The present findings indicate the need for further exploration of the interpersonal relationship determinants of an effective client-counselor working alliance. Although this exploratory study did not provide definitive findings, it suggests that both the affiliation and control dimensions of the interpersonal circumplex merit continued evaluation in this regard. Consistent with Bachelor (1995) we found that for both counselors and clients affiliation was the relationship dimension most strongly associated with the perception of a working alliance. Also worthy of further exploration is the finding that client perception of higher control on the part of the counselor was positively associated with independently rated behavioral change on the part of the client. This result was contrary to our expectation based on previous data obtained in the context of the physician-patient relationship (Kiesler and Auerbach, 2003). However, together with the finding of minimal relationships between any IMI interpersonal control and WAI measures, it suggests that client perception of increased counselor control (high dominance, low submission) may be a positive interpersonal dynamic that is especially potent in substanceabuse counseling and one that may be unrelated to the perception of a working alliance with the counselor.
Despite clear recommendations to screen and refer for suspected co-occurring disorders, adoption of these practices is a challenging issue. Individual counselor dispositions on the importance and relevance of new counseling practices are related to the adoption of practices. 19,20 Other clinician characteristics such as confidence in the practical use of screening have also been found to be important. Smolders et al 21 found that general practitioners’ rates of adherence to guidelines for managing mental health disorders and provid- ing referrals for specialized care were related to stronger confidence in depression identification and fewer perceived barriers for guideline implementation. McCall et al 22 found that professional comfort and competence, and system wide barriers contributed the most to practitioners’ attitudes toward their role in the management of patients with depres- sion and anxiety. According to a model of integrated treat- ment for mental health and substanceabuse problems, there Behavioral Sciences and Epidemiology Department, Naval Health
The worst thing you can do is nothing. Most people who misuse substances are not able to stop without support from others. Take the first step to help yourself, a friend, or a coworker. Many peer recovery and support programs are available. Some responder organizations have Employee Assistance Programs (EAPs) that focus specifically on substance misuse. Start by checking for your company’s EAP, or if you know a trusted health, mental health, or substanceabusecounselor, you may want to contact him or her for help. You can also download the SAMHSA Behavioral Health Disaster Response Mobile App and access a directory of behavioral health service providers in your area. You might also try the treatment locators, hotlines, and other resources that are listed in the Helpful Resources section on this page.
Both of these metabolites are further demethylated to 3-hydroxymorphinan. Dextrorphan is the active metabolite that produces neurobehavioral effects, while dextrometho- rphan does not exhibit the same actions. Dextromethorphan is therefore a prodrug, and the metabolic conversion of dex- tromethorphan to dextrorphan is an important determinant of the abuse potential of dextromethorphan in an individual. Experienced dextromethorphan users describe tachyphylaxis to the drug, but whether this effect is from alterations in cyto- chrome function or other effects is not known. 8
indicates that it is most effective at providing students with information about drugs. However, when compared to other prevention programs it demonstrated the poorest outcomes in terms of actual drug use. That is to say that of all the approaches that were studied the DARE program did the least to actually deter students from using substances of abuse (Ennett ,1994). The unfortunate problem is that because so much money, time and attention has already gone into the DARE program the key stakeholders are reluctant to abandon it and choose to try to justify its continued use instead. The result is that significant resources continue to go to an ineffective program that could be diverted to prevention approaches that have a greater effect on the actual frequency of drug abuse.
• The Department had not established an integrated process for providing substanceabuse treatment services to its prisoners. Although the Department was generally effective in providing a continuum of care for those prisoners referred to a substanceabuse treatment program, not all the prisoners requiring treatment were referred for substanceabuse treatment services (Finding 2).
Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence.
2. VOLATILE SUBSTANCEABUSE
Compounds such as diethyl ether, chloroform and nitrous oxide have been deliberately inhaled for recreational purposes since the early 1800s. Abuse of substances such as trichloroethylene in Germany and of products such as petrol (gasoline) in the United States of America was recorded as they became widely available during this century. Volatile substanceabuse has now been reported from most parts of the world. Solvents from adhesives, notably toluene, typewriter correcting fluids and thinners (until recently often 1,1,1-trichloroethane), hydrocarbons such as those found in cigarette lighter refills [forms of liquified petroleum gas (LPG), largely butane], aerosol propellants, halocarbon fire extinguishers and gases such as nitrous oxide are among the compounds or products which may be abused in this way (see Tables 1 and 2). Petrol (gasoline) is often abused, especially in developing communities. Acetone (propanone) too is often said to be abuseable in this way, although this compound is relatively water soluble and might not be expected to be a good intoxicant. Neither petroleum distillates such as white spirit and paraffin (kerosene), nor alcohols such as ethanol, 2-propanol, 2-methoxyethanol (methyl cellosolve) and ethylene glycol, are sufficiently volatile to be abused by inhalation.
A comprehensive HIV prevention strategy in a primary care practice includes interventions to provide drug treatment, to take care of mental health problems, and to prevent HIV transmission during drug use and sexual activity. The primary care provider should routinely screen for drug abuse and treat or refer for treatment as quickly as possible. This is particularly important for adolescents who are at high risk for HIV, hepatitis B and C, and other infections. One study has shown that once adolescents start injecting drugs, over 90% will become infected with hepatitis C within 18 months. The provider should also counsel patients who are actively using drugs not to share needles with others and to take advantage of programs that distribute clean needles. Programs use the needle distribution strategy as a first step to engage individuals who can then be encouraged to accept medical and drug abuse treatment services. When is an active substance abuser ready for HIV treatment?
Table 2). Counseling for children and adolescents should be developmen- tally appropriate and relevant across various age groups. Behavioral coun- seling from a health care professional can range in intensity from brief advice and encouragement to quit, to more in- tense multisession group-therapy pro- grams, to proactive telephone quit lines, to interactive computer-based pro- grams. The Public Health Service guide- line recommends that all clinicians strongly advise patients who use to- bacco in any form to quit. 7
Youths are the most vulnerable age group to drug addiction. Easy access to illegal drugs, wrong friends, and curiosity are of the significant factors spreading drug addiction. The use of injective substance has become more common in recent years, and tendency is more towards using psychotropic substance like ecstasy, crack, and crystal meth.
Hospice Yukon offers free support for individuals and their loved ones facing advanced illness, death and bereavement, and to caregivers and professionals who are supporting clients who are grieving. The society recognizes that unresolved grief and loss may often be at the core of substanceabuse issues. It is important to be supported through this difficult time and find a healthy way to express these feelings.
Researchers writing in the JAMA in 2000 called for drug dependences to be insured, treated and evaluated as chronic illnesses. Many states, including Tennessee, have passed “mental health parity” laws calling for insurance coverage for mental illnesses on a par with that for physical illnesses. However, by December 2007 Tennessee was among the 25 of 46 states still excluding substanceabuse coverage. Federal parity legislation, including substanceabuse coverage, passed the U.S. House of Representatives (268, yea; 148, nay) in March 2008 but had not been considered by the Senate by June 10, 2008.
burden resulting from substanceabuse is enormous. Substanceabuse not only affects personal health and accom- plishments, but also negatively affects the quality of life of abusers’ family members (eg, financial security, mental health, social networks, and productivity) and the functioning of society at large (eg, the criminal justice and health care systems). For example, in the United States, the direct and indirect economic cost to individual users, their families, and society was estimated to be $21.9 billion for heroin addiction and $184.6 billion for alcohol use problems per year. 16,17 Indeed, problems associated with substanceabuse