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Mental Illness and Substance Abuse

Clinical evidence suggests that women with mental illness or substance abuse are more likely to be abandoned by their partners than are men with similar problems (Beckman and Amaro 1986 Lex 1991). In Latino families, the stigma of mental illness and substance abuse is often increased for women because of their inability to meet expectations such as primary caregiving of children and nurturing the rest of the family. Latinas are therefore at risk for losing an important source of support, as well as an important source of self-esteem in fulfilling expected roles in the family.

Epidemiology of Substance Abuse

Although it is not within the scope of this chapter to discuss at great length the epidemiology of substance abuse among Hispanic Americans, it must be understood that drug use patterns vary by Hispanic subgroup, age group, and region of the United States. Research has found that substance use among Hispanics is generally lower than that among white non-Hispanic individuals, although Hispanic use may be higher for some substances (cocaine, crack cocaine, heroin) (Chavez and Swaim 1992). The variations in much of the literature may be due in large part to the cultural diversity and inherent complexity of the Hispanic population (Chavez and Swaim 1992). The reader is referred elsewhere (National Institute on Drug Abuse 1995 Ruiz and Langrod 1997) for a detailed epidemiology of the specific drugs used by various Hispanic subgroups. Alcohol and other drug use has been found to be a high predictor of attempted suicide among Puerto Ricans (Fernandez-Pol et al. 1986). The higher rates of...

Etiology of Substance Abuse

Drug use among Hispanic Americans is a complex and multidetermined behavior. The literature (Ruiz and Langrod 1997) that exists on this subject suggests that significant factors in the etiology of addiction among Hispanics are socioculturally related to a considerable extent. Although an in-depth discussion of economic and social policy lies outside the purview of this chapter, it must be emphasized that they are of paramount importance in any attempt to discern the etiology of substance abuse in the Hispanic population. In analyzing the various conditions that predispose Hispanics to substance abuse, it is undeniably clear that poverty is the single greatest risk factor. Family poverty is inextricably linked to high rates of drug use and academic failure. The condition of poverty immeasurably intensifies the suffering and adversity experienced by the Hispanic substance abuser by amplifying the In concluding this discussion of the factors relevant to substance abuse among Hispanics,...

Principles of Substance Abuse Treatment

A central doctrine in the drug treatment of Hispanic Americans is the need to match the patient to the most appropriate form of care. Unfortunately, the one-size-fits-all approach to substance abuse treatment is still evident in many clinics throughout the United States. These treatment agencies often lack Spanish-speaking, culturally competent staff who understand and are sensitive to the particular cultural characteristics of their patients. Because it is frequently not possible to have a bilingual and bicultural therapist available, the therapist assigned to a Hispanic patient should be at least knowledgeable and understanding of Hispanic cultural values and beliefs. The ability of the therapist to effectively integrate the value systems of the Hispanic individual and of United States society as they relate to the substance abuse problems of the patient is crucial. It is equally vital to be on guard against making assumptions of the patient's needs and potential response to...

Cultural Issues in Substance Abuse Treatment

The literature on the subject of substance abuse among Hispanic Americans suggests that cultural factors play a prominent role in initiating and maintaining drug use (Kail 1993). A distinctive characteristic of Hispanic culture is the importance of the family. Familismo is the trait that describes the family as the center of social support and characterizes it as a source of solidarity, cohesive-ness, and emotional closeness (Sanchez Mayers and Kail 1993). Family members are imbued with a strong sense of responsibility to one another. It is relevant to mention that although a strength of the Hispanic person is the importance of the family unit, this cultural trait also may discourage help seeking in the Hispanic drug user. Consequently, preventive and treatment efforts must include the family, whenever possible, but especially when adolescents are identified as substance abusers. One of the most extensively studied of all cultural constructs of Hispanics is acculturation, which refers...

Work Related Conditions and Health

European researchers and, to a somewhat more limited extent, U.S. researchers. Although longitudinal studies of European populations have demonstrated a significant relationship between unemployment and higher standardized mortality ratios (SMRs), even after adjusting for age and social status (Moser et al., 1984, 1986, 1987 Costa and Segnan, 1987 Iversen et al., 1987 Martikainen, 1990 Kasl and Jones, 2000 Stefansson, 1991), U.S. data based on the U.S. National Longitudinal Mortality Study (Sorlie and Rogot, 1990) have shown no significant association between age, education, and income-adjusted SMRs and unemployment for either men or women. However, other U.S. epidemiological findings associate unemployment or risk of job loss with health conditions such as depression and engagement in negative health behaviors such as substance abuse, poor diet, and inactivity (Dooley et al., 1996). Analysis of panel data from the U.S. Epidemiologic Catchment Area study suggested that the 1-year...

