Single-item measures of psychological experiences are often viewed as psychometrically suspect. The purpose of this study was to evaluate the validity and utility of a single-item measure of self-efficacy in a clinical sample of treatment-seeking young adults. Inpatient young adults (N=303; Age 18–24; 26% female) were assessed at intake to residential treatment, end of treatment, and at 1-, 3-, and 6-months following discharge. The single-item measure of self-efficacy consistently correlated positively with a well-established 20-item measure of self-efficacy and negatively with temptation scores from the same scale, demonstrating convergent and discriminant validity. It also consistently predicted relapse to substance use at 1-, 3- and 6-month assessments post discharge, even after controlling for other predictors of relapse (e.g., controlled environment), while global or subscale scores of the 20-item scale did not. Based on these findings, we encourage the use of this single-item measure of self-efficacy in research and clinical practice.

Objective: Population health surveys around the world have studied the epidemiology of comorbid substance use disorders (SUDs) and other mental disorders as part of larger efforts to assess needs and direct integrated planning and delivery of services. This study presents the first national assessment in Canada of the prevalence of co-occurring SUDs and other mental disorders, with attention to differences by substance problem severity, sex, age, and region. Methods: This work is a secondary analysis of data from the 2002 Canadian Community Health Survey: Mental Health and Well-Being. The sample was obtained using a multistage stratified cluster design ( n = 36 984, response rate = 77%). Results: The 12-month population prevalence of co-occurring disorders was 1.7%. The 12-month prevalence of other mental disorders was higher among those with illicit drug, relative to alcohol, problems and among those with dependence, compared with those with less severe problems. Sex and age differences mirrored population differences in pure disorders. Salient regional differences included the higher rate of co-occurring disorders in British Columbia and the lower rates in Quebec. Conclusions: Cross-study comparisons are hampered by methodological differences; however, these Canadian rates are at the lower end of the range reported internationally. This might have resulted from the exclusion of several disorders known to be highly comorbid with SUDs. Nonetheless, prevalence is high in certain subgroups, and efforts under way to improve Canada's substance abuse and mental health services should continue to ensure that adequate attention is directed to the needs of people with co-occurring disorders.

Objective: To investigate patterns and predictors of help seeking and met/unmet needs for mental health care in a national population health survey. Method: Participants were respondents to the 2012 Canadian Community Health Survey on Mental Health (CCHS-MH; n ¼ 25,133). We used regression to identify the diagnostic and sociodemographic predictors of the use of informal supports, primary care, and specialist care, as well as perceived unmet needs. Results: Eleven percent of Canadians reported using professionally led services for mental health or substance use in 2012, while another 9% received informal supports. Two-thirds of people with substance use disorders did not receive any care, and among those who did, informal supports were most common. Seventy-four percent of people with mood/anxiety disorders and 88% of those with co-occurring disorders did access services, most commonly specialist mental health care. Men, older people, members of ethnocultural minorities, those not born in Canada, those with lower education, and those with higher incomes were less likely to receive care. Unmet needs were higher among people with substance use disorders. Conclusions: Gaps in services continue to exist for some potentially vulnerable population subgroups. Policy and practice solutions are needed to address these unmet needs. In particular, the convergence of research pointing to gaps in the availability and accessibility of high-quality services for substance use in Canada demands attention. Abré gé Objectif : Rechercher les modèles et les prédicteurs de la recherche d'aide et des besoins satisfaits/non satisfaits de soins de santé mentale dans une enquête de santé dans la population nationale. Mé thode : Les participants étaient des répondants de l'Enquête de 2012 sur la santé dans les collectivités canadiennes-Santé mentale (ESCC-SM; n ¼ 25 133). Nous avons utilisé la régression pour identifier le diagnostic et les prédicteurs sociodémographiques de l'utilisation des soutiens informels, des soins de première ligne et des soins de spécialistes, et des besoins non satisfaits perçus. Ré sultats : Onze pour cent des Canadiens disaient utiliser les services dispensés professionnellement pour la santé mentale ou l'utilisation de substances en 2012, alors qu'un autre 9% recevait des soutiens informels. Deux tiers des personnes souffrant de troubles liés à l'utilisation de substances ne recevaient aucuns soins, et parmi ceux qui en recevaient, les soutiens informels étaient les plus communs. Soixante-quatorze pour cent des personnes souffrant de troubles anxieux/de

The differential use of services, satisfaction, and unmet need across diagnostic status allowed for speculation on differing levels of disability and stigma in the help-seeking process for different types of disorders. The strong association between co-occurring disorders and unmet need for care, including a large proportion of respondents who stated they preferred to self-manage their symptoms, is particularly troubling and deserves future research attention.

The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

In this article we discuss the findings from a series of focus groups conducted as part of a 3-year, mixed-method evaluation of clinical programs in a large mental health and substance use treatment facility in Canada. We examined the perceptions of clinical personnel on the physical design of new treatment units and the impact on service delivery and the work environment. The new physical design appeared to support client recovery and reduce stigma; however, it brought certain challenges. Participants reported a compromised ability to monitor clients, a lack of designated therapeutic spaces, and insufficient workspace for staff. They also thought that physical design positively facilitated communication and therapeutic relationships among clinicians and clients, and increased team cohesion. We suggest that, from these findings, new avenues for research on achieving the important balance between client and staff needs in health facility design can be explored.

Housing First programs in Canada are equally effective in people with and without comorbid substance use disorder (SUD). Overall, the intervention appears to be able to engage people with SUD and is reasonably successful at housing them, without housing being contingent upon abstinence or treatment.

Recent work has criticized the evidence base for the effectiveness of addiction treatment under social controls and coercion, suggesting that the development of sound policies and treatment practices has been hampered by numerous limitations of the research conducted to date. Implicit assumptions of the effectiveness of coerced treatment are evident in the organization and evolution of treatment, legal, and social service systems, as well as in related legislative practices. This review builds upon previous work by focusing in greater detail on the potential value of incorporating client perspectives on coercion and the implications for interpreting and applying existing research findings. Reviewing the existing empirical and theoretical literature, a case is made for greater accuracy in representing coercive experiences and events in research, so as to better align the measured concepts with actual processes of treatment entry and admission. Attention is given to studies of the effectiveness of treatment under social controls or pressures, the connections to coercion and decision-making, and theoretical perspectives on motivation and behaviour change, including Self-Determination Theory in particular. This synthesis of the available research on coerced addiction treatment suggests that it remains largely unclear to what extent many of the commonly employed methods for getting people into treatment may be detrimental to the treatment process and longer-term outcomes. The impact of coercion upon individual clients, treatment systems, and population health has not been adequately dealt with by addiction researchers to date.