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There is a lack of international research focusing on how the siblings-in-law of adults with a learning disability experience their commitment to provide support. Using narrative research, the authors have aimed to gain an insight into the perspectives of 14 siblings-in-law (living in the Flemish part of Belgium) about the decision to live together with a family member who has a learning disability. The decision to live together usually begins with a crisis. However, the decision process is a complex mechanism; it involves dynamics and events within a family (between family members both with and without blood relationships) and is intensified by experiences within a society that holds different views about families and disability. We are aided in gaining a deeper understanding of this complex process by considering interpretations based on the contextual framework of Boszormenyi-Nagy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.02.007 Byline: Veerle Soyez (a), George De Leon (b), Yves Rosseel (c), Eric Broekaert (a) Keywords: Treatment readiness and motivation; Assessment; Therapeutic communities; Psychometric properties; CMRS Abstract: There is empirical evidence that treatment motivation and readiness are closely linked to retention. Several instruments have been developed to measure these concepts; such instruments can reliably assess the stages of motivation and readiness, and predict treatment retention and outcome. However, limited efforts have been undertaken in Europe to translate those instruments and to determine their reliability and validity. In this study, the psychometric properties of a Dutch translation of the Circumstances, Motivation, Readiness, and Suitability (CMRS) scales by De Leon and Jainchill [Journal of Psychoactive Drugs 8 (1986) 203-208] and the shortened CMR Intake Version are illustrated in a Flemish sample of therapeutic community residents (n = 207). Exploratory factor analyses confirm three CMR subscales, although confirmatory factor analysis reveals only a moderate fit for both the CMRS and the CMR. In contrast, the predictive power of the instrument is strong, specifically for 1-year retention. Significant correlations were found between CMRS measures and age, drug severity, legal referral, and social problems. It is concluded that the Dutch translation of the CMRS and the CMR can be employed as a valid indicator of treatment motivation and readiness, although additional research concerning factorial structures is needed. Author Affiliation: (a) Department of Orthopedagogics, Ghent University, H. Dunantlaan 2, 9000 Gent, Belgium (b) Center for Therapeutic Community Research (CTCR), National Development and Research Institutes, Inc., 71 West 23rd street, New York, NY 10010, USA (c) Department of Data Analysis, Ghent University, H. Dunantlaan 1, 9000 Gent, Belgium Article History: Received 15 April 2005; Revised 16 January 2006; Accepted 8 February 2006

This article aims to search for a specific female, psychiatric profile based on a large European sample of substance dependent clients (828) entering therapeutic communities. First, all six areas of functioning of the EuropASI were included, using the composite scores to search for gender differences. Next, the 'psychiatric' status section was selected for further study. A binary logistic regression was performed with gender as the dependent variable, and nine individual psychiatric items, country, and age as predictors. According to this model a number of problem variables could be identified as being reported more often by women than by men in therapeutic community treatment. Women are more likely to report serious depression, problems in understanding, concentrating or remembering, being prescribed medication, and serious thoughts about suicide; they have also attempted suicide more often than men. Women find treatment for these psychological problems more important than their male counterparts. They also have a more severe history of abuse. Women in therapeutic communities may need specific treatment interventions for their more severe psychiatric needs. Keywords: Psychiatric status; Substance abuse; Gender differences; Female psychiatric profile; Therapeutic communities

The usage of residential therapeutic communities (TCs) to help addicts recover are discussed wherein the European and American antecedents of the TC and the model's evolution and dispersion are described. Emphasis is given to the family approach in the early TC and the major family therapeutic schools that influenced the model, specifically contextual therapy.

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]

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