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As members of the helping professions, we are drawn to giving. We craft our careers around service to others. But what exactly do the classical texts of Yoga say about duty, giving, and service? Is this in conflict with the messages we receive from our modern world and the values it projects? This article contrasts the philosophies of Vedanta and Samkhya in an examination of the concept of dharma, or duty, and how it pertains to Yoga teachers, Yoga therapists, and other members of the helping professions. From a careful reading of core Yogic texts and reflection on the risks of codependency, this article offers suggestions for finding balance and maintaining a practice in accordance with the values of Yoga and its teaching of dharma, through appropriate self-care. [ABSTRACT FROM AUTHOR]

The article presents a study on the importance of the Accelerated Resolution Therapy (ART), which allows patient to forget traumatic memories at will, in treating a man with bipolar disorder and a woman with codependency issues. It states that the man once had a suicide attempt and the woman had memories of her friend leaving her alone. It notes that ART is done to let the patients forget traumatic experiences just like how dreams are being forgotten. Results show that patients undergoing ART showed positive response to the therapy.

Abstract: Background: As drug abuse and addiction have been shown to decrease adherence to treatment of hepatitis C virus (HCV) or HIV, screening for substance use should be standard clinical practice in those undergoing an evaluation for these diseases. Aims: To assess the effectiveness of the Kreek–McHugh–Schluger–Kellogg (KMSK) scale to quantify substance use and dependence among patients with viral hepatitis. Methods: The KMSK scale, a validated instrument that quantifies lifetime use of alcohol, cocaine, heroin, and tobacco, was distributed to 161 consecutive patients referred to a hepatology clinic at an academic, tertiary-care center over a 1-year period. Results: Of the 159 patients who returned the KMSK scale, 62% reported illicit drug use and 30% met defined criteria for lifetime dependence on cocaine or heroin. We found that 15% of our population at some time had been co-dependent on cocaine and heroin. The KMSK scale identified significantly more cocaine, heroin, and alcohol use than that detected through the medical record (χ 2 =7.61, p <0.01, χ 2 =9.66, p <0.002, respectively). Cocaine dependence was significantly higher among HCV/HIV co-infected than among mono-infected patients (χ 2 =5.46, p <0.02). Conclusions: The KMSK scale may be useful to diagnose drug and alcohol use and dependence among patients undergoing evaluation for treatment of viral hepatitis. [ABSTRACT FROM AUTHOR]

Background: Pathological gambling (CPG) has been considered as a behavioral addiction having similarities with substance use disorders (SUDs). Objectives and Methods: Current conceptualizations of addiction, as well as experimental studies of PG and SUDs, are reviewed in order to provide a perspective on tbe areas of convergence between addictive behaviors in PG and SUDs. Results: Shared features exist in diagnostic, clinical, physiological, and behavioral domains. Conclusions and Scielltific Significance: Similarities between PG and SUDs have important implicatiol1s for categorizing, assessing, preventing and treating both PO and SUDs. [ABSTRACT FROM AUTHOR]

