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In this book, I make a case that schools should graduate students who know how to engage boredom productively when it arises. Rather than simply avoiding boredom or helplessly blaming boredom on something or someone else, such students take responsibility for their boredom. They develop internal resources for contending with boredom; they are adept and diplomatic at challenging boring circumstances, and they are equipped at finding worthwhile activities and practices that alleviate boredom. Such students acquire a capacity to discern a creative middle way between boredom avoidance, on the one hand, and stultifying boredom endurance, on the other hand. This middle way, I will argue, is the practice of leisure.
In this chapter, I examine the dynamics of contemporary so-called leisure, which is largely how we attempt to ameliorate boredom. With contemporary leisure what appears to offer self-renewal and self-actualization actually advances a form of blissful self-obliteration that enables the despair that Kierkegaard alerts us to. I then turn to an alternative conception of leisure, which draws inspiration from classical sources. This tradition, which has evolved and developed in several cultural eras, traces a line from Aristotle to St. Benedict of Nursia to Thomas Aquinas up to more recent leisure visionaries, including Simone Weil and Josef Pieper. Rather than enhancing self-restoration, these writers contend, the vacancy and inaction of free time are prey to acedia – a spiritual and mental sloth. The classical leisure tradition takes direct aim at this tendency, cultivating practices of leisure which protect the self from falling into despair. The argument here is that contemporary leisure, as it is often understood and practiced, offers a temporary anesthetic that in the end intensifies existential boredom and despair. True leisure, by contrast, restores and renews the self, offering a powerful antidote to existential boredom and the despair that afflicts the self.
Addiction is a chronic yet treatable disorder. Patterns of addiction, whether substance related or behavioural, vary among countries and regions. Addiction medicine practice and approaches used in management are not only different from one country to another but are influenced by other factors, including environmental ones. The COVID-19 pandemic is one of the major environmental changes that had an impact on addiction. In this editorial, light will be shed on three articles covering recent updates in addiction medicine, ranging from types of substances and service provision to inclusion of gaming disorder in ICD-11.
Boredom is an enduring problem. In response, schools often do one or both of the following: first, they endorse what novelist Walker Percy describes as a 'boredom avoidance scheme,' adopting new initiative after new initiative in the hope that boredom can be outrun altogether, or second, they compel students to accept boring situations as an inevitable part of life. Both strategies avoid serious reflection on this universal and troubling state of mind. In this book, Gary argues that schools should educate students on how to engage with boredom productively. Rather than being conditioned to avoid or blame boredom on something or someone else, students need to be given tools for dealing with their boredom. These tools provide them with internal resources that equip them to find worthwhile activities and practices to transform boredom into a more productive state of mind. This book addresses the ways students might gain these skills.
The detrimental impact of stigma toward people with mental illness and substance use problems (MISUP) is well documented. However, studies focusing on stigma reduction in Latin American primary health care (PHC) contexts are limited. This situational analysis incorporating a socioecological framework aims to provide a comprehensive understanding of MISUP-related stigma in PHC centers in Brazil. The objectives of this analysis are twofold: (1) to understand the current mental health and substance use service delivery context and (2) identify challenges and opportunities for addressing MISUP-related stigma in PHC centers in Ribeirão Preto, Brazil.
Environmental scans of four Family Health Units were conducted in early 2018 to explore population needs and service delivery for individuals with MISUP. In addition, a symposium was organized in October 2018 to consult with diverse stakeholders and gather local perspectives about MISUP-related stigma conveyed in PHC settings. NVivo 12 software was used to conduct a thematic analysis of the qualitative data collected from the environmental scans and the symposium consultation.
Themes identified at the national level in the socioecological framework indicate that political support for national policies related to reducing stigma is limited, particularly regarding social inclusion and the decentralization of mental health services. Themes at the regional, organizational, and interpersonal levels include insufficient mental health expertise and the limited involvement of those with lived experience in decision-making. Suggestions for stigma interventions were provided, including increased contact with individuals with lived experience outside of client-patient interactions, capacity building for professionals, and public education campaigns.
