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Over the influence : the harm reduction guide to controlling your drug and alcohol use
\"Just say no\" just doesn't work for everyone. Presenting a powerful alternate to abstinence-only addictions treatments, this empathic, nonjudgmental resource has already helped thousands set and meet their own goals for gaining control over alcohol and drugs. The science of harm reduction is translated into step-by-step strategies that readers can use to figure out which aspects of their habits may be harmful, what they would like to change, and how to put their intentions into action. Updated to reflect a decade's worth of research, the fully revised second edition is even more practical and reader friendly. It features additional concrete examples, engaging graphics, new worksheets (which can be downloaded and printed for repeated use), \"Self-Reflection\" boxes, and more.-- Source other than Library of Congress.
Book
Public health and international drug policy
In September, 2015, the member states of the UN endorsed Sustainable Development Goals (SDGs) for 2030, which aspire to human-rights-centred approaches to ensuring the health and wellbeing of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April, 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy and thought of as inconsistent with human rights norms, and in which scientific evidence and public health approaches have arguably had too limited a role.
Journal Article
The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010
The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders.
Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty).
Mental and substance use disorders were responsible for 22.5 million (14.8-29.8 million) of the 36.2 million (26.5-44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%-60.8%)) and anorexia nervosa the lowest (0.2% (0.02%-0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20-30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%-8.6%) to 8.3% (7.1%-9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden.
Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.
Journal Article
Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults
Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children’s and young adults’ receipt of mental health and substance abuse care using nationally representative data from the 2006–2012 Medical Expenditure Panel Surveys. Blacks’ and Hispanics’ visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.
Journal Article
Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need
ObjectivesIn this narrative review we illustrate the patterns of substance use among gay, bisexual and other men who have sex with men (MSM), including comparisons with heterosexual populations, subgroup analyses and settings of substance use. We also consider explanations and motivations for substance use and the impact of use on sexual health as well as wider health and well-being. Finally, we consider the implications for the provision of MSM-tailored substance use and harm reduction services.MethodsWe undertook a narrative review of diverse literature across the fields of public health, psychology and sociology to synthesise complex findings relating to the use and impacts of illicit drugs and alcohol among MSM. Attempts were made to draw on literature from across the globe, including all income settings.ResultsGlobal evidence relating to the use of substances among MSM is limited due to the lack of disaggregation of data by sexual orientation. While complicated by methodological diversity, most research indicates a higher prevalence of illicit drug use among MSM compared with their heterosexual counterparts, although the same is not necessarily true of alcohol. A sense of belonging, coping with everyday problems and the enhancement of pleasure, all feature in motivations for alcohol and drug use. Global association studies document a link between substance use and sexual risk behaviours, and event-level analyses suggest an especially strong association with respect to alcohol. While there is some evidence that generic harm reduction interventions can be effective among sexual minorities, these need to be tailored to the social and cultural circumstances of MSM.ConclusionsAssociations between substance use and sexual risk behaviour among MSM have been well documented, but the nature and pathway of these are poorly understood. A focus largely on substance use and sexual risk may have served to mask the impact of alcohol and drug use on the broader health and well-being of MSM.
Journal Article
Volitional social interaction prevents drug addiction in rat models
Addiction treatment has not been appreciably improved by neuroscientific research. One problem is that mechanistic studies using rodent models do not incorporate volitional social factors, which play a critical role in human addiction. Here, using rats, we introduce an operant model of choice between drugs and social interaction. Independent of sex, drug class, drug dose, training conditions, abstinence duration, social housing, or addiction score in Diagnostic & Statistical Manual IV-based and intermittent access models, operant social reward prevented drug self-administration. This protection was lessened by delay or punishment of the social reward but neither measure was correlated with the addiction score. Social-choice-induced abstinence also prevented incubation of methamphetamine craving. This protective effect was associated with activation of central amygdala PKCδ-expressing inhibitory neurons and inhibition of anterior insular cortex activity. These findings highlight the need for incorporating social factors into neuroscience-based addiction research and support the wider implantation of socially based addiction treatments.
Journal Article
The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men
The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales. Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AASs, and the need for an integrated health policy and regulatory response.
We searched for studies published prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment.
Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from \"muscle dysmorphia,\" a form of body dysmorphic disorder. AASs has been associated with cardiovascular disorders, psychiatric disorders, AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections. Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated Internet sales of AASs and selective androgen receptor modulators, which are easily purchased without a prescription, are of concern because of their potential to fuel the epidemic among adolescents and the military.
Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AASs and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.
Journal Article