Background: Several behaviors, besides psychoactive substance ingestion, produce short-term reward that may engender persistent behavior, despite knowledge of adverse consequences, i.e., diminished control over the behavior. These disorders have historically been conceptualized in several ways. One view posits these disorders as lying along an impulsive-compulsive spectrum, with some classified as impulse control disorders. An alternate, but not mutually exclusive, conceptualization considers the disorders as non-substance or “behavioral” addictions. Objectives: Inform the discussion on the relationship between psychoactive substance and behavioral addictions. Methods: We review data illustrating similarities and differences between impulse control disorders or behavioral addictions and substance addictions. This topic is particularly relevant to the optimal classification of these disorders in the forthcoming fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Results: Growing evidence suggests that behavioral addictions resemble substance addictions in many domains, including natural history, phenomenology, tolerance, comorbidity, overlapping genetic contribution, neurobiological mechanisms, and response to treatment, supporting the DSM-V Task Force proposed new category of Addiction and Related Disorders encompassing both substance use disorders and non-substance addictions. Current data suggest that this combined category may be appropriate for pathological gambling and a few other better studied behavioral addictions, e.g., Internet addiction. There is currently insufficient data to justify any classification of other proposed behavioral addictions. Conclusions and Scientific Significance: Proper categorization of behavioral addictions or impulse control disorders has substantial implications for the development of improved prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Quetiapine is an atypical antipsychotic approved by the FDA (Food and Drug Administration) for use in the treatment of schizophrenia, acute mania, and bipolar depression. Pharmacologically, it has antagonistic effects on serotonin 5-HT1A and 5-HT2A, dopamine D1 and D2, histamine H1, and adrenergic α1 and α2 receptors. In addition to reports of its use in schizophrenia and bipolar disorder, many studies have examined the use of quetiapine in the treatment of anxiety disorders and substance use disorders. In the treatment of patients with psychotic or bipolar disorder with a comorbid substance abuse disorder even though quetiapine was prescribed primarily for the treatment of the underlying psychotic symptoms, patients taking this medication reported a significant reduction in substance use. Yet, there are also case reports of quetiapine abuse and dependence; in particular among prisoners and patients diagnosed with substance abuse. Though quetiapine should be used peroral, it is also used intranasally and intravenously in these patient groups. Moreover, in some cases quetiapine is combined with other substances, such as cocaine or marijuana, to increase sedation. This abuse of quetiapine is thought to occur due to the anxiolytic and sedative effects of the drug. There are no controlled studies on quetiapine dependence in the literature and it remains unknown whether or not quetiapine causes dependence. This review aimed to present all published case reports on quetiapine abuse and to discuss the possible mechanisms that underlie its abuse and dependence. [ABSTRACT FROM AUTHOR]

This study investigated the role of psychosocial variables as mediators of the relationship between a childhood history of emotional maltreatment and codependency and a childhood history of emotional maltreatment and self-silencing in a sample of upper division female nursing students. Depression, self-esteem, self-differentiation, and self-concealment were considered as possible mediators of the relationship. Multiple regression analyses revealed that each psychosocial variable partially mediated the relationship between a history of emotional maltreatmentand codependency, and emotional maltreatment and self-silencing. [ABSTRACT FROM AUTHOR]

This article describes and illustrates the ongoing development of a treatment for working with families and friends of drug users using harm reduction principles. The author was instrumental in applying harm reduction principles to substance abuse and has used these same principles to help families deal with the pessimism, pain, and grief that accompany their relationship to a person with an active substance abuse problem. The treatment involves learning decision-making processes based on both self-care and love for the substance abuser and is based on the values of harm reduction, caring, and incrementalism, rather than those of codependency, tough love, and abrupt behavior change. A long-term family therapy group and two family consultations illustrate the treatment and its applications. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66: 1–11, 2010. [ABSTRACT FROM AUTHOR]

This article revisits the purpose, focus, and meaning of family education, and reflects on the direction of services. It first examines the "dependence" phenomenon of the new generation, followed by a review of the experiences of family education in Hong Kong and associated myths. The review reveals a need for a new vision and a new focus on family education. The article suggests clarifying the objectives and focuses of family education, as well as reconceptualising family education as "parent empowerment." For the concept of "parent empowerment" to be implemented, family workers must have a shift in perspective and change in roles. [ABSTRACT FROM AUTHOR]

If you were asked: ‘What are the most important things we know about addiction?’ what would you say? This paper brings together a body of knowledge across multiple domains and arranged as a list of 10 things known about addiction, as a response to such a question. The 10 things are: (1) addiction is fundamentally about compulsive behaviour; (2) compulsive drug seeking is initiated outside of consciousness; (3) addiction is about 50% heritable and complexity abounds; (4) most people with addictions who present for help have other psychiatric problems as well; (5) addiction is a chronic relapsing disorder in the majority of people who present for help; (6) different psychotherapies appear to produce similar treatment outcomes; (7) ‘come back when you're motivated’ is no longer an acceptable therapeutic response; (8) the more individualized and broad-based the treatment a person with addiction receives, the better the outcome; (9) epiphanies are hard to manufacture; and (10) change takes time. The paper concludes with a call for unity between warring factions in the field to use the knowledge already known more effectively for the betterment of tangata whaiora (patients) suffering from addictive disorders. [ABSTRACT FROM AUTHOR]