Increased government support, capacity building, and promoting social inclusion will provide opportunities to reduce stigma and reach marginalized populations. These findings will assist with addressing current gaps in PHC mental health service provision and may inform anti-stigma strategies for Brazil and other Latin American low- and middle-income countries.
Although health care is generally designed to help people, it has the potential to effectively impede recovery for people using substances by obvious and subtle discrimination. Stigmatizing attitudes among health professionals are common, regularly expected by people who use substances and potentially reduce quality of delivered clinical care. The power gradient that drives stigma and discriminatory behavior is particularly palpable in the healthcare setting and prevalent within different clinical situations like emergency medicine, primary care, and the psychiatric ward as within language. Comprising the current evidence of interventions, specific clinical settings and language regarding substance use stigma, we suggest recommendations for changes in clinical practice. Professionals need to avoid inflicting very real harm by increasing shame and reducing self-worth through stigmatizing settings, language, and concepts. Reducing substance use stigma is an integral and profoundly important part of caring for people who use substances and should be considered as such.
Significant issues influencing the stigmatization of substance use disorders (SUDs), like the assessment of responsibility and need for respectful relationships, involve ethical concerns. Despite this, much civic and professional debate on the topic is poorly equipped to make sound ethical judgments. This predicament is influenced by a number of obstacles. Firstly, the medical or disease model that often dominates debates in the field is characterized by a reductive science focus. This does not embrace the idea that ethical debate has an important role to play in addressing stigma. Secondly, traditional bioethics tends to be individually focused and so overlooks the social and relational issues that require attention when seeking to support recovery from a biopsychosocial condition like SUDs. After assessing these challenges, it is argued that increasing ethics literacy, as part of a broader interdisciplinary response to the stigmatization of SUDs, is critical to impact meaningfully on civic and professional debates.
This chapter integrates different parts of the book. A general model of motivation involves dopamine underlying the 'wanting' part and opioids the 'liking' part. Humans (and other mammals) appear to strive to maintain their mood within a tolerable zone, if necessary, through addictive activities. A widely observed feature amongst sexual serial killers is an early history of abuse, bullying and taunting. Many killers have failed to develop any bonding with an adult caregiver. High levels of stress are evident throughout their lives. Stressors that seem to carry particular weight are those of humiliation in social interaction, where revenge might seem appropriate. Chronic stressors repeated over years can be distinguished from the acute stressors that often immediately precede a killing. Many heterosexual killers disapproved of what they perceived to be immorality of an important female, such as a mother or wife. Sibling rivalry and excessive drug/alcohol intake characterize some of those described here.
Prior research suggests that religiosity may be associated with healthier levels of mental health in certain domains (eg, higher self-esteem and lower rates of substance use problems). However, very little is known about religiosity and impulsive plus compulsive tendencies. This study examined associations between religiosity and impulsive and compulsive behaviors and traits among university students.
Nine thousand, four hundred and forty-nine students received a 156-item anonymous online survey which assessed religiosity, alcohol and drug use, mental health issues, and impulsive and compulsive traits. Two groups of interest were defined: those with high religiosity, and those with low religiosity, based on z-scores. The two groups were compared on the measures of interest.
Three thousand, five hundred and seventy-two university students (57.1% female) responded to the survey. Those with high levels of organizational religious activity, as well as those with high levels of intrinsic or subjective religiosity, differed from their fellow students in having better self-esteem, being less likely to have alcohol or drug problems, and generally being less impulsive in terms of attention and planning. Compulsivity did not differ between groups. Associations were of small effect size except for the link between religiosity and lower impulsivity, which was of medium effect size.
This study shows a link between higher religiosity and lower impulsivity, as well as higher levels of mental health across several domains. Whether these associations are causal—and if so, the direction of such causality—requires rigorous longitudinal research.
The adolescent brain may be susceptible to the influences of illicit drug use. While compensatory network reorganization is a unique developmental characteristic that may restore several brain disorders, its association with methamphetamine (MA) use-induced damage during adolescence is unclear.
