Brad Hagen

GAMBLING AND PROBLEM GAMBLING WITHIN FORENSIC POPULATIONS A Review of the Literature

A review of problem gambling in forensic populations suggests that one third of criminal offenders meet criteria for problem or pathological gambling. This is the highest rate yet found in any population. Approximately 50% of crime by incarcerated problem and pathological gamblers is reportedly committed to support gambling. The prevalence of gambling within correctional facilities (40%) appears lower than in the general population. However, inmates who do gamble tend to do so regularly, and problem and pathological gamblers are disproportionately represented among this group. Inmate screening for problem gambling and provision of specialized treatment are currently lacking in most correctional facilities. In addition to more screening and treatment, there needs to be greater vigilance in detecting gambling and enforcing its prohibition.

Neuroleptic and benzodiazepine use in long-term care in urban and rural Alberta: Characteristics and results of an education intervention to ensure appropriate use

OBJECTIVES To examine the use of psychotropic drugs in 24 rural and urban long-term care (LTC) facilities, and compare the effect of an education intervention for LTC staff and family members on the use of psychotropic drugs in intervention versus control facilities. METHODS Interrupted time series with a non-equivalent no-treatment control group time series. Data on drug use were collected in 24 Western Canadian LTC facilities (10 urban, 14 rural) for three 2-month time periods before and after the intervention. Pharmacy records were used to collect data on drug, class of drug, dose, administration, and start/stop dates. Chart reviews provided demographics, pro re nata (prn) use, and indications for drug use. Subjects comprised 2443 residents living in the 24 LTC facilities during the 1-year study. An average of 796.33 residents (32.7%) received a psychotropic drug. An education intervention on psychotropic drug use in LTC was offered to intervention physicians, nursing staff, pharmacists and family members. RESULTS Approximately one-third of residents received a psychotropic drug during the study, often for considerable lengths of time. A minority of psychotropic drug prescriptions had a documented reason for their use, and 69.5% of the reasons would be inappropriate under Omnibus Budget Reconciliation Act (OBRA) legislation. Few psychotropic drug prescriptions were discontinued or reduced during the study. More urban LTC residents received neuroleptics and benzodiazepines than their rural counterparts (26.1% vs. 15.7%, and 18.0% vs. 7.6%, respectively). The education intervention did not result in any significant decline in the use of these drugs in intervention facilities. CONCLUSION The results suggest substantial use of psychotropic drugs in LTC, although rural LTC residents received approximately half the number of psychotropic drugs compared with urban residents. A resource-intensive intervention did not significantly decrease the use of psychotropics. There is a need for better monitoring of psychotropic drugs in LTC, particularly given that voluntary educational efforts alone may be ineffective agents of change.

Spider in a Jar: Women Who Have Recovered from Psychosis and Their Experience of the Mental Health Care System

A growing body of literature has documented considerable dissatisfaction with the mental health care system among people who use mental health services. This article adds to this literature by reporting on the results of qualitative interviews done with 18 women who had recovered from some form of transformative psychotic experience and were willing to share their experiences with the mental health care system. The participants unanimously felt that their experiences with the mental health system were very negative and detrimental to their overall healing and recovery process. Four main themes emerged from the qualitative analysis of the interview transcripts: (1) “the label factory,” which described the capricious and destructive nature of the psychiatric diagnoses they received; (2) “invalidated and unheard,” which described how little the women’s voices seemed to matter to the mental health care professionals caring for them; (3) “violence and violations,” which described the loss of free will and dignity the women experienced during inpatient psychiatric hospitalizations; and (4) “smashing the jar,” which described the hopes and dreams these women had for changing the way people receive mental health care. The implications of these findings for mental health practice are discussed.

Moral distress: an emerging problem for nurses in long‐term care?

Nurses and other professional caregivers are increasingly recognising the issue of moral distress and the deleterious effect it may have on professional work life, staff recruitment and staff retention. Although the nursing literature has begun to address the issue of moral distress and how to respond to it, much of this literature has typically focused on high acuity areas, such as intensive care nursing. However, with an ageing population and increasing demand for resources and services to meet the needs of older people, it is likely that nurses in long‐term care are going to be increasingly affected by moral distress in their work. This paper briefly reviews the literature pertaining to the concept of moral distress, explores the causes and effects of moral distress within the nursing profession and argues that many nurses and other healthcare professionals working with older persons may need to become increasingly proactive to safeguard against the possibility of moral distress.

Predictors of Nursing Home Placement from Assisted Living Settings in Canada.

