Throughout this working paper, under the scope of Prison Reform and Proposals of Prison Reform in Belgium and in Portuguese Prison System, between the periods of 2004 up to 2006, one is driven by the inseparability of Rehabilitative philosophy with Harm Reduction strategies.Whether Belgium, whether Portugal strongly tend to believe that the rehabilitative rationale is a must once speaking of a custodial sentence. Alike, in both countries, it is up to the State to ensure Rehabilitation as an inexorable part of execution of sentences. Overall, both States dismiss of a paternalist approach towards the inmates, namely through the Individual Detention Plan. Nevertheless, in Belgium, Rehabilitation within doors of the offender seems to go hand in hand with the need of doing Reparation towards the victim. Albeit the different political organization as far as execution of sentences is concerned, both Prison System of Belgium and Portugal seems to be constrained with similar defaults such as the lack of proper methodologies and of "follow up " measures. Yet, the recent developments in both countries do not seem to give concrete added value towards those points. Furthermore, the author of this working paper tries to answer to some of the following questions: Rehabilitation - Is it or is it not a consensual concept? Which other concepts may be intrinsically related to rehabilitative intervention when one is speaking about rehabilitation within prison environment? Which factors may play a role...
OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects); caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers); selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.
OBJECTIVE: To characterize adolescent drug use in terms of a risk continuum and to explore the rationale for harm reduction as a potential approach for school-based drug prevention. DESIGN: Self-reported surveys, in 1991 and 1996, of adolescent students concerning their use of drugs, especially alcohol, tobacco and cannabis, and the harmful consequences of such use. SETTING: Nova Scotia. PARTICIPANTS: A total of 3452 (in 1991) and 3790 (in 1996) junior and high school students in randomly selected classes in the public school system. OUTCOME MEASURES: Prevalence of drug use and patterns of multiple drug use and of alcohol- and drug-related problems; independent risk factors for multiple drug use. The risk continuum for the response to alcohol problems was used as a policy framework. RESULTS: The prevalence of cigarette smoking and the use of hallucinogens and stimulants was markedly higher in 1996 than in 1991. Over one-fifth (21.9%) of the students reported multiple drug use of alcohol and tobacco and cannabis in the 12 months before the 1996 survey. The 3 main subgroups--nonusers, users of alcohol only and users of multiple drugs--had distinct patterns of use, numbers of problems and risk factors. In all, 27.1% of the students had experienced at least 1 alcohol-related problem and 6% had experienced at least 1 drug-related problem in the 12 months before the 1996 survey. CONCLUSION: There is a need for integrated school- and community-based drug prevention programs...
The prevalence of blood-borne viruses in injecting drug users (IDUs) in Tayside, Scotland was determined by testing serum samples from IDUs who underwent attributable HIV antibody testing during 1993-7. The prevalence of antibodies to HIV was 29/802, (3.6%); to hepatitis C virus (HCV) 451/691, (65.3%); and to human T-cell leukaemia/lymphoma viruses type 1 and 2 (HTLV) 0/679, (0.0%). The prevalence of HIV and HCV antibodies were higher in subjects over the age of 25 (P = 0.03 and P = 0.001, respectively). During 1993-7 the prevalence of HCV fell only in younger female IDUs (P < 0.01). HIV prevalence has declined dramatically since 1985, when a rate of 40% was recorded in similar populations. Harm reduction measures have failed to control HCV the spread of infection among IDUs in Tayside, as indicated by the high proportion of antibody positive IDUs, particularly males under the age of 25. Future studies should address the nature and effective reduction of continuing risk taking among IDUs in Tayside.
We previously reported a continual decline in anti-HCV prevalence among young injectors from Glasgow and Lothian between 1990 and 1997. The original study was extended to ascertain if the anti-HCV prevalence among injectors from Glasgow, Lothian, Tayside and Grampian had changed since 1997. Residual sera from injectors who had undergone attributable anti-HIV testing were tested anonymously for anti-HCV. In all four regions, no significant changes in prevalence were found among those aged < 25 years during the late 1990s (Glasgow 1997-9/00: 43%-41%; Lothian 1997-9: 13%-17%; Tayside 1997-9: 45%-35%; Grampian 1996-9: 28%-29%). Among those aged > or = 25 years, significant decreases in prevalence were only observed in Glasgow (1997-9/00: 79%-72%, P = 0.03) and Lothian (1997-9: 54%-45%, P = 0.05). The findings highlight that existing harm reduction measures, acknowledged as having helped to reduce the spread of HCV, are not sufficient to bring this epidemic under control and reduce transmission to sporadic levels.
