摘要:

Objective:The purpose of this article is to discuss the interface between judicial discipline and behavioral science in the context of substance-related disorders.Method:We review the epidemiology of psychoactive drug use and crime and discuss the courts' decisions on relevant landmark cases, particularly as they influence the practice of psychiatry.Results:(1) The phenomenology of addiction and crime is of great epidemiological import. (2) Our legal system inclines toward the view that the use of alcohol or other substances involves an element of choice and therefore would not amount to a legal insanity defense if the substance abuser commits a crime while intoxicated. (3) A state can confine an addict or alcoholic for compulsory treatment if that individual presents a danger to self or others. (4) The law has found that alcoholism and drug abuse are both“willful misconduct”and a disabling condition; the former definition contains the end in view of punitive action. The latter is aimed toward treatment and rehabilitation. (5) The law gives the right to the employer to test a suspected employee for drug abuse. The addicted or alcoholic employee has the choice to either go for treatment or face job termination. (6) Our judicial system gives serious consideration to the welfare of a child whose parents are alcoholic or drug addicted.Conclusion:The two disciplines of psychiatry and law follow their own modes in resolving issues in alcoholism and other substance abuse. We need research and new approaches to build a bridge between the two.

ISSN:0095-2990    

DOI:10.3109/00952999609001642

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The dropout rates among cocaine abusers in outpatient treatment programs have averaged 55%. We sought to find patient predictor variables associated with early attrition. Dropouts were more likely to be African-American or Hispanic-American, younger, with an earlier onset of substance abuse. Among minorities, those with more education were less likely to drop out. Patients who were less educated and smoked or injected cocaine were particularly prone to discontinue treatment prematurely. The implications of these findings, and promising interventions for reducing the dropout problem, are discussed.

ISSN:0095-2990    

DOI:10.3109/00952999609001643

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack users. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

ISSN:0095-2990    

DOI:10.3109/00952999609001644

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This report is from a longitudinal study of a community sample of African-American males (N= 197) on the relationship of the degree of earlier substance use/abuse up to average age 24, to vocational performance (employment and occupational level) 2 1/2 A years later (at average age 26 1/2). The statistical analyses included numerous control variables developed from prospective data of the National Collaborative Perinatal Project, on the subjects and on their families from the subjects' birth to age 7, and from their school behavior and academic performance up to age 16, which may have influenced their vocational-occupational behavior during early adulthood. It was found that greater earlier marijuana use and greater earlier alcohol use predicted, to a significant degree, poorer occupational performance.

ISSN:0095-2990    

DOI:10.3109/00952999609001645

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

There is a paucity of studies concerning the prevalence of crime-related posttraumatic stress disorder (CR-PTSD) in individuals with substance use disorders, despite documentation of particularly high prevalence rates of sexual and physical assault in this population. A central objective of the present investigation was to assess victimization experiences and CR-PTSD among individuals receiving inpatient treatment for substance use disorders and evaluate gender and racial differences in assault characteristics and CR-PTSD prevalence rates. A total of 95 inpatients (34 men and 61 women; 41 African-Americans, 52 Caucasians, and 2 other minorities) were administered a structured interview to assess substance abuse/dependence, trauma, and PTSD. Approximately 90% of the participants had a lifetime history of sexual and/or physical assault, and approximately 50% had CR-PTSD. With the exception of rape, no gender differences in assault or CR-PTSD prevalence rates were observed. Women were more likely than men to perceive their life as endangered during a rape. Men were younger than women when they experienced their first (or only) aggravated assault and were more likely to have been assaulted by a family member. No racial differences were detected for assault or PTSD, although African-American patients were significantly more likely to identify cocaine as their primary drug than Caucasian patients. Given the strikingly high rate of comorbid CR-PTSD among substance use disordered patients, exploration of the type and timing of interventions would be of clinical interest.

ISSN:0095-2990    

DOI:10.3109/00952999609001646

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This study examines prevalence rates for DSM-III-R anxiety and affective disorders in three follow-up samples of opioid addicts who were treated with methadone maintenance. At least one anxiety disorder was diagnosed in 55% of the total sample. Affective disorders were found in 58%. At least one anxiety disorder coexisted with at least one affective disorder in 36% of the sample. The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology. It suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders. It also suggests the need for treatment that focuses on diagnosed mental disorders in addition to drug counseling for the substance abuse disorder.

ISSN:0095-2990    

DOI:10.3109/00952999609001647

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This research examines whether self-reported information about drug use severity can be obtained as reliably using a paper/pencil format as the traditional interviewer format. A sample of 67 patients seeking treatment for substance use disorders was recruited from a Veterans Administration Medical Center. Subjects self-reported information related to drug use severity using both paper/pencil and interview formats. The results of comparisons of the two approaches indicate that method of test administration does not affect the test-retest reliability for most questions tested. Test-retest reliability estimates for these relatively brief indicators of drug use severity generally ranged from good to excellent. Although assessing drug use severity using a paper/pencil format is certainly not appropriate for all individuals with substance use disorders, for many individuals and situations it may prove to be a cost-effective alternative to the interview format. Further research is required to determine if parallel paper/pencil versions of widely used interviews can be developed.

ISSN:0095-2990    

DOI:10.3109/00952999609001648

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This study investigated the perception of family functioning of rehabilitating inner-city substance abusers and one of their family members. Subjects were 39 residents of a treatment center and 39 family members. The design was compromised experimental, comparing the group who had family members in ALANON (n= 36) with a non-randomized control group whose family members had no help (n= 42). Data were collected three times: at the beginning of the abuser's treatment, at the end, and one month after treatment. Subjects completed two family functioning instruments: Assessment of Strategies in Families (ASF) and Family APGAR. Repeated-measure MANOVAs yielded significant differences in all family scores between the ALANON and the control groups. An increase in the perception of family effectiveness was most pronounced between time 2 and time 3, after the substance abuse program was completed. Family members changed their perceptions more than the abusers and maintained their favorable family perception, even though five of the abusers had relapsed shortly after discharge. At 3 months after treatment, the relapse rate for addicts in the ALANON group (n= 15) was 39% compared with 61% for addicts in the control group (n= 18). The difference was not of statistical significance due to the small group sizes, however. Evidence suggests the usefulness of ALANON in empowering families and assisting them in reevaluating the family system more positively.

ISSN:0095-2990    

DOI:10.3109/00952999609001649

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor