Drugs as instruments: a new framework for non-addictive psychoactive drug use

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a "necessary" prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of "drug instrumentalization." Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific "instrumentalization goals" and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future.     

Psychotherapeutic Drugs: A Brief Review of Their Effects on Psychological Processes

Abstract

Since the 1950s, psychotherapeutic drugs with increasingly specific behavioral and pharmacological actions have become available for treatment of abnormal behavior. In recent years, behavioral pharmacology has emerged as a new discipline which incorporates behavioral and pharmacological analysis of the effects of psychoactive drugs. Many of the findings in this area are highly relevant for professionals concerned with the treatment of abnormal behavior (i.e., psychiatrists, psychologists, etc.). The present paper attempts to present a brief overview of psychotherapeutic drugs and their effects on behavioral processes with an emphasis on psychological therapy. It is concluded that drugs, in addition to their beneficial effects of relieving symptoms, also have many other effects which may potentially interfere with the acquisition and maintenance of normal behavior.     

Psychopharmacology's debt to experimental psychology

The role of experimental psychology in the development of psychopharmacology has largely been ignored in recent historical accounts. In this article the authors attempt to redress that gap by outlining work in early experimental psychology that contributed significantly to the field. While psychiatrists focused on the therapeutic nature of drugs or their mimicry of psychopathology, experimental psychologists used psychoactive drugs as tools to study individual differences in normal behavior as well as to develop methodologies using behavior to study mechanisms of drug action. Experimental work by Kraepelin, Rivers, and Hollingworth was particularly important in establishing drug-screening protocols still used today. Research on nitrous oxide and on the effects of drug combinations is discussed to illustrate the importance of experimental psychology to psychopharmacology.     

General practitioners' perceptions of psychologists: A response to the Medicare changes in Australia

General practitioners (GPs) have historically been at the centre of primary health‐care delivery in Australia, including delivery of mental health‐care services. Recent changes, however, by the Australian Federal government have led to the creation of a number of mental health‐care items provided by psychologists that are now available on the Medicare Benefits Schedule. The aim of the present study was to examine GPs' perceptions of psychologists and the ways in which GPs have responded to these policy changes in making referrals for mental health patients. Nine GPs were interviewed regarding the provision of mental health‐care services. Analysis of the interviews indicated a number of themes including the benefits of the new Medicare policy in increasing accessibility of psychologists, GPs' frustrations with the bureaucracy surrounding the use of this policy, GPs' knowledge about the specific skills and training of psychologists, and the importance of GPs' matching patients and clinicians. Recommendations are made to facilitate the professional and clinical relationship between GPs and psychologists.     

Psychologists' Experiences with the Better Access Initiative: A Pilot Study

The Australian Government's Better Access initiative was introduced in late 2006 to increase treatment rates for people with mental disorders. It provides for reimbursement of psychologists' services through Medicare. The current pilot study examines the experiences of psychologists with this initiative. A random sample of 204 of 4,235 psychologists in private practice was approached and 73 psychologists (36%) were interviewed. The current study suggests that psychologists have had positive experiences with Better Access. They have appreciated the greater security of income and greater variety of work afforded by the initiative, and they have observed flow‐on benefits in terms of increased access and reduced stigma for their clients. Additional research is required to corroborate these findings with a larger sample of psychologists, but the current findings provide indicative evidence that Better Access is assisting psychologists to meet a previously unmet community need for mental health care.     

Exploring unique roles for psychologists

Presents a comment on "Psychological Treatments" by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from their own clinical practice with special psychiatric populations, such as adults with severe and persistent mental illness and behaviorally disordered youths, to illustrate some potential unique roles for psychologists. The authors believe psychologists are uniquely trained to design such individualized functional behavioral analysis protocols because of their training in research design, behavior analysis, learning theory, and behavior change. Psychologists may also be uniquely qualified to design, implement, and evaluate many specialized therapy techniques, as Barlow has outlined and suggested.     

The Self‐Care of Psychologists and Mental Health Professionals: A Review and Practitioner Guide

It has been documented in the professional literature that psychologists and mental health professionals in general tend to neglect their own mental health, despite serving in a field that promotes the health and well‐being of others. Numerous empirical studies support the need for psychologists and mental health professionals to be more conscientious of the effect that stress and the nature of their work has on them. This article reviews some of the recent literature and discusses the pertinent issues at hand. A number of interventions are suggested along with tips for professionals to consider in order to function in a more productive and ethical fashion.     

Application of the APA ethics code for psychologists working in integrated care settings: Potential conflicts and resolutions

ABSTRACT

Increasingly, there is evidence of the potential benefits of an integrated care model. In fact, the American Psychological Association (APA) supports the role of psychologists in integrated healthcare given the positive outcomes for patients in primary care settings such as increased access to mental health services, reduced mental illness stigma, and improved health associated with recognizing the impact of psychosocial factors on physical wellbeing. Less attention has been paid, however, to ethical dilemmas that may arise for psychologists working in integrated healthcare. This paper explores considerations for resolving potential ethical conflicts that may arise for psychologists working in integrated care settings.     

The age of androgyny: The new views of psychotherapists

Male therapists no longer engage in sexual stereotyping in their views of mentally healthy men and women as 15 previous studies had shown. Both male and female therapists, both psychiatrists and psychologists, held a single androgynous standard of mental health for both men and women. Psychologists scored higher on this androgyny factor than psychiatrists. Therapists with many women patients scored higher on this androgyny factor than therapists with few women patients.     