Preventing alcohol-related harm in drinking environments is a growing international priority. Factors relating to the physical, social and staffing environments in bars can contribute to increased alcohol consumption and harm. Understanding the relationships between such factors and intoxication in European drinking environments is critical to developing appropriate interventions. We undertook a quantitative observational study in 60 bars in four European cities, in The Netherlands, Slovenia, Spain and the UK (n = 237 observational visits). Using a structured observational schedule, researchers recorded characteristics of the bar environment and rated customer intoxication levels. All physical bar characteristics showed associations with intoxication before interactions between them were controlled for. Hierarchical modelling found significant independent associations between intoxication and use of plastic glassware, promotion of non-alcoholic drinks (often energy drinks), permissive environments, poor washroom facilities, the presence of a dance floor, customer sexual activity/competitiveness and later observational time. Findings suggest that prevention efforts should focus on raising and enforcing managerial standards in bars. While harm reduction measures such as plastic glassware are often promoted for high risk bars...
Harm reduction has been increasingly finding its way into public drug policies and healthcare practices worldwide, with successful intervention measures justifiably focussing on the highest-risk groups, such as injecting drug users. However, there are also other types of drug users in need for harm reduction, even though they pose less, low, or no public health risk. Occasionally, drug users may autonomously organise themselves into groups to provide advocacy, harm reduction, and peer-help services, sometimes online. The http://www.daath.hu website has been operated since 2001 by the “Hungarian Psychedelic Community”, an unorganised drug user group with a special interest in hallucinogenic and related substances. As of today, the website serves about 1200 visitors daily, and the online community comprises of more than 8000 registered members. The Daath community is driven by a strong commitment to the policy of harm reduction in the form of various peer-help activities that aim to expand harm reduction without promoting drug use. Our review comprehensively summarises Daath’s user-led harm reduction services and activities from the last ten years, firstly outlining the history and growth phases of Daath, along with its self-set guidelines and policies. Online services (such as a discussion board...
Electronic cigarettes (ECs) have been rapidly gaining ground on conventional cigarettes due to their efficiency in ceasing or reducing tobacco consumption, competitive prices, and the perception of them being a much less harmful smoking alternative. Direct confirmation that long-term EC use leads to reductions in smoking-related diseases is not available and it will take a few decades before the tobacco harm reduction potential of this products is firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor. Acute investigations do not appear to support negative respiratory health outcomes in EC users and initial findings from long-term studies are supportive of a beneficial effect of EC use in relation to respiratory outcomes. The emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category.
Emphasizing the reduction of risk over the cessation of drug use, needle exchange in the United States is often condemned for coddling its participants. Declining the punitive measures or unwavering teleology of criminal justice and drug treatment approaches, harm-reduction measures in general are faulted by naysayers for their refusal to establish clear normative boundaries for behavior modification. This article will seek to subvert such critiques by describing the ways in which disciplinary technologies suffused one needle exchange program in New York City. Drawing upon 1 year of participant observation at “Bronx Harm Reduction,” this article will consider how the “minor procedures” of disciplinary power first characterized by Foucault (1977) worked to shape and organize different user bodies in needle exchange; it will further employ the work of Mitchell Dean to reflect upon the connections between program-level “technologies of agency” and government-led “technologies of performance.” While conceding the overarching disciplinary transformation of late harm reduction, this article is specifically interested in the ramifications of this trajectory within one specific time and place. Namely, it postulates that attempts to “raise the bar” within a low-threshold program may serve to alienate or explicitly exclude certain service users.
Broda, Anja; Bosworth, Leslie B; LaPlante, Debi A.; Nelson, Sarah E.; LaBrie, Richard A.; Shaffer, Howard Jeffrey
Fonte: BioMed CentralPublicador: BioMed Central
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
Background: In an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin), imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior. Methods: We compared (1) gambling behavior of those who exceeded deposit limits with those who did not, and (2) gambling behavior before and after exceeding deposit limits. We analyzed 2 years of the actual sports gambling behavior records of 47000 subscribers to bwin. Results: Only 160 (0.3%) exceeded deposit limits at least once. Gamblers who exceeded deposit limits evidenced higher average number of bets per active betting day and higher average size of bets than gamblers who did not exceed deposit limits. Comparing the gambling behavior before and after exceeding deposit limits revealed slightly more unfavorable gambling behavior after exceeding deposit limits. Conclusion: Our findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However...
