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Article

Psychotropic Medications and Contemporary Social Work  

Kia J. Bentley and Christopher P. Kogut

To advance the discussion of the interface between psychopharmacology and contemporary social work practice, we present a brief primer on the different types of medications used in psychiatry and our current understanding of how they work. We also discuss how decisions are made about psychiatric medications in the real world to treat some of the more common mental illnesses. Along the way, we will also present some of the recent research in psychopharmacology of particular interest to social workers and the clients they serve, as well as some of the future directions we can expect in the years to come. From that foundation, we review major activities of social workers in psychiatric medication, address some of the key controversies centering on issues of access, the role of drug companies, and especially medication for children. We conclude with brief reflections on what is “best practice” and notions of the future of interdisciplinary practice in health, mental health, and beyond.

Article

Adherence and Communication  

Teresa L. Thompson and Kelly Haskard-Zolnierek

Patient adherence (sometimes referred to as patient compliance) is the extent to which a patient’s health behavior corresponds with the agreed-upon recommendations of the healthcare provider. The term patient compliance is generally synonymous with adherence but suggests that the patient played a more passive role in the healthcare professional’s prescription of treatment, whereas the term adherence suggests that the patient and healthcare professional have come to an agreement on the regimen through a collaborative, shared decision-making process. Another term related to the concept of adherence is persistence (i.e., taking a medication for the recommended duration). Some patients are purposefully or intentionally nonadherent, whereas others are unintentionally nonadherent due to forgetfulness or poor understanding of the regimen. Patients may be intentionally nonadherent because of a belief that the costs of the regimen outweigh the benefits, for example. Nonadherence behaviors in medication taking include never filling a prescription, taking too much or too little medication, or taking a medication at incorrect time intervals. Patient adherence is relevant not only in medication-taking behaviors, but also in health behaviors such as following a specific dietary regimen, maintaining an exercise program, attending follow-up appointments, getting recommended screenings or immunizations, and smoking cessation, among others. A number of factors predict patient adherence to treatment, but the relationship between provider-patient communication and adherence to treatment will be stressed. Focusing on recent research, the article examines the concept of patient adherence, describes how provider-patient communication can enhance patient adherence, explains what elements of communication are relevant for adherence, and illustrates how interventions to improve communication can improve adherence.

Article

First Trimester Medication Abortion: Public Health Challenges and Clinical Guidance  

Devanshi Somaiya and Candace Lew

According to 2015–2019 data, there are 121 million unintended pregnancies each year globally. One hundred eleven million of these occur in low- and middle-income countries. Of all unintended pregnancies, 61%, or about 73 million pregnancies, end in abortions annually, at the rate of 39 abortions per 1,000 women of reproductive age. About half the abortions, or 35 million of them, are unsafe, contributing to the 299,000 maternal deaths each year. These, in turn, have implications for the realization of almost every one of the 17 United Nations Sustainable Development Goals, specifically ensuring good health and well-being, achieving gender equity, and ending poverty. Abortions occur in every country irrespective of income level or the legal status of abortion. From 1990 to 2019, there has been a greater increase in the proportion of pregnancies ending in abortions in countries where abortion is restricted compared with countries where abortion is broadly legal. A growing proportion of these abortions are medication abortions, incorporating the use of mifepristone or misoprostol or both. The availability of this becomes even more important in areas where policy or infrastructure or both are more restrictive for providing safe, legal abortions. Providing quality, women-centered, comprehensive abortion care that is equitably accessible hence becomes imperative to addressing a woman’s ability to access appropriate medical care for her reproductive needs. Making this amenable to a digital platform overcomes even more barriers, be they socioeconomic or policy-driven. Fortunately, recent research and evidence support this, hence broadening the availability of safe abortion care into areas and demographics that remained precluded from the availability of comprehensive reproductive health care. Targeted progress and strengthened commitments are needed to further this penetration and provide access to compassionate, safe, and quality care for abortion and family planning.

Article

Disability: Psychiatric Disabilities  

W. Patrick Sullivan

The psychosocial catastrophe that accompanies serious mental illness negatively impacts individual performance and success in all key life domains. A person-in-environment perspective, and with a traditional and inherent interest in consumer and community strengths, is well positioned to address psychiatric disabilities. This entry describes a select set of habilitation and rehabilitation services that are ideally designed to address the challenges faced by persons with mental illness. In addition, it is argued that emphasis on a recovery model serves as an important framework for developing effective interventions.

Article

Substance Use in Later Life  

Stephen J. Bright

In the 21st century, we have seen a significant increase in the use of alcohol and other drugs (AODs) among older adults in most first world countries. In addition, people are living longer. Consequently, the number of older adults at risk of experiencing alcohol-related harm and substance use disorders (SUDs) is rising. Between 1992 and 2010, men in the United Kingdom aged 65 years or older had increased their drinking from an average 77.6 grams to 97.6 grams per week. Data from Australia show a 17% increase in risky drinking among those 60–69 between 2007 and 2016. Among Australians aged 60 or older, there was a 280% increase in recent cannabis use from 2001 to 2016. In the United States, rates of older people seeking treatment for cocaine, heroin, and methamphetamine have doubled in the past 10 years. This trend is expected to continue. Despite these alarming statistics, this population has been deemed “hidden,” as older adults often do not present to treatment with the SUD as a primary concern, and many healthcare professionals do not adequately screen for AOD use. With age, changes in physiology impact the way we metabolize alcohol and increase the subjective effects of alcohol. In addition, older adults are prone to increased use of medications and medical comorbidities. As such, drinking patterns that previously would have not been considered hazardous can become dangerous without any increase in alcohol consumption. This highlights the need for age-specific screening of all older patients within all healthcare settings. The etiology of AOD-related issues among older adults can be different from that of younger adults. For example, as a result of issues more common as one ages (e.g., loss and grief, identity crisis, and boredom), there is a distinct cohort of older adults who develop SUDs later in life despite no history of previous problematic AOD use. For some older adults who might have experimented with drugs in their youth, these age-specific issues precipitate the onset of a SUD. Meanwhile, there is a larger cohort of older adults with an extensive history of SUDs. Consequently, assessments need to be tailored to explore the issues that are unique to older adults who use AODs and can inform the development of age-specific formulations and treatment plans. In doing so, individualized treatments can be delivered to meet the needs of older adults. Such treatments must be tailored to address issues associated with aging (e.g., reduced mobility) and may require multidisciplinary input from medical practitioners and occupational therapists.

Article

Effectiveness and Availability of Treatment for Substance Use Disorders  

Dominic Hodgkin and Hilary S. Connery

Drug and alcohol use disorders, also called substance use disorders (SUD), are among the major health problems facing many countries, contributing a substantial burden in terms of mortality, morbidity, and economic impact. A considerable body of research is dedicated to reducing the social and individual burden of SUD. One major focus of research has been the effectiveness of treatment for SUD, with studies examining both medication and behavioral treatments using randomized, controlled clinical trials. For opioid use disorder, there is a strong evidence base for medication treatment, particularly using agonist therapies (i.e., methadone and buprenorphine), but mixed evidence regarding the use of psychosocial interventions. For alcohol use disorder, there is evidence of modest effectiveness for two medications (acamprosate and naltrexone) and for various psychosocial treatments, especially for less severe alcohol use disorder syndromes. An important area for future research is how to make treatment more appealing to clients, given that client reluctance is an important contributor to the low utilization of effective treatments. A second major focus of research has been the availability of medication treatments, building on existing theories of how innovations diffuse, and on the field of dissemination and implementation research. In the United States, this research identifies serious gaps in both the availability of SUD treatment programs and the availability of effective treatment within those programs. Key barriers include lack of on-site medical staff at many SUD treatment programs; restrictive policies of private insurers, states, and federal authorities; and widespread skepticism toward medication treatment among counseling staff and some administrators. Emerging research is promising for providing medication treatment in settings other than SUD treatment programs, such as community mental health centers, prisons, emergency departments, and homeless shelters. There is still considerable room to make SUD treatment approaches more effective, more available, and—most importantly—more acceptable to clients.