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Whether people believe that they have control over their behaviors is an issue that is centrally involved in definitions of addiction. Our research demonstrates that believing in free will-that is, believing that one has control over one's actions-has societal implications. Experimentally weakening free will beliefs led to cheating, stealing, aggression, and reduced helping. Bolstering free will beliefs did not change participants' behavior relative to a baseline condition, suggesting that most of the time people possess a belief in free will. We encourage a view of addiction that allows people to sustain a belief in free will and to take responsibility for choices and actions. [ABSTRACT FROM AUTHOR]

This paper studies the codependence among, and drawdown and drawup properties of, US$ interest rates. The problem is attacked from the angle of regime switching. Different regimes are identified using the Hidden Markov Models (HMMs). The statistical properties in each state are examined separately and reconciled to form a coherent picture. We found that high fractions of reversals exist in the normal state and that consecutive bursts exist in the excited state. In large drawdowns and drawups (draws), long draws tend to be 'democratic', short draws tend to be 'oligarchic' and medium-size draws stay in either 'democratic' or 'oligarchic' mode, while conditionally independent draws are rarely found. We also investigated the distributions of draws. We found that HMMs recover the draw properties well and that the overall distribution of draws is an informationally-rich indicator about the correlation regime(s) in the various Markov states. [ABSTRACT FROM AUTHOR]

This article asks: What kind of blueprint would be helpful to translating diverse research evidence into residential services? One possible answer is explored with reference to the practical task of designing a blueprint for a statewide adolescent residential service for addiction in Australia. The article describes the blueprint using a typology of the key features of the ideal service that it models. These aim to help practitioners and policymakers see how to create the different interacting parts of a three-dimensional service based on a learning ethos. [ABSTRACT FROM AUTHOR]

This article is the edited text of the acceptance speech given by Gloria Noriega in Johannesburg, South Africa, during the 2008 World TA Conference. It describes her epidemiological research into four mechanisms of transgenerational script transmission: ulterior transactions, psychological games, transference psychodynamics, and projective identification. Codependency was used as an example of a cultural script that is transmitted by unconscious communication to subsequent generations. The Codependency Instrument (ICOD), which is based on transactional analysis theory, was used with a sample of 830 women at a health center in Mexico City. Significant results were obtained by analyzing alcoholism, domestic violence, affective losses, cultural scripts, and female illiteracy as risk factors related to codependency, both in the family of origin and in current couple relationships. [ABSTRACT FROM AUTHOR]

The article provides information related to the dual diagnosis enhanced (DDE) programs in the U.S. It relates that DDE programs provide primary substance abuse treatment to clients who are more symptomatic and/or functionally impaired as a result of their co-occurring mental disorder. A description of the two divisions of the programs, the DDE mental health (MH) programs and DDE chemical dependency (CD) programs is offered, as well as the difference of the DDE with the dual diagnosis capability (DDC) programs.

The purpose of the present study was to learn about the self-perception of women who live with alcohol-addicted partners. It was hoped that avoiding to label the women in advance as codependent would facilitate a better understanding of their lives and self-perceptions. The qualitative naturalist methodology used was based on a feminist framework. In-depth interviews with 10 women living with alcoholic partners were conducted and analyzed. The findings revealed 3 central dialogues around which the women’s self-perceptions evolved—with deviance, with strength, and with self-fulfillment. Findings are discussed relative to the ongoing discourse between the codependency approach and other social, psychological, and gender conceptions in this domain. Clinical implications and directions for future research are offered. [ABSTRACT FROM AUTHOR]

Students respond to case about a codependent relationship in a letter by identifying the symptoms, offering solutions, and demonstrating sensitivity for the subject; addressing the case in the letter improves student's descriptions of symptoms and expressions of care. [ABSTRACT FROM AUTHOR]