Crime and violence are now a key
development issue for Central American countries. In three
nations El Salvador, Guatemala, and Honduras crime rates are
among the top five in Latin America. This report argues that
successful strategies require actions along multiple fronts,
combining prevention and criminal justice reform, together
with regional approaches in the areas of drug trafficking
and firearms. It also argues that interventions should be
evidence based, starting with a clear understanding of the
risk factors involved and ending with a careful evaluation
of how any planned action might affect future options. In
addition, the design of national crime reduction plans and
the establishment of national cross-sectoral crime
commissions are important steps to coordinate the actions of
different government branches, ease cross-sectoral
collaboration and prioritize resource allocation. Of equal
importance is the fact that national plans offer a vehicle
for the involvement of civil society organizations, in which
much of the expertise in violence prevention and
rehabilitation resides. Prevention efforts need to be
complemented by effective law enforcement. The required
reforms are no longer primarily legislative in nature
because all six countries have advanced toward more
transparent adversarial criminal procedures. The
second-generation reforms should instead help deliver on the
promises of previous reforms by: (i) strengthening key
institutions and improving the quality and timeliness of the
services they provide to citizens; (ii) improving efficiency
and effectiveness while respecting due process and human
rights; (iii) ensuring accountability and addressing
corruption; (iv) increasing inter-agency collaboration; and
(v) improving access to justice...
This book contributes to the debate
about the role of agriculture in poverty reduction by
addressing three sets of questions: Does investing in
agriculture enhance/harm overall economic growth, and if so,
under what conditions? Do poor people tend to participate
more/less in growth in agriculture than in growth in other
sectors, and if so, when? If a focus on agriculture would
tend to yield larger participation by the poor, but slower
overall growth, which strategy would tend to have the
largest payoff in terms of poverty reduction, and under
Alcohol abuse is one of the leading
causes of death and disability worldwide. Alcohol abuse is
responsible for 4 percent of global deaths and disability,
nearly as much as tobacco and five times the burden of
illicit drugs (WHO). In developing countries with low
mortality, alcohol is the leading risk factor for males,
causing 9.8 percent of years lost to death and disability.
Alcohol abuse contributes to a wide range of social and
health problems, including depression, injuries, cancer,
cirrhosis, dependence, family disruption, and loss of work
productivity. Health and social problems from drinking often
affect others besides the drinker. While men do the bulk of
the drinking worldwide, women disproportionately suffer the
consequences, including alcohol related domestic violence
and reduced family budgets. Heavy alcohol use takes a
particular toll on the young, and has been linked to high
rates of youthful criminal behavior, injury, and impaired
ability to achieve educational qualifications. Many deaths
and much disease and suffering could be prevented by
reducing alcohol use and related problems. The most
effective approach to reduce alcohol-related problems is to
implement a comprehensive set of measures to reduce alcohol
consumption and related problems. Policy options include
In recent years, China has dramatically
scaled up its response to the HIV/AIDS epidemic. Key steps
include the establishment of HIV prevention and control as a
priority in the 11th National Five-Year Development Plan
(2006-2010), the development of a comprehensive policy
framework for HIV/AIDS prevention treatment and care
(reflected in the Five-Year action Plan to Control HIV/AIDS
2006-2010), and in March 2006, the issuance of the first
legislation directly aimed at controlling HIV/AIDS
(Regulations on AIDS prevention and treatment., Decree of
the State Council No. 457). Under this framework, China has
implemented a number of innovative harm reduction and
prevention interventions and significantly strengthened its
epidemiological and behavioral surveillance system. In
addition, the government has launched a major treatment,
care and support initiative (the Four Free and One Care) for
poor rural and urban patients. These measures have been
accompanied by firm demonstrations of commitment to fighting
AIDS by key Chinese leaders.
Many people see an effective preventive
AIDS vaccine as the best solution to the HIV/AIDS pandemic.
Ten years ago many scientists had hoped that a vaccine would
be available by now. Most scientists are still optimistic
that vaccines will be developed and many candidates are
being tested. Strategies to implement HIV/AIDS vaccination
need to be developed to be ready when vaccines do become
available. The nature of those programs will depend on the
characteristics of each vaccine. How much does it cost? How
effective is it? How long does protection last? The answers
to these and other questions will help determine issues such
as: What will be the impact of the vaccine on the epidemic?
Who should be vaccinated? Will an AIDS vaccine be more
cost-effective than other prevention measures? Will other
measures still be necessary? What will happen to the
epidemic if vaccination leads to riskier behavior? How much
funding will be needed? The authors use two computer
simulation models to investigate the effects of various
vaccine characteristics and implementation strategies on the
impact and cost-effectiveness of vaccines in different
contexts. A simulation model is applied to data from rural
Zimbabwe and the iwgAIDS model is applied to Kampala
(Uganda) and Thailand. The models are used to investigate
the effects of efficacy...
OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks...
OBJECTIVES--To assess spread of bloodborne viruses among prison entrants in Victoria, Australia. DESIGN--Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with collection of minimal data on demography and risk factors over 12 months. SETTING--Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Australia. SUBJECTS--3429 male and 198 female prison entrants (> 99% of all prison entrants); 344 entered prison and were tested more than once. MAIN OUTCOME MEASURES--Prevalence and incidence of antibodies to HIV, hepatitis B, and hepatitis C viruses, and minimal data on risk factors. RESULTS--1562 (46%) gave a history of use of injected drugs, 1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepatitis C positive including 914 (64%) of the men who injected drugs, 91 (2.5%) were positive for hepatitis B surface antigen, and 17 (0.47%) were positive for antibody to HIV. Incidence rates for infection with hepatitis B and C virus were 12.6 and 18.3 per 100 person years, respectively; in men who injected drugs and were aged less than 30 years (29% of all prison entrants) these were 21 and 41 per 100 person years. Seroconversion to hepatitis B or C was associated with young age and shorter stay in prison. Only 5% of those who were not immune to hepatitis B reported hepatitis B immunisation. CONCLUSIONS--Hepatitis B and C are spreading rapidly through some populations of injecting drug users in Victoria...
The present paper explores strategies that drug-using women employ to protect their children from drug-related harm. Twenty-two mothers were recruited through word-of-mouth, field recruitment, and flyers. Semi-structured interviews were used to collect mother's views on parenting and heroin use. Analysis was conducted using a standard qualitative software package. A hierarchy of seven strategies was identified: (1) stop using; (2) go into treatment; (3) maintain a stable small habit; (4) shield children from drug-related activities; (5) keep the home environment stable, safe, and secure; (6) stay out of gaol; and, if the children's needs still cannot be met, (7) place them with a trusted caregiver and maintain as active a parental role as possible. These strategies, derived innovatively from mothers' experiences, provide progressive goals for treatment and can also serve as measures of success. In addition, they may determine how well children fare in drug-affected families.
There is a paucity of literature on the topic of sobering-up centres (non-custodial safe overnight accommodation for the publicly intoxicated). This paper presents findings of a retrospective longitudinal case study of a sobering-up centre in regional South Australia over the ten years 1991 to 2000. There were 6,486 admissions during this period, 97.1% of which were of Aboriginal people. We collated and analysed primary data including demographic details of admissions and re-admissions, and qualitative and quantitative measures of intoxication. The findings from this case study, considered together with contextual understandings from a wider social study in this region by three of the authors, provide supporting evidence of the important role of sobering-up centres in averting the known harms of a custodial response to public drunkenness, as well as avoiding the potential harm of alcohol-related injury among vulnerable Aboriginal people.
Bon nombre de consommateurs de substances psychoactives se retrouvent dans les institutions carcérales québécoises et canadiennes. Or, leur consommation ne s'arrête pas nécessairement avec l'incarcération. Les taux de prévalence de consommation en prison et en pénitencier en témoignent. Aux prises avec les méfaits qui y sont associés (propagation des maladies virales, intoxication, etc.), les autorités pénitentiaires et de santé publique sont priées de trouver une réponse appropriée. En communauté, les pratiques de réduction des méfaits ont déjà démontré des résultats positifs au-delà de l'amélioration des comportements à risque. Toutefois, est-il possible d'adopter, dans un contexte carcéral, une approche visant à atténuer les méfaits associés à la consommation de drogue plutôt que de prôner l'abstinence totale de toute drogue? Cet article tente une réponse à cette question en se basant sur un bref survol international des mesures adoptées en prison, mais plus spécifiquement en analysant celles entérinées à l'intérieur des murs québécois et canadiens. Il en ressort qu'une concertation entre les différentes instances correctionnelles, judiciaires et de santé publique s'avère essentielle dans l'adoption de mesures de réduction des méfaits et que doivent s'arrimer les soins prépost et carcéraux. / Many consumers of psychoactive substances are found in Quebec's and Canada's prisons. However...