Journal articles on the topic 'Drug abuse counselling'

Drug use has not been the problem but rather its abuse and irrespective of the risk thereof, people still abuse them. That is why this study was set out to examine the perceptions of drug use and abuse among adults in Enugu-Ezike in Igbo-Eze North Local Government Area, Enugu State, Nigeria. The study utilized a cross-sectional survey design. The study subjects consisted of 195 respondents (107 males and 88 females) aged 18 years and above. The quantitative data gathered were analyzed with Statistical Package for the Social Sciences (SPSS) using percentages and frequency distribution tables. Chi-square (X2) statistics were used to test the hypotheses The findings showed that 52.3% of the respondents know the meaning of drug use while majority of the respondents were aware of drug abuse. 81.0% of the respondents have negative perception of drug abuse. Also, 54.9% stated that Marijuana is the most abused drug in the study area. Eighty percent (80%) believed that increase in drug abuse increases the rate of crime in the communities. Above thirty-one percent believe that family problems contributed in abusing drugs. The implications of the study to social work practice therefore, is to carry out the public enlightenment, community education, counselling and research on the dangers of drug abuse in Nigeria. The study recommends that the stakeholders in drug use and management should develop appropriate measures to combat the menace of drug abuse that is ravaging our society.

The family is the smallest unit of society that affects the lives of drug users undergoing rehabilitation programs. Family can be a source of social support for substance users in solving problems through perception. The perception of family support is a source of social support to foster confidence in drug rehabilitation programs. This study aims to determine the level of family support for substance users undergoing drug rehabilitation programs and recommendations for individual, group, and family counselling services. This study used a descriptive research type with the subject N = 217. The research subjects consisted of male and female genders; the data analysis used quantitative descriptive analysis. The results showed that the category of substance users' perceptions of family support had a low level. The types of users at a deficient level were 2.30%, the low level was 57.14%, the high level was 33.18%, and the very high level was 7.37%. These findings prove that the family's influence is still very minimal for users to recover during rehabilitation. The contribution of family perceptions supports beliefs about recovering from drug addiction. The addiction counsellor profession from guidance and counselling graduates needs to implement family counselling services in collaboration with families in developing perceptions of drug addicts. Recommendations from this study's results are the implementation of family counselling services and support from families in concrete, emotional, informational, and reward.

The study examined Academic Stress and drug abuse as factors inhibiting psychological well-being among undergraduate students and its counselling implications. Three faculties in IBB University were purposively selected for the study and 90 students were randomly selected in the three faculties for the study. Three instruments (PPPWQ, ASRS. and DAST.) that were validated by experts and with confirmed reliabilities were used for the study. Each instrument was administered on the respondents and retrieved by the researcher with the efforts of 3 research assistants.Simple percentage, Rank order and chi-square were used for bio-data and the analysis of data respectively. The findings revealed that, lack of time management, text anxiety, uncoverage of course contents and difficult in course component are the causes of academic stress among students. The intake of drugs makes the students feel lonely, sexual urge, Bullying, poor Odour, among others, Sweating, accelerated heart rate, trembling, maladjustment, fear of failure, among others are the nasty effects of academic stress and drug abuse on their personalities as such, inhibiting their psychological well-being. It was vividly seen that academic stress and drug abuse are significant factors that inhibit psychological well-being of students. Based on the findings, the counsellor could use systematic desensitization technique to discourage drug use among students and seminars, advocacy programmes, among others, are recommended to help the students.

: In Zimbabwean rural schools, drug abuse is observed to be on the increase trend. It is in this context that this paper delved into experiences that are encountered by vulnerable learners abusing drug in rural schools. Accordingly, it targeted at how this social phobic has become entrenched in learners’ way of being and the plausible antidotes to this drawback. In this regard, a framework derived from social constructionist and symbolic interactionist standpoints provided the lens through which the researchers perceived the issue under investigation. The researchers used literature review in the generation and analysis of learners’ lived experiences with regards to the issue under study from different sources. The researchers used the narration of information from commissioned reports, newspaper articles and empirical findings. From consulted sources, the researchers noted that there is widespread drug abuse in most rural schools through the influence of the institution linked dynamics, age issues, life stress, peer group pressure, obtainability of ready money and ease of access to drugs. With respect to these findings, the researchers concluded that drug abuse by learners in rural schools in Zimbabwe was from literature perspective mostly due to multi-pronged influences. Hence the researchers recommended that key interested parties such as Government, Non- Governmental Organizations, parents, teachers and policymakers should consistently implement and monitor strategies such as peer counselling to mitigate the drug abuse among rural learners.

