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1/13. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives.

    Individuals with alcohol and drug use problems may receive health care from medical, mental health, and substance abuse providers, or a combination of all three. Systems of care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, we outline (1) the possible benefits of linking primary care, mental health, and substance abuse services from the perspective of the major stakeholders-medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for suboptimal linkage and opportunities for improving linkage within the current health care system. We also review published models of linked medical and substance abuse services. Given the potential benefits of creating tangible systems in which primary care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority.
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2/13. Network therapy for addiction: bringing family and peer support into office practice.

    Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the internet in dissemination.
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3/13. Drug treatment effectiveness: African-American culture in recovery.

    African-Americans are overrepresented among drug abusers in the united states when compared to European-Americans, and have lower rates of recovery from drug addiction after treatment. There has been no comprehensive research to date to specifically explain either this overrepresentation or lower rates of recovery among African-Americans. In this article, it is suggested that one reason for this lack of attention is due to the failure of drug abuse treatment providers and researchers to see race as a cultural rather than physical phenomenon. The point is made that cultural factors are intrinsic to successful efforts to address drug abuse among African-Americans. Several historic African-American coping strategies are outlined and shown to be powerful factors in client addictive behavior and barriers to recovery. Through case studies of clients who were successful in their effort to recover, the necessity to address cultural as well as personal issues is shown to be vital to successful recovery among African-Americans.
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4/13. Collaboration--together we can find the way in dual diagnosis.

    Service systems in health and community agencies are struggling to deliver mental health services to adults with an intellectual disability. Many professionals feel ill equipped to assess and treat mental health disorders in this population. This Australian case study describes the collaborative effort required to meet the complex health needs of a client with an intellectual disability and the needs of her family, and the role played by a specialist, Disability Health Service. The key elements of this successful interagency collaboration are outlined and include good communication, adequate resourcing, and a willingness to resolve dynamic tensions and learn from each other.
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5/13. Engaging dual diagnosis patients into treatment: the T.E.E.A.C.H. program.

    This article outlines a model for engaging dually-diagnosed patients into treatment, particularly those patients in the precontemplation and contemplation phases of treatment. The model first focuses on the development of a positive therapeutic relationship with the patient. It then helps patients to realize both the positive and the negative aspects of their substance use. By acknowledging this central conflict and their ambivalence about using, and delivering hope that patients can learn other ways to obtain the benefits of their substance use without the negative consequences, patients can be engaged into treatment and helped to begin the process of change.
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6/13. Unrecognized substance misuse: clinical hazards and legal vulnerabilities.

    This paper explores clinical psychologists' relative lack of attention to alcohol and other drug problems, and examines clinical consequences as well as legal vulnerabilities. The ease with which manifestations of substance abuse readily imitate every other entity seen in clinical practice allows both use and abuse to influence treatment in ways which remain often unrecognized. borderline personality disorder is a common example. Failure to assess and appropriately treat or refer places the psychologist in an increasingly untenable position, especially as sophistication about alcohol and drug problems increases among other professionals and the lay public. The paper outlines sources of legal vulnerabilities, such as negligence and deviation from the standard of care, as they could be arise in substance abuse cases.
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7/13. Drug dependence and pregnancy: antenatal and intrapartum problems.

    The last decade has seen an increase in the use of illicit drugs and alcohol in the community including an increase in the use of these agents by women in the reproductive age group. With this in mind, health-care workers need to avoid being complacent in caring for these women--they are a high-risk obstetric population with a significant incidence of medical, obstetric and paediatric complications. This paper concentrates on the antenatal and intrapartum problems, and outlines their management. An overview of the problem is presented as well as an illustrative case report.
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8/13. family issues in working with chemically dependent adolescents.

    The authors review research describing family dynamics in adolescent chemical abuse and dependency. family systems theory is outlined, suggesting that family members, parents in particular, be included in accurate diagnosis and effective treatment. The pediatrician is viewed as having a relationship of trust with parents, being in a unique position to provide counsel, direction, and referral. Specific treatment strategies are recommended and illustrated with case studies.
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9/13. The spectrum of fetal abuse in pregnant women.

    Physical assault by a woman or her partner upon their unborn child has received minimal attention in the psychiatric or obstetric literature. The spectrum concept facilitates the application of knowledge about one type of fetal abuse (e.g., physical assault in response to fetal movements) to other types (e.g., neglect or failure to protect the fetus from chemical assault by alcohol, nicotine, or drugs). Three illustrative case histories are presented, including two cases of assault by the mother via the anterior abdominal wall. Fetal abuse may be one antecedent of child abuse, and this paper attempts to transpose the known correlates of child abuse into an antenatal time framework. The resultant preliminary etiological model also draws upon research findings from neonaticide, the psychology of pregnancy, and the psychology of aggression. In addition, recent research on the maternal-paternal-fetal triad is reviewed in an attempt to delineate under what circumstances ambivalence in the parental-fetal relationship may find expression as fetal abuse. The characteristics of individuals most at risk of perpetrating fetal abuse are outlined.
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10/13. Alcohol and other drug abuse in elders.

    With the growing population of older persons, ET nurses can expect an increasing number of elderly clients in their practice settings. Elderly persons are not immune to alcohol and other drug abuse. Detection of substance abuse in this population is complex and often missed. The purposes of this article are as follows: (1) examine barriers that may prevent nurses from addressing substance abuse among the elderly population; (2) suggest risks for psychoactive substance abuse in this population; (3) identify warning signs that should alert nurses to the problem; and (4) outline treatment options for substance-abusing clients.
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