Children who experience well-being are engaging more confidently and positively with their caregiver and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care, and whether this association is affected by (...) ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ temperament and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs. (shrink)

The “hijacking” and “drug instrumentalization” models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.

Seeking integration of drug consumption research by a theory of memory function and emphasizing drug consumption rather than addiction, Müller & Schumann (M&S) treat drug self-administration as part of a general pattern of consumption. This insight is located within a more comprehensive framework for understanding drug use as consumer behavior that explicates the reinforcement contingencies associated with modes of drug consumption.

The making and taking of psychotropic drugs, whether on medical prescription or as self-medication, whether marketed by pharmaceutical companies or clamoured for by an anxious population, has been an integral part of the twentieth century. In this modern era of speed, uncertainty, pleasure and anguish the boundaries between healing and enhancing the mind by chemical means have been redefined. Long before Prozac would become a household name for an ‘emotional aspirin’ did consumers embrace the idea and practice of taking psychotropics (...) not only to treat mental illness but also to make them feel better about living in a modern world. The Freudian promise that each individual can remake him- or herself in the pursuit of health and happiness was helpful in promoting and legitimizing the idea and practice of seeking wellness on prescription. We will argue that the modern consumer-driven political culture of medicine will continue to transverse the boundaries of therapy and enhancement of the mind into the largely unexplored territories of human cognition and behaviour. However exciting, this endeavour will come at the cost of further widening the problem of iatrogenic addiction in the age of happiness pills as ‘botox’ for the mind. (shrink)

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a “necessary” prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of “drug instrumentalization.” Psychoactive drugs are consumed for their effects on mental states. Humans (...) are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific “instrumentalization goals” and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future. (shrink)

The Müller & Schumann (M&S) view of drug use is courageous and compelling, with radical implications for drug policy and research. It implies that most nations prohibit most drugs that could promote happiness, social capital, and economic growth; that most individuals underuse rather than overuse drugs; and that behavioral scientists could use drugs more effectively in generating hypotheses and collaborating empathically.

Based on their framework, Müller & Schumann (M&S) propose a staged drug policy that matches well the neoliberal governance scheme. To mend the sad loss of the sociocultural dimension in their model, I propose three such considerations: first, sociocultural interactions with the brain; second, sociocultural context and justice of drug use; and third, sociocultural preparedness for implementing their drug policy.

ZusammenfassungDer Einsatz von Psychopharmaka im Altenpflegeheim unterliegt aufgrund institutioneller und struktureller Besonderheiten dieses Versorgungsbereiches, aber auch aufgrund der großen Abhängigkeit und Vulnerabilität eines großen Teils der Altenpflegeheimbewohner in besonderer Weise der Gefahr, in inadäquater und missbräuchlicher Weise durchgeführt zu werden. Die Beachtung der ethischen Grundprinzipien des Wohltuns und des Nichtschadendürfens sowie des Respekts vor der Autonomie der Bewohner sollte für alle an der Versorgung unmittelbar und mittelbar Beteiligten handlungsleitend sein. Zum Schutz der Heimbewohner, aber auch mit dem Ziel die Versorgungsqualität (...) in diesem Bereich nachprüfbar zu verbessern, werden in diesem Beitrag Kriterien zur Definition einer inadäquaten bzw. adäquaten Anwendung von Psychopharmaka explizit formuliert, sowie deren Implementierung in prozessorientierte Handlungsalgorithmen und Behandlungsleitlinien vorgeschlagen. Darüber hinaus sollen die Möglichkeiten und Grenzen nicht-pharmakologischer, psychologischer Interventionen als Alternative zur Psychopharmakamedikation diskutiert und hinsichtlich ihrer ethischen Implikationen reflektiert werden. (shrink)

The term “off-label drug use” refers to drugs that have not yet acquired “approved” status or drugs that have acquired “approved” status but are used with a different dosage, route, or administration method other than that for which the drug has been approved. In New Zealand, the Medicines Act 1981 specifically allows for off-label drug use. However, this authority is limited by the Health and Disability Commissioner Regulations 1996 and the common law, which require that off-label (...) class='Hi'>drug use is of an acceptable standard, that the patient should be fully informed, and that the patient should give informed consent. Off-label drug use is an important issue because the current law provides medical practitioners very wide discretionary power, without providing clarification for what is required of the practitioner in exercising his or her discretion in prescribing off-label. This paper discusses possible solutions to this issue, for example, establishing protocol for off-label use, an electronic database of off-label use, and the amendment of legal provisions. (shrink)

This research is part of the last study Drugs and School IX developed in the Basque Country (Spain) by the Instituto Deusto de Drogodependencias (Deusto Institute of Drug Addiction) of the University of Deusto and the data gathered by means of cluster sampling in two stages. The sample is made up of N= 6.007 girls and boys ranging from 12 to 22 years of age in Secondary Education and the aim is to answer the following new research questions based (...) on those parameters: (1) describe the reality of drug consumption and some psychosocial variables in this sample, as well as analyse several relations between variables; (2) analysing the role of school well-being, self-esteem and self-concept regarding consumption; (3) taking a close look at the moderating role of age and gender on the relationship of school well-being, self-concept and self-esteem with consumption; and (4) understand the existing interaction between all these variables, studying the moderating role of self-esteem and self-concept in the influence of school well-being on consumption. Using a correlation, hierarchical regression and mediation analysis with SPSS (v. 26) and Amos (v. 26) applications, three main conclusions were reached. Firstly, that educational and academic well-being, academic self-concept and self-esteem seem to play the role of protecting factors in adolescence, while assertiveness is linked to a higher consumption level. Secondly, that academic self-concept has a mediating effect between well-being and consumption. Some of these relations are moderated by the variables of gender and age. Thirdly, that age and gender are very relevant sociodemographic variables that must be taken into account in order to understand this phenomenon. Age has shown its covariant effect, which is especially relevant in the influence of academic well-being measured as being held back years. It has also proved to be important in order to understand its experiential or experimental and transitory character. Moreover, significant differences in consumptions have been found based on gender. (shrink)

The potential to instrumentalize drug use based upon the detection of very many different drug states undoubtedly exists, and such states may play a role in psychiatric and many other drug uses. Nevertheless, nonaddictive drug use is potentially more parsimoniously explained in terms of sensation seeking/impulsivity and drug expectations. Cultural factors also play a major role in nonaddictive drug use.

This paper argues for two claims. First, recreational drug use is immoral because it undermines cognitive functioning. Second, for similar reasons, the state has a prima facie public policy interest in enacting legal restrictions on recreational drug use. In this context, “recreational drug use” refers to activities in which a person uses some intoxicating substance to impair, destroy, or otherwise frustrate the functioning of his cognitive faculties for the sake of pleasure or enjoyment.

The newly proposed framework for non-addictive psychoactive substances postulated by Müller & Schumann (M&S) provides an interesting and plausible explanation for non-addictive drug use. However, with specific reference to the relevant behavioral addiction literature, this commentary argues that the model may unexpectedly hold utility not only for non-addictive use of drugs, but also for non-addictive use of other potentially addictive behaviors.

Varcoe, Shane Until recently, there has been a largely unnoticed contingent of stakeholders who have not merely abandoned the ideal scenario of a drug free culture, but have quickly stepped through a phase of passive indifference, into what is a 'pro-drug' position in active pursuit of rights for individuals to be protected and supported in their consumption of currently illicit drugs. The players engaged in attempting to bring about this disturbing cultural shift are varied, but certainly these advocates (...) are 'spinning' data and even engaging noble platforms such as 'human rights' to speciously gain leverage. A key strategy in what is now a further 'push' down the slippery slope of dysfunction is the notion of normalisation. (shrink)

Few sports-related events have generated as much controversy as the steroid crisis in baseball. Both ardent fans and casual observers wonder why professional baseball players would choose to use such substances when their use was viewed as outside the bounds of fair play. This article attempts to answer that question by applying concepts from the area of organizational culture. Understanding the culture of baseball and the ways leaders embedded and strengthened that culture adds insight into the decisions by athletes to (...) engage in steroid use. In general, such use was consistent with the already-existing culture. In addition, key decisions and events likely created the conditions in which steroid use was more likely. (shrink)

Why does American law allow the recreational use of some drugs, such as alcohol, tobacco, and caffeine, but not others, such as marijuana, cocaine, and heroin? The answer lies not simply in the harm the use of these drugs might cause, but in the perceived morality—or lack thereof—of their recreational use. Despite strong rhetoric from moral critics of recreational drug use, however, it is surprisingly difficult to discern the reasons they have for deeming the recreational use of (some) drugs (...) morally wrong. In this book, Rob Lovering lays out and dissects various arguments for the immorality of using marijuana, cocaine, heroin, and other drugs recreationally. He contends that, by and large, these arguments do not succeed. Lovering's book represents one of the first works to systematically present, analyze, and critique arguments for the moral wrongness of recreational drug use. Given this, as well as the popularity of the morality-based defense of the United States' drug laws, this book is an important and timely contribution to the debate on the recreational use of drugs. (shrink)

Individual differences in moral views are often explained as the downstream effect of ideological commitments, such as political orientation and religiosity. Recent studies in the U.S. suggest that moral views about recreational drug use are also influenced by attitudes toward sex and that this relationship cannot be explained by ideological commitments. In this study, we investigate student samples from Belgium, The Netherlands, and Japan. We find that, in all samples, sexual attitudes are strongly related to views about recreational (...) class='Hi'>drug use, even after controlling for various ideological variables. We discuss our results in light of reproductive strategies as determinants of moral views. (shrink)

Prescribing drugs for uses that the FDA has not approved — off-label drug use — can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should (...) address the cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers’ conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. (shrink)

The Food and Drug Administration authorizes the marketing of a drug only for uses that the manufacturer has demonstrated to be safe and effective, based on evidence from at least two clinical trials. However, the FDA does not regulate the practice of medicine, so physicians may prescribe drugs in any manner they choose. Prescribing drugs in ways that deviate from the uses specified in the FDA-approved drug label, package insert, and marketing authorization is referred to as off-label (...) prescribing. This occurs when physicians prescribe a drug for a therapeutic purpose other than the one approved by the FDA; treat patients in a different age cohort or gender than the population on which it was tested; or prescribe a different dose, for a different duration of use, or a different mode of administration than indicated on the label. (shrink)

The contributions of adolescent and parent perspectives to ethical planning of survey research on youth drug use and suicide behaviors are highlighted through an empirical examination of 322 7th-12th graders' and 160 parents' opinions on questions related to 4 ethical dimensions of survey research practice: evaluating research risks and benefits, establishing guardian permission requirements, developing confidentiality and disclosure policies, and using cash incentives for recruitment. Generational and ethnic variation in response to questionnaire items developed from discussions within adolescent and (...) parent focus groups are described. The article concludes with a discussion of the potential contributions and challenges of adolescent and parent perspectives for planning scientifically valid and ethically responsible youth risk survey research. (shrink)

The war on drugs is widely criticized as unjust. The idea that the laws prohibiting drugs are unjust can easily lead to the conclusion that those laws do not deserve our respect, so that our only moral reason to obey them flows from a general moral obligation to obey the law, rather than from anything morally troubling about drug use itself. In this paper, I argue that this line of thinking is mistaken. I begin by arguing that the (...) class='Hi'>drug laws are indeed unjust. However, so long as they remain prohibited, I argue that we have strong moral reasons to avoid drug use. First, drug users are partly responsible for the violent and exploitative conditions in which many drugs are produced and distributed. Second, the unequal ways in which drug laws are enforced make drug use by many an unethical exercise of privilege. These reasons do not depend on the existence of a general moral obligation to obey the law; we ought to refrain from illegal drug use even if prohibition is unjust and even if we have no general obligation to obey the law. In fact, drug laws turn out to represent an interesting exception case within the broader debate about this obligation, and I argue that it is the very injustice of the law that generates the reasons not to violate it. (shrink)

Drugged bodies are commonly depicted as passive, suffering and abject, which makes it hard for them to be known in other ways. Wanting to get closer to these alternative bodies and their resourcefulness for living, I turned to body-mapping as an inventive method for telling different kinds of drug-using stories. Drawing on a research project with people who inject heroin and crack cocaine in London, UK, I employed body-mapping as a way of studying drugged bodies in their relation to (...) others, human and non-human, in the injecting event. I invited participants to draw their bodies in describing these otherwise hard-to-articulate experiences. Following Donna Haraway, I conceptualise body-mapping as a more-than-human mode of storytelling where different kinds of bodies can be known. Here, I look at three such bodies – sensing-bodies, temporal-bodies and environment-bodies – and argue that it is through being able to respond to such bodies that more hospitable ways of living with drugs can become possible. (shrink)

A strong moral reason for prohibiting doping in sport is to be found in the bad choices that would be faced by clean athletes in a sporting world that tolerated doping. The case against doping is not, however, to be grounded in the concept of coercion. Instead, it is grounded in a general duty of sport to afford fair opportunity to the goods that are distinctively within sport's sphere of control. The moral reason to prohibit doping need not be balanced (...) against any autonomy claim of athletes who would prefer to dope because, upon closer examination, such claims have no force. The moral reason to prohibit doping does, however, need to be balanced against the enforcement costs imposed on all athletes by effective prohibition. (shrink)

There is a wide array of arguments for the immorality of recreational drug use, ranging from the philosophically rudimentary to the philosophically sophisticated. But the vast majority of these arguments are unsuccessful, and those that succeed are quite limited in scope. In this article, I present and evaluate a few examples of such arguments.

Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one (...) patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder. (shrink)

_Illegal Leisure _offers a unique insight into the role drug use now plays in British youth culture. The authors present the results of a five year longitudinal study into young people and drug taking. They argue that drugs are no longer used as a form of rebellious behaviour, but have been subsumed into wider, acceptable leisure activities. The new generation of drug user can no longer be seen as mad or bad or from subcultural worlds - they (...) are ordinary and everywhere. Illustrated throughout with interview material, _Illegal Leisure _shows how drug consumption has become normalised, and provides a well-informed analysis of the current debate. (shrink)

Aim Genetic research representative of the population is crucial to understanding the underlying causes of many diseases. In a prospective evaluation of informed consent we assessed the willingness of individuals of different ethnicities, gender and drug dependence history to participate in genetic studies in which their genetic sample could be shared with a repository at the National Institutes of Health. Methods Potential subjects were recruited from the general population through the use of flyers and referrals from previous participants and (...) clinicians with knowledge of our study. They could consent to 11 separate choices so that they could specify how and with whom their genetic sample could be shared. Rates of affirmative consent were then analysed by gender, ethnicity and drug dependence history. Results Of 1416 volunteers enrolled, 99.7% gave affirmative informed consent for studies of addiction conducted in our laboratory. No significant difference was found for participation in genetic studies conducted in our laboratory by gender, ethnicity or drug dependence history. Over all 11 questions, individuals with a history of drug use were more likely to agree to consent to participate in our study than were healthy volunteers. Conclusion A high percentage of each category of gender, ethnicity and drug history, gave affirmative consent at all levels. The level of detail in and the amount of time spent reviewing the informed consent, and a relationship of trust with the clinical investigator may contribute to this outcome. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 209 Trysh Travis Toward a Feminist History of the Drug-Using Woman— and Her Recovery In 1995, public health scholars Laura Schmidt and Constance Weisner published “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment.”1 The article, aimed at specialists in the growing field of behavioral sciences, explored the history of medpsych attitudes toward (...) women drinkers. That history had been characterized, until the 1970s, by ignorance and neglect, but it began to shift in the wake of Second Wave feminism and what Schmidt and Weisner called “the women’s alcoholism movement.”2 To be fair, attitudes toward male drinkers had also long been inchoate. But beginning in the 1940s, advocacy by a handful of scientific and legal professionals, as well as the mutual aid group Alcoholics Anonymous (founded in 1935) and the National Council on Alcoholism (founded in 1944), created a new vision, which went on to be underwritten by federal funding and private insurance.3 “Alcoholism is a disease 1. Laura Schmidt and Constance Weisner, “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment,” in Recent Developments in Alcoholism, Vol. 12: Women and Alcoholism, ed. Marc Galanter (New York: Plenum Press, 1995), 309–334. 2. Ibid., 310. 3. The organization was originally called the National Committee for Education on Alcoholism; it became the National Council on Alcoholism in 1950 and changed to the current National Council on Alcoholism and Drug Dependence in 1990. 210 Trysh Travis Books Discussed in This Essay Lady Lushes: Gender, Alcoholism, and Medicine in Modern America. By Michelle L. McClellan. New Brunswick, NJ: Rutgers University Press, 2017. The Recovery Revolution: The Battle over Addiction Treatment in the United States. By Claire D. Clark. New York: Columbia University Press, 2017. Addicted to Rehab: Race, Gender, and Drugs in the Era of Mass Incarceration. By Allison McKim. New Brunswick, NJ: Rutgers University Press, 2017. Through a Trauma Lens: Transforming Health and Behavioral Health Systems. By Vivian Barnett Brown. New York: Routledge, 2017. and the alcoholic a sick person,” argued National Council on Alcoholism founder Marty Mann in a host of magazine articles beginning in the late 1940s. From that assertion followed the beliefs that “the alcoholic can be helped and is worth helping” and that “alcoholism is a public health problem and therefore a public responsibility” (29).4 Behind Mann’s carefully gender-neutral language lay an image of the alcoholic as a white man from the respectable middle classes. The mid-century legitimation of that man’s problems, Schmidt and Weisner argue, paved the way for “problem-drinking women” to finally come into focus half a century later. Schmidt and Weisner’s article centers on the ways the Great Society funding streams that first steered funds to community-based alcohol and drug treatment changed during the 1980s. But along the way, they briefly explore organized feminism’s views of alcohol- and drug-using women. They note that Second Wave feminists had dealt aggressively with behavioral health issues such as domestic violence, child sexual 4. Marty Mann, “Can We Conquer Alcoholism?” Health (1947): 12–13, 29–30. Trysh Travis 211 abuse, and rape—all of which correlated closely with substance use and abuse. But they see no feminist activism around alcohol or drugs. Instead, “representatives from organizations in the broader feminist and women ’s health movements” were “conspicuously absent” from the women’s alcoholism movement, which consisted chiefly of activists motivated by alcohol issues, not gender.5 Interest in—and action on—women’s alcohol and other drug use consequently became the province chiefly of clinicians and policy makers, not movement women. Although many of those professionals saw substance-using women’s needs as important and worthy of services, few viewed them through the lenses of gender and power. The blind spot that Schmidt and Weisner observe among feminist activists is interesting not only for what it tells us about a conceptual boundary of Second Wave feminism (both liberal and radical) but also for the way it points to a gap in the feminist scholarship that is ostensibly a central legacy of the earlier movement. Like... (shrink)

The narrative of the digital phenotype as a transformative vector in healthcare is nearly identical to the concept of “data drivenness” in other fields such as law enforcement. We examine the role of a prescription drug monitoring program in California—a computerized law enforcement surveillance program enabled by a landmark Supreme Court case that upheld “broad police powers”—in the interprofessional conflict between physicians and law enforcement over the jurisdiction of drug use. We bring together interview passages, clinical artifacts, and (...) academic and gray literature to investigate the power relations between police, physicians, and patients to show that prescribing data appear to the physician as evidence of problematic patient behavior by the patients, and to law enforcement as evidence of physician misconduct. In turn, physicians have adopted a disciplinary approach to patients, using quasi-legalistic documents to litigate patient behavior. We conclude that police powers have been used to pave data infrastructure through a contested jurisdiction, and law enforcement have used that infrastructure to enroll physicians into the work of disciplining patients. (shrink)

Illicit drug users are frequently identified as a ‘vulnerable population’ requiring ‘special protection’ and ‘additional safeguards’ in research. However, without specific guidance on how to enact these special protections and safeguards, research ethics committee (REC) members sometimes fall back on untested assumptions about the ethics of illicit drug use research. In light of growing calls for ‘evidence-based research ethics’, this commentary examines three common assumptions amongst REC members about what constitutes ethical research with drug users, and whether (...) such assumptions are borne out by a growing body of empirical data. The assumptions that form the focus of this commentary are as follows: (i) drug users do not have the capacity to provide informed consent to research; (ii) it is ethically problematic to provide financial incentives to drug users to participate in research; and (iii) asking drug users about their experiences ‘re-traumatizes’ and ‘re-victimizes’ them. (shrink)

This volume was initiated to meet the challenges of the increasing contemporary trend to "treat" substance users (in the broadest sense of this concept), whether in institutional settings, ambulatory programs, or even controlled environments such as prisons. Although several essays concentrate more particularly on some of the ethico-moral problems encountered by juridico-moral interventions--problems relating to criminalization, decriminalization, legalization, and interdiction--the main focus is on broadly medical or therapeutic responses to drug use, and in particular on problems encountered within the (...) domain of drug user counseling. Codes of ethics for drug user counselors can be found as an appendix. (shrink)

Background This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to (...) engage in screening using the Alcohol Smoking and Substance Involvement Screening Test and urinalysis. Results Significant agreements between dichotomous and ASSIST scores were observed. A higher rate of self-reported alcohol use was detected, relative to urine screening with a predictive value of 34.9; while underreporting of illicit substance use was observed with an overall predictive value of 50.0. Conclusion Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed. (shrink)

Pregnant adolescents have a higher risk of poor maternal and fetal outcomes, particularly in the setting of concomitant maternal alcohol and other drug (AOD) use. Despite numerous programmes aimed at reducing overall teen pregnancy rates and the recognition of AOD use as a risk factor for unintended pregnancy in adolescents, interventions targeting this specific group have been sparse. In adult drug-using women, financial incentives for contraception have been provided but are ethically controversial. This article explores whether a trial (...) could ethically employ monetary incentives in adolescents with AOD use to promote the use of long-acting reversible contraception (LARC), with special attention to the relevant distinctions between adults and adolescents. We conclude that a trial of incentives to promote LARC in this patient population is ethically permissible if the incentives are small, are tied to completion of an educational activity to minimise the quick fix temptation and potential for non-attendance to the risks and benefits of LARC and are provided only to the adolescent after an assessment of her reasoning to rule out coercion (eg, by guardians) as motivation. Information about treatment for AOD use and follow-up care in case of problems with the contraceptive or desire for removal should also be provided. Before implementing such a trial, qualitative research with input from providers, potential patients and their parents should be conducted to inform the programme's specific structure. (shrink)