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Hundreds of studies deal with some aspect of addiction teva women's health birth control guide purchase 50mg clomiphene free shipping, but fewer than a dozen give substantial consideration to occasional use breast cancer metastasis to lung buy 50mg clomiphene with mastercard. In addition define women's health issues purchase clomiphene online, a large number of the articles describing these studies deal solely with the "captive" or medical population of treatment centers while only a few are concerned with the nonmedical populations of users "at large pregnancy progress order 25mg clomiphene amex. The first is related to the persistence of cultural beliefs that heroin is an inherently "bad" drug. Gusfield (1975) has noted that because researchers are not immune to the cultural atmosphere in which they work, the prevailing attitudes toward heroin use may have made it difficult for them to appreciate that much of the conventional wisdom contained in the literature was inaccurate. The tendency to regard any kind of heroin user as a "junkie" made it difficult for investigators to delineate groups that did not fit that cultural stereotype or to recognize how valuable the study of such groups could be. A second, and probably more important, reason is that noncompulsive and therefore nontreatment users are very difficult to locate and study (Geber 1969; Catton & Shain 1976; Rittenhouse 1977). Opiate use is still so rare that the identification of users of any kind in the general population is a very expensive task. It is generally agreed that fewer than 1% of Americans are nonmedical opiate users: hence 10. It is true, of course, that data on opiate users can be gathered efficiently from treatment, law-enforcement, correctional, and other captive populations. But such sources provide a highly selective sample of users who "have encountered significant personal, medical, social, or legal problems in conjunction with their drug use, and thus often represent the most pathological end of the using spectrum" (Greene, Nightingale & DuPont 1975). Third, questions of ethical responsibility have probably impeded the study of nonaddictive use. Some researchers, aware of the popular belief that any use of heroin results in depravity and enslavement and that this belief undoubtedly serves to discourage heroin use, may have been reluctant to undertake the study of occasional use lest they undermine that attitude. Furthermore, some investigators may have feared that if they reported the existence of occasional users they might be accused of endorsing experimentation with opiates (Zinberg 1881). Fourth, the widespread confusion of terms relating to the level and quality of opiate use has been a substantial obstacle to research (Lasagna 1965; Smart 1974; Robins 1977; Apsler 1978). In the literature the terms "occasional use" and "chipping" are most often used to indicate a nonaddictive pattern of opiate use, but they do not necessarily connote moderate use. Rather, they tend to indicate less than daily use and the absence of physical dependence. Further, they do not necessarily imply anything about the consistency of use over time or about the frequency or quality of the concurrent use of other drugs. The Emergence of Research Interest in Occasional Opiate Use Alfred Lindesmith (1947), a pioneer in the study of heroin, was one of the first twentieth-century researchers to refer to nonaddictive use. Having only a few examples of joy poppers and no long term data about them, Lindesmith speculated that most such users eventually became addicted. Scher (1961, 1966), through his work at the Cook County (Illinois) Narcotics Court and jail, came in contact with "addicts" who had confined their use to weekends or parties. Although he felt that this pattern often progressed to more frequent use, he observed several cases "in which relatively gainful and steady employment has been maintained for two or three years while the user was on what might be called a regulated or controlled habit" (original emphasis). Brill discussed a model of the life cycle of addiction in 1967, they indicated that some drug-takers seemed able to "control their use" and to continue in occasional or limited use for "an indefinite period of time. At the same time, however, they expressed the need for future research to document their theory. Unlike many of the earlier investigators of occasional use, Erich Goode (1972) felt that "the occasional (weekend) heroin user is probably a good deal more common than most of us realize. He based this opinion on the lack of cultural norms (which I call sanctions and rituals) to limit heroin use, the rapidity with which a user could become physiologically addicted, and the tendency of new users to discount the risk of becoming addicted. In view of these repeated declarations that in a majority of cases occasional use quickly leads to addiction, it is not surprising that the first study to focus specifically on occasional opiate use did not appear till 1973, when Douglas H. Powell published data on twelve occasional users who had responded to his newspaper advertisements. He concluded that these subjects had never become addicted even though they had all been using heroin for at least three consecutive years. Some of them, however, appear to have followed patterns of opiate use that, according to the standards of my project, could hardly be defined as "well controlled": one, for example, had used heroin for "six weeks straight" within the previous six months. Nevertheless, his work established the existence of patterns of opiate use that differed significantly from the classic model of intensive and destructive heroin consumption. His investigation, which legitimized further studies (including my own) that were aimed at describing these alternative patterns, touched off increased research interest in occasional opiate use. Occasional Opiate Users in Treatment Centers the fact that occasional users turn up and are identified in treatment populations has raised concern about the propriety of giving treatment to such users.

