[Argentinian women and the uses of drugs: A sociohistorical analysis of female drug use in Argentina (1860-1930)]. / Mujeres argentinas y usos de drogas: análisis sociohistórico del uso femenino de sustancias psicoactivas en Argentina (1860-1930).

This article describes cases presented by experts from the legislative and medical-legal fields regarding the use of psychoactive substances among Argentinian women from 1878 to 1930. Background information is presented regarding the relationship between women and the use different drugs, medical interventions on the female body where psychoactive substances were used are analyzed, and experts' descriptions of cases of female drug users are detailed. Experts' discourses during this period did not attempt to comprehend the specificities of female consumption, but were rather used to position the issue of drug use as a social problem. This was done using three prototypes: the victim of a sick husband; the prostitute who encourages drug use among the weak in spirit (natural-born criminals); and the virtuous young woman who succumbs to drug addiction in spite of her father's rule. Each figure reinforces the need for state intervention and increased social control.

Este trabajo describe casos expuestos por expertos de los ámbitos legislativo y médico-legal periodístico, en los que se reporta el consumo de sustancias psicoactivas por parte de mujeres de Argentina, entre 1878 y 1930. Se presentan antecedentes sobre mujeres y usos de distintos fármacos, se analizan las intervenciones médicas que utilizan sustancias psicoactivas sobre el cuerpo femenino, y se detallan los casos de mujeres consumidoras desde las miradas expertas. En este periodo, los discursos expertos no buscaron comprender la especificidad femenina del consumo, sino promover el tema drogas como un problema. Esto se produce utilizando tres prototipos: la víctima de un marido enfermo, la prostituta que envicia a los débiles de espíritu (criminal nata), y la joven virtuosa que contraviene la ley del padre y sucumbe en la toxicomanía. Cada figura refuerza la necesidad de intervención estatal y control social.

Working County Lines: Child Criminal Exploitation and Illicit Drug Dealing in Glasgow and Merseyside.

This article explores recent developments within the U.K. drug market: that is, the commuting of gang members from major cities to small rural urban areas for the purpose of enhancing their profit from drug distribution. Such practice has come to be known as working "County Lines." We present findings drawn from qualitative research with practitioners working to address serious and organized crime and participants involved in street gangs and illicit drug supply in both Glasgow and Merseyside, United Kingdom. We find evidence of Child Criminal Exploitation (CCE) in County Lines activity, often as a result of debt bondage; but also, cases of young people working the lines of their own volition to obtain financial and status rewards. In conclusion, we put forward a series of recommendations which are aimed at informing police strategy, practitioner intervention, and wider governmental policy to effectively address this growing, and highly problematic, phenomenon.

Genetic and environmental vulnerabilities underlying adolescent substance use and problem use: general or specific?

Are genetic and environmental risks for adolescent substance use specific to individual substances or general across substance classes? We examined this question in 645 monozygotic twin pairs, 702 dizygotic twin pairs, 429 biological sibling pairs, and 96 adoptive (biologically unrelated) sibling pairs ascertained from community-based samples, and ranging in age from 12 to 18 years. Substance use patterns and symptoms were assessed using structured psychiatric interviews. Biometrical model fitting was carried out using age- and sex-specific thresholds for (a) repeated use and (b) problem use, defined as one or more DSM-IV symptoms of abuse or dependence. We hypothesized that problem use would be more heritable than use in adolescence, and that both genetic and environmental risks underlying tobacco, alcohol, and marijuana use and problem use would be significantly correlated. Results of univariate analyses suggested significant heritable factors for use and problem use for all substances with the exception of alcohol use. Shared environmental factors were important in all cases and special twin environmental factors were significant for tobacco use, tobacco problem use, and alcohol use. Multivariate analyses yielded significant genetic correlations between each of the substances (for both levels studied), and significant shared environmental correlations among use variables only. Our results suggest that tobacco, alcohol, and marijuana problem use are mediated by common genetic influences, but shared environmental influences may be more substance-specific for problem use.

Disadvantaged but different: variation among deprived communities in relation to child and family well-being.

BACKGROUND: Disadvantaged communities are increasingly the target for interventions. Sure Start was launched in England in 1999 to tackle child poverty and improve child and family services, with Sure Start Local Programmes (SSLPs) targeted at relatively small areas of marked deprivation. However, they are located in a range of different types of communities where they may provide services to very different resident populations. They are all disadvantaged but underlying that label there are specific patterns of variability, relevant for service provision. To evaluate the implementation, impact, and cost-effectiveness of SSLPs, or other area-based initiatives, it is important to consider ways in which they can be grouped meaningfully according to these patterns. METHOD: Data were collected from administrative databases to describe SSLPs in terms of demography, deprivation, and aspects of child and family functioning and grouped using cluster analysis. RESULTS: Five different 'types' of SSLP community were identified, based on their socio-demographic and economic characteristics; typified by more, less or average deprivation in relation to all SSLPs, and in terms of the proportion of ethnic minority families resident in the areas. The groups differ in terms of community measures of child health, educational attainment, school disorder and child welfare and their prediction from demographic community characteristics. CONCLUSIONS: The groupings have implications for service delivery and the evaluation of area-based initiatives.

La situación traumática básica en la relación analítica / The basic traumatic situation in the analytical relationship

El autor trata de desarrollar un concepto de trauma psíquico que respete el nucleo de esa noción freudiana, es decir, un exceso de excitación no procesable por el aparato mental, pero que también considere las funciones y el papel crucial de los objetos en la constitución del psiquismo y en las condiciones traumáticas, así como que tenga en cuenta el posicionamiento metodológico de que la relación analítica es el único locus posible de observación, inferencia e intervención del psicoanalista. Considera una situación psicoanalítica traumática básica o mínima aquella en la cual una magnitud o calidad de emociones excede la capacidad de continencia de la pareja analítica traumática básica o mínima aquélla en la cual una magitud o calidad de emociones excede la capacidad de continencia de la pareja analítica, hasta el punto de generar un período o área de desmentalización en el psiquismo de uno o ambos participantes – lo cual necesitará a su vez un trabajo analítico- y de promover un significativo cambio positivo o negativo en al relación. Valéndose de la teoría de Bion sobre la función alfa y de las concepciones metapsicológicas de Freud y Green acerca de las representaciones psíquicas, plantea dos formulaciones teóricas relativas a esta situación traumática, utilizándolas según el modelo de la reversión de la perspectiva propuesto por Bion. Tres ejemplos clínicos sirven para ilustrar el concepto y las formulaciones teóricas pertinentes (AU)

The writer develops a concept of psychical trauma which respects the nucleus of this Freudian notion, i.e., an excess of non-processable excitation for the psychic apparatus, but which, at the same time, takes into consideration the functions and crucial role of the objects in the constitution of the psychism and in traumatic conditions, and which likewise bear in mind the methodological positioning of which the analytical relation is the only possible locus of observation, inference and intervention of the psychoanalyst. The author considers that a basic or minimum traumatical, psychoanalytical situations is one in which a magnitude or quality of emotions exceeds the analytical tandem´s capacity contain, to the point of generating a period or area of dis-mentalization in the psyche of one or both participants – this implies analutical work- and of bringing about a significant positive or negative change in the relation. As from Bion´s theory of the Alfa function, and from the metapsychological conceptiopns of Freud and Green regarding psychical representations, the author offers two theoretical formulations relative to this traumatic situation, and uses these formulations in agreement with the reversal of the perspective model proposed by Bion. Three clinical vignettes are described in order to illustrate the concept and relevant theoretical formulations (AU)

Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff.

A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.

Buzzwords in campaign 2000 as possible rank index of contemporary social issues: an informal look.

Frequencies from a 3-mo. sample of words heard in TV speeches are applied as a ranking index to identify current public policy issues.

Social distance of deviants and deviant offenders.

Previous studies have focused on the seriousness of the offenses but have neglected the offenders. This analysis used a Bogardus-type social distance scale of 23 deviant roles using a sample of 524 respondents who indicated decided preferences for some types of deviant offenders over others. It was concluded that individuals occupying various roles such as judges, defenders, juries, and so on may feel great social distance toward certain types of offenders and may act differentially toward them.

HIV-risk behavior and the public health context of HIV/AIDS among women living with a severe and persistent mental illness.

We documented HIV-risk behavior and the public health context of AIDS in women living with a severe and persistent mental illness. Sixty-one women were recruited from outpatient clinics and day-treatment programs at a state psychiatric hospital. They completed a survey that included measures of HIV-related risk behavior, the perceived importance of 11 public health and social problems including AIDS, HIV/AIDS-related knowledge, perceived risk, and behavioral intentions. Thirty-eight percent of participants engaged in at least one type of HIV-risk behavior during the 2 months before assessment, 23% reported two or more risk factors, and 16% reported three or more risk factors. Consistent condom use was rare. Participants reporting 1 or more risk factors were more likely than those reporting no risk to report histories of alcohol or drug treatment, sexually transmitted diseases, HIV testing, and more perceived risk of HIV infection. Poverty and unemployment were viewed as more serious problems than HIV infection and AIDS. HIV-prevention interventions that are tailored to the needs and priorities of women with a severe mental illness are urgently needed to prevent further infections.

Shifting categories of the social harms associated with alcohol: examples from late medieval and early modern England.

This paper offers a historical perspective on our own attempts to define the social harms associated with the abuse of alcohol. Challenging the notion that categories are necessarily objective and constant, it instead emphasizes the extent to which even harms that are visible and thus susceptible to measurement are in fact socially constructed. English sources from the preindustrial era revealed six broad categories of social harms associated with the abuse of alcohol. Four of the categories consisted of visible harms in the form of income lost, domestic violence, brawling, and accidents, all of which are still recognized as social harms associated with the abuse of alcohol. The other two categories, reversal of the established moral order and susceptibility to trickery, were of an essentially intrinsic or subjective nature and have since dropped from the lexicon of social harms.

Psychosocial problems in primary care. Pilot study of a new taxonomy.

BACKGROUND: In this study, the Massachusetts Academy of Family Practice Research Network (MAFP ReNet) was used to test a new taxonomy of psychosocial problems presenting to family physicians and to examine physician variability in determining when a psychosocial problem plays a role in a patient's visit. METHODS: Thirty physicians completed a form listing the taxonomy of psychosocial issues for 19 standard case vignettes. These physicians then completed the same form for every patient seen in their practices over a 2-week period. RESULTS: The proposed taxonomy was well received by practicing physicians as appropriate for how they think about their patients and practices. The case vignettes demonstrated a large variability in physician identification of psychosocial problems. The 30 physicians who participated in all phases of the study completed evaluations of 2876 patient visits, identifying 43% of these as involving one or more psychosocial problems. The frequency of psychosocial problem identification among the physicians ranged from 23% to 81%, with a standard deviation of 15%. CONCLUSIONS: The proposed new taxonomy may be helpful in both future research and teaching. The high degree of variation in physician responses both to the same clinical vignettes and to patients in their practices suggests that physicians vary widely in their identification of psychosocial issues.

Psychosocial problems and outcome: an external validity study.

Six acute-care teaching hospitals participated in a study to determine the validity of a problem-outcome classification system. Three hundred and forty-three randomly selected clients of 152 social workers served as external sources to determine the validity of the instrument. In 77 percent of the problems, social workers and clients agreed on the nature of the problem dealt with during intervention. However, workers tended to give more negative values to their assessments of outcome of intervention than did their clients.