behaviors. Where longer screening tools are not appropriate, the SSBA may be used to identify individuals who would benefit from further assessment. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: There is currently no well‐validated measure that assesses a broad spectrum of substance‐related and behavioural addictions in general populations. This study aimed to develop a brief self‐attribution Screener for Substance and Behavioural Addictions (SSBA) to screen for four substances and six behaviours, and to compare its performance with established individual‐behaviour screening instruments. Design: A small, psychometrically optimal set of items to assess self‐attributed indicators of addiction across alcohol, tobacco, cannabis, cocaine, gambling, shopping, videogaming, overeating, sexual activity and overworking were identified from a broader pool that was developed using a lay epidemiology qualitative approach. The suitability of the four‐item single‐factor solution was tested for each behaviour and scores were compared with those obtained from the sample using individual‐behaviour screening instruments. Setting and Participants: Participants (n = 6000), broadly representative of the Canadian English‐speaking adult population, were recruited through the Ipsos Reid Canadian Online Panel. Measurements: Participants completed an item pool of 15 indicators of addiction for each target behaviour and a validation instrument for one randomly assigned behaviour. Findings: A set of four items identified using principal component and confirmatory factor analyses demonstrated good fit and excellent internal consistency (α = 0.87–0.95) across behaviours, and good convergent validity (rs = 0.44–0.8) with extant instruments measuring similar constructs, with only one exception (r = 0.26). Conclusions: The proposed Screener for Substance and Behavioural Addiction is a reliable and valid measure assessing the lay public's self‐attributed indicators of addiction across 10 substances and behaviours. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. Methods: Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies (N = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. Results: Of 3054 included studies, 70.7% (n = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). Conclusions: Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care.Design and Methods: A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined.Results: Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs.Discussion and Conclusion: Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304]. [ABSTRACT FROM AUTHOR]

Background and aims: The aims of this study were (a) to describe the prevalence of single versus multiple addiction problems in a large representative sample and (b) to identify distinct subgroups of people experiencing substancerelated and behavioral addiction problems. Methods: A random sample of 6,000 respondents from Alberta, Canada, completed survey items assessing self-attributed problems experienced in the past year with four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviors (gambling, eating, shopping, sex, video gaming, and work). Hierarchical cluster analyses were used to classify patterns of co-occurring addiction problems on an analytic subsample of 2,728 respondents (1,696 women and 1032 men; Mage = 45.1 years, SDage = 13.5 years) who reported problems with one or more of the addictive behaviors in the previous year. Results: In the total sample, 49.2% of the respondents reported zero, 29.8% reported one, 13.1% reported two, and 7.9% reported three or more addiction problems in the previous year. Cluster-analytic results suggested a 7-group solution. Members of most clusters were characterized by multiple addiction problems; the average number of past year addictive behaviors in cluster members ranged between 1 (Cluster II: excessive eating only) and 2.5 (Cluster VII: excessive video game playing with the frequent co-occurrence of smoking, excessive eating and work). Discussion and conclusions: Our findings replicate previous results indicating that about half of the adult population struggles with at least one excessive behavior in a given year; however, our analyses revealed a higher number of co-occurring addiction clusters than typically found in previous studies. [ABSTRACT FROM AUTHOR]

Objectives: To describe absolute and relative prevalence of 10 self-attributed substance-related and behavioural addiction problems among Canadian adults, to describe perceived prevalence of these problems in the general population, and to examine whether estimates varied by survey mode. Methods: Sample 1 included 4000 adults recruited from an online research panel; Sample 2 included 2000 randomly selected adults who completed a computer-assisted telephone interview. Respondents in both samples were asked (1) whether or not they had experienced a problem in the preceding year with each of four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviours (gambling, eating, shopping, sex, video gaming, and work), (2) whether they had ever personally knew someone exhibiting a problem with each behaviour, and (3) perceived prevalence of problems in the general population. Results: About half of the respondents reported experiencing any past-year addiction problems. Tobacco and alcohol were the most common substance-related problems, while the most common behavioural problems were related to eating and work. Respondents consistently overestimated perceived population prevalence relative to self-attributed problems; however, the magnitude of overestimation was significantly greater among those who personally reported a problem with these behaviours. Online survey participants consistently reported higher self-attributed problem rates compared with CATI respondents, but rank-order correlations across self-, acquaintances-, and population-attributed prevalence estimates were very high in both samples. Conclusions: Both survey modes provided accurate relative prevalence estimates, but further research should explore determinants of higher prevalence rates among online participants and respondents' consistent tendency to overestimate perceived population prevalence. [ABSTRACT FROM AUTHOR]

