Met and unmet needs of homeless individuals at different stages of housing reintegration: A mixed-method investigation.

This study aimed to identify and compare major areas of met and unmet needs reported by 455 homeless or recently housed individuals recruited from emergency shelters, temporary housing, and permanent housing in Quebec (Canada). Mixed methods, guided by the Maslow framework, were used. Basic needs were the strongest needs category identified, followed by health and social services (an emergent category), and safety; very few participants expressed needs in the higher-order categories of love and belonging, self-esteem, and self-actualization. The only significant differences between the three housing groups occurred in basic needs met, which favored permanent housing residents. Safety was the only category where individuals reported more unmet than met needs. The study results suggested that increased overall access to and continuity of care with family physicians, MD or SUD clinicians and community organizations for social integration should be provided to help better these individuals. Case management, stigma prevention, supported employment programs, peer support and day centers should particularly be more widely implemented as interventions that may promote a higher incidence of met needs in specific needs categories.

Formal and Informal Control of Cannabis: Regular Users' Experience.

BACKGROUND: The debate on recreational use of cannabis, recently relaunched by the election of the Liberal Party of Canada that intends to legalize and regulate its use and access, implies a better understanding of social control mechanisms that are in place, and their influence on users' behaviors. OBJECTIVE: This study addresses the issue of formal and informal controls by providing, first, a theoretical perspective of this concept, and, second, by illustrating its operation from the users' perspective. METHODS: Semi-structured interviews were conducted with 164 regular, adult cannabis users recruited in four large Canadian cities (Vancouver, Toronto, Montreal, and Halifax). An initial qualitative analysis based on the principles of grounded theory was conducted. The main categories identified were then used to find and re-code relevant material on the respondents' experience with formal and informal control (secondary analysis). RESULTS: The users' perspective shows that mechanisms of informal control play an important role in defining the social context of their use (when, where, and with whom cannabis is consumed). In contrast, formal control had no deterrent impact on the cessation or reduction of use, but affected their behavior by influencing them to change the context of their practices to avoid criminal legal consequences and stigmatization. Conclusions/Importance: The regulatory controls based in public health that the Canadian government plans to implement (replacing criminal ones), should be based on a better understanding of current practices and patterns of cannabis users, and in accordance with informal controls already in place. Legislative formal controls, in a regulatory model, that are better defined and consistent with social practices, will be more accepted and respected by the user population and thus likely to be more effective in reducing harm.

Does the transtheoretical model predict attrition in domestic violence treatment programs?

Attrition in intervention programs for domestically violent men is considered to be a serious and enduring problem. Researchers have found a number of sociodemographic variables that partially explain this phenomenon; however, models based on these variables have a limited predictive power. Scott (2004) argues that a firm theoretical base is needed in future investigations of the problem and suggests the use of the transtheoretical model of behavior change (TTM), which was found to predict dropout with accuracy in other areas of behavioral change. This study investigated the relationship between four TTM constructs (Stages of Change, Decisional Balance, Self-Efficacy, and Processes of Change) and premature termination with a sample of Canadian French-speaking men (N = 302) in five domestic violence treatment programs. Contrary to the initial hypotheses, the TTM constructs did not predict dropout. Discussion investigates how social desirability bias affects results being obtained by current TTM measures and whether more motivation to change at intake necessarily relates to involvement in treatment for longer periods of time.

The costs of alcohol, illegal drugs, and tobacco in Canada, 2002.

OBJECTIVE: The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002. METHOD: Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach. RESULTS: Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco. CONCLUSIONS: Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.

How much for a dime bag? An exploration of youth drug markets.

Relatively little is known about how youth obtain marijuana and other drugs. The Drugs, Alcohol and Violence International (DAVI) study explored youthful drug markets among samples of school students, detained youth, and school dropouts (ages 14-17 years) in the greater metropolitan areas of Philadelphia, Toronto, Montreal, and Amsterdam. Students frequently reported sharing drugs, either getting them from others or giving them to others for free. Sharing was less common among the more drug-involved detainees and dropouts. Marijuana was typically obtained either outdoors or in a house or apartment. Few youth reported getting marijuana at school. In Amsterdam, where marijuana can be purchased in small quantities in coffeeshops, this was the most common place to get marijuana, even though 18 is the legal age for purchase. Alcohol was also most likely to be obtained in stores or restaurants across all the sites, even though none were of legal age except those in Amsterdam age 16 or older. Youth most often reported purchasing marijuana in nickel, dime or other small bags, which are not standardized units. The exception again was Amsterdam, where youth most often reported quantities in grams or joints, which is how it is sold in coffeeshops. The lack of standardization of units makes economic cost estimates suspect. Even standardized units such as alcohol present problems since youth report a wide range of 'typical purchases.' Survey data can, however, more aptly describe drug market characteristics such as general location of purchase, and relationship with the seller.

Illicit opioid use in Canada: comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study).

Most of the estimated 125,000 injection drug users (IDUs) in Canada use illicit opioids and are outside treatment (i.e., methadone maintenance treatment). Empirical data suggest that illicit opioid users outside treatment are characterized by various health and social problem characteristics, including polydrug use, physical and mental morbidity, social marginalization, and crime. Although required for evidence-based programming, systematic information on this specific substance-user population is sparse in Canada to date. This article presents and compares key characteristics of population of illicit opioid users outside treatment in five cities across Canada (OPICAN cohort). Overall, the majority of OPICAN participants regularly used both a variety of illicit opioids and cocaine or crack, reported physical and mental health (e.g., mood disorder) problems, lacked permanent housing, were involved in crime, and had their "ideal" treatment not available to them. However, key local sample differences were shown, including patterns of heroin versus prescription opioid use and levels of additional cocaine versus crack use as well as indicators of social marginalization. Illicit opioid user population across Canada differ on key social, health, and drug use indicators that are crucial for interventions and are often demonstrated between larger and smaller city sites. Differentiated interventions are required.