Background: Despite comparable rates of mental health problems, youth in custody, in-and outpatient groups typically differ with respect to experiences of trauma and expression of internalizing and externalizing behaviours. While comparisons between these groups have been made, an exploration of specific care planning needs have yet to be investigated.Objectives: To compare the care planning needs identified for youth in custody and those within inpatient (e.g., mental health hospital admissions) and outpatient treatment (e.g., community mental health agencies), while controlling for age and sex differences.Methods: The sample consisted of 755 youth aged 16-19 recruited from youth justice and mental health facilities in Ontario, Canada. Semi-structured interviews using the interRAI child and youth suite of instruments were completed. Items that signify imminent risk, as well as the accompanying Collaborative Action Plans among samples of youth were compared.Results: Male youth in custody were more likely to require care planning related to substance/tobacco/nicotine use and withdrawal symptoms than both in-and outpatient youth. They also were more likely to report harm to others, while inpatient females were most likely to report self-harm. Irrespective of case type, males were more likely to require care planning related to educational needs and communication. Youth in custody were more likely to trigger Collaborative Action Plans related to transition planning compared to patient groups.Conclusions: Evidence suggests that youth involved within the justice system present with a unique and complex set of needs. This research supports the need for tailored services and evidence-based intervention that may transgress the boundaries of the youth justicesetting to the community.

This paper examines the patterns of harmful weapon behavior and the protective influence of perceived collective efficacy on harmful weapon behavior among a cross-national sample of youth detainees in Toronto and Philadelphia. Despite different firearms policies, detained youth in both cities reveal considerable knowledge of where to get a gun. Multivariate analyses reveal that participating in gang fights, non-violent delinquency, and neighborhood gun markets are significantly related to harmful gun behavior in both cities. Only one collective efficacy subscale, perceived social cohesion, exerted a protective influence on harmful gun behavior among youth in both cities. These results suggest that in the absence of "strong ties," reflected in family and residential stability, there may be added value in the "weak ties" provided by the community, making social cohesion an important protective characteristic for this high-risk group of youthful detainees. The significance of the findings, limitations, and potential policy implications are discussed.

BACKGROUND:Existing studies of attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use or substance use disorders have produced mixed results, with some identifying a direct link between ADHD and general or disordered substance use and others suggesting that comorbid CD may explain this relationship. Insufficient research has addressed the issue, which is particularly relevant in the context of the opioid crisis. This study examined the association of probable ADHD and childhood CD with self-reported opioid use in a general-population sample.METHOD:The 2011-2013 cycles of the CAMH Monitor, a cross-sectional survey of adults (18+ years) from Ontario, Canada provided data from 6074 respondents. Binary logistic regressions were conducted of self-reported medical, non-medical, and any prescription opioid use in the previous 12 months, assessing demographic characteristics, perceived physical and mental health, and probable ADHD, childhood (before age 15 years) symptoms of CD, or their combination.RESULTS:Adjusting for potential covariates, probable ADHD alone was not associated with prescription opioid use. Childhood symptoms of CD significantly predicted non-medical use (OR = 2.10, 95% CI = 1.10, 4.03). ADHD and CD symptoms combined significantly predicted medical (OR = 3.27, 95% CI = 1.20, 8.91), non-medical (OR = 4.73, 95% CI = 1.05, 21.30), and any (OR = 3.02, 95% CI = 1.13, 8.11) prescription opioid use, although a low base rate of non-medical use may have negatively affected model fit.CONCLUSIONS:Previous findings relating ADHD to opioid use could be explained, in part, by the high rate of comorbidity between ADHD and CD. These data support prevention and treatment programs targeting individuals with comorbid ADHD and CD symptoms.

Detained youth display substantive mental health and substance use problems. However, Canadian information is limited. The purpose of this study was (1) to assess mental health and substance use problems of youth in residential detention/custody facilities in Ontario, Canada, at intake, using the interRAI Youth Justice in Custodial Facilities (YJCF), and (2) to explore the added value of using the YJCF in addition to the facilities' standard intake tool. This paper presents the findings of this pilot study. Drawing on all 20 youth secure custody facilities in Ontario, Canada, two groups were created through stratified random group assignment: 10 intervention and 10 non-intervention sites. Staff recruited eligible admitted youth aged 16-19 years between November 2014 and May 2016, with 164 in intervention and 143 in non-intervention arms. Substance use and traumatic life events were reported for the majority of youth. For youth who were assessed using the YJCF, a substantial number of integrated evidence-informed care plans, or Collaborative Action Plans (CAPs) were triggered for specific areas of risk and need. The majority of intervention group youth with YJCFs had CAPs triggered for substance use, interpersonal conflict, traumatic life events, education challenges, transitions and family functioning problems, while for almost half the youth, CAPs were triggered for harm to others and suicidality/purposeful self-harm. The YJCF, compared to the standard admission tool, identified a greater percentage of youth with mental health and substance use problems. Implications for providing expanded assessment for youth are discussed.

Abstract Background Approximately 40–70% of justice-involved youth have untreated mental health problems. There is no current research that directly compares the mental health profiles of youth involved in the justice system to that of inpatients and outpatients. The research reported is significant because it directly compares the needs of these population by use of the same suite of standardized assessment tools. Methods The sample consisted of 755 youth aged 16–19 years recruited from youth justice and mental health facilities in Ontario, Canada. Participants completed semi-structured assessment interviews using the interRAI child and youth suite of instruments to assess for internalizing and externalizing concerns as well as exposure to traumatic life events. Results Findings indicated that justice-involved youth experienced higher levels of certain types of trauma. Analyses examining sex differences indicated that, controlling for age, males in the youth justice group reported higher cumulative trauma compared to male outpatients but not inpatients. Females in the youth justice group reported experiencing higher cumulative trauma compared to female outpatients and inpatients. In addition, controlling for sex and age, the youth justice group reported lower internalizing symptoms scores than inpatients and outpatients. Finally, males in the youth justice group scored lower than inpatients in externalizing symptoms, whereas females within the youth justice group scored higher in externalizing symptoms compared to inpatients and outpatients. Conclusions Results indicated that youth who are involved with the justice system exhibit significant psychosocial issues that represent complex service needs which require unique interventions in order to be addressed appropriately.

Introduction: Despite limited research, existing evidence suggests that there is an association between conduct disorder (CD) and various risky driver behaviours, such as driver aggression and driving after drinking. The current study sought to estimate the association between probable CD during childhood and past-year collision risk. Methods: Data were based on interviews with 5297 respondents who reported having driven in the past year, derived from the 2011-2013 cycles of the CAMH Monitor, a cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression was conducted of self-reported collision involvement in the previous 12 months, assessing demographic characteristics, driving exposure, demonstrated symptoms of ADHD, mild driver aggression, driving after drinking, and childhood (before age 15 years) symptoms of CD. Results: The unadjusted odds ratio of past-year collision involvement for those reporting childhood symptoms of CD was 1.76 (95% CI = 1.10, 2.82). Adjusting for potential covariates, self-reporting childhood symptoms of CD was significantly associated with a 77% increase in the odds of a crash (OR = 1.77; 95% CI = 1.01, 3.11). Conclusion: These findings add to a growing literature and suggest that treatment for CD should include a focus on driver safety.

Canada is on course to become, in October 2018, the second country in the world, after Uruguay, to federally legalize cannabis for recreational use. Prime Minister Justin Trudeau’s Liberal governme...

BACKGROUND/OBJECTIVES:The drug normalization framework investigates the social integration of substance use. This article contributes a quantitative assessment of cannabis normalization as differentiated by social location predictors.METHODS:Logistic and zero-inflated negative binomial regression models assess three areas of cannabis normalization: accessibility, acceptability, and recent use. Peer network cannabis use prevalence, gender, nativity, campus locale and living arrangement are explored as focal predictors of variation in normalization among 1,713 cannabis using and nonusing undergraduate students in Canada.RESULTS:Women report lower odds of positive cannabis acceptability attitudes. While women report lower rates of recent cannabis use, gender is not a significant predictor for lifetime prevalence. Being a recent immigrant significantly predicts lower recent use, lower odds of favorable attitudes to cannabis, and reduced accessibility in comparison to students born in Canada. Longer-term immigrants do not show significant differences from students born in Canada on accessibility and acceptability, suggesting a substance use acculturation effect. Lower peer cannabis use prevalence exhibits a protective effect against use. In comparison to students who report that "some" of their peer network uses cannabis, those with "all" users in their network exhibit lower acceptability attitudes. This suggests a threshold relationship between peer use prevalence and acceptability. Conclusions/Importance: This article provides a data point for assessing future shifts in cannabis normalization prior to impending changes in Canadian drug policy that will legalize recreational cannabis use. Results show that normalization components of recent use, acceptability, and accessibility are differentiated by gender, nativity, and peer network cannabis use prevalence.

