Search PubMed⌕ Search

Biomedical subjects

T Cameron Wild

Publications and source records attributed to T Cameron Wild.

At least 19 recordsLinked to original sources
PubMed2007

Controlled study of brief personalized assessment-feedback for drinkers interested in self-help.

AIMS: Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. DESIGN: A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. SETTING AND PARTICIPANTS: A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). INTERVENTION: Current drinkers interested in receiving alcohol self-help materials (n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). MEASUREMENTS: Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. FINDINGS: Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers. CONCLUSIONS: The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.

Adult↗
PubMed2006

Social pressure, coercion, and client engagement at treatment entry: a self-determination theory perspective.

Research on coercion in addiction treatment typically investigates objective sources of social pressure among legally mandated clients. Little research has examined the impact of clients' perceptions of social pressures in generalist addiction services. Clients seeking substance abuse treatment (N=300; 221 males and 79 females; M age=36.6 years) rated the extent to which treatment was being sought because of coercive social pressures (external motivation; alpha=.89), guilt about continued substance abuse (introjected motivation; alpha=.84), or a personal choice and commitment to the goals of the program (identified motivation; alpha=.85). External treatment motivation was positively correlated with legal referral, social network pressures to enter treatment, and was inversely related to problem severity. In contrast, identified treatment motivation was positively correlated with self-referral and problem severity, and was inversely related to perceived coercion (ps<.05). Hierarchical multiple regression analyses showed that referral source (i.e., mandated treatment status), legal history, and social network pressures did not predict any of 6 measures of client engagement at the time treatment was sought. However, treatment motivation variables accounted for unique variance in these outcomes when added to each model (DeltaR(2)s=.06-.23, ps<.05). Specifically, identified treatment motivation predicted perceived benefits of reducing substance use, attempts to reduce drinking and drug use, as well as self (and therapist) ratings of interest in the upcoming treatment episode (betas=.18-.31, ps<.05). Results suggest that the presence of legal referral and/or social network pressures to quit, cut down, and/or enter treatment does not affect client engagement at treatment entry.

Age Factors↗
PubMed2006

Autonomy (vs. sociotropy) and depressive symptoms in quitting smoking: evidence for trait-congruence and the role of gender.

According to Beck's cognitive theory of depression, autonomy (high achievement concerns) and sociotropy (high interpersonal concerns) are vulnerability factors for depression when achievement or interpersonal stressors, respectively, are experienced. This hypothesis was tested among men and women attempting to quit smoking, an achievement stressor that can provoke depressive symptoms. Smokers recruited from the community (N=210) provided information about their quit attempt through mailed questionnaires. For the 48-h period following the quit, relationships among autonomy, sociotropy, coping, depressive symptoms and lapsing were assessed. Structural equation models supported the trait-congruence hypothesis because greater autonomy, but not sociotropy, was associated with elevated depressive symptoms among both men and women smokers. However, results were stronger for men (beta=.47, p=.0001) than for women (beta=.20, p=.05). After accounting for autonomy's relationship with depressive symptoms, greater autonomy was inversely associated with lapsing among men (beta=-.35, p=.01), but not women. Results point to the potential usefulness of a theoretical approach to understanding relationships between depressive symptoms and smoking cessation, and indicate that autonomous personality may be an important factor in smoking cessation in men.

Adaptation, Psychological↗
PubMed2006

Social control and coercion in addiction treatment: towards evidence-based policy and practice.

BACKGROUND: Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research. APPROACH: Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic. FINDINGS: Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views. CONCLUSIONS: Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.

Attitude to Health↗
PubMed2005

Motivation and life events: a prospective natural history pilot study of problem drinkers in the community.

A prospective natural history study was conducted of problem drinkers who were thinking about quitting or reducing their alcohol consumption. Two primary constructs, cognitive appraisals and life events, were measured in a mailed-out baseline survey. A one-year follow-up survey identified those who had made reductions in drinking. Partial correlations controlling for baseline drinking severity revealed some support for both cognitive appraisal and life events explanations of change.

