Birgitte Thylstrup

Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers

BackgroundEvidence is accumulating that a cannabis withdrawal syndrome is common, of clinical significance, and has a clear time course. Up till now, very limited data exist on the cannabis withdrawal symptoms in patients with co-morbid substance use disorders, other than cannabis use and tobacco use.MethodsSymptoms of withdrawal were assessed through patient self-reports during detoxification in Danish residential rehabilitation centers. Patients (n = 90) completed booklets three times during their first month at the treatment centre. Self-reported withdrawal symptoms was rated using the DSM-5 Withdrawal Symptom Check List with withdrawal symptoms from all classes of substances, with no indication that the described symptoms should be attributed to withdrawal. Self-reported time since last use of cannabis was used as a predictor of cannabis withdrawal severity.ResultsWith the exception of loss of appetite, time since last use of cannabis was associated with all types of withdrawal symptoms listed in the DSM-5. Only four of 19 symptoms intended to measure withdrawal from other substances were related to time since last use of cannabis, including vivid, unpleasant dreams.ConclusionsThe findings yield strong support to the notion of a cannabis withdrawal syndrome, and gives further evidence for the inclusion of the criterion of vivid, unpleasant dreams. Further, the findings speak against the significance of demand characteristics in determining the course of the symptoms of cannabis withdrawal.

‘When you're boxing you don't think so much’: pugilism, transitional masculinities and criminal desistance among young Danish gang members

ABSTRACT This paper draws upon international research evidence that suggests a relationship between protest masculinity and the manifestation of violent crime among young males, and that criminal desistance may be linked to (inter-) subjective processes such as the reconstruction of masculine identity. The paper considers the potential that pugilism (the art and practice of boxing) may have on enabling young, disadvantaged minority male gang members to find avenues for alternative identity construction and to gain transitional experiences which trigger self-confessed desistance actions. Drawing upon an ethnographic study conducted in a boxing rehabilitation centre on the outskirts of Copenhagen, Denmark, the paper reports on data gleaned from participant observation and qualitative interviews with 22 ethnic minority young men. Findings suggest that the masculine context within the rehabilitation programme provided the young men with a safe space to perform broader versions of locally dominated views on masculinity and to reflect on their current situations and dilemmas. The young men were clearly in transition and their desistance journeys were characterized by hope and ambition but also disappointment and despair. In some cases it appeared that the young mens dogged attempts to desist from crime became a new way for them to ‘do masculinity’. The authors draw upon the findings to make recommendations for policy, practice and research.

Desistance and the micro-narrative construction of reformed masculinities in a Danish rehabilitation centre:

Juvenile justice systems and reformatory institutions hold the potential to help young offenders and drug abusers change their behaviours and life-courses. Driven by an ambition to pave new ways to examine the inner workings of reformatory institutions this study explores how young male offenders’ gendered identities are engaged in a Danish reformatory programme. In recent years existing research on the gendered aspects of reformatory interventions has highlighted how reformatory institutions at times work to promote desistance by problematizing offenders’ and drug-abusers’ performance of hyper-masculinity and by constructing therapeutic spaces where men can reformulate softer versions of masculinity. Contributing to this line of research, this study explores and discusses how reformatory programmes at times also utilize hyper-masculine symbolism and imaginaries to encourage young offenders and drug abusers to engage in narrative re-constructions of identities and to socialize these into new subject positions defined by agency, self-responsibility and behavioural changes.

Dual diagnosis and psychosocial interventions*Introduction and commentary

Treatment of patients with concurrent mental illness and substance abuse represents a challenge to the traditional treatment systems. This article gives: 1) an introduction of the concept and frequency of dual diagnosis (DD), 2) a presentation and discussion of the latest guidelines on DD treatment, 3) status on the current situation in the DD field in Denmark, and 4) potentials for future research. The article is based on systematic examination of evidence-based research and popularized latest guidelines on DD treatment. Methodologically, both treatment and research is challenged by the diversity in DD combinations. Although integrated treatment with the inclusion of cognitive–behavioural therapy, motivational interviewing and family intervention in DD treatment show promising results, it remains to establish which treatment programme is the most qualified in improving mental health and reducing substance use. A future priority is the development of DD treatment that targets specific co-morbid combinations and treatment needs.

The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment

Antisocial behavior is associated with low quality of life for the patient and with adverse effects on society and those close to the antisocial patient. However, most patients with antisocial behavior are not seen in treatment settings that focus on their personality but rather in criminal justice settings, substance-abuse treatment, and social welfare settings. This article describes the adaptation and implementation of a highly structured manualized treatment, Impulsive Lifestyle Counseling (ILC), based on the Lifestyle Issues program, a 10-week psychoeducation program studied in prison settings. ILC consists of four sessions over 4 weeks and a booster session 8 weeks later. The goal of treatment is described to patients as “to help people identify their impulsive thoughts and lifestyle leading to problems with drug use, other people, and the police.” Two clinical examples and reflections on our experiences with the training and implementation of the ILC program are presented.

Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with antisocial personality disorder: A randomized study

Patients with antisocial personality disorder in outpatient treatment for substance use disorders are at high risk of drop-out. Using a randomized design, this study tested the impact of adding a brief psycho-educational program, the Impulsive Lifestyle Counseling program, to outpatient substance abuse treatment in order to prevent treatment dropout. Patients (N=175) were recruited from 13 municipal treatment centers in Denmark, and assigned to treatment as usual or to the experimental condition. In all, 172 patients could be included in the analyses. In the intent-to-treat analysis, the risk of treatment dropout was reduced among patients randomized to the experimental program (hazard ratio=0.63, p=.031), after controlling for age, gender, and substitution treatment status. The study supported the efficacy of the Impulsive Lifestyle Counseling program as a method for preventing treatment dropout for patients with comorbid antisocial personality disorder in substance abuse treatment. Trial registration #ISRCTN67266318.

Inter-rater agreement of comorbid DSM-IV personality disorders in substance abusers

BackgroundLittle is known about the inter-rater agreement of personality disorders in clinical settings.MethodsClinicians rated 75 patients with substance use disorders on the DSM-IV criteria of personality disorders in random order, and on rating scales representing the severity of each.ResultsConvergent validity agreement was moderate (range for r = 0.55, 0.67) for cluster B disorders rated with DSM-IV criteria, and discriminant validity was moderate for eight of the ten personality disorders. Convergent validity of the rating scales was only moderate for antisocial and narcissistic personality disorder.DiscussionDimensional ratings may be used in research studies and clinical practice with some caution, and may be collected as one of several sources of information to describe the personality of a patient.

Assessment of personality-related levels of functioning: a pilot study of clinical assessment of the DSM-5 level of personality functioning based on a semi-structured interview

BackgroundThe personality disorder categories in the Diagnostic and Statistical Manual of Mental Disorders IV have been extensively criticized, and there is a growing consensus that personality pathology should be represented dimensionally rather than categorically. The aim of this pilot study was to test the Clinical Assessment of the Level of Personality Functioning Scale, a semi-structured clinical interview, designed to assess the Level of Personality Functioning Scale of the DSM-5 (Section III) by applying strategies similar to what characterizes assessments in clinical practice.MethodsThe inter-rater reliability of the assessment of the four domains and the total impairment in the Level of Personality Functioning Scale were measured in a patient sample that varied in terms of severity and type of pathology. Ratings were done independently by the interviewer and two experts who watched a videotaped Clinical Assessment of the Level of Personality Functioning Scale interview.ResultsInter-rater reliability coefficients varied between domains and were not sufficient for clinical practice, but may support the use of the interview to assess the dimensions of personality functioning for research purposes.ConclusionsWhile designed to measure the Level of Personality Functioning Scale with a high degree of similarity to clinical practice, the Clinical Assessment of the Level of Personality Functioning Scale had weak reliabilities and a rating based on a single interview should not be considered a stand-alone assessment of areas of functioning for a given patient.

Numbers and narratives. Relations between patient satisfaction, retention, outcome and program factors in outpatient substance abuse treatment

Aims Research on substance abuse treatment suggests patient satisfaction is linked to use of services and abstinence. However, patient perspectives on treatment are rarely examined. This study used mixed methods to examine correlations between patients’ treatment satisfaction, retention and abstinence from drugs and provide a transpersonal account of patient perspectives on treatment. Data and Methods Eight Danish outpatient substance abuse treatment centres participated in the study. Data was collected from 186 patients. Quantitative measures were used at baseline screenings and at 6 months follow-up interviews, including the Client Satisfaction Questionnaire-8 (CSQ-8). Qualitative measures were used for patient descriptions of treatment at follow-up. Results Patient satisfaction with treatment was linked to retention, abstinence and program differences. The qualitative data described patients views on high or low treatment satisfaction. Conclusion The CSQ-8 is a valuable tool for monitoring patient engagement and treatment effect in substance abuse treatment services. The inclusion of patient perspectives underlined the importance of a more contextual understanding of program components.

Experiences and narratives – Drug users with antisocial personality disorder retelling the process of treatment and change

Abstract Aim: The aim of this study was to explore the value of adding a narrative perspective when listening to how two drug users with comorbid antisocial personality disorder (ASPD) experienced their participation in an intervention treatment targeting their antisocial behaviour. Methods: Two cases were chosen, representing a low and high level of change after participation in a programme intervention targeting ASPD within outpatient drug treatment. Interpretative Phenomenological Analysis was used to capture the quality of their experiences and their narrative sense-making strategies. Findings: The two cases converged with some of the core preconceptions about individuals with ASPD but contradicted them in others. Experiences and narratives differed in the ways they perceived their life challenges and their feelings of agency and control concerning their ability to engage in change processes without losing their core self. Conclusions: Responding adequately to user experiences requires paying attention to individual narratives and sense-making strategies. Certain aspects of ASPD may not be exclusive indications of pathological processes, but serve an important function when engaging in treatment and change. Taking this approach has the potential to facilitate a more constructive dialogue about which aspects of their behaviour that it makes sense to change.