Using independent component (IC) analysis on structural magnetic resonance imaging data, spatially ICs described as morphometric networks were extracted to examine the effects of MA use on gray matter (GM) volumes and network module connectivity in adolescents (51 MA users v. 60 controls) and adults (54 MA users v. 60 controls).
MA use was related to significant GM volume reductions in the default mode, cognitive control, salience, limbic, sensory and visual network modules in adolescents. GM volumes were also reduced in the limbic and visual network modules of the adult MA group as compared to the adult control group. Differential patterns of structural connectivity between the basal ganglia (BG) and network modules were found between the adolescent and adult MA groups. Specifically, adult MA users exhibited significantly reduced connectivity of the BG with the default network modules compared to control adults, while adolescent MA users, despite the greater extent of network GM volume reductions, did not show alterations in network connectivity relative to control adolescents.
Our findings suggest the potential of compensatory network reorganization in adolescent brains in response to MA use. The developmental characteristic to compensate for MA-induced brain damage can be considered as an age-specific therapeutic target for adolescent MA users.
The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.
Cognitive impairment is common in individuals presenting to alcohol and other drug (AOD) settings and the presence of biopsychosocial complexity and health inequities can complicate the experience of symptoms and access to treatment services. A challenge for neuropsychologists in these settings is to evaluate the likely individual contribution of these factors to cognition when providing an opinion regarding diagnoses such as acquired brain injury (ABI). This study therefore aimed to identify predictors of cognitive functioning in AOD clients attending for neuropsychological assessment.
Clinical data from 200 clients with AOD histories who attended for assessment between 2014 and 2018 were analysed and a series of multiple regressions were conducted to explore predictors of cognitive impairment including demographic, diagnostic, substance use, medication, and mental health variables.
Regression modelling identified age, gender, years of education, age of first use, days of abstinence, sedative load, emotional distress and diagnoses of ABI and developmental disorders as contributing to aspects of neuropsychological functioning. Significant models were obtained for verbal intellectual functioning (Adj R2 = 0.19), nonverbal intellectual functioning (Adj R2 = 0.10), information processing speed (Adj R2 = 0.20), working memory (Adj R2 = 0.05), verbal recall (Adj R2 = 0.08), visual recall (Adj R2 = 0.22), divided attention (Adj R2 = 0.14), and cognitive inhibition (Adj R2 = 0.07).
These findings highlight the importance of careful provision of diagnoses in clients with AOD histories who have high levels of unmet clinical needs. They demonstrate the interaction of premorbid and potentially modifiable comorbid factors such as emotional distress and prescription medication on cognition. Ensuring that modifiable risk factors for cognitive impairment are managed may reduce experiences of cognitive impairment and improve diagnostic clarity.
The Research Domain Criteria (RDoC) approach proposes a novel psychiatric nosology using transdiagnostic dimensional mechanistic constructs. One candidate RDoC indicator is delay discounting (DD), a behavioral economic measure of impulsivity, based predominantly on studies examining DD and individual conditions. The current study sought to evaluate the transdiagnostic significance of DD in relation to several psychiatric conditions concurrently.
Participants were 1388 community adults (18–65) who completed an in-person assessment, including measures of DD, substance use, depression, anxiety, posttraumatic stress disorder, and attention-deficit hyperactivity disorder (ADHD). Relations between DD and psychopathology were examined with three strategies: first, examining differences by individual condition using clinical cut-offs; second, examining DD in relation to latent psychopathology variables via principal components analysis (PCA); and third, examining DD and all psychopathology simultaneously via structural equation modeling (SEM).
Individual analyses revealed elevations in DD were present in participants screening positive for multiple substance use disorders (tobacco, cannabis, and drug use disorder), ADHD, major depressive disorder (MDD), and an anxiety disorder (ps < 0.05–0.001). The PCA produced two latent components (substance involvement v. the other mental health indicators) and DD was significantly associated with both (ps < 0.001). In the SEM, unique significant positive associations were observed between the DD latent variable and tobacco, cannabis, and MDD (ps < 0.05–0.001).
These results provide some support for DD as a transdiagnostic indicator, but also suggest that studies of individual syndromes may include confounding via comorbidities. Further systematic investigation of DD as an RDoC indicator is warranted.