Normative femininity offers mothers a tightrope of nurturance and dependency, on the one hand, good mothers should be dependent through a relationship with a male provider. Conversely, they should provide nurturance through active, involved and expert mothering. This tightrope poses challenges to women with disabilities whose dependency on male partners can bring vulnerability to abuse, while dependency on the state can result in poverty and surveillance. This article explores the dilemmas disabled mothers face, reconciling their position of dependency against their children's need for nurturance. Complicating negative conceptions of dependency, many women described how some relations of dependency provided them and their children with positive networks of support. [ABSTRACT FROM AUTHOR]

This article suggests that evidence based practice instruction should be preceded by an introduction to the 3 types of knowledge about addiction: experiential, professional and research. Each knowledge base should be defined and critiqued. This introduction can create a climate for acceptance of evidence-based practices. The article outlines the elements of this introduction and offers some pedagogical suggestions and student exercises. [ABSTRACT FROM AUTHOR]

A clinical trials training approach to supervision is a promising and empirically supported method for preparing addiction counselors to implement evidence-based behavioral treatments in community treatment programs. This supervision approach has three main components: (1) direct observation of treatment sessions; (2) structured performance feedback about counselors' treatment adherence and competence; and (3) coaching to improve the ability of counselors to implement psychosocial treatments proficiently. This article describes how to teach addiction counselors this approach to supervision as it is applied to Motivational Interviewing (MI) using a clinical supervision procedure called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency. We describe teaching points and strategies instructors may use to develop supervisory skills in each of the three main supervision components (performance observation, feedback, and coaching), how to supervise in a MI consistent manner, recommended qualifications for supervising MI, and future directions for MI supervision research. [ABSTRACT FROM AUTHOR]

There is strong evidence for a genetic contribution to individual differences in vulnerability to drug addictions. Studies have shown that the 68-base pair repeat polymorphism in the promoter region of the human prodynorphin gene contains a putative AP-1 binding site, and that three or four repeat copies result in greater transcriptional activation. Here, we report on a separate cohort of 302 subjects ascertained and characterized extensively by Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition and Addiction Severity Index criteria as: (1) a control group of 127 subjects with no history of alcohol or drug abuse or dependence; (3) a case group of 82 with cocaine dependence only; and (3) a case group of 93 with cocaine and alcohol codependence. The promoter region of the prodynorphin gene containing the repeat was amplified from genomic DNA by polymerase chain reaction and analyzed via gel electrophoresis. Statistical tests were performed with data stratified by the three major ethnic groups studied: African American, Caucasian and Hispanic. For analyses, genotypes were grouped into short (1,1; 1,2; 2,2), short/long (1,3; 2,3; 1,4; 2,4) and long (3,3; 3,4; 4,4) repeats. Deviation from Hardy–Weinberg Equilibrium in the African American control group necessitated testing for association using grouped genotypes rather than grouped alleles. In controls, a significant difference was found in grouped genotype distribution among ethnicities. We found a point-wise, but not experiment-wise across-ethnicities, significant difference in grouped genotype frequency between the cocaine/alcohol-codependent group and the controls in African Americans, with genotypes containing longer alleles found at higher frequency in the codependent group. [ABSTRACT FROM AUTHOR]

This study explored a model of codependent attitude and behavior as moderators of the relationship between AOD problems in the family of origin (AODF) and offspring self-reports of psychological distress in a counterbalanced multiple-treatment experiment with a small heterogeneous sample of adult males and females. Three-directional hypotheses suggested by the literature were tested. Codependent attitude and behavior buffered Somatization, as predicted by the model, but exacerbated Anxiety, Hostility, and Paranoid-Ideation. Our findings suggest that codependent attitude and behavior may be adaptations that protect AODF offspring from somatic distress, not the broadband expressions of offspring neuroticism reported in the literature. Owing to the small size and self-selection of our volunteer sample, replications with larger samples are called for. [ABSTRACT FROM AUTHOR]

The article presents a transcript of the step twelve of an online twelve-step support group meeting of recovering substance abuse students. In this meeting, the initial conversation expresses the attendees concern about the lack of participation by other on the previous meeting. It is also stressed that attending in the meeting is a form of service in carrying the message of recovery from addiction to professionals in the community. It is noted that the primary purpose of each of the twelve steps, it to strengthen and safeguard the individual's sobriety.