: In Zimbabwean rural schools, drug abuse is observed to be on the increase trend. It is in this context that this paper delved into experiences that are encountered by vulnerable learners abusing drug in rural schools. Accordingly, it targeted at how this social phobic has become entrenched in learners’ way of being and the plausible antidotes to this drawback. In this regard, a framework derived from social constructionist and symbolic interactionist standpoints provided the lens through which the researchers perceived the issue under investigation. The researchers used literature review in the generation and analysis of learners’ lived experiences with regards to the issue under study from different sources. The researchers used the narration of information from commissioned reports, newspaper articles and empirical findings. From consulted sources, the researchers noted that there is widespread drug abuse in most rural schools through the influence of the institution linked dynamics, age issues, life stress, peer group pressure, obtainability of ready money and ease of access to drugs. With respect to these findings, the researchers concluded that drug abuse by learners in rural schools in Zimbabwe was from literature perspective mostly due to multi-pronged influences. Hence the researchers recommended that key interested parties such as Government, Non- Governmental Organizations, parents, teachers and policymakers should consistently implement and monitor strategies such as peer counselling to mitigate the drug abuse among rural learners.

Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community pharmacies in Aden city, from the users’ perspective. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. The majority of interviewees were male (n = 11/15) with an age range of 21–40 years. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor.

AbstractObjectives: To audit the incidence of a history of childhood sexual abuse (CSA) in women with diagnoses of drug and alcohol misuse disorders.Method: A definition of CSA encompassing the US National Centre on Child Abuse and Neglect's definition of child sexual abuse was used. In the six month period of audit details of CSA were recorded from clinical data for all consecutive female new patients (n = 49) of the substance misuse service in St. Luke's Hospital, Armagh.Results: Of the 49 new patients, information on childhood sexual abuse was available for 44 subjects. Sixteen (36.36%) of 44 had a positive history of CSA.In 13 (81.25%) abuse occurred before the age of 16 years. Sexual intercourse was described by 50% and sexual contact by 50%. Only one patient had reported CSA to the police and only one patient had received counselling. There was a difference noted in the addiction profile of those with a history of CSA, 44% of this group had either alcohol dependence syndrome/harmful use of alcohol compared with 66% of the non-CSA group. The perpetrators were all male.Conclusions: Our audit confirmed other work which showed a high incidence of childhood sexual abuse histories in addicted women. This is one of the areas which may not be properly addressed by conventional addiction treatment programmes, which are male centred and male dominated. It adds to the growing body of evidence that suggests adaptations must be made as increasing numbers of women present for addiction problems.

The article deals with the organization of primary prevention of drug abuse in an institution of higher education. Effective psychological and educational prerequisites include: early detection of illegal use of narcotic drugs and psychotropic substances; raising students' awareness of the legal consequences of abusing narcotic drugs and psychotropic substances; informing all participants in educational process on how to obtain medical and social help in the regions they live (are educated); organizing of educational activities in a higher school aiming at creation of possibilities for students to take part in active prosocial work; development of psychological and educational competency of teachers and parents (or legal representatives) in the field of prevention of addictive behavior among the youth; arrangement, carrying out and methodological support for peer training; psychological assistance for students, including educational and developmental work, psychological help and support, as well as psychological counselling.

This paper discussed the emerging factors of alcohol and substance abuse and how theorists have tried to account for why people use alcohol and other drugs, and especially why they continue or relapse despite negative consequences. Some theories suggest genetic and other biological factors, while others emphasize personality factors or social-environmental factors. While these factors have all been shown to contribute to persistent substance use and to relapse following periods of abstinence, no one set of factors can account for all types of substance use. Rather, substance use appears to result from complex interactions of biological, psychological and social- environmental structures and. processes. Some counselling implications suggested were that drug taking could be reduced through a variety of avenues and also by experimenting with biological, psychological and environmental interventions.

Children enter state care because their parents are unable to care for them or because of abuse and neglect. Invariably they experience considerable distress and emotional trauma with many having clinically significant mental health problems. Few, however, receive the assessment, counselling and supportive services that they need. When they leave care, many experience extensive problems including mental health difficulties, unemployment, poverty, homelessness, drug abuse, relationship difficulties and lack of social support.This paper will discuss the findings of a qualitative study utilising in-depth interviews with young people who have been in state care. Illustrations of their pathways to and from care will highlight their experiences, and direct quotations from the participants will provide particular insights into the complex issues they have had to confront.The paper will outline key opportunities for prevention and intervention approaches at various points along these pathways.

The family practitioner's role has traditionally been to maintain health with periodic examinations and to restore health in times of illness and injuries. Today. family practitioners are expected to play a more proactive role by assessing unexpressed patient needs. This new approach focuses on global knowledge of the patient, including lifestyle and workplace history. When assessing sexually transmitted diseases (STDs) in particular, it is important for the family practitioner to recognize the association of morality issues and to counsel without being judgemental. Primary prevention of STDs is aimed at reducing or eliminating risks before exposure occurs. and includes counselling on safe sex, condom use. substance abuse, needle/syringe use, and consideration of hepatitis B immunization and universal screening of pregnant women for hepatitis B surface antigen. Secondary prevention refers to the recognition and elimination (if possible) of an STD after exposure and includes early disease detection, adequate STD treatments, screening, human immunodeficiency virus testing with pre- and post test counselling, epidemiological treatment of patient contacts, and hepatitis B prophylaxis by passive or active immunization. Tertiary prevention is aimed at limiting disease progression or reversing damage, but such measures are usually quite expensive and of limited value. Assessment of risks for hepatitis B virus infection should include lifestyle indices such as sexual preference, sexual expression, number of partners and alcohol/drug consumption. Prostitutes, street youth and sexually abused individuals should be considered at high risk for hepatitis B virus infection. Counselling about hepatitis B virus infection involves risk evaluation, patient education, evaluation of immune status to hepatitis B virus and discussions about vaccine needs and availability.

ABSTRACT This research is motivated by the circulation and use of narcotics in adolescents which are still rife in Ogan Komering Ilir Regency. This study aims to determine the effectiveness of prevention of drug abuse in adolescents in Ogan Komering Ilir Regency. The method used in this study is a qualitative method. Data collection techniques are done through in-depth interviews and documentation studies. The theory used in this study is the theory of open systems according to Richard M Steers, namely effectiveness can be seen based on three dimensions, namely input, process and output. Based on the results of field research shows that the input, process and output has not been effective. The conclusion of this research is that the effectiveness of prevention of narcotics abuse in adolescents in Ogan Komering Ilir Regency (study at the National Narcotics Agency Ogan komering Ilir Regency) has not been effectively implemented. This research suggests that the effectiveness of preventing narcotics abuse among adolescents (a study at the National Narcotics Agency of Ogan Komering Ilir) can run well and effectively: (1) There needs to be communication and cooperation between BNNK OKI and the Regency Government, Police and Related Agencies to help resources in the prevention of narcotics, (2) socialization activities or counselling on the dangers of anti-drugs must be increased, and (3) prioritizing the use of traditional media.

Substance abuse among young adults is a major public health issue which can cause significant damage to their mental health. The screening, brief, interventions and referral to treatment (SBIRT) is a public health prevention tool used in identifying persons at risk of substance use and abuse. This study assessed the approach to screening, brief intervention and referral to treatment of substance abuse management in a higher institution of learning. The study adopted a qualitative key informant’s interviewer assessment method. Key informants from the Student Support Service (SSS) Centre were interviewed to assess the SBIRT management approach of substance abuse in a university setting. The interview guide had a total of 5 themes with 8 questions and 14 follow-up questions. Interviews and observation of key informants was used to obtain research information. Data was analyzed using thematic analysis. This study revealed that the study population utilized reliable drug tests, students’ performance, behavior and appearance of the students as an approach to screening students for substance abuse. Management was dependent on level of risk of the student determined from the screening process. Substance use disorders varying from moderate to high risk were given counselling therapy; patients with severe risk dependency were referred to specialty treatment (rehabilitation) for further treatment. The SBIRT approach in the treatment of students at risk of substance abuse have been found to be useful. There are however challenges with students complying to treatment which needs to be addressed.

One of the unsettling society not only in Indonesia but also in the rest of the world is the circulation of drugs, especially among students. Not only consume, nowadays there are also students and the young generation which helped distribution, ranging from airport to the courier. Drug abuse is a social problem that always comes up in the midst of the community. Drug circulation increasingly bolder worrying; drugs became one of the nation's character Assassin. Indonesia was in a crisis of character. The spread of drug prevention efforts among the younger generation is supposed to be a shared responsibility, in this case all parties including parents, teachers, and the public should be aware of are active in contributing to the threat of drugs towards the younger generation. One way is to establish and improve the character of the young generation is by providing help through counseling. Counseling counselor should be done through a clear procedure, so that the process happens more effectively and right on target. Counselling is not solely the verbal sentence formulation, but also load the roles that run by counsellors and clients, the procedure is, and the behavior of clients that will be transformed in the process. Because of that in providing services to the client whether or not there are nine Sha-counseling model that can be used by counselors.

Abstract Background The so-called “novel psychoactive substances” (NPS) or “legal highs” have been highly used by adolescent and young population in the last decade, reaching a level at which they became a challenge for policy makers and public health [1]. Drugs like synthetic cannabinoids, synthetic cathinones, Salvia divinorum, phenylethylamines, synthetic cocaine substitutes and Mitragyna speciosa have been included in the NPS category and patients diagnosed with bipolar disorder, personality disorders or schizophrenia and related disorders were the most frequently associated disorders with NPD use (between 11.6 and 23.1%) [2]. Case reports of the NPS-induced relapses among patients with schizophrenia exist, and a toxicology screening rarely detect these substances [3]. The impact of NPS in the prodromal phase of schizophrenia is associated with several important questions, like “is there a common predisposition for both NPS abuse and schizophrenia spectrum disorders?”, or “how can the early treatment of the NPS abuse may interfere with the risk for the development of schizophrenia?”. Methods A number of three patients who presented NPS use and attenuated psychotic syndrome (according to the DSM-5 criteria for conditions for further study) were monitored for 3 months during their detox treatment and after that period, during which they received a maintenance treatment with moodstabilizers (carbamazepine 600–900 mg daily or sodium valproate 500–1000 mg daily) and naltrexone (50 mg daily). Two patients accepted also low-dose antipsychotic treatment with olanzapine (5 mg/daily). Psychological counselling was offered and accepted by all three patients. These patients were evaluated every 4 weeks using Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impressions – Severity (CGI-S), and Inventary for Drug Taking Situations (IDTS). No other axis I or III diagnoses were detected in any of these patients. However, two patients presented features of cluster A personality disorders, without reaching the threshold for a clear-cut axis II diagnosis. Results All three patients reached the week 12 visit, and they presented improvements in the PANSS scores, including the patient who refused antipsychotic treatment (mean PANSS reduction was 23.7 points compared to baseline). GAF increased with 29.9 points, and CGI-S decreased with 1.9 points. IDTS had a more fluctuating course, with final values being modestly reduced to baseline (-10.7, p=0.127). One patient remained abstinent from NPS for 2 months, while the other two admitted a continuation of the drugs use during the 3 months of their monitoring period. No discontinuation of the treatment was reported during to the low tolerability. Discussion The initiation of pharmacological treatment and psychological counselling could improve the evolution of patients diagnosed with both NPS abuse and attenuated psychotic syndrome, as reflected at least by the PANSS scores, even if patients did not significantly improve their drug consumption. References

This article looks at how intravenous drug users in Finland perceive their problems and the social and health care interventions designed to address those problems. Aim The aim is to open up new perspectives on the current debate around the services and treatments available to drug users. The study is based on an ethnographic observation and interview material collected at health counselling centres for intravenous drug users, including users' talk about the service system and their service needs as well as my own observations of how drug users cope within the service system. Methods The discourse analysis is grounded in the concept and idea of talking back, which I use to challenge current constructions (often by experts and the authorities) of the drug abuse problem. I juxtapose these constructions with drug users' interpretations, which I address by the concept of interpretative framework. Results Drug users themselves also describe their lives largely via their problems, but their explanations of these problems are rather different from those offered by experts and the authorities. The first key characteristic is the tension that is constructed between drug users who look upon themselves as abnormal and the so-called normal population. A second distinctive feature in drug users' everyday life is its multiple, simultaneous problems and it's oppressive, unbearably forced rhythm. Conclusion Existing social and health care interventions do not provide adequate support to drug users, but on the contrary may even complicate their lives.

Aim of the study: We aimed to study the efficacy of triple drug therapy which is considered as a standard regimen. Objective of the study: To observe the role of pharmacist in preventing the recurrence of H. pylori infection. To assess whether the drug regimen prescribed eradicates the H. pylori infection. Results: In a period of 6 months a total of 358 cases were observed. Among them 142 cases are rapid urease test +ve and 216 are rapid urease test – ve cases. Of 142 patients included in the analysis, Peptic ulcer disease was more common in men when compared to women and prevalent in age group of 51-60 years. The body mass index analysis showed that 35.2% of patients were obese. From the personal history of the patients, it was concluded that 32.3% were smokers whereas 31.6% were alcoholic. The medication history analysis showed non-steroidal anti-inflammatory drugs were commonly used by the patients. The diagnostic endoscopic reports show that patients suffer from erosive pan gastritis followed by erosive gastritis. Conclusion: A 14-day triple therapy was found to be completely eradicate H. pylori infection. Out of the various demographic details that were taken into consideration age, gender, BMI, smokers, alcoholics, spicy food intake and drug abuse increased symptoms whereas co-morbid illness, sleeping pattern and food interval didn’t affect much. Structured patient counselling and follow up had a significant effect which was seen in the form of zero recurrence, 100% medication adherence and improved quality of life.

IntroductionPatients with antisocial personality disorder incur high costs on society, and are at high risk of dropping out of treatment and are often excluded from treatment, yet very little research has been conducted on how to best help these patients.ObjectivesTo test a six-session psychoeducation program, Impulsive Lifestyle Counselling, in outpatients with substance use disorders and antisocial personality disorder.AimsTo test the efficacy of the intervention versus treatment as usual in community outpatient treatment for substance use disorders.MethodsPragmatic randomized trial in 13 outpatient community substance abuse treatment uptake areas. Patients were interviewed by blinded interviewers 3, 9 and 15 months post-randomization and tracked through a national substance abuse treatment register. Mixed effects regression were used to assess substance use and self-reported aggression and Cox regression was used to assess risk of dropout.ResultsA total of 175 patients was randomized. At 3-month follow-up, patients randomized to intervention reported more days abstinent and less drug use severity than patients randomized to treatment as usual. In addition, patients randomized to intervention were at lower risk of dropout after intervention. In addition, patients randomized to intervention were more likely to report having received help for antisocial personality disorder at follow-up interviews.ConclusionsA brief psychoeducational intervention may improve outcomes for outpatients with antisocial personality disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

AbstractObjective: To ascertain the views of Irish GPs with regard to local child psychiatry provision.Method: 180 randomly selected general practitioners were sent a questionnaire designed to ascertain their views on child psychiatry services. They were asked to rate service provisions, professional staff and therapies offered in terms of priority.Results: 74 (41%) returned completed questionnaires. Written reports, short waiting list times and emergency inpatient provisions were accorded the highest priority by the largest number of GPs (77%, 64.9%, and 63.5% respectively). Expertise in child sexual abuse, mental handicap and alcohol/drug addiction were also prioritised (77%, 66.2%, & 58.1% respectively). The core staffing required included child psychiatrists, community psychiatry nurses, psychologists and social workers. Family therapy followed by counselling were the most popular treatment modalities. However, more than two thirds (68.6%) of the sample rated their current service as unsatisfactory.Conclusion: In planning service provision it is important to take into account the needs of the community, referrers' views and accessibility in order to provide optimum services for both users and referrers.