Abstract: Illicit and prescription drug use disorders are two to four times more prevalent among Aboriginal peoples in North America than the general population. Research suggests Aboriginal cultural participation may be protective against substance use problems in rural and remote Aboriginal communities. As Aboriginal peoples continue to urbanize rapidly around the globe, the role traditional Aboriginal beliefs and practices may play in reducing or even preventing substance use problems in cities is becoming increasingly relevant, and is the focus of the present study. Mainstream acculturation was also examined. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Associations were analysed using two sets of bootstrapped linear regression models adjusted for confounders with continuous illicit and prescription drug problem scores as outcomes. Psychological mechanisms that may explain why traditional culture is protective for Aboriginal peoples were examined using the cross-products of coefficients mediation method. The extent to which culture served as a resilience factor was examined via interaction testing. Results indicate Aboriginal enculturation was a protective factor associated with reduced 12-month illicit drug problems and 12-month prescription drug problems among Aboriginal adults in an urban setting. Increased self-esteem partially explained why cultural participation was protective. Cultural participation also promoted resilience by reducing the effects of high school incompletion on drug problems. In contrast, mainstream acculturation was not associated with illicit drug problems and served as a risk factor for prescription drug problems in this urban sample. Findings encourage the growth of programs and services that support Aboriginal peoples who strive to maintain their cultural traditions within cities, and further studies that examine how Aboriginal cultural practices and beliefs may promote and protect Aboriginal health in an urban environment. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: Research on coercion in addiction treatment typically investigates objective sources of social pressure among legally mandated clients. Little research has examined the impact of clients'' perceptions of social pressures in generalist addiction services. Clients seeking substance abuse treatment (N =300; 221 males and 79 females; M age=36.6 years) rated the extent to which treatment was being sought because of coercive social pressures (external motivation; α =.89), guilt about continued substance abuse (introjected motivation; α =.84), or a personal choice and commitment to the goals of the program (identified motivation; α =.85). External treatment motivation was positively correlated with legal referral, social network pressures to enter treatment, and was inversely related to problem severity. In contrast, identified treatment motivation was positively correlated with self-referral and problem severity, and was inversely related to perceived coercion (ps<.05). Hierarchical multiple regression analyses showed that referral source (i.e., mandated treatment status), legal history, and social network pressures did not predict any of 6 measures of client engagement at the time treatment was sought. However, treatment motivation variables accounted for unique variance in these outcomes when added to each model (ΔR 2s=.06–.23, ps<.05). Specifically, identified treatment motivation predicted perceived benefits of reducing substance use, attempts to reduce drinking and drug use, as well as self (and therapist) ratings of interest in the upcoming treatment episode (βs=.18–.31, ps<.05). Results suggest that the presence of legal referral and/or social network pressures to quit, cut down, and/or enter treatment does not affect client engagement at treatment entry. [Copyright &y& Elsevier]

Little is known about changes over time in Ontario workplace health programs. In this paper, changes were examined in the prevalence and characteristics of Employee Assistance Programs (EAPs), drug testing programs (DTP) and Health Promotion Programs (HPPs) in Ontario from 1989 to 2003. Methods: Results from a representative survey of worksites with 100 or more employees conducted in 2003 were compared with the results from two other similar surveys conducted in 1989 and 1993. Results: The percentage of Ontario worksites with EAPs increased markedly from 28.2% in 1989 to 66.8% in 2003 (p < .001). In terms of characteristics of EAPs, significantly fewer worksites were actively involved in the management of EAPs in 2003 than in 1989 (p < .0001 ). As well, more privately contracted treatment services were being utilized in 2003 (p < .00011 and the use of public community service agencies declined significantly (p < .0001 ). Finally, mandatory management, initiated referral mechanisms significantly declined (p < .01). The prevalence of DTPs increased from 1.8% in 1989 to 4.6% in 2003, but this change was not significant. Significant increases from 1989 to 2003 were found for fitness programs (p < .00011, weight reduction programs (p < .05) and stress management programs (p < .05). Conclusions: The results show a trend towards HPP programs based on philosophies of prevention, early intervention and treatment. Deterrence-based programs, such as drug testing, have remained stable. [ABSTRACT FROM AUTHOR]

