Tessa Parkes

Family solidarity in the face of stress: responses to drug use problems in Greece

Abstract Background: In the past, Greek drug-affected families had predominantly been conceptualized as one of the main causes of drug problems. This study explored the ways drug-affected families respond to, and cope with, a relative’s drug problem by examining the perceptions of both Greek drug users and drug-affected families. Method: A qualitative study comprised of semi-structured in-depth interviews was conducted in two state drug agencies in Thessaloniki, Greece. A total of 40 adult problem drug-using men and women and eight parents of problem drug users were asked to reflect on the ways families respond to, and cope with, drug use. The method of data analysis involved a manual systematic identification of themes in participant narratives in line with analytic induction principles. Results: After discovery of the drug problem, all families were reported as coping with their adult children’s drug problems in ways consistent with the stress-strain-coping-support model. The emergent high engagement and low withdrawal coping exhibited by study participants can be contextualized by situating these strategies within the Greek cultural milieu and the notion of familism. While the data illustrate the importance of family solidarity in the face of addiction, caution is invited in making generalizations as sample selection may provide an alternative explanation for study findings. Conclusion: The paper advocates for a non-pathological view of drug-affected families and highlights the importance of cultural context. The stress-strain-coping-support model helps to depathologise and better understand family reactions to problem drug use. Implications for non-stigmatizing and culturally relevant policy and practice are outlined.

Ethical pathways to informed consent when collecting information from children in research

Aim: This study’s purpose is to determine what themes patients with Cerebral Palsy (CP) rate most highly for importance in their quality of life. Additionally, we aim to determine and compare the parent’s perception of quality of life measures for their child with CP. Methods: Thirty one patients with CP and their guardians were administered a 50 item questionnaire. Results: When comparing the quality of life ratings of patients with CP to parents, five measures were statistically significant. Patients thought that playing video games (p=0.039), using the TV (p=0.004) and how their physical disability affects their appearance in comparison to their peers (p=0.018) were more important than their parents did. Parents thought their child’s future financial independence (p=0.017) and access to healthcare (p=0.008) were more important than their adolescent children did. Interpretation: Parents can accurately predict a few of the quality of life measures important to their child such as eating and drinking independently and going to school. However, disparities exist in many psycho-social domains. A better understanding of the importance of quality of life themes for patients with CP is important because it helps to direct care that can both take advantage of and improve what our patients feel is most important.

The politics of providing opioid pharmacotherapy.

People using opioid pharmacotherapy (OPT, methadone and uprenorphine medications used for maintenance purposes) have ecently provided accounts of the stigma that is often part of the reatment experience (Anstice, Strike, & Brands, 2009; Harris & cElrath, 2012; Strike, Millson, Hopkins, & Smith, 2013), as well s the restrictive and punitive practices (Chandler et al., 2013; rawford, 2013), and structural violence (Treloar & Valentine, 013), inherent within the treatment systems they encounter. The iews of treatment providers about their social and political locaion and agency within OPT systems have not, we believe, been dequately examined from a critical perspective. While Neale, n her editorial for this special issue (2013), refers to research n providers’ perspectives, such studies have tended to focus n specific clinical aspects of OPT rather than locating providers ore explicitly within the contexts of what many understand o be an inherently controversial and contested area of health are. Physicians have spoken out for some time about the recuring political anxiety linked to OPT, and the polarised and often deologically-driven discussions that commonly fail to engage eaningfully with either the new or old science on the effectiveess of this treatment, or with the practitioner ‘art’ of OPT in its any guises (see Ford, 2010, 2012; McNamara, 2012; Robertson Burrowes, 2010; Robertson, 2012; Wodak, 2002). However, the mpact has received little attention. We have therefore considered the papers in this special issue or the ways that they pay attention to the different political, social nd cultural contexts of OPT in the countries they are describing. e aim to discern the impact such heterogeneous contexts (China nd Nepal are featured as well as European, North American and ustralian examples) have on the development and ‘mainstreamng’ of OPT, access to treatment and treatment systems, regimes nd practices. We hope that this editorial goes some way towards ddressing the absence of explicit provider perspectives in this ompilation.

Military veterans with mental health problems: a protocol for a systematic review to identify whether they have an additional risk of contact with criminal justice systems compared with other veterans groups

BackgroundThere is concern that some veterans of armed forces, in particular those with mental health, drug or alcohol problems, experience difficulty returning to a civilian way of life and may subsequently come into contact with criminal justice services and imprisonment. The aim of this review is to examine whether military veterans with mental health problems, including substance use, have an additional risk of contact with criminal justice systems when compared with veterans who do not have such problems. The review will also seek to identify veterans’ views and experiences on their contact with criminal justice services, what contributed to or influenced their contact and whether there are any differences, including international and temporal, in incidence, contact type, veteran type, their presenting health needs and reported experiences.Methods/designIn this review we will adopt a methodological model similar to that previously used by other researchers when reviewing intervention studies. The model, which we will use as a framework for conducting a review of observational and qualitative studies, consists of two parallel synthesis stages within the review process; one for quantitative research and the other for qualitative research. The third stage involves a cross study synthesis, enabling a deeper understanding of the results of the quantitative synthesis. A range of electronic databases, including MEDLINE, PsychINFO, CINAHL, will be systematically searched, from 1939 to present day, using a broad range of search terms that cover four key concepts: mental health, military veterans, substance misuse, and criminal justice. Studies will be screened against topic specific inclusion/exclusion criteria and then against a smaller subset of design specific inclusion/exclusion criteria. Data will be extracted for those studies that meet the inclusion criteria, and all eligible studies will be critically appraised. Included studies, both quantitative and qualitative, will then undergo stage-specific analysis and synthesis. The final stage will combine the findings of both syntheses to enable new understandings of why, how, and by how much, military veterans with mental health problems, including problematic drug and alcohol use, come into contact with the criminal justice system.

Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study

BackgroundAlcohol Brief Interventions (ABIs) are increasingly being delivered in community-based youth work settings. However, little attention has been paid to how they are being implemented in such settings, or to their feasibility and acceptability for practitioners or young people. The aim of this qualitative study was to explore the context, feasibility and acceptability of ABI delivery in youth work projects across Scotland.MethodsIndividual, paired and group interviews were conducted with practitioners and young people in nine community projects that were either involved in the delivery of ABIs or were considering doing so in the near future. A thematic analysis approach was used to analyse data.ResultsABIs were delivered in a diverse range of youth work settings including the side of football pitches, on the streets as part of outreach activities, and in sexual health drop-in centres for young people. ABI delivery differed in a number of important ways from delivery in other health settings such as primary care, particularly in being largely opportunistic and flexible in nature. ABIs were adapted by staff in line with the ethos of their project and their own roles, and to avoid jeopardising their relationships with young people. Young people reacted positively to the idea of having conversations about alcohol with youth project workers, but confirmed practitioners’ views about the importance of these conversations taking place in the context of an existing trusting relationship.ConclusionABIs were feasible in a range of youth work settings with some adaptation. Acceptability to staff was strongly influenced by perceived benefits, and the extent to which ABIs fitted with their project’s ethos. Young people were largely comfortable with such conversations. Future implementation efforts should be based on detailed consideration of current practice and contexts. Flexible models of delivery, where professional judgement can be exercised over defined but adaptable content, may be better appreciated by staff and encourage further development of ABI activity.

Opiate Pharmacotherapy: Treatment, Regimes, Constructions and Control

The terms ‘pharmacotherapy’, ‘substitution therapy’, ‘substiution treatment’, ‘agonist treatment’, ‘agonist pharmacotherapy’, nd ‘agonist replacement therapy’ all refer to “the adminisration under medical supervision of a prescribed psychoactive ubstance, pharmacologically related to the one producing dependnce, to people with substance dependence, for achieving defined reatment aims” (WHO/UNODC/UNAIDS, 2004). Various pharacological agents are used in substitution programmes for llicit opioids (including methadone, buprenorphine and injectable iamorphine) and studies (including randomised trials and obserational research) consistently show that opioid pharmacotherapy OPT) is effective in the treatment of opioid dependence (Bell, 2012; ICE, 2007; WHO/UNODC/UNAIDS, 2004). Despite this, the polcy and practice world of OPT often resembles a fairground hall f mirrors. This is because wherever one stands and in whichever irection one looks, unexpected, distorted and frequently trouling images of therapy stare back. OPT is a widely practised, ell-evidenced treatment; yet it is also persistently controverial, politically divisive, and much maligned – even by those ho use it.

Alcohol brief interventions in youth and social work settings in Scotland

Scotland has one of the highest liver cirrhosis mortality rates in Western Europe. The Scottish government has invested in a range of policies to address this and the wider harms from alcohol, including a national programme on alcohol brief interventions (ABIs). The initial focus of this work was primary care, accident and emergency care, and antenatal care but it was expanded in 2012 to include ABIs delivered in wider settings and with populations such as social work service users and young people. This process evaluation aims to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings. The study involves two phases: one that maps existing projects providing ABIs in these areas and examines barriers and facilitators to their delivery, and a second that explores case study projects in depth and develops proposals for a potential future outcome evaluation. Phase 1 of the study involved conducting 24 semi-structured interviews with 28 professionals from 12 projects providing ABIs in the wider settings of social work and young peoples services between December 2012 and April 2013. Two field visit observations were also completed and documentation/data gathered from all projects, including numbers of clients and ABIs delivered where possible. A framework approach was used for coding and analysis of data. In addition to a detailed thematic analysis, 10 project case summaries were produced to retain the specificity of information about the diversity and similarities across the cases studied. Results from Phase 1 of the study will be presented and implications for policy and practice will be discussed.