Cannabis (marijuana) has undergone a normalizing process as indicated by high use rates, social tolerance, and broader cultural acceptance of its use in many countries. Users also maintain access through extended friendship networks that facilitate the cultural diffusion of the practice. The social nature of supply is herein theorized in terms of Goffman's understanding of activities that function to preserve a sense of normalcy as a collective achievement enabling predictable constructions of reality. Based on in-depth interviews with undergraduate students, we explore how social networks of supplycharacterized by casual access, reciprocity, and sharingcontribute to shared meanings about using marijuana as an unremarkable or normal thing to do.

Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.

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.

Illegal drug markets are shadowy, subterranean enterprises that are not readily accessible to law abiding citizens, researchers or the police. The chapter presents the results of interviews with 17 male flexers in a Toronto locale with an active street drug market. Compared to poor, homeless crack users, middle class users have many other activities and demands competing with drug use and often choose them over drugs. Crack addiction appears more likely to have reinforced or intensified, rather than launched, flexer's deviant trajectory. Central to an understanding of their embeddedness in a deviant lifestyle is flexer's sense of addiction to crack cocaine. With nothing to compete with crack, it is hardly surprising that middle-class routes out of addiction - treatment, rehabilitation, education, jobs, family support - have little relevance to the men. Flexers are ignored or arrested, neither of which events addresses their drug use or their lifestyle, but rather serves to amplify their deviance through further stigmatization and criminalization.

BACKGROUND:Several studies have found a connection between attentional deficit hyperactivity disorder (ADHD) and criminal behaviour in clinical and prison samples of adults, but there is a lack of representative general population data on this.AIM:To test relationships between histories of ADHD and arrest. Our main research question was whether any such relationship is direct or best explained by co-occurring variables, especially indicators of social bonds.METHOD:Data were from a sample of 5,376 adults (18+) representative of the general population of Ontario, Canada. Logistic regression analysis was used to explore the relationship between self-reported arrest on criminal charges and ADHD as measured by the Adult Self Report Scale (ASRS-v1.1). Indicators of strong social bonds (post secondary education, household size) and weak bonds (drug use, antisocial behaviours, alcohol dependence) were also obtained at interview and included in the statistical models.RESULTS:In a main effects model, screening positive for ADHD was twice as likely (OR 2.05 CI 1.30, 3.14) and past use of medications for ADHD three times as likely (OR 3.94 CI 2.46, 6.22) to be associated with ever having been arrested. These associations were no longer significant after controls for weak and strong social bonds were added to the models. In the best fitting statistical model, ever having been arrested was not associated with ADHD, but it was significantly associated with indicators of strong and weak social bonds.CONCLUSIONS:The observed connection between ADHD and criminality may be better understood through their shared relationships with indicators of poor social bonds. These include antisocial behaviour more generally, but also drug use and failure to progress to any form of tertiary education, including vocational training. Copyright © 2017 John Wiley & Sons, Ltd.