Background Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research. Approach Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic. Findings Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views. Conclusions Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion. [ABSTRACT FROM AUTHOR]

Abstract: A prospective natural history study was conducted of problem drinkers who were thinking about quitting or reducing their alcohol consumption. Two primary constructs, cognitive appraisals and life events, were measured in a mailed-out baseline survey. A one-year follow-up survey identified those who had made reductions in drinking. Partial correlations controlling for baseline drinking severity revealed some support for both cognitive appraisal and life events explanations of change. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

An overview of research trends and issues in the area of compulsory substance abuse treatment is presented, using a sample of 170 English-language articles obtained from a search of 4 databases (Medline, PubMed, Embase, PsychINFO, supplemented by a manual search). About half (51%) of these articles were non-empirical (i.e. literature reviews, policy proposals, legal and ethical commentaries on compulsory treatment). A subsample of empirical studies published since 1988 (n = 71) was coded to summarize research trends in relation to 3 key issues: (1) how compulsory treatment was studied (country of origin; type of compulsory treatment; treatment population), (2) the evidence base for judging effectiveness of compulsory treatment (research design; sampling; type, timing and results of outcome measures), and (3) the relationship between compulsory treatment and coercion (measurement strategies). Directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Using a transdiagnostic perspective, the present research examined the prominent indicators of substance (alcohol, cocaine, marijuana, tobacco) and behavioral (gambling, video games, sex, shopping, work, eating) addictions nominated by people with lived experiences. Specifically, we aimed to explore whether the perceived most important indicators nominated were consistent across the 10 addictions or differed based on the specific addiction. Additionally, we explored gender differences in the perceived most important indicators across addictive behaviors. A large online sample of adults recruited from a Canadian province (n = 3503) were asked to describe the most important signs or symptoms of problems with these substances and behaviors. Open-ended responses were analyzed among a subsample of 2603 respondents (n = 1562 in the past year) who disclosed that they had personally experienced a problem with at least one addiction listed above. Content analyses revealed that dependence (e.g., craving, impairments in control) and patterns of use (e.g., frequency) were the most commonly perceived indicators for both substance and behavioral addictions, accounting for over half of all the qualitative responses. Differences were also found between substance and behavioral addictions regarding the proportion of the most important signs nominated. Consistent with the syndrome model of addiction, unique indicators were also found for specific addictive behaviors, with the greatest proportion of unique indicators found for eating. Supplemental analyses found that perceived indicators across addictions were generally gender invariant. Results provide some support for a transdiagnostic conceptualization of substance and behavioral addictions. Implications for the study, prevention, and treatment of addictions are discussed. [ABSTRACT FROM AUTHOR]

Background Recently, the concept of addiction has expanded to include many types of problematic repetitive behaviors beyond those related to substance misuse. This trend may have implications for the way that lay people think about addictions and about people struggling with addictive disorders. The aim of this study was to provide a better understanding of how the public understands a variety of substance-related and behavioral addictions. Methods A representative sample of 4000 individuals from Alberta, Canada completed an online survey. Participants were randomly assigned to answer questions about perceived addiction liability, etiology, and prevalence of problems with four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviors (problematic gambling, eating, shopping, sexual behavior, video gaming, and work). Results Bivariate analyses revealed that respondents considered substances to have greater addiction liability than behaviors and that most risk factors (moral, biological, or psychosocial) were considered as more important in the etiology of behavioral versus substance addictions. A discriminant function analysis demonstrated that perceived addiction liability and character flaws were the two most important features differentiating judgments of substance-related versus behavioral addictions. Perceived addiction liability was judged to be greater for substances. Conversely, character flaws were viewed as more associated with behavioral addictions. Conclusions The general public appreciates the complex bio–psycho-social etiology underlying addictions, but perceives substance-related and behavioral addictions differently. These attitudes, in turn, may shape a variety of important outcomes, including the extent to which people believed to manifest behavioral addictions feel stigmatized, seek treatment, or initiate behavior changes on their own. [ABSTRACT FROM AUTHOR]