<p class="abstract"><strong>Background:</strong> Over-the-counter (OTC) medicine or non-prescription medicine refer to medicine that you can buy without a prescription from a health care professional. The prevalence, clinical patterns and causative agents of cutaneous drug reactions vary among different populations. The most widely used over the counter medication in dermatological practice are topical steroids. The main objective is to know awareness among the people about over the counter medication and clinical analysis of effects caused by them, to find the most commonly used OTC medication.</p><p class="abstract"><strong>Methods:</strong> Prospective questionnaire based study comprising of 453 cases of cutaneous effects due to over the counter medication was carried out for a period of 1 year. Diagnosis was made mainly based on clinical features.<strong></strong></p><p class="abstract"><strong>Results:</strong> Super potent and high potent steroids were the most common OTC medication used which caused nodulocystic acne in 51.6% patients, atrophy in 3.97% patients, tinea incognito in 23.8% patients. Irritant contact dermatitis (due to hydroquinone, cotrimoxazole, neomycin) was seen in 18.5% patients. Fixed drug eruption was seen in 1.32% patients, cushingoid features in 0.66% patient.</p><p class="abstract"><strong>Conclusions:</strong> Indiscriminate abuse of steroids by people due to lack of awareness should be stopped. This misuse and damage have serious effect on the quality of life of the patients in general and the skin of the face in particular. Management is difficult and necessitates psychological counselling as well as physical soothing of the sensitive skin. For the safety of people Indian association of Dermatology, Venereology and Leprology (IADVL) also started IADVL Task force Against Topical Steriod Abuse (ITATSA).</p>

ObjectivesTo assess the demographic, behavioural, psychosocial and structural factors associated with non-utilisation of HIV testing and counselling (HTC) services by female sex workers (FSWs) and men who have sex with men/transgender (MSM/TG).MethodsThis study involved a cross-sectional design. We used the national surveillance survey data of 2012, which included 610 FSWs and 400 MSM/TG recruited randomly from 22 and three districts of Nepal, respectively. Adjusted prevalence ratio (aPR) and 95% confidence interval (CI) using modified Poisson regression was used to assess and infer the association between outcome (non-utilisation of HTC in last year) and independent variables.ResultsNon-utilisation of HTC in the last year was 54% for FSWs and 55% for MSM/TG. The significant factors for non-utilisation of HTC among FSWs were depression (aPR=1.4 (95% CI 1.1 to 1.6)), injectable drug abuse (ever) (aPR=1.4 (95% CI 1.1 to 1.8)), participation (ever) in HIV awareness programmes (aPR=1.2 (95% CI 1.0 to 1.4)), experience of forced sex in previous year (aPR=1.1 (95% CI 1.0 to 1.3)) and absence of dependents in the family (aPR=1.1 (95% CI 1.0 to 1.3)). Non-utilisation of HTC among MSM/TG had significant association with age 16–19 years (aPR=1.4 (95% CI 1.1 to 1.7)), non-condom use (aPR=1.2 (95% CI 1.0 to 1.4)), participation (ever) in HIV awareness programmes (aPR=1.6 (95% CI 1.3 to 2.0)), physical assault in previous year (aPR=1.8 (95% CI 1.0 to 3.1)), experience of forced sex in previous year (aPR=0.5 (95% CI 0.3 to 0.9)).ConclusionAlthough limited by cross-sectional design, we found many programmatically relevant findings. Creative strategies should be envisaged for effective behavioural change communication to improve access to HIV testing. Psychosocial and structural interventions should be integrated with HIV prevention programmes to support key populations in accessing HIV testing.

Harm minimisation strategies aim to reduce the deleterious health and social consequences to the individual in drug use and abuse and the potential financial burden to the community. Harm minimisation is the guiding principle of the Steroid Peer Education Program (SPEP). This is an outreach program funded by the Department of Human Services (DHS) which provides counselling, education and needle exchange facilities for body-builders who inject with anabolic steroids. In 1998, SPEP became aware that a substantial number of clients were misusing insulin in an attempt to enhance muscle growth. It appears that these athletes were unaware of the dangers of insulin use, such as hypoglycaemia, and the potentially fatal consequences of this practice. Research was carried out which highlighted the need for education material as a harm reduction strategy. Such education material could be used to raise awareness of the dangers of non-medical insulin use and outline how to prevent and treat a hypoglycaemic episode. It appears pertinent to raise awareness of the non-medical use of insulin especially preceding the Sydney 2000 Olympic Games. In addition to the dangers inherent in insulin use as an anabolic enhancement agent, its use cannot be detected by existing control measures. Finally, the long term health consequences of this practice are largely unknown and represent, therefore, an area for future investigation.

