Reexamining opioid addiction as a co-occurring disorder: A clinical perspective on the “Chronic Pain Paradox”
The use of opioids as an anodyne for chronic pain was not prevalent before the 1980s1. Students in medical schools had learnt to avoid prescribing opioids, considered highly addictive for treatment of non-malignant chronic pain1. Yet, from the early 1990s, prescription opioids emerged as a widely accepted method of treating chronic pain and palliative care2. Previously, chronic pain was treated in multidisciplinary clinics with coordinated care which included physical exams, medication management, biopsychosocial evaluation, cognitive behavioral treatment, physical therapy, and occupational therapy2. Starting in the early 1990’s, under dubious antecedence, opioid analgesics were promoted as the proprietary remedy for chronic pain and received endorsement and support from care providers across the United States3. Non-cancerous chronic pain, as a phenomenon, was thus elevated to an ailment or a medical condition by its own right from its erstwhile status as a corollary to another medical condition. This led to an increase in opioid analgesic prescriptions, followed by a wide-ranging abuse by patients, converting opioid use disorder (OUD) to a problem of epidemic proportions4. Apart from the legal course of action initiated against Perdue Pharma, in 2020, the maker and distributor of Oxycontin that resulted in a $3.8 billion lawsuit settlement, in which Perdue Pharma pleaded guilty; since the recognition of this problem, new measures have been adopted to counter the opioid epidemic by clinicians. There has been a significant shift towards circumvention by physicians prescribing opioids for non-cancerous chronic pain. In a few instances, providers have resorted to putting a temporary moratorium on prescribing opioids to all non-cancerous chronic pain cases5. The Center for Disease Control (CDC) and various state agencies have passed protocols, installed prescription monitoring programs (PMPs), and created taskforces to rein in flagrant prescription practices by medical providers. Mental health counseling and alternative, non-prescriptive pain management procedures have been…
Social work is one of the youngest scientific disciplines, it has developed itself as a discipline to address individuals, families and communities in social crisis (poverty, low level of education, un- employment, diseases, social isolation). In the last decade also problems with alcohol and drug dependencies increasingly became the subject of social work support(systems). Due to coming global- isation, where living space has become wider than the community itself, social work was forced to operate within wider horizons and to go beyond communities boundaries. Social work nowadays has been becoming a more global scientific discipline seeking answers to global questions. Social work is therefore linked to all seventeen global goals of sustainable development (SDGs). As the prevention and treatment of drug addiction in Germany and Central Asia has reached a common urgency, a training and research project in the field of social work in addiction support was developed in Germa- ny, Central Asian countries (Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan) and China. The development of social work in these countries increasingly led to the development of common principles in the technology and ethics of social work, comparing standards and working out the socio-cultural peculiarities in the definition and practice of social work. These developments are examined and presented and their common solution ideas discussed in the con- text of achieving the UN Sustainable Development Goals.
Rationale: The significance of this research stems from the impact implicit attitudes have on smoking behavior, where positive implicit attitudes can result in a greater likelihood of smoking behavior. Even though it has previously been argued that implicit attitudes can drive addictive behavior there is a lack of research on whether cigarette packaging has an influence on implicit attitudes. Objectives: The purpose of this study was to examine the effect of plain cigarette packaging and designed/logo cigarette packaging on implicit attitudes. Methods: Implicit attitudes towards cigarette packaging were assessed by means of the Brief Implicit Association Test (BIAT). A questionnaire was conducted to assess sociodemographic and smoking behavior. The Fagerström Test for Nicotine Dependence (FTND) was used to assess level of dependence. The sample consisted of 264 participants. Results: BIAT indicate a significant association between designed/logo cigarette packaging and positive implicit attitudes (Mean d-score > .15). Cigarette packaging design’s influence on implicit attitudes is positive (Mean d-score = .22), where there is a slight association between designed/logo packaging and positive implicit attitudes. Conclusions: When compared with plain packaging, designed/logo cigarette packaging leads to positive implicit attitudes. These findings support the effectiveness of plain packaging regulations where the removal of color, design and logo from cigarette packaging will decrease positive implicit attitudes formed by cigarette packaging.