Kleptomania is an addiction to stealing without an economic motive; therefore, an examination of effective interventions as a preventive measure is needed. The effectiveness of cognitive behavioural therapy (CBT) combined with mindfulness for the treatment of addiction has been previously indicated, and it is presumed to be effective for kleptomania; however, this relationship remains unstudied. Therefore, this study aimed to examine the effectiveness of cognitive behavioural group therapy (CBGT) combined with mindfulness for treating kleptomania. The results of a 12-session programme of CBGT combined with mindfulness for 22 patients with kleptomania showed that kleptomania symptoms and quality of life (QOL) improved. Furthermore, the recovery process revealed that the improvement of distress tolerance affected the improvement of kleptomania symptoms and that the improvement of reward perception and distress tolerance affected the improvement of stress response and QOL. These results suggest that CBGT combined with mindfulness may be effective in improving symptoms and QOL in kleptomania.
Key learning aims
(1) To understand the clinical features of patients suffering from kleptomania.
(2) To learn about CBT interventions for patients with kleptomania.
(3) To gain an increased understanding of the mechanisms of recovery in patients with kleptomania.
This chapter traces the evolution of the term ‘addiction’ over time, demonstrating how its meaning has altered in the face of social and political changes in society. The second half explores the story behind the diagnostic terminology used in clinical practice today, and describes the recent changes to the addiction section of the major classificatory systems. Addiction is conceptualised as a disorder involving a loss of the normal flexibility of human behaviour, leaving a dehumanised state of compulsive behaviour (‘overwhelming involvement’). It has acquired a variety of terminology over time, much of it inferring moral weakness. Addiction may be associated with psychoactive substances or other pleasurable behaviours and occurs on a spectrum of use and harms, which vary in severity. The term ‘dependence’ may refer to physiological aspects of addiction (tolerance or withdrawal), but is also used to define the severe end of the spectrum. Confusion around this terminology has led to it being removed from the latest version of the Diagnostic and Statistical Manual (DSM-5).
Advocates of the therapeutic use of psychedelic drugs have argued that a promising approach to treatment was prematurely abandoned in the 1960s primarily because of Richard Nixon's ‘War on Drugs’.
This paper (1) briefly describes research in the 1950s and 1960s in North America on the use of LSD to treat alcohol dependence, anxiety in terminal illness, and anxiety and depression; and (2) discusses the factors that led to its abandonment.
An analysis of historical scholarship on psychedelic research in the 1950s, 1960s and 1970s in North America.
Research on psychedelic drugs in psychiatry was abandoned for a number of reasons that acted in concert. A major factor was that clinical research on psychedelic drugs was caught up in the tighter regulation of pharmaceutical research after the Thalidomide disaster in 1963. Psychedelic drugs also presented special challenges for randomised, placebo-controlled clinical trials in the 1970s that were not as positive as the claims made by their advocates in the 1950s and 1960s. Clinical research became more difficult after 1965 when Sandoz ceased providing psychedelic drugs for research and their nonmedical use was prohibited in 1970.
The demise of psychedelic drug research was not solely due to the ‘War on Drugs’. It was hastened by tighter regulation of pharmaceutical research, the failure of controlled clinical trials to live up to the claims of psychedelic advocates, and the pharmaceutical industry's lack of interest in funding clinical trials.
Naloxone, which reverses the effects of opioids, was synthesized in 1960, though the hunt for opioid antagonists began a half-century earlier. The history of this quest reveals how cultural and medical attitudes toward opioids have been marked by a polarization of discourse that belies a keen ambivalence. From 1915 to 1960, researchers were stymied in seeking a “pure” antidote to opioids, discovering instead numerous opioid molecules of mixed or paradoxical properties. At the same time, the quest for a dominant explanatory and therapeutic model for addiction was likewise unsettled. After naloxone’s discovery, new dichotomizing language arose in the “War on Drugs,” in increasingly divergent views between addiction medicine and palliative care, and in public debates about layperson naloxone access. Naloxone, one of the emblematic drugs of our time, highlights the ambivalence latent in public and biomedical discussions of opioids as agents of risk and relief.
Gaming is a source of addiction for adolescents. It is recognized as a behavioral and mental health condition, both by the American Psychiatric Association and by the World Health Organization.
To determine the prevalence of gaming addiction among secondary school students.
This cross-sectional study was conducted between September and October of 2020 among students enrolled in secondary school. The participants had filled the Game addiction scale and a data file regarding the socio-demographic information, physical and information about the internet access and use.
The initial sample was composed of 180 secondary school students. Among them 28 were excluded because they did not play video games. Final sample consisted of 152 students (90 males, 62 females) with a mean age of 13.14 ± 1.2 years. The average duration of connection among participants was 5.3 hours per day. Nearly one quarter of the participants (24,3%) played videogames more than 20 h per week. The prevalence of gaming addiction was 21,7%. The participants with gaming addiction were, on average, younger than those who were not addicted to gaming Game-addicted individuals were more likely to be male than female (13,8% vs 7,9%; p=0,036). There was, also, a significant relation between IA and having academic difficulties (p=0.042).
Based on our study findings, that gaming addiction is a challenging problem among Tunisian adolescents. We recommend authorities consider gaming addiction a serious problem for the young population and make this growing phenomenon an adolescent health priority.
Alcohol dysphoria is a pathognomonic, severe, and therapeutically resistant syndrome considerable for alcohol and drug-addicted patients. The term “dysphoria” (from Greek δυσφορέω to suffer, torment, annoy) means an abnormally low type of mood, characterized by anger, gloom, irritability, feelings of hostility to others. In addictology, it is often identified in the withdrawal syndrome structure.
To develop innovative improvement in treatment for alcohol dysphoria.
The proposed method involves a complex of anti-affective, anti-abstinence, anti-craving pharmacological agents and drug-free methods, and differs from those conventional, along with psychotherapeutic potentiation, by additional targeted pharmacological triad (peroral Carbamazepine 200 mg twice a day: in the morning and in the evening; intramuscular Halopril (Haloperidol) 1 ml (5 mg) daily; oral Sonapax 1 tablet (25 mg) three times a day for 3-5 day treatment) used for a new purpose. 17 patients experienced this method. Efficacy: alcohol dysphoria acute manifestations were relieved by our method within 3-5 days that 37.8% exceeds conventional treatment. In 15 minutes, patients decreased irritability, motor restlessness, stress, cravings for alcohol. In 30 minutes, the patients fell asleep. Sleep lasted 3.5 hours on average. Subsequently, patients denied craving for alcohol, calmed down emotionally and psychomotorically, wished to be treated for alcoholism. No dysphoric relapses were observed.
The proposed multimodality method alleviates alcohol-induced dysphoria, involving pharmacotherapeutic triad along with psychotherapeutic potentiation.
Comorbid substance misuse in mental illness presents a significant challenge to mental health services. It may lead to higher rates of relapse, hospital admissions and poorer treatment outcomes. Up to 47% of inpatients in Irish mental health units may experience substance misuse. Despite the Irish government’s ‘Vision for Change’ policy (2006), access to specialised services remains variable.
Evaluate: -prevalence of substance misuse at an Irish mental health unit. -quality and detail of the recorded substance misuse history. -access to specialised services for patients experiencing substance misuse.
A retrospective chart review of inpatients in a mental health unit over 12 months, was completed. Information recorded included: demographic details, diagnosis, substance use history; access to substance misuse services. Microsoft Excel was utilised for data input and analysis.
267 patients were admitted over twelve months. Substance misuse was the primary diagnosis of 6% and the secondary diagnosis of 67%. 46% of patients reported current substance misuse, 52% reported historical substance misuse. Frequency and quantity of use was documented in 65% and 48% of cases respectively. 4% of patients with a substance misuse history were in current contact with addiction services.
Although 46% of patients reported substance misuse, only 4% were in contact with specialised addiction services. This highlights a significant unmet need. There was variability in the quality of the recorded substance misuse history. In order to fully understand comorbid substance misuse, this be addressed. The addition of a more formatted substance misuse section, to admission proformas, may help to alleviate this issue.