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Similarly zinc menstrual cycle buy clomiphene 50mg visa, internal or external pressure to return to work as soon as possible so that they can provide for their children may cause some men to leave treat ment prematurely breast cancer x ray images buy cheap clomiphene 25 mg line. Some fathers breast cancer volleyball t-shirts buy discount clomiphene line, particularly single custodial fathers menstrual vs pregnancy symptoms purchase clomiphene 25mg overnight delivery, may avoid seeking treatment or leave treatment if they believe it could interfere with their ability to effectively parent their children. Also, men living with their children may be less likely to commit themselves to an extended period of inpatient, residential, or maintenance treatment. Men involved in family court proceedings might believe involvement in treatment could be used against them in hearings concerning child custody or visitation rights. For these reasons, among others, it is important for fa thers to have some contact with their children during treatment, even if only through super vised visitation. Counseling fathers in substance abuse treatment When entering treatment, men sometimes discover that they lack basic parenting skills- a problem they did not recognize when they were using. Substance abuse programs that treat male clients should consider adding a component that teaches parenting skills, as many men with children will express an inter est in such an option if offered. Although formal evaluation data are scarce regarding parenting programs for men in treatment, criminal justice system providers believe they are helpful for both the men and their chil dren; men are interested in such programs and view them favorably (Jeffries et al. Given the complex, multidimensional nature of their problems, fathers who abuse substances may need a great deal of support and assistance from their counselors to be able to provide for and have close, healthy relationships with their Advice to Behavioral Health Clinicians: Parenting Issues Programs specifically designed to teach men parenting skills are almost universally absent in sub stance abuse treatment settings. Unfortunately, formal resources for clinicians interested in helping men become more effective parents are somewhat limited. There are generic parenting interventions, such as Focus on Families (Catalano et al. Because the parenting problems of men with substance use disorders range broadly from decisions to vol untarily terminate parental rights to new re sponsibilities to care for children as single custodial fathers, flexible treatment approaches are necessary. When working with fathers who have sub stance use disorders, behavioral health clini cians should be particularly aware of the Family Issues: Helpful Resources for Behavioral Health Service Providers Programs specifically designed to teach men parenting skills are almost universally absent in sub stance abuse treatment settings. The programs teach youth skills, such as problem-solving, coping, social competence, autonomy, and sense of pur pose. Although the material is oriented toward Native American communities, it can easily be adapted for use with non-Native groups. The toolkit also addresses cultural awareness and offers ways to facilitate cultural competence in child welfare practice. Ongoing substance use, past or present do mestic violence, allegations of child abuse, and ongoing involvement in criminal activity may raise ethical questions about promoting in volvement that may prove harmful to children or partners, particularly as ongoing research begins to better define those circumstances (Jaffe et al. Similarly, when men have systematically abused or neglected children for a long period of time, clinicians may need to help them negotiate difficult decisions about petitions for extended placement of children, voluntary termination of parental rights, and/or adoption by others interested in func tioning as parents. Substance abuse treatment programs are an ideal setting in which to raise and discuss is sues about male sexuality, unwanted paternity, and reproductive responsibility. Legal Issues Affecting Families Child support Fathers with substance abuse problems are twice as likely to fail to pay child support as those without such problems (Garfinkel et al. The Child Support Enforcement Pro gram links Federal, State, and local authorities to ensure that orders for child support are fol lowed. All of this may add to the stress of a father who is in substance abuse treatment and unable to meet child support payments. Family court involvement Men seeking substance abuse treatment may need support and assistance in navigating the child welfare and family court systems. As ste reotypes involving substance abuse collide with traditional ideas about family life, men involved in family court proceedings may ex perience bias that labels them as entirely nega tive influences to be excluded from the family (McMahon and Giannini 2003). Stereotypes of men who abuse substances may reinforce tradi tional ideas about gender and family such that these men, more so than others, are quickly but inappropriately dismissed as indifferent, unin volved, irresponsible, and irrelevant (McMahon and Giannini 2003; Parke and Brott 1999). When fathers with substance use disorders are involved in family court proceedings, the courts use clinical evaluations to inform their 63 Reproductive Responsibility Most interventions focusing on male sexuality emphasize the prevention of sexually transmit ted diseases-if discussed at all, issues of un wanted paternity seem to be of secondary concern.