Objectives: While some existing studies suggest that conduct disorder (CD) significantly increases risk of driving after drinking, outcomes have typically been assessed only up to age 21 years. Therefore, the current study sought to assess the relationship between symptoms of CD during childhood (before age 15 years) and the risk of engaging in driving after drinking during adulthood. Methods: Data are taken from interviews with 5299 respondents derived from the 2011-2013 cycles of the Monitor, an ongoing cross-sectional telephone survey of adults aged 18+ years in one Canadian province. A hierarchical-entry binary logistic regression analysis of driving after drinking in the previous year was conducted, consisting of measures of demographic characteristics (sex, age, marital status, education, region), driving exposure, problem alcohol use, symptoms of attention deficit hyperactivity disorder (ADHD), and childhood (before age 15 years) symptoms of CD. Results: Childhood symptoms of CD significantly increased the odds of reporting driving after drinking in adulthood (OR=2.59, 95% CI=1.67, 4.03, p < 0.001). Even after adjusting for demographic characteristics, driving exposure, problem alcohol use, and symptoms of ADHD, childhood symptoms of CD significantly increased the odds of the behaviour (OR = 1.67, 95% CI =1.00, 2.79, p = 0.05). Conclusions: Results from a general population survey in one Canadian province suggest that symptoms of CD during childhood are associated with significantly increased odds of driving after drinking in adulthood. These findings add to a growing literature, and could suggest that within treatment for CD special attention should be focused on driver safety. Additional implications for injury prevention will be discussed.

Aims: This study provides an examination of normalization trends associated with the use of cannabis and tobacco, and whether and to what extent health concerns and legal contexts appear to modify the tolerance displayed to users. Methods: Data for this paper are drawn from a mixed methods interview study involving 202 respondents who reported being regular users of cannabis (alone n=100 or in conjunction with tobacco n=67) or tobacco only users (n=35), in four Canadian cities (Halifax, Montreal, Toronto and Vancouver). Findings: While participants commonly attributed serious health risks to the use of tobacco, cannabis was viewed as relatively low risk. All groups described cannabis laws as too punitive, while most agreed with the regulatory controls for tobacco. Drawing on norms around appropriate context for use, cannabis users illustrate the expansion of normalization, with varying degrees of acceptability in different spaces. In contrast, tobacco users' heightened awareness of the dangers of smoking leads them to engage in a reflexive process-limiting appropriate venues and contexts for use. Conclusions: These findings suggest that perceptions of health risk shape users' experience of normalization (and denormalization) and help to contextualize the larger societal processes where both drugs are in a stage of societal re-evaluation. Much can be learned about the cannabis future from the tobacco past.

Background: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.Methods: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.Results: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.Conclusions: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.

Aims: To critically investigate the extent of normalisation of the use of cannabis by undergraduate students. To examine the extent of peer accommodation, this paper focuses on attitudes of students who abstain. It sheds light on social meanings of the practice by exploring non-users' reasons for abstaining in addition to their attitudes, perceptions and experiences of use among their peers. Methods: Respondents were recruited to participate in interviews through an online survey of undergraduate students in social science classes at three Canadian universities. Findings: Peer accommodation of the use of cannabis requires that users exercise due caution and discretion and be respectful of the choices of non-users not to use. Non-users' attitudes, however, still reflect longstanding cultural assumptions about drug use as a deviant behaviour. Attitudes towards the use of cannabis reflect norms and expectations about gender among other culturally constructed social statuses and roles. Conclusions: Future research should continue to investigate nuances of the differentiated normalisation process. A better understanding of the cultural transformation of cannabis, and other drugs in common use by youth, requires more exploration of the emerging social context and attitudes of users and non-users of the drug.

Background: Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood.Methods: Data are based on telephone interviews with 5230 respondents who reported having driven in the past year. Data are derived from the 2011-2013 cycles of the CAMH Monitor, an ongoing cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression analysis of self-reported driver aggression in the previous 12 months was conducted, consisting of measures of demographic characteristics, driving exposure, problem substance use, alcohol- and drug-impaired driving, symptoms of attention deficit hyperactivity disorder, and childhood (before age 15) symptoms of CD.Results: When entered with demographic characteristics, driving exposure, and other potential confounders, childhood symptoms of CD increased the odds of reporting driver aggression more than two-fold (adjusted OR = 2.12). Exploratory analyses of the interaction between childhood symptoms of CD and age was not a significant predictor of driver aggression.Conclusions: Results suggest that symptoms of CD during childhood are associated with significantly increased odds of self-reported driver aggression during adulthood. Limitations and future directions of the research are discussed. (C) 2015 Elsevier Ltd. All rights reserved.