Introduction: Vaping has become an epidemic with serious health concerns. The Centers for Disease Control and Prevention recently released a national alert on vaping hazards and its associations with a mysterious lung disease. The prevalence of alternative tobacco products such as waterpipe and vaping have been on the rise, with health hazards similar to those of cigarettes. However, the public is less aware of those hazards. Because the literature on alternative tobacco use among Veterans is limited, the purpose of this study is to examine veterans’ use, perceptions, and knowledge of the hazards linked to alternative tobacco products. Materials and Methods: A convenience sample of 200 veterans seeking medical care at the Rocky Mountain Regional VA Medical Center, primary care clinics completed a survey on tobacco use. Results: Cigarettes remain the most prevalent form of tobacco used by veterans. The prevalence of “ever use” of waterpipe and/or vaping was 21% among participants, and almost all of those participants also reported cigarette use, 20.5%. About 42% of participants were unaware of harm levels from waterpipe. Discussion: Veterans are unaware of the risks associated with vaping and other alternative tobacco products and show similar use rates as the general population. Because educational campaigns have proven to be successful in decreasing smoking, the next step is to conduct educational campaigns on the hazards of alternative tobacco products among the veteran population to address myths and misperceptions regarding those products.
Cultural competence is more than speaking the language or recognizing the cultural icons of a given group of individuals. Treating the individual is treating their culture. A culturally competent treatment professional must acknowledge an individual’s cultural strengths, values, and experiences while encouraging behavioral and attitudinal change. A significant variable in the change process is the relationship between racial or ethnic matching of clients and counselors. Successful treatment reveals a group of cultural dynamics on how this therapeutic alliance might affect treatment outcomes. To meet these complex cultural challenges, the movement towards a pluralistic cultural framework of helping with its bilingual and bicultural sensitivity appears to be a significant variable to engage the community and the individual in the healing process. Environmental exposures, such as pollution, high-crime areas, and lack of parks or playgrounds, social services, such as transportation, housing, and childcare, mental health care, significantly impact on lifestyle choices. Building strong, grassroots recovery community organizations (RCOs) and linking RCOs into a national movement to develop recovery leaders, offer many opportunities for the recovery community. It helps people in recovery, family members, friends, and allies to express their collective individual and neighborhood voices on issues of common concern by providing a forum for recovery-focused community services that support individual growth.
Higher rates of anger and aggression have been observed in problem gamblers. In this cross-sectional study the relationship between anger, aggression and a community sample of problem gamblers was examined within two subtypes of gambling: Perceived Skill Gambling (sports, cards, track) and Chance Gambling (bingo, lotteries, slot machines) gambling. Aggression and anger were assessed by the Aggression Questionnaire (AQ) and the Trait Anger Scale (TAS), respectively. Results indicated that Perceived Skill Gamblers (i.e., sports, card, track) scored higher on expressing anger on the AQ as well as on the hostility, physical and verbal and aggression subscales of the TAS. There were no sex differences on any AQ subscale except for the Physical Aggression Subscale. We did not find gender differences on the TAS. The study shows evidence that Perceived Skill Gamblers experience more anger, hostility, physical and verbal aggression as measured by the AQ. The current findings contribute to an improved understanding of the complexity of the factors that are implicated in gambling disorder, and suggests that anger and aggression should be routinely assessed among disordered gamblers seeking treatment.