Chlorpromazine Trade name Thorazine A

Still other studies have suggested that egg yolk (a dietary source of choline) may be useful to patients suffering from memory problems and seem to show an improvement in alcoholics and drug addicts. The major dietary source of choline is lecithin foods rich in lecithin include eggs (average size), salmon, and lean beef. While some researchers dismiss the idea that eating these foods can significantly improve memory, other scientists note at least that a normal level of lecithin in the diet may not be enough as people age.

Referral to Mental Health Professionals

Several types of mental health professionals are available, including psychiatrists, psychologists, social workers, and nurse therapists. The nature of the clinical problem should determine which of these is most appropriate to treat an anxious patient. For example, prompt referral to a psychiatrist is indicated if the patient has severe symptoms that impair daily functioning or are associated with suicidal thoughts. A psychiatrist should also be selected when there is diagnostic uncertainty when advice is needed about medications when the patient has complicated medical comorbidity when another psychiatric condition, such as major depression, substance abuse, or personality disorder, is present and when the anxiety is due to OCD or posttraumatic stress disorder. In addition, psychiatrists should be able to design pharmacologic treatments for patients whose disorder has failed to respond completely to initial medication trials by primary care physicians.

Studies on Central Pain Syndrome

14 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Community Programs for Clinical Research on AIDS

Broadly speaking, there are two positions on disseminating information about AIDS and AIDS prevention. The first may be called the public health viewpoint and advocates providing complete information as widely as possible. The second, more moralistic view is that since the activities that lead to getting AIDS are morally unacceptable, information about them should not be widely publicized. Among people holding this view, advocating abstinence or saying no to drug use are strongly, even exclusively, favored as AIDS prevention techniques. For those holding the first view, vocabulary is important because it may determine the success of any attempt to overcome public discomfort or hostility to honest and open discussion. The language of AIDS has therefore been evolving toward a more neutral or medical-sounding usage. Examples include prostitutes (now referred to as commercial sex workers) AIDS patients victims (people with aids) drug addicts (injection drug users) promiscuity (multiple...

Scope of Agency Responsibilities and Activities

At both the state and local levels, there are differences among public health agencies in terms of the scope of their authority, responsibilities, and activities. At the state level, activities such as immunization, infectious disease control and reporting, health education, and health statistics are common to most public health agencies. States are also responsible for licensing and regulating the institutional and individual providers that deliver health care services. However, states differ in whether the public health agency has responsibility for programs such as mental health and substance abuse, environmental health, and Medicaid. These organizational differences make it more complicated to frame and pursue a coherent national agenda concerning changes and improvements in the governmental public health infrastructure. disease control, community assessment, community outreach and education, environmental health services, epidemiology and surveillance, food safety, health...

Organization of the Federal Public Health Infrastructure

At the federal level, the lead entity responsible for public health activities is DHHS. Several key agencies in DHHS comprise the U.S. Public Health Service (PHS) the Agency for Healthcare Research and Quality, CDC, the Agency for Toxic Substances and Disease Registry (ATSDR), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), IHS, the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, various White House agencies such as the Office of Science and Technology Policy and the Office of National Drug Control Policy, 14 cabinet-level departments and agencies (e.g., Department of Agriculture, Department of Transportation, EPA, Department of Veterans Affairs VA , and Department of Defense DOD ), and more than 10 public corporations and commissions and subcabinet agencies are responsible for certain health programs.

Incidence of Mental Illness

In 1996, a large-scale nationwide mental health and substance abuse epidemiological study was conducted by researchers from the University of Antioquia and the University CES of Medellin. Funded by the Ministry of Health and working with a national team of more than 100 interviewers, the researchers interviewed a random sample of 15,046 individuals older than 12 years of age across the country, using the Clinical Diagnostic Inventory II questionnaire, which is based on the DSM-IV classification. This is the most comprehensive mental health study ever conducted in Colombia. The lifetime prevalence of diagnosable disorders was as follows nicotine dependency, 28 major depression, 19.3 alcohol abuse and dependency (combined), 16.6 posttraumatic stress disorder, 4.5 somatization, 4.3 generalized anxiety, 3.8 and schizophrenia, 1.4 . The lifetime use of marijuana was 7.8 and of cocaine 2.5 (Torres and Montoya 1997). Suicide is also a public health problem in 1995, a total of 58,830 suicides...

Suicide and Psychiatric Disorders

When investigators in different countries examine the medical records and interview the family and friends of people who have died by suicide, they find the same result almost everyone who commits suicide had signs of a psychiatric disorder, and about half had sought psychiatric help in the past. The posthumous diagnoses most often are affective disorders (major depression or bipolar disorder), substance abuse disorders, personality disorders, and schizophrenia. At least two-thirds of persons who committed suicide had symptoms of major depression before death.

Federally Funded Research on Seizures and Epilepsy

18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Alcohol and Substance

Cuban Americans' socioeconomic conditions have permitted them to do well with respect to access to health and mental health services (Ruiz 1994 Ruiz et al. 1995). It has been found that the incidence of psychiatric illness among Cuban Americans does not differ from its incidence among other Hispanic-American subgroups, with the exception of substance abuse and alcoholism.