TheCenter for the Study of Addiction and Recovery (CSAR) (a Center within the College of Human Sciences at Texas Tech University, TTU), has developed a comprehensive Collegiate Recovery Community (CRC). This community provides a model of support and relapse prevention for college students recovering from addictive behaviors—primarily alcohol/drug addiction. This model is specifically targeted for implementation in the college/university setting and has been used at TTU for 20 years. The purpose of this paper is to briefly review the literature related to substance use among college-aged individuals, discuss the challenges of recovery within this population, describe existing collegiate programs, and provide an extensive description of the CRC model. The CRC model specifically incorporates recovery support, access to higher education/educational support, peer support, family support, and community support/service in an effort to help individuals attain what we describe as systems-based sustained recovery. Preliminary evidence of success indicates that support services offered by the CRC work for the current population as evidenced by an average relapse rate of only 8%, a graduation rate of 70%, and an average GPA of 3.18 among members. Limitations of themodel and plans for future research are also discussed. [ABSTRACT FROM AUTHOR]

Traci G. Bowermaster, Lead Teacher and Special Education Teacher at the Insight Program, a recovery high school in White Bear Lake, Minnesota, explains how her school was created and how it has evolved. Using the framework of many recovery stories, shewrites about howitwas in the early days of recovery schools before special education was emphasized, what happened that lead to the formation of her school, and what her school program is like now. She uses her unique perspective of having taught in a treatment center to explain the importance of incorporating strong special education programming in recovery high schools and illustrates the process her team used to form a recovery school with little financial means. Pitfalls along the way helped the Insight Program find its weak spots, eventually grow stronger, and create an ambitious vision for the program's future. [ABSTRACT FROM AUTHOR]

This article provides a first person narrative of one teacher's experience in three different recovery schools over more than a decade of teaching. The author discusses some of the recurring challenges and successes encountered by many recovery high schools and discusses key concepts such as the importance of a clear school mission, the role of restorative practices in recovery education, successful classroom methods, and the importance of communication and support between recovery schools. [ABSTRACT FROM AUTHOR]

The recovery school movement exploded across the nation in the late nineties and early part of the twenty-first century. Secondary and postsecondary recovery schools have become a vital part of the chemical dependency continuum of care and our nation's educational system. Solace Academy is a restorative practices high school designed for recovering chemically dependent students. Through the collaboration of professionals in Carver and Scott Counties, the Carver-Scott Educational Cooperative's Solace Academy recovery high school opened its' doors in the fall of 2001. Appropriately colocated with other programs provided by the Carver-Scott Educational Cooperative, Solace Academy provides a high school education, life skills and support for its recovering chemically dependent students. Colocation has insulated the existence of Solace Academy by shared staff, increased academic opportunities and financial stability. A typical day at Solace Academy is like and unlike many high schools across the nation. These similarities and differences have provided many lessons during Solace Academy's tenure. [ABSTRACT FROM AUTHOR]

The authors compared college adult children of alcoholics (ACOAs) and non-ACOAs using the Substance Abuse Subtle Screening lnventory-3 (F. G. Miller, 1999).The results failed to support the hypothesis that ACOAs have higher rates of substance dependence, defensiveness, and codependency than do non-ACOAs. Practical implications are offered for college counselors. [ABSTRACT FROM AUTHOR]

The present study investigated the relationship between self-reported history of child abuse, neglect, and codependency in a sample of undergraduate nursing students. One hundred and two upper-division nursing students attending a medium-sized regional public university in the Southeast completed a four-part questionnaire containing the Childhood Trauma Questionnaire-Short Form (CTQ), the Psychological Maltreatment Inventory (PMI) and the Codependency Assessment Tool (CODAT). Correlations were computed. All forms of childhood abuse and neglect measured by the CTQ and PMI were significantly related to total codependency score. The strongest relationships overall were found between reported history of emotional neglect, emotional abuse, physical abuse, and codependency. [ABSTRACT FROM AUTHOR]