Adaptation, Psychological↗
PubMed2005

Patterns of opioid and cocaine co-use: a descriptive study in a Canadian sample of untreated opioid-dependent individuals.

This study examined prevalence and patterns of co-use of opioids and cocaine in regular users of illicit opioids (N = 729) recruited from 5 Canadian cities. Fifty-seven percent (n = 417) reported having used both opioids and cocaine in the month and week preceding the interview; of these, 73% (n = 304) were able to identify a typical pattern of daily co-use. In a typical day, injectors of opioids and cocaine (n = 119) and injectors of opioids who inhaled cocaine (n = 111) showed stable opioid use but variable cocaine use, which peaked at 21 hr. Overall, 30% of the individuals used both drugs exclusively in a sequential fashion, 35% reported taking opioids and cocaine within the same hour, and 35% reported taking them together at the same time or mixing them. These findings indicate that different individuals display different patterns of opioids and cocaine co-use.

Adolescent↗
PubMed2005

Continuity of care and health outcomes among persons with severe mental illness.

OBJECTIVES: Continuity of care is considered to be essential to the effective treatment of persons with severe mental illness, yet evidence to support the association between continuity and outcomes is sparse because of a lack of longitudinal studies and of comprehensive continuity measures. The purpose of this study was to examine the relationship between continuity of care and outcomes. METHODS: A new multilevel measure of service continuity, the Alberta Continuity of Services Scale for Mental Health (ACSS-MH), was used in a 17-month follow-up study of 486 adults with severe mental illness in three health regions of Alberta, Canada. RESULTS: Endpoint information was obtained for 411 participants (85 percent). The mean continuity score reported by patients was 131+/-20 out of a possible 185. The mean continuity score as rated by observers was 39+/-10 out of a possible 59. Higher levels of observer-rated continuity were associated with older age, lower annual household income, a diagnosis of psychotic disorder, and no suicidality or alcohol use. Continuity was also significantly associated with a better quality of life at endpoint (generic and disease specific), better community functioning, lower severity of symptoms, and greater service satisfaction. The associations between continuity and quality of life held after adjustment for empirically identified confounders. CONCLUSIONS: Positive relationships between continuity of care and health outcomes among persons with severe mental illness suggest that efforts at improving continuity in and among mental health services are worthwhile.

Activities of Daily Living↗
PubMed2005

Comorbid depression among untreated illicit opiate users: results from a multisite Canadian study.

OBJECTIVES: This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. METHOD: Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. RESULTS: Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). CONCLUSIONS: Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population.

Adult↗
PubMed2005

Understanding why adolescents decide to visit family physicians: qualitative study.

OBJECTIVE: To understand why Canadian adolescents go or do not go to see family physicians for annual checkups using the Theory of Planned Behavior as a conceptual framework. DESIGN: Qualitative analysis of small group discussions. SETTING: Edmonton, Alta, a large Canadian city. PARTICIPANTS: Seventeen adolescents (6 male, 11 female) recruited from a medical clinic and an organized youth group. METHOD: Two small group discussions and one validation focus group were held. A combination of category coding and thematic analysis was used to analyze the data transcribed. MAIN FINDINGS: Adolescents reported that regular checkups, although uncomfortable, are a good idea. They also reported that going to a family doctor for a checkup is out of their control because of numerous barriers (eg, lack of time, not knowing how to set it up, or lack of transportation). Participants thought their parents' opinions on going for routine checkups were more important than the opinions of their peers. CONCLUSION: Family physicians should recognize adolescents' attitudes toward visiting family physicians' offices and understand the potential barriers adolescents face in coming in for checkups in order to make visits to their offices more comfortable and beneficial.

Adolescent↗
PubMed2004

Using collaterals to validate self-reports of problem drinkers: any impact on client attrition and quantity of drinking reported?