The Doctorpatient Relationship

The ability to listen, understand, explain, advise, and educate are central to the role of an internist. Without strong interpersonal skills, it would be difficult to diagnose an underlying substance abuse problem, help a patient start an exercise program or quit smoking, encourage healthier eating habits, or guide a patient's decision to sign a do-not-resuscitate order and abandon aggressive treatment. Through comprehensive history and physicals, internists spend a great deal of time with their patients talking with them and gaining insight into their lives, their values, and their concerns. Physicians with these qualities will establish lifelong, trusting relationships with their patients.

The Expansion Of Health

Over the past decade GPs have moved away from their traditional commitment to the individual patient to take on a wider role in tackling the problems of society. The treatment of drug addicts is one example of this trend, which is leading to a transformation in the nature of medical practice as GPs take on some of the concerns of the criminal justice system. The expanding scope of general practice extends into the field of mental health, a territory that has itself expanded through the annexation of more and more areas of personality and behaviour under psychiatric disease labels. We focus here on the expansion of the concept of addiction and at the way this has contributed to the growing medicalisation of society. We look finally at the treatment of these problems in general practice, through counselling and medication and at the consequences of these developments for both doctors and patients.

Sustaining Community Action On Health

The sustainability of health improvement efforts is reflected in the extent of community change and the degree to which initiatives remain in place after funding ends (Paine-Andrews et al., 2000b). A study of six community initiatives, three for teen pregnancy and three for substance abuse prevention, found that after the end of a 5-year grant period, at least a quarter of the activities initiated in each of the six projects were continuing. These activities included mentoring programs and an annual youth job fair, as well as alternative activities (Paine-Andrews et al., 2000b). Among the strategies for sustainability of initiatives identified by the study were grant writing, making a business plan, and integrating programs or individual program components into the regularly budgeted activities of a partner agency (Paine-Andrews et al., 2000b).

Communication Disorders in Infants and Toddlers

Early intervention services under Part C is decided by each state's lead ICC, and as a result, varies from state to state. Eligibility is often determined by the presence of a developmental delay in physical, cognitive, speech and language, social or emotional, and adaptive (i.e., self-help) skills or eligibility may be based on the degree of risk that the child has for developing a delay. There are three types of risks established risk, biological risk, and environmental risk. In the case of established risk, a child displays a diagnosed medical condition, such as Down syndrome, fragile X syndrome, or Turner's syndrome, that is known to influence development negatively. Children with an established risk qualify for early intervention services. In contrast, a child who is biologically at risk exhibits characteristics (e.g., very low birth weight, otitis media, prematurity) that may result in developmental difficulties. A child with an environmental risk is exposed to conditions that...

Methadone maintenance

At the very time, in the mid-1990s, that I was coming to the conclusion that prescribing methadone was not a useful way of treating drug addicts, GPs came under renewed government pressure to participate in a more comprehensive drug treatment programme. The sequence of events leading up to the current large scale prescribing of methadone in general practice reflects not only a significant change in the management of drug abuse, but also a transformation in the nature of general practice. The government White Paper Tackling Drugs to Build a Better Britain, published in 1998, and the 'guidelines on clinical management' published the following year, proclaimed the leading role of GPs in managing drug abuse and the virtues of 'methadone maintenance treatment' (President of the Council 1998 DoH 1999). This marked a significant shift away from the earlier strategy of encouraging GPs to refer drug addicts to specialist centres. It also reflected the ascendancy of what has been dubbed the...

Collaboration With Governmental Public Health Agencies

The failure to collaborate characterizes not only the interactions between governmental public health agencies and the organizations and individuals involved in the financing and delivery of health care in the private sector but also financing within the federal government. Within the Department of Health and Human Services (DHHS), the Centers for Medicare and Medicaid Services (CMS) administer the two public insurance programs with little interaction or joint planning with agencies of the U.S. Public Health Service (PHS). Even the congressional authorizing committees for these activities are separate. For example, the Substance Abuse and Mental Health Services Administration, a PHS agency, administers block grants to states to augment funding for mental health and substance abuse programs, neither of which is well supported under Medicaid. Until recently, the Medicaid waiver program, administered by CMS on behalf of the Secretary of Health and Human Services, did not provide...

Management trials 301

Patients insured under the medicaid or medicare programs also are experiencing a growing shift toward mandatory managed care plans, although many state Medicaid programs have little experience providing HIV care under this new type of system. Managed care presents particular problems for both HIV specialists and HIV AIDS care. First, most persons with HIV AIDS, even if they are treated initially by a primary care physician, eventually become the patients of an AIDS specialist. Studies have demonstrated that experience of primary care physicians in the management of AIDS is significantly associated with survival of their patients. one of the hallmarks of managed care is the gate-keeping function of the primary care physician referrals to specialists are closely monitored and often reluctantly granted. The supply of primary care physicians is inadequate, and many of those already in practice are not trained in state-of-the-art HIV AIDS management. Limiting the choice of primary health...