This essay explores video game cybersubjects and the myths surrounding video game violence and its addiction, made possible through new forms of interactive media. Three psychic structures – psychotic, obsessive and hysterical – are developed to better grasp why a moral “panic” has emerged concerning these games. I develop the concept of “interpassivity” to further our understanding of why the addictive potential of video games continues to make them controversial.Psychoanalysis, Culture & Society (2006) 11, 282–303. doi:10.1057/palgrave.pcs.2100088 [ABSTRACT FROM AUTHOR]

This study explored the relationship between the concept of codependency, a term originating in the field of addictions, and DSM-IV (APA, 1994) descriptions of dependent and borderline personality disorders. Seventy-five undergraduates (16 men and 59 women) were administered the Potter-Efron Codependency Scale (Potter-Efron & Potter-Efron, 1989), the borderline and the dependent scales of the MCMI-II (Milton, 1987), and the Dysfunctional Attitude Scale (DAS, Weissman, 1979). Pearson Product Moment correlations were computed and revealed a significant positive correlation between codependent and borderline traits and a significant but weaker correlation between codependent and dependent traits. Codependent and borderline personality traits were also similarly correlated on specific cognitive schema assessed by the DAS. These findings are one of only a few first empirical tests of the relationship between borderline personality disorder, dependent personality disorder and codependency, possibly indicating that codependency may be a combination of disorders already extant in the DSM-IV. [ABSTRACT FROM AUTHOR]

Older adults with loved ones who are dependent on alcohol or drugs often experience the adverse effects of a codependent relationship. Many experience anxiety, low self-esteem, depression, and suicidal thoughts. A pilot psychoeducational codependency support group was developed to promote well-being and reduce the adverse effects of codependency among older persons. The study participants were a voluntary convenience sample of 22 older adults (ages 65 and older) residing in the community. A pretest and posttest were administered. Six 90-minute group sessions based on a curriculum developed by the authors were held during a 2-month period. Yalom's Therapeutic Factors were used to evaluate the group process. Results indicated that older adults benefit from a psychoeducational support group format and that codependency issues can be reduced. [ABSTRACT FROM AUTHOR]

The present paper is a description and analysis of the process of activation of resilience carried on twenty families belonging to the therapeutic community Luis Amigó of Medellín, as a project of investigation-action during the year 1999. As a strategy, the eight principles of emotional interaction and cognitive mediation were followed, as proposed by the International Child Development Programs ICDP. The expected result at the end of the process, which could be ascertained at the final evaluation of the project, was the strengthening of bonds of healthy affection among its members, necessary for the generation of an ambience different from co-dependency. [ABSTRACT FROM AUTHOR]

Evidence garnered by this study may help provide college counselors with a clinically useful model of codependency, informing their assessment and treatment planning of students who present with self-identified codependency characteristics. Specifically, codependence inclined students may exhibit tendencies toward self-defeating and covert patterns of narcissistic relating (e.g., rejection sensitivity, attachments to painful relationships, shame-proneness, caretaking to earn relationship). Additionally; this study raises the possibility that codependency might be as closely related to fears of intimacy and being hurt in relationship as it is related to a preoccupied concern over maintaining or controlling a security relationship. These results, together with the negative relationship between codependency and overt narcissism, lend preliminary support for Cermak's conceptualization of codependency as a complement to narcissism. [ABSTRACT FROM AUTHOR]