The purpose of the present study was to introduce stochastic search variable selection (SSVS) as a procedure to identify a subset of important predictors of gambling harm. The target set of predictors were dimensions of trait impulsivity, gambling cognitions, and gambling motivations. Five types of gambling harm (feeling one has a personal problem; social criticism; feeling guilt; health; and, financial) were measured by the Problem Gambling Severity Index. Casino patrons completed the measures. As a first step, we identified the significant predictors that would be included in modelling an aggregate harm score. The most important predictors, the cognition that one is not able to stop gambling, and the motivation to escape or avoid life stressors, were positively associated with overall harm. Two weaker, but statistically significant, predictors were negatively associated with harm: sensation-seeking and illusion of control. Although a perceived inability to stop gambling was the most important predictor of each individual harm, the pattern of predictors varied across harms. For example, sensation-seeking was an important predictor only for the belief that one has a gambling problem, and escape/avoidance motivation was strongly predictive of financial harm. The results suggest that primary interventions designed to mitigate harm should address the belief that the gambler is unable to stop gambling, and motivations related to escape/avoid life stressors. Other interventions would be tailored to the specific harms experience by the gambler.
The article discusses anger and anxiety in the context of recovery. It relates social determinants of health to individual pathology and how an individuals stress level is related to one’s community. How stressors such as, drug infected areas, lack of access to parks and playgrounds, quality education, etc impact significantly on a person’s anxiety is discussed. To help facilitate healthy change the use of peer specialists and partnering with the faith-based community can create a more comprehensive network of supportive allies.
Introduction The active methodology is an educational conception that stimulates critical-reflexive teaching-learning processes. Objective to apply the Arco de Maguerez in the Jardim Oasis community, in the municipality of Iguatu-CE. Methodology The first method was applied to the Hanlon method, in which priorities were established, based on the criteria of magnitude, severity, effectiveness and feasibility. Each criterion was analyzed using numerical score scores: magnitude (1-10); severity (1-10), effectiveness (0.5-1.5) and feasibility (0 or 1). It was through the observational analysis that the problematization “difficulty in adhering to the treatment of alcoholism” was highlighted. As a methodological framework, he used the Maguerez Arch based on “five steps”: observation of reality; key points of the problem; theorization; hypotheses of solution; application of action in reality. Results First Step – Observation of Concrete Reality. Second Step – Determination of Key Posts Third Step – Theorizing: There is a consensus in the literature on the low adherence rate of dependents, the dropout rates are generally above 50%. The literature found that more than 50% of patients evade in the first month. Fourth Step – Solution Hypotheses: Establish Links; inform; use harm reduction policy. Step Five – Application to Reality; Action plans to improve the problem in the reference territory. Conclusion It was understood that despite being a pedagogical instrument focused on the teaching – learning process, it can be fully applied in the daily routine of health services, starting from a social reality up to the moment of effective
Socio-demographic correlates of heavy drinking after hospital discharge among Thai alcohol-dependent patients: 6-month follow-up
Background: After receiving in-patient treatment for alcohol abuse, alcohol-dependent patients (ADP) are at risk to return to heavy drinking. Little has been known regarding the correlates of socio-demographic and heavy drinking within 6-month after inpatient treatment. Objectives: This study aims to examine the socio-demographic correlates of heavy drinking among Thai ADP after hospital discharge within six-months. Methods: A prospective cohort study of 618 ADP who received inpatient treatment at two tertiary care hospitals in Northern Thailand between July and December 2014. Heavy drinking is defined by the World Health Organization as ≥5 standard drinks for men and ≥4 standard drinks for women per occasion. Heavy drinking data was collected using a Timeline Follow Back Calendar (TLFB) every month after discharge. Other measures included the Alcohol Use Disorder Identification Test (AUDIT), Rosenberg Self-esteem Scale, Alcohol Craving Control (ACC), Severity of Alcohol Dependence Questionnaire (SADQ), and demographic questionnaires. Results: 618 participants present with a mean age of 43.28 (SD=10.01) years, 94.2% male, 216 (35%) reported that family members are drinkers, and 400 (70.7%) continue to exhibit heavy drinking behaviour. The logistic regression model revealed that age at onset of alcohol use was correlated with heavy drinking after hospital discharge within 6 months (p