Learning Disabilities Association

Treatment for learning disabilities is extremely important if the child is to be successful. In fact, 35 percent of students with untreated learning disabilities do not finish high school. Most students with learning disabilities were not fully employed one year after graduating from high school. Adolescents with untreated learning disabilities are at higher risk for drug and alcohol abuse. One study showed that up to 60 percent of adolescents in treatment for substance abuse had learning disabilities.

Understanding Complex Partial Seizures

Summary Understanding Complex Partial Seizures is a 14-minute videotape about the nature of complex partial epileptic seizures. Complex partial seizures are often different from the typical tonic-clonic generalized seizures that people often associate with epilepsy. Because of this, they may be difficult to recognize or diagnose as seizures. Complex partial seizures are caused by brief electrical disturbances in the brain and are characterized by a loss of awareness, sometimes accompanied by specific or repeated motor activities or verbal activity. Studies of individuals with complex partial seizures have led to an increased awareness and understanding of the condition, but complex partial seizures are so varied they can be misdiagnosed. Each individual tends to have his or her own characteristic pattern of activity during seizures. Sometimes this is easily recognized as a seizure, but often it is not. Complex partial seizures are sometimes misinterpreted as behavior problems or...

Studies on Post Polio Syndrome

17 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Pelvic inflammatory disease 385

Ment of behavioral, developmental, and functional social problems. With structured evaluation and early intervention, the primary care pediatrician can identify and address the developmental and behavioral issues related to poverty, violence, personal and familial substance abuse, and single-parent households.

Benzodiazepines A Question of Abuse vs Therapeutic

Current reports based on substance abuse treatment admissions also lend support to a recent increase in benzodiazepine use. Based on findings from the Treatment Episode Data Set (TEDS), an annual compilation of patient characteristics in substance abuse treatment facilities in the US, admissions owing to primary tranquilizer use (including, but not limited to, benzodiazepine-type drugs) increased 79 from 1992 to 2002 (27). For both the DAWN and TEDS data sets, a primary characteristic of the abuse of benzodiazepine-type drugs was that they were combined with other substances (usually alcohol) in the majority of cases.

Baltimore Site Visit July 2001

The Sandtown-Winchester community of Baltimore, Maryland, is a largely African-American, 72-block urban community of 10,500 people that has experienced significant rates of substance abuse, unemployment, and other problems. The Vision for Health (VFH) Consortium emerged from a comprehensive neighborhood transformation program begun in 1990 by the Community Building in Partnership, Inc., a partnership among Sandtown-Winchester residents, the mayor, and the city government, with funding from the Enterprise Foundation and a neighborhood block grant from the city. At the end of a 2-year process of planning, assessing, and discussing community needs, health (particularly substance abuse issues, children's health, chronic disease, HIV AIDS, and homicide) emerged as an area of high community priority, second only to education. The goals of the Community Building in Partnership, Inc., initiative were to transform a range of community systems that seemed inadequate or ineffective in addressing...

New Hampshire Site Visit November 2001

CCNTR has six main objectives, including (1) improving access to health and mental health care (2) establishing programs to lower youth risk behaviors related to substance abuse and other issues (3) health promotion and disease prevention (4) community public health improvement (5) increasing social capital, engagement in community health, and development and (6) supporting the basic needs of individuals and families. There has been some progress in both planning and implementing activities in most areas. In 1998, for instance, CCNTR conducted a large-scale community needs assessment that revealed youth risk behaviors as a major issue, especially because teens do not have many available activities or opportunities for after-school and extracurricular entertainment. As a result, the community and CCNTR developed three strategies for addressing risk behaviors. The first two, which have already been funded and initiated in several communities, include school-based prevention curricula...

Sexually transmitted disease 447

Level, STD HIV prevention methods include adding HIV STD education to the information taught in schools, improving the quality of STD HIV counseling and treatment among primary care providers, and increasing access to reproductive health care among those who are uninsured. Expanded access to substance abuse treatment may have an indirect effect on STD prevention at the community level as expanded services decrease an important driving force for high-risk sexual behavior.

Jo Ellen Brainin Rodriguez MD

IN THIS CHAPTER, I review the literature on Latina women and discuss treatment approaches that are culturally congruent. I emphasize the heterogeneous nature of the Latina population and identify critical issues to incorporate into the clinical assessment. I also cover the effect of migration, mental illness, and substance abuse on Latinas and comment on developmental gender issues. Last, I touch on resistance and feminism in the Latina community, which has become an important mental health resource.

Committee Biographies

Pablo Hernandez, M.D. (Wyoming Mental Health Division), has been the hospital administrator at the Wyoming State Hospital since 1995. On June 1, 1997, he was appointed as the Behavioral Health Division Administrator (now known as the Mental Health Division) for the Wyoming Department of Health, which encompasses the State Hospital and the state's community programs. Dr. Hernandez received a medical degree from the Salamanca Medical School in Salamanca, Spain. His clinical career began in 1968 in the state of Virginia, where he was director of gerontological services. He moved on to the state of Mississippi, where he spent the next 14 years establishing community-based service programs as well as active psychiatric treatment modalities and substance abuse services. He also served as the director of the East Mississippi State Hospital and the Las Vegas Medical Center in Las Vegas, Nevada. Dr. Hernandez has served on multiple state and national committees addressing issues of persons...

Louis R Alvarez MD MPH

SUBSTANCE ABUSE IS CONSIDERED by many to be the number one public health problem in the United States (Botvin et al. 1995). More deaths, illnesses, and disabilities are caused by substance abuse than by any other preventable health condition (Schneider Institute for Health Policy, Brandeis University 1993). Significant segments of the Hispanic American population have been devastated by alcohol and drug abuse (Soriano 1994). Hispanics are among the most severely affected of all groups because of unique sociocultural conditions. For many Hispanics, drugs and alcohol are major social anesthetics from the pain of poverty, discrimination, and underemployment. The increasingly conservative tenor of the times, reduced access to health care, inadequate health insurance coverage, and disproportionately less federal spending on treatment than on law enforcement are fueling the substance abuse crisis among Hispanics (Greig 1996). The Hispanic population will more than triple in size from 24...

Adult Attachments and Relationships

Attachment styles continue after infancy (Hazan & Shaver, 1994). Attachment in adulthood helps regulate emotion and reduce stress (Feeney & Kirkpatrick, 1996 Silverman, 1998). In the language of another theorist, Erik Erikson, infant relationships provide a person with an enduring sense of trust or mistrust of people that remains significant throughout life. Researchers have found that, indeed, securely attached adults feel more trust toward their partners than do those without secure attachment (Mikulincer, 1998b) and are able to resolve conflicts within relationships more maturely (Corcoran & Mallinckrodt, 2000). They also describe their parents more positively (Levy, Blatt, & Shaver, 1998). Adolescents hospitalized for psychiatric disorders are reported to be insecurely attached, as are their mothers (Rosenstein & Horowitz, 1996). Furthermore, the specific kind of insecure attachment predisposes individuals to particular kinds of psychiatric disorders. Dismissing attachment, in...

The Idealized Self Moving away from the Real Self

Not all perfectionists are suicidal, of course. Some have high self-esteem and are able to strive successfully for achievement, and they are not at risk (Adkins & Parker, 1996 Rice, Ashby, & Slaney, 1998). It is when perfectionism is accompanied by other indicators of dysfunction, such as mood disorders, anxiety, and substance abuse or dependence, that it may turn self-destructive (Dean & Range, 1996 Gould et al., 1998). For example, exercise is healthy, but the extreme exercise patterns of some eating-disordered patients and male body-builders is not (Blouin & Goldfield, 1995 Davis et al., 1998 Shafran & Mansell, 2001). Even if they succeed, perfectionists may feel like impostors (Henning, Ey, & Shaw, 1998). Bernard Paris (1999) conveys wise advice Horney recognized that the absolute best is the enemy of the good, that we must not disregard our accomplishments because we have failed to attain perfection.

Fiingers Tridimensional Model

The first temperament trait, novelty seeking, is proposed to be related to levels of the neurotransmitter dopamine (with low levels of dopamine producing greater novelty seeking). It selves as a behavioral activation system. People high in novelty seeking become more excited in response to novel stimuli, and they explore their environments more. They report that they often try new things for the thrill of it and that they seek excitement. In a double-blind placebo-control study, people with higher Novelty Seeking scores reported greater mood elevation to amphetamine than those scoring low (Sax & Strakowski, 1998). In mice, exploratory behavior (which is analogous to human novelty seeking) increases when dopamine is increased (Sabol et al., 1999)- Novelty seeking, which can lead to impulsive behavior, tends to run in families (Sher & Wood, 1995). Novelty seeking is higher among those with drug abuse, although sometimes substance abuse is produced by the second genetic trait, harm...

Longitudinal Studies of Attachment

A representative sample of LT.S. adults provides considerable support for the claim that parents have an impact on their children's attachment. Having warm parents and protective fathers bodes well for adult attachment. Adults were less likely to be securely attached if, in childhood, their parents had suffered various forms of psychopathology (including depression, anxiety, and substance abuse), committed suicide, died, or were absent for long periods of time. Other traumas and hardships also were related to insecure attachment physical and sexual abuse, neglect, accidents, natural disaster, financial adversity, and other distressing events. This same study also finds that adults who are securely attached are more mentally healthy. They are less likely than avoidant or

About the Barratt Impulsiveness Scale

Support his informal observations, he collected evidence that did indicate that psychiatric patients, and especially those with substance abuse problems, were likely to be impulsive people. The potential problems associated with saying almost always to several of the items on the test seem obvious. Clearly, someone who consistently does things without thinking, or who finds it difficult to concentrate easily, will have problems in day-to-day life. Interestingly, the relationship between some items and impulsiveness is not at all obvious. Item 4, for instance, which states, I am happy-go-lucky, may not seem to have much to do with impulsiveness but it was included on the test because Barratt found that impulsive people were indeed more likely to endorse this item than nonimpulsive people.

Communitybased Collaboration

Privately funded community public health improvement grant programs and Center for Substance Abuse Prevention programs, which support community-based substance abuse prevention systems that involve community coalitions and intersectoral collaboration (Lasker et al., 2001).

Speech Disorders in Children Birth Related Risk Factors

Children with hearing impairment and those with Down syndrome are two relatively large populations with birth-related conditions and factors that are likely to experience future speech disorders (see mental retardation and speech in chiLdren). Two additional relatively large populations of newborn children likely to experience future speech disorders are those born underweight and those whose mother engaged in substance abuse during pregnancy. Approximately 36 -41 of women in the United States abuse illicit drugs, alcohol, or nicotine sometime during pregnancy (Center on Addiction and Substance Abuse, 1996). Illicit drugs account for 11 of this substance abuse, and heavy use of alcohol or nicotine accounts for the other 25 -30 . Approximately three-quarters of pregnant women who abuse one substance also abuse other substances (Center on Addiction and Substance Abuse, 1996). For example, a pregnant woman who abuses cocaine might also drink heavily. When alcohol is an abused substance,...

Studies on Occipital Neuralgia

15 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

The Prognosis of Anxiety Disorders

Patients with panic disorder have been found to be symptomatic for 16 percent of their lives after the onset of their illness. For panic disorder with agoraphobia, the figure is 29 percent. Despite this relatively good prognosis, the relapse rate in panic disorder is 80 percent within two years after stopping treatment, and up to 20 percent of patients are chronically ill. Patients with agoraphobia, major depression, substance abuse, or personality disorders have poorer treatment outcomes, as do those who discontinue

Project Title Disruption Of P53 Pathway In Pediatric Adrenal Cancer

26 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Selecting the Right Medication

Antidepressants are the second medications to consider. I prescribe these if benzodiazepines don't work or have unacceptable side effects. In addition, I sometimes use antidepressants in special situations, such as for people who have respiratory disease or untreated sleep apnea, a history of substance abuse, or a coexisting emotional problem.

Anesthesiologists And Drug Addiction

Drugs).3 Regardless of drug or practice environment, physician substance abuse is a serious and universal problem. Because physician drug addiction is a concern in every specialty, this issue should not discourage medical students from considering anesthesiology. But medical students who have a personal history of substance abuse, whether of alcohol or illicit drugs, should be wary of the possible occupational hazard in anesthesiology. Because of the daily temptation, recovery and re-entry into the operating room environment can be exceptionally difficult. Most departments of anesthesiology have developed excellent mechanisms to identify individuals who may be susceptible to addiction. After all, the consequences are quite damaging. Depending on the point of their career, addicted anesthesiologists can lose their medical license, job, residency program position, or, at the worst, their life. A recent mortality study found that anesthesiologists are, compared to internists, at twice...

Counselling and Prozac

Doctors of all sorts, notably psychiatrists and GPs, have helped to encourage the inflation of addiction and other psychological disorders and the demand for medical or psychological treatment that follows from it. Experts are continually advising us of the need to identify problem drinkers and others with 'substance abuse' problems so that they can be offered appropriate treatment. In 1992 the Health of the Nation white paper identified mental health as a key area and, for the first time, set targets on reducing the suicide rate. The neglect of any means of achieving this (or indeed its other targets) meant that this policy had little consequence, but this defect was remedied when the New Labour government after 1997 also established a target. It also sponsored a 'Defeat Depression' campaign, which sought to encourage GPs to increase their diagnosis of depression, in the hope that this would facilitate treatment and thus reduce the suicide rate. Treatments on offer in the surgery...

Acknowledgements

The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to seizures and epilepsy. All of the Official Patient's Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the...

Case Presentation

His medical history is also noteworthy for a diagnosis of small cell lung carcinoma that was treated with radiation and chemotherapy 7 years ago. He had metastasis involving his brain with multiple strokes and transient ischemic attacks secondary to whole-brain radiation in 1998. He has only mild residual deficits secondary to these multiple strokes. Additionally, he has hypertension and a history of substance abuse.

Taking a History

The physician should also assess past psychiatric illnesses other than mood disorders. Panic disorder, eating disorders, and obsessive-compulsive disorder may be associated with major depression and occasionally are its earliest manifestation. Moreover, substance abuse is seen in up to a third of patients with major depression or bipolar disorder, and treatment of the mood disorder will not be successful if substance abuse persists.