OBJECTIVE: To explore the impact of asking for a collateral on respondent attrition and the impact of providing versus not providing a collateral on self-reported drinking. METHOD: As part of a larger trial assessing the efficacy of self-help materials for problem drinkers, respondents were randomly assigned to be asked or not asked to provide a collateral at the time of their 6-month follow-up. RESULTS: While there was no significant impact of client attrition, respondents who were asked for a collateral and provided one reported higher levels of alcohol consumption at the 6-month follow-up as compared to those who were asked for a collateral but did not provide one. CONCLUSIONS: Providing a collateral may have an impact on respondent's self-reported drinking. Alternate explanations for this finding are discussed.

Adult↗
PubMed2004

Continuity of care in mental health services: toward clarifying the construct.

OBJECTIVE: To clarify "continuity of care" (COC), a construct associated with the delivery of services for persons suffering from severe and persistent mental illness (SPMI), with attention to the service recipient's perception of COC. METHOD: The study involved a systematic appraisal of the literature on COC, supplemented by interviews with 36 SPMI patients and their families. Statements highlighting attributes of COC were extracted from both sources. RESULTS: Comments by patients and families corresponded to descriptions of COC in the mental health literature. Attribute classifications by independent teams of judges showed good consistency. The following 4 attribute domains of the COC construct were identified: service delivery, accessibility, relationship base, and individualized care. CONCLUSIONS: Service recipients' perceptions of COC overlapped with representations of the construct in the mental health literature. The qualitative inquiry resulted in a draft, 47-item, self-report questionnaire for use in studies of interventions designed to facilitate COC.

Continuity of Patient Care↗
PubMed2004

Perceived environment and physical activity in youth.

The examination of physical environments to explain and promote physical activity is an important yet under-investigated area of research inquiry. This study explored relationships between the perceived availability of physical environmental resources and the perceived importance of these resources in relation to physical activity levels amongst youth. A self-report questionnaire was completed by 610 students (mean age = 15.5 years old; 62% female participants) from four high schools (grades 9-12) in rural Alberta, Canada. Perceived physical environment constructs explained 5% of the variance in physical activity, with home, neighborhood, and school as significant domains. Perceived importance constructs explained 8% of the variance in physical activity with school context showing the only significant relationship with physical activity. A hierarchical regression analysis entered sex, grade, self-efficacy, peer, family and physical education teacher relationships, as the first block and eight environmental constructs as the second block. The first block variables accounted for 22% of the variance and environmental constructs accounted for an added 4% of the variance in physical activity. Perceived importance of the school environment was the only environment variable significantly associated with physical activity (beta = .14; p < .05) after taking into account the impact of these traditional predictors. These findings reinforce the need to provide and support school physical environments related to physical activity.

Adolescent↗
PubMed2003

Substance abuse treatment and pressures from the criminal justice system: data from a provincial client monitoring system.

AIMS: Compulsory treatment is discussed increasingly as a way to reduce the population burden of addictive behaviours. This study explores the extent to which social control strategies exercised through the criminal justice system are used to bring people into substance abuse treatment at a system level. We also assessed whether particular subgroups may be more or less likely to be brought into treatment in this manner. DESIGN: We employed a secondary analysis of data from a client-based information system which captured demographic, referral and substance use characteristics from people seeking treatment for substance abuse. PARTICIPANTS: A census of clients (n = 45123) entering specialized Ontario addiction treatment programmes between 1 April 1999 and 31 March 2000. FINDINGS: Some 28.9% of clients reported legal problems at treatment intake, and 13.9% had an explicit corrections-related condition of treatment contact. Logistic regression analyses indicated that legal problems and corrections-related conditions of treatment were more prevalent among younger, unmarried and unemployed males, who had not completed high school. A number of important interactions were identified between these factors and substance of abuse. CONCLUSIONS: Implications for equity, accessibility and effectiveness of substance abuse treatment are discussed in relation to the tendency of treatment mandates from criminal justice system to disproportionately affect the entry of this segment of substance-abusing clients.

Adolescent↗
PubMed2002

Effects of gender in social control of smoking cessation.

This study of 93 men and 117 women smokers during an ongoing quit attempt examined the roles of gender and social network influences on quitting. For men, social influences appeared to positively affect their ability to reduce their smoking but were less effective for women. Specifically, increased reports of a spouse or partner's influence, and family and friends' influence, were associated with greater reductions in men's smoking 2 days and 4 months post quit date, respectively. In contrast, for women, greater reports of spouse or partner influence and of family and friends' influence were associated with smaller reductions in smoking. Sex differences in social control strategies and perceived autonomy supportiveness of those strategies are discussed as possible explanations for these results.

Adult↗
PubMed2002

Compulsory substance abuse treatment: an overview of recent findings and issues.

An overview of research trends and issues in the area of compulsory substance abuse treatment is presented, using a sample of 170 English-language articles obtained from a search of 4 databases (Medline, PubMed, Embase, PsychINFO, supplemented by a manual search). About half (51%) of these articles were non-empirical (i.e. literature reviews, policy proposals, legal and ethical commentaries on compulsory treatment). A subsample of empirical studies published since 1988 (n = 71) was coded to summarize research trends in relation to 3 key issues: (1) how compulsory treatment was studied (country of origin; type of compulsory treatment; treatment population), (2) the evidence base for judging effectiveness of compulsory treatment (research design; sampling; type, timing and results of outcome measures), and (3) the relationship between compulsory treatment and coercion (measurement strategies). Directions for future research are discussed.

Coercion↗
PubMed2002

Personal drinking and sociocultural drinking norms: a representative population study.

OBJECTIVE: This study examined relationships between personal drinking and perceived social norms for alcohol use. It was hypothesized that frequent heavy drinkers (i.e., those consuming five or more drinks at least once a week or greater in the last 12 months) would exhibit biases in sociocultural expectations for alcohol use. METHOD: A representative sample of Ontario residents who had consumed alcohol in the previous 12 months (N = 937, 51.8% women, mean [SD] age = 42.7 [15.2] years) compared their own alcohol use with the drinking habits of friends, coworkers and the general public. Respondents rated the importance of seven psychosocial factors that might define "problem drinking" and estimated the number of drinks social and problem drinkers are likely to have in different contexts. RESULTS: Compared with lighter drinkers, frequent heavy drinkers (1) believed that heavy alcohol use is more normative in social reference groups, (2) overestimated the amount of alcohol that social and problem drinkers consume in different contexts, (3) rated several criteria (e.g., frequency of intoxication) as less definitive of problem drinking and (4) did not exhibit pluralistic ignorance (i.e., they shifted private approval of the drinking habits of others to match [mistaken] social norms of reference groups). CONCLUSIONS: Frequent heavy drinkers calibrate their beliefs about drinking in reference groups in order to view their drinking as normative. Results are discussed in relation to the development of brief public health interventions.

Adolescent↗
PubMed2002

Treating alcohol problems with self-help materials: a population study.

OBJECTIVE: An experimental trial was used to assess the effectiveness of a self-help book and a personalized assessment-feedback intervention, both separately and in combination with each other, in a general population survey. METHOD: Participants (N = 86; 66.3% male) were recruited through a random digit dialing telephone survey conducted by the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Respondents were randomly assigned to one of four conditions in a two-by-two factorial design: "no-intervention" control group, "personalized feedback only," "self-help book only" and "both personalized feedback and self-help book." Respondents were followed up in 6 months' time, and differences in drinking status were compared between experimental conditions using a multivariate analysis of covariance with baseline drinking severity as the covariate. RESULTS: Support was provided for an interaction hypothesis in which respondents who received both interventions reported significantly improved drinking outcomes at 6-month follow-up, compared with respondents who received just one of the interventions or who received no intervention. CONCLUSIONS: Because respondents were recruited from a representative sample of the general population into a randomized trial with a no-intervention control group, this research design maximized both external and internal validity in examining the effectiveness of self-help interventions.

Alcohol Drinking↗