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Clinical supervisors should be nonjudgmental and create a safe relational space for male counselors to bring up any strong reactions they might have to their male clients breast cancer foundation 50mg clomiphene with visa. If the male counselor is able to explore pregnancy mood swings order clomiphene now, with understanding and self-compassion womens health robinwood clomiphene 50 mg line, his own internalized beliefs about what it means to be a man menstrual synchrony buy clomiphene, he will be in a much better position to help male clients challenge a story of mascu linity that might not be their preferred way of being in the world. He will also be able to model a different kind of male behavior simp ly by being more open emotionally, less com petitive and powerful, and working more collaboratively with clients. Countertransference dynamics for men working with men Scher (2005) states that "countertransference issues are more significant with men working with men than women working with men" (p. He suggests that countertransference issues for male behavioral health clinicians may be more subtle when working with men than when working with women. He states that "when power elements surface, the male therapist goes into competitive mode and does not easily give the competitiveness up; once he does, he begins to feel closer and therefore more vulnerable to the client, which raises homophobic issues and necessitates a pulling back" (p. How can he be supportive, model vulnerabil ity, and develop the intimacy required to es tablish a strong therapeutic alliance without pulling away from the male client due to in ternalized homophobia How can he do so 35 Addressing the Specific Behavioral Health Needs of Men Countertransference dynamics for women working with men Female behavioral health clinicians may have, at one time or another, been ignored or belit tled by men in authority; sexually harassed; and/or subjected to domestic violence, child abuse, or childhood sexual abuse. As a result, two of the most potent countertransference issues female counselors may experience in working with men are fear and unresolved an ger. A female counselor may subconsciously fear that her male clients will ignore, judge, or belittle her, dominate or take over the therapy, or reject her efforts to help. One of the most difficult experiences women face in our society due to gender role socialization and culturally defined gender norms is a sense of being invis ible. Such feelings should be normalized and addressed in clinical supervision, where supervisors can address gender differences between themselves and their supervisees to help them understand countertransference toward male clients. Carlson (1981) suggests that "deference to male thinking, again reinforcing the tradition al sex role for both, rarely assists the client in considering alternatives to his perception. In stead, it may only help to avoid the real prob lems and the potential for his growth" (p. This can be a particularly challenging situa tion for female counselors in predominantly male substance abuse treatment programs. Case example: Clinical team discusses male counselor/male client interaction this behavioral health team consists of six cli nicians (Jim, Larry, Lillian, Jason, Mary, and Kristen) and the clinical supervisor, Ken. The team is part of an intensive outpatient sub stance abuse treatment program at a major metropolitan hospital, which provides group therapy 5 days a week and individual counsel ing sessions twice a week. He had been a heavy drinker most of his adult life; because of the stress of the economic downturn and his bank teetering on the brink of bankruptcy, Kurt has been getting drunk three to four times a week and recently started taking tran quilizers to deal with his anxiety. I want to talk about whether or not we should consider shifting Kurt to another counselor. Jim: Well, he seems to be more relaxed in the "Feelings Group" when Kristen is co-leading. He reminds me of my older brother who was a varsity football player and won all kinds of awards. Now that I am talking this through, it seems to me that Kurt probably feels the same kind of shame about not being a real man because he was forced to come to treatment. It sounds like you are even beginning to feel less irritated and more com passionate toward Kurt. Ken: Well, I am wondering if you would be interested in briefly role-playing with Kristen. Inviting Kristen to take on the role of counselor allows all participants to indirectly challenge their own gender stereotypes and biases. He leaves the team meeting feeling reas sured that he can ask his female colleagues for help with countertransference. Advantages of Female Behavioral Health Counselors in All-Male Settings the reality in most behavioral health clinical settings is that female counselors outnumber male counselors, and this disparity is even more striking when considering that male cli ents in substance abuse treatment significantly outnumber female clients (Lyme et al. Even in criminal justice settings, where the client population is typically all male, there are more female counselors than men (Ewing 2001). Both male and female medical patients talk more and provide more relevant information 37 Addressing the Specific Behavioral Health Needs of Men to female physicians (Bertakis 2009; Bertakis et al.