Cette étude visait à évaluer l’incidence de placement dans un établissement de soins de longue durée (SLD) et d’identifier les facteurs prédictifs de placement résidentiel et d’installation parmi résidents âgés dans établissements aidant à la vie autonome en Alberta, au Canada. 1,086 résidents de 59 installations en Alberta ont été inclus. Infirmières de recherche ont effectué des évaluations de résidents interRAI-AL et ont interrogé les aidants familiaux et les administrateurs. Les prédicteurs de placement ont été identifiés avec des modèles de risques proportionnels de Cox multivariés. L’incidence cumulative SLD de l’admission était de 18,3 pour cent en 12 mois. Le risque de placement a augmenté significativement pour les résidents âgés et ceux avec des relations sociales médiocres, peu d’implication dans les activités, la dépreciation cognitive et/ou fonctionnelle, l’instabilité de la santé, une histoire des chutes et des hospitalisations récentes/visites à l’urgence, et l’incontinence urinaire sévère. Une diminution du risque de placement a été montré pour les résidents de grandes établissements avec une infirmière autorisée et/ou une infirmière auxiliaire autorisée disponible 24 heures par jour et un médecin de premier recours affilié. Nos résultats font ressortir les domaines cliniques et politiques ou des interventions ciblées peuvent retarder les admissions SLD.

Psychosis and transformation: A phenomenological inquiry

Conventional views towards psychosis typically portray psychosis as an illness of the brain with a generally poor prognosis, even if treated with antipsychotics. However, there is a growing body of literature which presents an alternative view of psychosis, whereby people are not only able to recover from psychosis, but can also experience transformative and/or spiritual growth through psychosis. To learn more about the transformative potential of psychotic experiences, a phenomenological approach was used to research the experiences of six people who self-identified as having benefited from psychosis in a spiritual and/or transformative manner. Keys themes emerging from interviews with these six individuals included in the pre-psychosis phase “childhood foreshadowing” and “negative childhood events,” and in the psychosis phase, “sudden psychosis,” “psychic/intuitiveness and unusual visual experiences,” “comprised day-to-day functioning,” “experiences of dying,” and “communication with god.” Four themes made up the transformation of psychosis phase including “detachment and mindfulness,” “accepting the dissolution of time into now,” “embracing a spiritual pathway,”“ and ”re-alignment of career path.“ Overall, the results suggest that at least for some individuals, the experience of psychosis can be an important catalyst for spiritual and personally transformative growth.

FAMILY CAREGIVER EDUCATION AND SUPPORT PROGRAMS: USING HUMANISTIC APPROACHES TO EVALUATE PROGRAM EFFECTS

This article critiques previous caregiver evaluation efforts and describes the evaluation of an education and support program for family caregivers in British Columbia, Canada. Thirty family caregivers, predominantly adult daughters caring for parents with dementia, participated in one of three facilitator‐led groups offering the Supporting Caregivers in British Columbia program. They met weekly for 2 hr over a 10‐week period. A rich array of qualitative data indicated that caregivers perceived the program to have numerous positive effects on their caregiving, thus demonstrating the importance of learner perspectives and experiences in the evaluation process. The study offers a distinct alternative to experimental and quasi‐experimental designs for evaluating educational programs.

Recovery from Psychosis: A Phenomenological Inquiry.

While mainstream psychiatry tends to view psychosis as an enduring and chronic condition, there is growing interest in the possibility of recovery from psychosis. A phenomenological research method was utilized in interviewing 17 individuals who all self-identified as being in recovery from psychosis. The research question was, “What was the lived experience of having a psychosis episode and now being in recovery?” Through thematic analysis, the authors found four major themes and seven subthemes that described the experience of recovery from psychosis. The four major themes included: (i) pre-psychosis childhood traumatic experiences, (ii) the descent into psychosis, (iii) paths to recovery, and (iv) post-recovery challenges. These findings suggest both some potential pathways and barriers toward recovery and transformation from psychosis.

Female Gambling, Trauma, and the Not Good Enough Self: An Interpretative Phenomenological Analysis

A gap exists within current literature regarding understanding the role that trauma may play in the initiation, development, and progression of female problem and pathological gambling. The purpose of this study is to further illustrate the relationship between trauma and the development problem and pathological gambling by investigating the lived experiences of six women who self-report having a history of trauma and problem with gambling. An interpretive phenomenological analysis (IPA) methodology was applied in the research process in which six women share their life journey through the progression of their gambling addiction. Thematic analysis constructed into 5 themes illustrates a link between the role of trauma in the development and perpetuation of problem and pathological gambling, with female participants progressing through a series of experienced stages involving the development of the not good enough self, seduction & intoxication with gambling, opening the doorway to oblivion through gambling, trauma and the ties that bind, and culminating in gambling becoming trauma. Finally the implications of these findings towards the understanding and treatment of problem and pathological gambling by health care practitioners is discussed.

Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada

OBJECTIVES Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents. METHODS Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization. RESULTS The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization. CONCLUSIONS DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk.