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Winner of the 2014 Outstanding Book Award presented by the Academy of Criminal Justice SciencesOver 2% of U.S.children under the age of 18more than 1,700,000 childrenhave a parent in prison. These children experience very real disadvantages when compared to their peers: they tend to experience lower levels of educational success, social exclusion, and even a higher likelihood of their own future incarceration. Meanwhile, their new caregivers have to adjust to their new responsibilities as their lives change overnight, and the incarcerated parents are cut off from their childrens development.Parental Incarceration and the Familybrings a family perspective to our understanding of what it means to have so many of our nations parents in prison. Drawing from the fields most recent research and the authors own fieldwork, Joyce Ardittioffers an in-depth look at how incarceration affects entire families: offender parents, children, and care-givers. Through the use of exemplars, anecdotes, and reflections, Joyce Arditti puts a human face on the mass of humanity behind bars, as well as those family members who are affected by a parents imprisonment. In focusing on offenders as parents, a radically different social policy agenda emergesone that calls for real reform and that responds to the collective vulnerabilities of the incarcerated and their kin.

Background Evidence 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. Methods Symptoms 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. Results With 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. Conclusions The 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.

Millions of children in the United States have a parent who is incarcerated and a growing number of these nurturers are mothers. Disrupted Childhoods explores the issues that arise from a mother's confinement and provides first-person accounts of the experiences of children with moms behind bars. Jane A. Siegel offers a perspective that recognizes differences over the long course of a family's interaction with the criminal justice system. Presenting an unparalleled view into the children's lives both before and after their mothers are imprisoned, this book reveals the many challenges they face from the moment such a critical caregiver is arrested to the time she returns home from prison. Based on interviews with nearly seventy youngsters and their mothers conducted at different points of their parent's involvement in the process, the rich qualitative data of Disrupted Childhoods vividly reveals the lived experiences of prisoners' children, telling their stories in their own words. Siegel places the mother's incarceration in context with other aspects of the youths' experiences, including their family life and social worlds, and provides a unique opportunity to hear the voices of a group that has been largely silent until now.

In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments.

The extent to which adolescents are influenced by their peers has been the focus of developmental psychological research for over 50 years. That research has yielded contradicting evidence and much debate. This study consists of a systematic review and meta-analysis, with the main aim of quantifying the effect of peer influence on adolescent substance use, as well as investigation into the factors that moderate this effect. Included studies needed to employ longitudinal designs, provide the necessary statistics to calculate cross-lagged regression coefficients controlling for target adolescent’s initial substance use, and comprise participants aged 10–19 years. A search of academic databases and reference lists generated 508 unique reports, which were screened using Covidence. The final inclusion criteria yielded a total of 99 effect sizes from 27 independent studies. A four-level meta-analytic approach with correction to allow the inclusion of multiple effect sizes from a given study was used to estimate an average effect size. Results revealed a significant effect of peer influence ( β ¯ = .147, p  < .001), indicating that adolescents changed their substance use behaviour in accordance with their peers’ perceived or actual use. Moderation analyses found peer influence effects varied significantly as a function of substance use behaviour (categorised as alcohol, tobacco, marijuana, or composite substance use) and peer influence measure (perceived vs. actual peer report); however, no significant effects emerged in the multivariate moderation model simultaneously examining all five main moderators. These results suggest that adolescent substance use is affected by peer influence processes across multiple substance use behaviours and both directly and indirectly through perceived norms. This has significant implications for substance use prevention, including the potential of harnessing peer influence as a positive force and the need to target misperceptions of substance use.

Background SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. Methods Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. Results Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. Conclusions Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.

BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors (representing 20% of all Irish registered doctors), which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were obtained, the majority of which were from young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe (χ 2=17.51, p<0.001). Interns being less likely to self-prescribe was not unexpected (χ 2=69.55, p<0.001), while general practitioners (GPs) and paediatricians were more likely to self-prescribe (χ 2=13.33, p<0.001; χ 2=11.35, p<0.001). GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family (χ 2=5.19, p<0.05; χ 2=8.38, p<0.05; χ 2=6.17, p<0.05) and surgeons were more likely to prescribe to friends (χ 2=15.87, p<0.001). Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids (χ 2=7.82, p<0.01; χ 2=7.31, p<0.01; χ 2=4.91, p<0.05), while those in hospital medicine were more likely to self-prescribe psychotropic medications (χ 2=5.47, p<0.05).ConclusionPrescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it.

To describe and compare the characteristics of people with SUD and their use of healthcare services in two ways: 1) across varying levels of marginalization and 2) before and during the pandemic. We conducted a population-based cross-sectional study using administrative data from Ontario, Canada. We included individuals age 16+ with a recorded diagnosis of SUD between June 2018-2019 (pre-pandemic) and June 2021-2022 (during-pandemic). Baseline sociodemographic and clinical characteristics and use of healthcare services were enumerated across the five quintiles of the Ontario Marginalization Index. 259,497 pre-pandemic and 276,459 during-pandemic people with SUD were identified. Over 40% belonged to the two highest marginalization quintiles (Q4/Q5). Most had an outpatient visit with similar percentages across quintiles, however the number of visits increased with increasing marginalization (pre-pandemic: mean 8.5 visits in Q1 vs 13.0 visits in Q5; during-pandemic: mean 9.5 in Q1 vs 13.4 in Q5). There was no consistent pattern in percent of people who sought alcohol-related outpatient care, however more marginalized people sought drug-related outpatient care (pre-pandemic: 19.1% in Q1 vs 31.7% in Q5; during-pandemic: 18.7% in Q1 vs 32.5% in Q5). Almost half of people with SUD had an emergency department (ED) visit, of which more belonged to higher marginalization quintiles (pre-pandemic: 43.5% in Q1 vs 49.8% in Q5; during-pandemic: 41.4% in Q1 vs 49.3% in Q5). SUD prevalence and most health service utilization remained similar from pre- to during-pandemic. Increasing marginalization was associated with increased use of healthcare among people with SUD. Future research should aim to further explore the complex relationship between marginalization and substance use.