Benefit

Behavioral techniques One of several types of activities that constitute effective HIV prevention. Others include HIV treatment interventions and other medical interventions, such as timely treatment of STDs, substance abuse treatment, and psychiatric and mental health treatment for persons with psychological disorders or severe mental illness. Behavioral techniques include the promotion

Drug addict

Drug addiction is a psychic and physical state encompassing a compulsion to take a given drug on a continuous or periodic basis in order to experience its pleasurable effects or avoid the discomfort of its absence. Tolerance may or may not be present, and a person may be dependent on more than one drug. Drug addicts run a number of serious risks aside from organ damage and other long-term destructive effects, users may have serious reactions to unknown substances present in illicit drugs, and hepatitis and AIDS can be transmitted through the use of dirty needles and syringes.

Geriatrics

Other areas that family physicians have chosen for specialty training (but not necessarily through formal accredited fellowships) include preventive medicine, research, substance abuse, palliative care, primary care outcomes research, occupational environment medicine, community medicine, health policy, informatics, family systems medicine, medical education, public health, minority health policy, osteopathic manipulative medicine, health psychology, family planning and reproductive health, emergency medicine, patient-doctor relationship, and family medicine hospitalist.

HIV genome

Some 30 percent of people with HIV disease experience minor cognitive impairment, and 20 percent have a serious deficit, affecting their ability to function in social or occupational settings. Because the primary involvement of the illness is seen in subcortical regions of the brain, some people refer to this as white matter disease. Nearly 80 percent of HIV patients who have autopsy of the brain after death show evidence of some CNS disease process. The action of the illness is similar to the involvement profile seen in Parkinson's disease and Huntington's disease, and not like that seen in Alzheimer's disease. The major difference between Alzheimer's disease and HIV encephalopathy is that HIV patients typically remain well oriented in their day-to-day lives. If patients show sudden changes of orientation or display quick deterioration, this may be the result of drug reactions or other illnesses such as cryptococcosis, toxoplasmosis, CYTOMEGALOVIRUS INFECTION, drug...

Adolescent Medicine

In this growing subspecialty, prominent areas of prevention and treatment include substance abuse, eating disorders, acne, sexually transmitted diseases, pregnancy, and depression. In addition, adolescent medicine emphasizes the management of chronic diseases that begin in childhood and continue into adulthood, such as asthma, cystic fibrosis, congenital heart disease, and diabetes. Practice settings include high school- and university-based student care centers, mobile clinics, and outpatient clinics. Many adolescent medicine specialists work within large academic medical centers or in the public health sector.

Clinical Diagnosis

Certain headache disorders appear to relate to the nature versus nurture hypothesis with evidence to support both heritable and acquired etiologies. The family history should include both headache and systemic medical disorders through second-degree relatives. Assessment of familial migraine, TTH, temporomandibular joint disease, intracerebral neoplasia, psychiatric illness, and substance abuse may suggest a congenital headache disorder. Alternatively, the patient's social history may unearth a pattern of maladaptive behaviors that may influence the headache symptomatology. A discussion of smoking, alcohol, and drug use is recommended, in addition to day-to-day stressors such as occupation, finances, marriage, and family.

Lesbian 281

Many lesbians have been personally affected by AIDS-related deaths or illnesses of people close to them. The AIDS epidemic raises the need to address problems of substance abuse, and especially Iv drug abuse, in the lesbian community. Insemination choices and coparenting options have been limited by AIDS. Many lesbians are involved in AIDS-related work as volunteers and paid workers. Lesbian contributions have strengthened and enriched the entire gay and lesbian community and furthered the fight against AIDS.

Malpractice

Note that gynecologic problems are common among HIV-positive women and are frequently present at the time of initial evaluation and care. Some gynecologic issues are unrelated to the patient's serologic status, whereas others are directly related to HIV disease and associated with immunosuppression. Still others are associated epi-demiologically with HIV because of common risk factors, such as sexual behavior or substance abuse. To date, breast cancer has not been related to HIV disease, associated with immunosuppres-sion, or associated epidemiologically with HIV. Nonetheless, along with routine gynecologic evaluations, pap smears, STD screening, and sigmoi-doscopy colonoscopy, routine mammography is one of the core components of a sound health maintenance program for women. managed care The goal of containing costs by coordinating care through a gatekeeper, or general practitioner who decides on all referrals. Employers increasingly are choosing managed care plans to cut costs even...

Pregnancy 389

Potential variables in vertical transmission have been identified. These include HIV-related factors, such as HIV RNA level strain variation (genotype) biologic growth characteristics (phenotype) plasma versus genital tract viral load genotypic resistance CD4 cell count and maternal immune response. Maternal and obstetric factors have also been identified clinical stage, STDs or other coin-fections, vitamin A deficiency, substance abuse, cigarette smoking, antiretroviral agents, sexual behavior, gestational age, duration of membrane rupture, placental disruption-abruption, chorio-amnionitis, invasive fetal monitoring, episiotomy, forceps use, and vaginal versus cesarean delivery. Finally, fetal neonatal factors have been identified, including immune system immaturity and genetic susceptibility.

Mental Health Issues

A study of hospital epidemiology in Lima showed that the prevalence of substance abuse was massively predominant among males, with an age at onset that reached a peak between 22 and 24 years. Being single, attending secondary education, being unemployed, and having an age at onset between 9 and 19 years were the most salient variables. Crack cocaine, marijuana, tranquilizers, stimulants, barbiturates, narcotics, and inhalants were the drugs abused most often. Personality problems, schizophrenia, and alcohol abuse were the most frequent comorbid disorders.

Prison 395

Prison The health problems, including HIV AIDS, tuberculosis, and sexually transmitted diseases, that increasingly affect correctional inmate populations pose difficult programmatic and fiscal challenges for the administrators and staff of prison and jail systems. Populations continue to increase in both federal and state facilities, but budgets are often frozen or declining for the facilities. In addition, the problems of substance abuse, high risk sexual activity, poverty, homelessness, and poor access to preventive and primary health care in the community cause many more problems than are faced in typical medical settings. Prisons consider themselves as control facilities and not medical facilities. So concern is primarily to control the people there and not to treat them for illness. Prisons have been known to be notoriously slow in offering medical treatment for illness, inefficient in providing prescriptions to

The Problem

With increasing use of opioids in pain management, opioid abuse, and diversion of prescribed drugs to illegitimate use are on the rise. Diversion of these important pain management medications from medical use to illegal market and abuse is overshadowing their legitimate use. Compared to other forms of substance abuse, prescription drug abuse tends to be a closet offense and often is not recognized until overdose mishaps occur or the users begin to exhibit cognitive or functional impairment. This forensic case highlights the problems associated with prescription opioid abuse.

Homosexuality

It has been widely reported in the media that gay and lesbian youth are at higher risk to complete suicide than other youth and that a significant percent of all attempted or completed youth suicides are related to issues of sexual identity. However, there are no national statistics for suicide completion rates among gay, lesbian, or bisexual persons, and in the few studies examining risk factors for suicide completion where an attempt was made to assess sexual orientation, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.

Botulism

Botulism, also known as sausage poisoning, results from the ingestion of food containing Clostridium botulinum spores that have germinated and produced botulin. In Poland in 2001, the morbidity rate was 0.1 per 100,000 and two deaths were reported (Przybylska, 2003b). Each year in the U.S., 110 cases are recorded, and it has been found that 25 of botulism is of food origin, 72 affects infants, and the rest is caused by wound infections among drug addicts. The onset of botulism starts up to 18 hours after ingestion of contaminated food. Symptoms do not include vomiting or diarrhea, whereas paresis or oculogyric, facial or other nerve paralysis will occur. Anisocoria and double or blurred vision, dropping eyelids, salivation, slurred speech, difficulty in swallowing, bloating, abdominal pains, and increasing symptoms of paralytic occlusion are typical for botulism. Headaches and trouble with urination are also observed. Symptoms are usually not accompanied by fever.

Outlook

Treatment for learning disabilities is extremely important if the child is to be successful. in fact, 35 percent of students with untreated learning disabilities fail to finish high school. Most students with learning disabilities were not fully employed one year after graduating from high school. Adolescents with untreated learning disabilities are at higher risk for drug and alcohol abuse. one study showed that up to 60 percent of adolescents in treatment for substance abuse had learning disabilities. Even though learning disabilities cannot be cured, there is still cause for hope. Because certain learning problems reflect delayed development, many children do eventually catch up.

Mass suicide

In 1978 about 900 people, members of a religious sect called the People's Temple, died in Guyana, South America. Founded in California by Jim Jones, a faith-healing preacher, the sect comprised a motley group including drug addicts, the maladjusted, mentally afflicted, and some ex-convicts. When a group of relatives arrived determined to investigate the activities of the sect, the founder managed to convince his followers to drink a potion prepared by the medical officer, which contained potassium cyanide and was highly effective. Jones then shot himself.

Reporting Abuse

Some states also require others to report suspected abuse or neglect, including animal control officers, veterinarians, commercial film or photograph processors, substance abuse counselors, and firefighters. Four states Alaska, Arkansas, Connecticut, and South Dakota include domestic violence workers on the list of mandated reporters. About 18 states require all citizens to report suspected abuse or neglect, regardless of profession.

The demon drink

Couple of glasses of wine a day had a 'cardio-protective' effect, reducing the risk of coronary heart disease. Doll's paper provoked an angry denunciation from the director of the World Health Organisation's 'programme on substance abuse', whose response is quoted at the head of this section. The WHO was concerned that the publicity given to this study might encourage people to start drinking 'we are seeking to demystify the idea that alcohol is good for your health and to debunk the idea that to have a drink a day will keep the doctor away' (Craft 1994).

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