Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Response

We argue that Shogan's critique, as well as that of Fox, fails to engage with the central focus of our article, which was to characterize and evaluate different approaches to lesbian ethics and to propose an alternative to the more familiar approaches.     

Menarche: A crossroads that previews developmental change

In recent years the developmental implications of menarche have garnered particular attention. Investigators have determined that this developmental event tends to affect three significant domains of the adolescent girl's function: psychological status, relationships with peers, and role in the family. This paper explores these issues and introduces a new technique, referred to as previewing, that may help the teenage girl acclimate to the status of sexual maturity. Derived from the early life interactions of caregiver and infant, previewing promotes representational skills and enhances self-esteem as the adolescent confronts developmental challenges.     

The Patient Self-Determination Act and Advance Directives: Snapshots of Activities in a Tertiary Health Care Center

This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

Group therapists and AIDS groups: An exploration of traumatic stress reactions

As the AIDS epidemic continues unabated, there is growing clinical evidence that the catastrophic nature of this disease is creating a second category of trauma casualties. They are the health care practitioners who witness the narratives of those who are living with and dying from AIDS. This article examines how multiple AIDS-related deaths of group members exert a traumatizing effect on group therapists, creating vicarious traumatization. Vignettes are presented that illustrate reactions associated with traumatic stress, including death images, survivors' guilt, psychic numbing, suspicion of counterfeit nurturance, and struggle for meaning. Possible therapeutic interventions for group therapists coping with multiple deaths are also explored.The author wishes to acknowledge the endeavors of the volunteer group therapists and the Clinical Group Services staff of the Gay Men's Health Crisis of New York City, who provide group therapy to over 900 clients a week. This article is written in admiration of their extraordinary effort and dedication.     

Involving the family in the evaluation and treatment of the child patient: A psychodynamic approach

The purpose of this article is to provide psychotherapists with a tool for family evaluation using the basic principles of psychodynamic work; and to introduce a transitional format for therapists who have practiced family evaluations in their training institutions and now need to adapt this model to the private practitioner's office. A case example illustrates: (1) Use of the therapist's unconscious for diagnosis of the child and its family, (2) joining the family's intersubjective space, and (3) use of play and therapist's neutrality as ways that the psychodynamically oriented clinician involves the family in the evaluation and treatment of the child.     

Gender,psychological well-being and somatic cardiovascular risk factors

The purpose of this study is to determine associations between cardiovascular risk factors and subjective experience of psychological general well-being with special reference to gender-related differences. One hundred fifty white-collar workers in a car manufacturing plant in Sweden participated in a health care screening program. Subjective experience of psychological well-being was significantly correlated with cardiovascular risk factors among both men and women. There were, however, marked differences between the genders. For men, the following specific psychological variables were significantly correlated with cardiovascular risk factors: estimation of general health, anxiety, self-control and vitality. For women, more complex significant relationships between the two sets of variables were found. Moreover, the direction of the correlations differed between the genders. For example, men with cardiovascular risk factors, such as increased blood pressure, blood lipids and body mass index, reported significantly morepositive estimation of their general health. For women the relation was the opposite with a significantly positive correlation (p-0.004) between experience of good health and a low risk factor profile indicating the concordance between physiological and psychological parameters. Possible reasons for these sex differences are discussed.     

Requiem for “schizophrenia”

In this article a brief overview of the treatment of chronic psychosis for the last two centuries is covered, with particular emphasis on many scientifically demonstrated causes of chronic organic psychosis and their medically successful treatment, including recent neurotransmitter manipulations. With respect for the important contributions of Bleuler, the term “schizophrenic” is considered as an unscientific and unprovable nosological construct, which has hampered the successful resolution of chronic psychosis and has outlived its usefulness in the lexicon of modern psychiatry.     

A behavioral experimental analysis of dyslexia

A behavioral analysis of specific dyslexia is contrasted with traditional genetic, neurological and developmental theories which hold that the dyslexic's inability to read is based on impaired intellectual functioning and decreased perceptual and attentional skills caused by a biological limitation. Two groups of six children, aged 9 and 10 years and comprised of dyslexic and non-dyslexic subjects, were given either traditional remedial reading treatment or behavior therapy consisting of the Staats Motivated Action Reading Technique. Both dyslexic and non-dyslexic subjects receiving the behavioral intervention significantly improved in reading achievement to approximately the same degree, and the dyslexic subjects improved in several perceptual and attentional measures as well. These results are taken to support the position that the specific dyslexia syndrome is subject to the laws of learning and can be viewed as a function of a deficient learning history.