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The chapter then discusses at length the issue of gender dynamics pregnancy test calculator generic clomiphene 100 mg without prescription, transference menopause 53 order clomiphene 50mg visa, and countertransference for male and female behavioral health counselors working with male clients breast cancer yard signs buy clomiphene with a mastercard. The chapter also discusses the pros and cons of having ei ther male or female counselors working with male clients menopause test safe 25mg clomiphene. Because the majority of substance abuse treatment clients are male but most counselors are female, the chapter also in cludes some ideas about recruiting male coun selors. These issues include counseling men who have difficulties expressing emotion and men who feel exces sive shame, both common problems for men in substance abuse treatment. Male roles and training may result in difficulties accessing some or all emotions, or in problems reacting appropriately to some emotions, such as anger. Men are affected by different kinds of shame and social stigma than women, and men are expected to engage in different rituals or rites of passage, many of which involve alcohol. Men are much more likely to commit violent acts than women, and those acts of violence are often associated with substance use/abuse. Violence, criminal behavior, and anger are fac tors that often need to be addressed if a man is to remain substance free. Although providers may be aware of the possibility that men may commit violent acts, they are less likely to con sider that men are often victims of violence as well. Clinicians often do not look for-and men are rarely forthcoming about-histories of childhood physical or sexual abuse or cur rent victimization by domestic partners, and Chapter 3: Treatment Issues Chapter 3 explores issues that may affect sub stance abuse treatment for most, if not all, men. It also discusses sexual dys function, the effects of substance abuse on the male reproductive system, sexual identity, compulsive sexual behaviors, and other issues. Behavioral health service providers have be come more aware in recent years of the im portance of parenting and child custody for women entering treatment, and they have re sponded with the creation of programs that work with mothers and their children togeth er. Children and other family members can also play an important role in encouraging men to enter treatment, and fears about losing custody of children can inhibit treatment en try. This chapter pro vides some guidance to clinicians who want to address parenting in treatment programs for men. Reproductive responsibility, child sup port, and family court involvement are also discussed. These and similar groups have helped many individuals, both men and women, make tremendous progress on their road to recovery. This chapter discusses the spiritual element of 12-Step groups and the relationship between spirituality and health. Men typically begin using substances at a younger age than women do, and this appears to be a major fac tor in greater rates of substance use disorders among adult men than among women. Boys and young men may also turn to substance use/abuse for different reasons than girls and young women do. For example, early use of substances by men may be attributable to the fact that they are not adept at addressing emo tional pain constructively. Men are less likely to have a serious mental illness than women are, but men make up the majority of adults with co-occurring substance xvii Addressing the Specific Behavioral Health Needs of Men use and other mental disorders in behavioral health settings. This chapter considers rates of different co-occurring mental disorders among men and discusses how the course and presen tation of different disorders may differ be tween the sexes. The chapter also looks at the related problem of suicidality, as men are more likely than women to die of suicide despite being less likely to attempt suicide. This chapter covers special treatment needs of young men (ages 18 to 24) and older adult men (ages 65 and older). Re search suggests that patterns of substance use/abuse for gay and bisexual men may differ from those of heterosexual men; a discussion of the treatment needs of gay and bisexual men is also included. In some cases, occupation may also affect substance abuse for men who are employed. The special dynamics of men entering treat ment through the criminal justice system or men who may interact with the criminal jus tice system while in substance abuse treatment are also addressed in this chapter. The criminal xviii justice system is the largest single source of referrals to substance abuse treatment for men, and many other men receive treatment while incarcerated in jails or prisons.