South African Hindu Psychologists’ Perceptions of Mental Illness

Conceptualisations of mental illness are not universally applicable, as culture shapes the expression, perceptions and treatment preferences thereof. By focusing on the perceptions of Hindu psychologists regarding mental illness, this study aimed to provide a deeper understanding of the impact that religious beliefs have on such conceptualisations. Semi-structured interviews were conducted with six Hindu psychologists around the Johannesburg area, South Africa. Responses were analysed using thematic content analysis. From the findings, it was evident that religion plays a critical role in the understanding and treatment of mental illness. Hindu beliefs around psychological disturbances were salient. Additionally, it was found that a tension existed between psychologists’ awareness of the influential function of religion, particularly amongst collectivistic communities such as the Hindu community, and their occupational understandings and practices, which are deeply rooted in Western thought. Furthermore, it was suggested that the fear of stigma prevented Hindu clients from reaping the benefits of seeking help from culturally competent psychologists.     

Social Responsibility and the Mental Health Professions

Summary

While mental health professionals tend to primarily focus on their professional responsibilities toward the specific members of the public whom they serve, many are also concerned about positively impacting the broader society or culture in which they live and work. This notion of social responsibility is addressed in the ethics codes of both psychologists and social workers. This article reviews how this notion is addressed for these two mental health professions and also examines the changes that have occurred for psychologists between the 1992 and 2002 ethics codes. Finally, some general issues regarding the role of mental health professionals in changing society are considered.     

Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment

The increasing use of pharmacotherapy raises specific ethical concerns for psychologists working with vulnerable populations. Due to a shortage of trained specialists, professionals without training in mental health, such as primary care providers, are increasingly prescribing and monitoring psychotropic medications. Vulnerable populations (e.g., older adults, people currently low in social status, immigrants, and racial/ethnic minorities) face additional barriers to mental health treatment and are at heightened risk when these factors intersect. Hence, these patients experience unique barriers to receiving optimal psychopharmacological care and are differentially vulnerable to deleterious outcomes associated with misdiagnosis and overmedication. Taken together, these factors fuel inequities in the access, quality, and utilization of mental health care. Psychologists working with these patients are ethically mandated to protect patients from harm and ensure equitable care across patient populations. Specifically, psychologists must respond to the dilemma of how to effectively treat patients within these vulnerable populations who have been misdiagnosed or poorly medicated while remaining within the bounds of their competence. This article recommends pathways to address these dilemmas through education, training, research, and advocacy.     

Psychologists' and social workers' self-descriptions using DSM-IV psychopathology

There is limited information on mental health of psychologists and social workers despite their rendering mental health services, so their subjective perception of mental disorder was explored via a self-evaluation survey in which they self-diagnosed the presence of DSM-IV disorders within themselves. The sample of 128 professionals included 63 psychologists and 65 social workers. The presence of Axis I traits was reported by 81.2%, the three most frequent traits being mood, obsessive-compulsive disorder, and eating disorder. Axis II traits were reported by 73.4% of subjects, the three most frequent conditions being narcissistic, avoidant, and obsessive-compulsive personality traits. While a high percentage of subjects reported the presence of either an Axis I or Axis II disorder, the average severity reported was low. More psychologists reported on mood, social phobia, and eating problems than social workers, while the latter reported more on psychotic problems. Psychologists reported more Axis II traits, especially paranoid, narcissistic, and avoidant subtypes. More women than men reported eating problems, while more men reported schizoid and avoidant personality traits. In conclusion, manifestations of subthreshold psychiatric conditions were prominently reported. These findings suggest encouraging mental health care professionals to explore treatment for problems if present.     

The senile mind: psychology and old age in the 1930s and 1940s

In the 1930s, some psychologists began to study and discuss the normal and pathological mental abilities of old age. This paper explores this research and its implications for an emerging definition of old age in the 1930s and 1940s. The argument is that these psychologists explained old age in terms of tests they had performed on children and young adults. In addition, these professionals projected their culturally bound assumptions onto their study of old age. In the process, psychologists helped to define old age as a problem that required a professional solution.     

Medication status of participants in psychopathology research: selective review of current reporting practices.

The majority of Ss included in studies of psychopathology are typically receiving psychoactive medication. In view of concerns regarding the confounding effects of psychoactive medication, it appears that researchers should provide information regarding at least the drug status of the Ss studied. A review of the articles on adult psychopathology that appeared in the Journal of Abnormal Psychology during a 5-year period, however, revealed that nearly 50% of reports on Ss presumably receiving psychoactive medications failed to specify the medication status of those Ss. Few studies (15%) provided adequate information regarding the types and dosages of psychoactive drugs received by the Ss. It is argued that researchers should provide a full report of the psychoactive drugs received by research participants and, when participants are unmedicated, to indicate the reasons for drug-free status.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Mental Health Value Differences Between Psychologists and Clergy

Mental health values of national samples of Baptist, Catholic, and Methodist clergy were compared with those previously reported for psychologists. Small differences were found on 3 of 8 value dimensions. Clergy considered untrustworthiness to be more indicative of poor mental health than did psychologists. Psychologists considered receptivity to unconventional experiences to be more indicative of poor mental health than did Catholic and Methodist clergy. Catholic and Methodist clergy considered religious commitment to be more indicative of good mental health than did psychologists.