Greg Martin

Web-based interventions for substance use disorders: A qualitative review

Substance use disorder is one of the most common mental health problems in the Western world with a significant contribution to the global burden of disease and a high level of unmet treatment need. To assess the use and effectiveness of web-based interventions for substance use disorders. A qualitative review of the published literature across databases Medline, EMBASE, PsychINFO, GrayLIT Network, and Web of Science using relevant key terms. A search of the worldwide web was also conducted using search engines such as Google. There were a number of computerized and internet-based interventions for mental health disorders including substance use disorders located; however, they are largely descriptive with no large randomized controlled trials of internet-delivered interventions for substance use disorders reported. While the literature on internet-based substance use interventions is sparse and flawed, the potential impact of effective intervention is considerable. On the basis of the limited research available it is reasonable to suggest that a demand for such interventions exists and there is a likelihood that they would be as effective as those delivered by therapists for the majority of less severely dependent clients. Further clinical outcome research, particularly in the area of brief interventions for alcohol use disorders and extension to other drugs such as cannabis and club drugs, is certainly justified. (c) 2004 Elsevier Science Inc. All rights reserved.

Barriers and facilitators to cannabis treatment

UNLABELLED INTRODUCTION AND AIMS. Despite its continued widespread use, relatively few individuals with cannabis use disorders present to treatment services. There is a dearth of research examining the reasons for this observed underutilisation of treatment. The aim of this paper is to examine barriers and facilitators to entry into cannabis treatment. DESIGN AND METHODS Three surveys of regular cannabis users in treatment (n=100), in the community (n=100) and from a widespread Internet sample (n=294). RESULTS Perceived barriers included: not being aware of treatment options; thinking treatment is unnecessary; not wanting to stop using cannabis; and wanting to avoid the stigma associated with accessing treatment. Perceived facilitators included: improving available information on treatment; keeping treatment specific to cannabis; offering additional services, such as telephone support; and simplifying treatment admission processes. DISCUSSION AND CONCLUSIONS Participants perceptions differed significantly depending on their age, gender and treatment status. Participants in treatment typically reported barriers intrinsic to the individual while participants from the community reported barriers relating to the treatment available. Reported facilitators were more homogenous and most commonly related to availability of information.

Development of a short cannabis problems questionnaire for adolescents in the community.

The widespread and harmful use of cannabis amongst young people in the community has been well established. In order to assist in identifying young people at risk of harm for their cannabis use, the present paper documents the development of a short 12-item cannabis problems measure--the Cannabis Problems Questionnaire for Adolescents, Short form (CPQ-A-S). The CPQ-A-S was derived from the 27-item Cannabis Problems Questionnaire for Adolescents (CPQ-A) which had been shown in an earlier study to be a reliable and valid indicator of cannabis problems in adolescents. Tetrachoric correlations amongst items were examined and the more redundant items removed. Psychometrics of the shorter scale were then evaluated through factor analysis, and logistic regression used to demonstrate scale validity. This is the first short scale of cannabis problems derived for adolescents and it should prove a useful tool in both research and community applications.

Brief intervention for regular ecstasy (MDMA) users: Pilot randomized trial of a Check-up model

The prevalence of ecstasy (MDMA) use has increased significantly in recent years, particularly amongst young people. Despite the existence of a sizable population of regular ecstasy users and emergent evidence of a range of associated harms, including dependence, to date no effective targeted intervention responses have been reported specifically for this group. The aim of this study was to evaluate the efficacy of a single session brief intervention in reducing ecstasy use and related problems among regular ecstasy users. In a randomized controlled trial conducted in Sydney, Australia, 50 adult ecstasy users were assigned to either a single session brief intervention or an assessment-only 3-month delayed treatment control condition. Primary outcome measures were days of ecstasy use and number of DSM-IV dependence symptoms reported. At 3-month follow-up significant differences were found in favour of the intervention group on measures of DSM-IV dependence symptoms reported and Severity of Dependence Scale score. No statistically significant differences were detected on measures of quantity and frequency of use. While abstinence rates differed between groups by a factor of 4 (16% vs. 4%), this difference did not achieve statistical significance. Between group effect sizes at follow-up, all in favour of the intervention group, were moderate on the main outcome measures. The approach is acceptable to participants and merits further evaluation.

Eldercare work, migrant care workers, affective care and subjective proximity

Objectives. To document and explore the experience of migrant care workers providing health and social care to the elderly in institutional care settings and in the homes of the elderly in the community in New Zealand with a particular focus on the affective components of care work. Design. This qualitative study involved conducting face-to-face, open-ended, semi-structured interviews with 29 migrant care workers in the eldercare sector in the cities of Auckland and Wellington, New Zealand. Participants were recruited through various agencies focusing on aged care and engaged with migrant eldercare workers and snowballing through participant referral. Sample size was determined when saturation was reached. The interviews were audio recorded, transcribed verbatim, themes were identified and then analysed drawing on a body of theoretical work in the fields of emotional anthropology and moral geography and the international empirical literature addressing migrant eldercare workers. Results. As with the international research in this field we found that these workers were vulnerable to exploitation, the workforce is largely feminised and stereotypical understandings of racial groups and national characteristics informed recruitment and the workplace experience. Here attributing gradients of affect to particular migrant groups in the workforce was the main mechanism employed to establish worker worth and difference. Identifying with these gradients of affect enabled these eldercare workers to demonstrate that they met the moral and ethical requirements of permanent residency and ultimately citizenship. Eldercare workers in the home were vulnerable to ‘blurred emotional boundaries’ and care recipient demand for greater emotional commitment. The migrant eldercare workers in this study all shared vulnerable residential status and many feared they would never obtain permanent residency or citizenship. All had family who remained in the Philippines and towards whom they had an obligation to substitute care support. Conclusion. Central to understanding how this labour force issue is experienced by both caregivers and the elderly is the notion of subjective proximity and how emotional and moral trajectories serve to mediate the connection between the eldercare worker and workplace, the Filipino migrant eldercare relationship with employers, agencies and institutions; and, the transnational nature of this mobility and social and actual citizenship.

Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand:

Objectives: This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More Convenient policy programme involved the development of business plans and, within each business plan, a range of areas of focus and associated work-streams. Methods: The evaluations employed a mixed method multi-level case study design, involving qualitative face-to-face interviews with front-line staff, clinicians and management in two districts, one in the North Island and the other in the South Island, and an analysis of routine data tracked ambulatory sensitive hospitalisations and emergency department presentations. Two postal surveys were conducted, one focussing on the patient care experiences of integration and care co-ordination and the second focussing on the perspectives of health professionals in primary and secondary settings in both districts. Results: Both evaluations revealed non-significant changes in ambulatory sensitive hospitalisations and emergency department presentation rates and slow uneven progress with areas of focus and their associated work-streams. Our evaluations revealed a range of implementation issues, the barriers and facilitators to greater integration of healthcare services and the implications for those who were responsible for putting policy into practice. Conclusion: The business plans were shown to be overly ambitious and compromised by the size and scope of the business plans; dysfunctional governance arrangements and associated accountability issues; organisational inability to implement change quickly with appropriate and timely funding support; an absence of organisational structural change allowing parity with the policy objectives; barriers that were encountered because of inadequate attention to organisational culture; competing additional areas of focus within the same timeframe; and consequent overloading of front-line staff which led to workload stress, fatigue and disillusionment. Where success was achieved, this largely hinged on the enthusiasm of a small pool of front-line workers and their initial buy-into the idea of integrated care.