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Before the advent of printing menstrual bleeding for 3 weeks cheap clomiphene 25mg online, it was quite natural for the means of communication to be regarded as extensions of a single body pregnancy 0-40 weeks order clomiphene 100 mg visa. In an increasingly literate society pregnancy portraits purchase clomiphene 100mg mastercard, money and the clock assumed a high degree of visual or fragmented stress womens health u of a buy clomiphene 50 mg overnight delivery. In practice, our Western use of money as store and translator of communal work and skill has depended upon long accustomation to the written word, and upon the power of the written word to specialize, to delegate, and to separate functions in an organization. When we look at the nature and uses of money in nonliterate societies, we can better understand the ways in which writing helps to establish currencies. Uniformity of commodities, combined with a fixed-price system such as we now take for granted, does not become possible until printing prepares the ground. In general, the West is little aware of the way in which the world of prices and numbering is supported by the pervasive visual culture of literacy. Nonliterate societies are quite lacking in the psychic resources to create and sustain the enormous structures of statistical information that we call markets and prices. Far easier is the organization of production than is the training of whole populations in the habits of translating their wishes and desires statistically, as it were, by means of market mechanisms of supply and demand, and the visual technology of prices. It was only in the eighteenth century that the West began to accept this form of extension of its inner life in the new statistical pattern of marketing. So bizarre did this new mechanism appear to thinkers of that time that they called it a "Hedonistic calculus. In a word, the fragmentation of the inner life by prices seemed as mysterious in the eighteenth century, as the minute fragmentation of space by means of calculus had seemed a century earlier. The extreme abstraction and detachment represented by our pricing system is quite unthinkable and unusable amidst populations for whom the exciting drama of price haggling occurs with every transaction. Today, as the new vortices of power are shaped by the instant electric interdependence of all men on this planet, the visual factor in social organization and in personal experience recedes, and money begins to be less and less a means of storing or exchanging work and skill. Automation, which is electronic, does not represent physical work so much as programmed knowledge. As work is replaced by the sheer movement of information, money as a store of work merges with the informational forms of credit and credit card. From coin to paper currency, and from currency to credit card there is a steady progression toward commercial exchange as the movement of information itself. This trend toward an inclusive information is the kind of image represented by the credit card, and approaches once more the character of tribal money. For tribal society, not knowing the specialisms of job or of work, does not specialize money either. Its money can be eaten, drunk, or worn like the new space ships that are now designed to be edible. The primitive hunter or fisherman did no work, any more than does the poet, painter, or thinker of today. Work begins with the division of labor and the specialization of functions and tasks in sedentary, agricultural communities. In nonliterate societies money relates itself to the other organs of society quite simply. The role of money is enormously increased after money begins to foster specialism and separation of social functions. Money becomes, in fact, the principal means of interrelating the ever more specialist activities of literate society. The fragmenting power of the visual sense, as literacy separates it from the other senses, is a fact more easily identified now in the electronic age. Nowadays, with computers and electric programming, the means of storing and moving information become less and less visual and mechanical, while increasingly integral and organic. The total field created by the instantaneous electric forms cannot be visualized any more than the velocities of electronic particles can be visualized. The instantaneous creates an interplay among time and space and human occupations, for which the older forms of currency exchange become increasingly inadequate. A modern physicist who attempted to employ visual models of perception in organizing atomic data would not be able to get anywhere near the nature of his problems. Both time (as measured visually and segmentally) and space (as uniform, pictorial, and enclosed) disappear in the electronic age of instant information. In the age of instant information man ends his job of fragmented specializing and assumes the role of information gathering.

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