The development of acquired resistance to ErbB2 tyrosine kinase inhibitors limits the clinical efficacy of this class of cancer therapeutics. Little is known about the mechanism(s) of acquired resistance to these agents. Here we establish a model of acquired resistance to N-{3-chloro-4-[(3-fluorobenzyl) oxylphenyl}-6-[5-({[2 (methylsulfonyl)ethyl]amino)methyl)-2-furyl]-4-quinazolinamine (lapatinib), an inhibitor of ErbB2 and ErbB1 tyrosine kinases by chronically exposing lapatinib-sensitive ErbB2-overexpressing breast cancer cells to lapatinib, simulating the clinic where lapatinib is administered on a daily chronic basis. Analysis of baseline gene expression in acquired lapatinib-resistant and parental cells indicates estrogen receptor (ER) signaling involvement in the development of resistance. Using gene interference, we confirm that acquired resistance to lapatinib is mediated by a switch in cell survival dependence and regulation of a key antiapoptotic mediator from ErbB2 alone to codependence upon ER and ErbB2 rather than loss of ErbB2 expression or insensitivity of ErbB2 signaling to lapatinib. Increased ER signaling in response to lapatinib is enhanced by the activation of factors facilitating the transcriptional activity of ER, notably FOXO3a and caveolin-1. Importantly, we confirm that lapatinib induces ER signaling in tumor biopsies from patients with ErbB2-overexpressing breast cancers receiving lapatinib therapy. These findings provided the rationale for preventing the development of acquired resistance by simultaneously inhibiting both ER and ErbB2 signaling pathways. Establishing clinically relevant models of acquired resistance to ErbB2 kinase inhibitors will enhance therapeutic strategies to improve clinical outcomes for patients with ErbB2-overexpressing breast cancers. [ABSTRACT FROM AUTHOR]

Many scholars have characterized the United States as a welfare state "laggard" less generous than most other nations because of a peculiarly American set of historical circumstances and values. This article explores "American exceptionalism" in the context of welfare state reforms over the past two decades. The authors first describe recent social policy innovations in Western democracies, considering two competing views of welfare state change. The first asserts that welfare states have been fundamentally transformed into "enabling" states, characterized by efforts to promote work, privatize benefits and services, and target benefits to the most needy. The second holds that policy structures have remained essentially intact because of "path-dependent" processes that create institutional continuity. Although evidence for the United States is somewhat mixed, the general direction of policy decisions and current frameworks of policy debates is consistent with a transition toward an enabling state. [ABSTRACT FROM AUTHOR]

This paper presents an intensive analysis of 61 Northwest Washington State (USA) elder family care providers and their stories of choice, challenge and wisdom as they care for their aged and chronically ill spouses, parents and other loved ones. Family caregivers typically experience crisis conditions in their efforts to deal with their chronically ill relatives or friends. Overall, they lack the skill, knowledge and familiarity with elderly illness conditions to provide the level of care demanded of them. Additionally, they face inadequate financial, social and emotional resources for coping with the extended care of their chronically ill loved ones. The result? Caregivers succumb to depression, illness, financial upheaval and even death long before their work is done. Through their stories, we capture the fundamental imbalances of a society that ignores the needs of the very elderly and those confronting the end of life, as well as those who care for them. As the number of persons living in their 80s, 90s and beyond continues to grow in the U.S. and abroad, so, too, does the need to revamp ill-conceived social policies that fail to address the needs of both the frail elderly and their family caregivers. The stories and experiences of the caregivers will be analyzed using both caregiver data derived from the closed-ended interview schedule, and caregiver narratives, drawing on the responses of the women to open-ended questions. After a description of the sample, the paper explores the ‘caregiver burden’ concept, as an integral part of a descriptive model. This model explores a twofold approach to managing stress among these caregivers: negative emotions, experiences, and outcomes versus positive emotions, experiences and outcomes. As our interview data reveal, these women display high levels of compassion that enable them to overcome their unexpected challenge of care, despite severe self sacrifices. The paper concludes with recommendations for a transformation to a humanistic policy of care that addresses various issues raised by the plight of these overburdened and largely unskilled—although life-affirming—caregivers struggling with their family crisis. [ABSTRACT FROM AUTHOR]

The article focuses on the management of cancer pain in clinical, policy and political perspectives. The confusion of clinicians, patients and family members over addiction with physical dependence can be a major obstacle to managing pain. Psychoeducation about dosing, alternate and adjuvant medications is essential to build a relationship in which multidimensional aspects of pain and suffering are attended to. Oncology psychosocial clinicians who embrace pain management as a multidimensional construct create an opportunity to enhance this aspect of care within the larger political and policy community.

Although marijuana dependence is prevalent, most individuals with marijuana dependence do not seek treatment. There are few data characterizing treatment seeking marijuana-dependent patients compared to patients presenting for treatment of other drugs regarding the severity of illness and motivation for treatment. Forty-two marijuana-dependent individuals were compared to 58 cocaine-dependent individuals seeking treatment. Compared to cocaine-dependent patients, those with marijuana dependence were younger and less likely to be dependent on alcohol or other drugs. Both groups had similar rates of comorbid anxiety and affective disorders. Marijuana-dependent individuals had lower total number of dependence symptoms but had a higher percentage of individuals endorsing withdrawal symptoms. Although marijuana-dependent individuals had less outpatient treatment exposure, the difference between the two groups was not significant and motivation for change, based on the University of Rhode Island Change Assessment, was similar for both groups of treatment seekers. However, the Circumstances, Motivation, Readiness for Treatment Scale suggested that cocaine-dependent individuals were more motivated for treatment. Taken together, these data suggest that treatment seeking marijuana-dependent individuals have substantial withdrawal dependence symptomatology although it is less clear if they are as motivated to seek out treatment as cocaine-dependent treatment seekers. [ABSTRACT FROM AUTHOR]

The addictions are common chronic psychiatric diseases that today are prevented and treated using relatively untargeted and only partially effective methods. The addictions are moderately to highly heritable, which is paradoxical because these disorders require use; a choice that is itself modulated by both genes and environment. The addictions are interrelated and related to other psychiatric diseases by common neurobiological pathways, including those that modulate reward, behavioural control and the anxiety or stress response. Our future understanding of addictions will be enhanced by the identification of genes that have a role in altered substance-specific vulnerabilities such as variation in drug metabolism or drug receptors and a role in shared vulnerabilities such as variation in reward or stress resiliency. [ABSTRACT FROM AUTHOR]

Some clinicians working with families with alcohol or other drug problems continue to use the codependency model to guide their practice despite the limited empirical support for this approach. Research into codependency has been hampered by the lack of psychometrically sound instruments. The Holyoake Codependency Index (HCI; G. E. Dear & C. M. Roberts, 2000) is a 13-item self-report measure of codependent traits that has previously shown adequate to high reliability, initial evidence of construct validity, and an internal structure that is consistent across samples. In the 4 studies reported here, the internal structure of the HCI was confirmed using confirmatory factor analysis, and further evidence of construct validity was found in that the HCI subscales showed meaningful associations with other psychological and demographic variables. [ABSTRACT FROM AUTHOR]

Using Foucault's concepts of power relations, discourse and internalization, this article uncovers some basic dissemination and internalization strategies of power relations on several levels. First, it looks at power at the individual level, with an analysis of family abuse and torture. It then applies this analysis to Westernization in Africa, arguing that the basic strategies by which power is disseminated and internalized into the bodies, psyches and cultures of Africans are the same as in abuse. The internalization of the Western discourse at the individual and small-community levels was studied through field research, undertaken in Ghana, that included participant observation and interviews. The research shows that even in the case of small, local, sustainable development projects, one sees a Westernization of power relations between men and women, chiefs and population, and elders and youth, with changes in related values. The field research reveals that actors are not merely passive victims of changes in discourses: they resist it, cooperate, disseminate and adapt it to their needs, but within the rules of the Western regime of discourse. The general conditions, processes and actors' strategies in this process of discursive change go further than a mere analogy to abuse and torture. The article shows that the process by which an initially violent, dominant discourse is transformed into a 'normal' way of living, into beliefs and wishes, is the same in these different cases, suggesting that there exist some general strategies by which power is disseminated at the international and individual levels and by which it is propagated and internalized by individuals. [ABSTRACT FROM AUTHOR]