This study aims to analyze the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education. The study was conducted in 2 communities of post-rehabilitation education providers in Semarang city. The level of psychological well-being of 40 respondents was measured by filling in the 18-item psychological well-being scale developed by Ryff (r = 0.83; v = 0.97). Measurement includes indicators: (1) self-acceptance; (2) positive relationships with others; (3) autonomy; (4) environmental mastery; (5) purpose in life; and (6) personal growth. Hypothesis test results indicate that the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education is significantly greater or equal to 80 (t = 49,140; sig = 0,000). Based on the results of this study, it is recommended to further researchers to further explore certain differences in the level of psychological well-being of the counselee by the factors of age, demographics, educational background, and length of abstinence. In addition, further studies with a larger number of samples and questionnaire items are needed so that study results can be generalized to a wider population.Ardiantina, D. (2016). Studi Kasus Kehidupan Remaja Mantan Pecandu Narkoba. Jurnal Bimbingan dan Konseling, 5(1), 1-12.Astuti, R., & Ismandari, F. (2014). Gambaran Umum Penyalahgunaan Narkoba di Indonesia. Buletin Jendela Data dan Informasi Kesehatan. I, pp. 1-52. Jakarta: Kementrian Kesehatan RI.Aztri, S., & Milla, M. N. (2013). Rasa Berharga Dan Pelajaran Hidup Mencegah Kekambuhan Kembali Pada Pecandu Narkoba Studi Kualitatif Fenomenologis. Jurnal Psikologi, 9(1), 48-63.Bhandari, S., Dahal, M., & Neupane, G. (2015). Factors Associated With Drug Abuse Relapse: A Study On The Clients Of Rehabilitation Centers. Al-Ameen Journal of Medicine and Science, 8(4), 293-298.BNN. (2015). Laporan Akhir Survei Nasional Perkembangan Penyalahgunaan Narkoba Tahun Anggaran 2014. Jakarta: Badan Narkotika Nasional Indonesia.Buchanan, T. (2011). Attention Defi cit/Hyperactivity Disorder and Well-being: Is Social Impairment an Issue for College Students with ADHD? Journal of Postsecondary Education and Disability, 24(3), 193-210.Bukoye, R. O. (2017). Academic Stress and Drug Abuse as Factors Inhibiting Psychological Well-Being Among Undergraduates: It’s Counselling Implications. European Scientific Journal, 13(8), 60-74.Chong, J., & Lopez, D. (2008). Predictors of Relapse for American Indian Women After Substance Abuse Treatment. Journal of The National Center, 14(3), 24-47.Dogaheh, E. R., Jafari, F., Sadeghpour, A., Mirzaei, S., Maddahi, M. E., Hosseinkhanzadeh, A. A., & Arya, A. R. (2013). Psychological Well-Being and Quality of Sleep in Addicts under Methadone Maintenance Treatment. Research Papers, 1(2), 71-75.Fard, A. E., Rajabi, H., Delgoshad, A., Rad, S. A., & Akbari, S. (2014). The Possible Relationship between University Students' Personality Traits, Psychological Well-being and Addiction Potential. International Journal of Social Science Studies, 2(2), 120-125.Garcia, D., Nima, A. A., & Kjell, O. N. (2014). The Affective Profiles, Psychological Well-Being, and Harmony: Environmental Mastery and Self-Acceptance Predict the Sense of a Harmonious Life. PeerJ, 1-21.Green, M., & Elliott, M. (2010). Religion, Health, and Psychological Well-Being. Journal of Religion and Health, 49, 149-163.Greenfield, E., Vaillant, G., & Marks, N. (2009). Doformal religious participation and spiritual perceptions have independent linkages with diverse dimensions of psychological well-being? Journal of Health and Social Behavior, 50, 196–212.Haryadi, R. (2018). Prospek Konseling Komunitas bagi Individu Eks-Pecandu Narkoba (Studi Pada Lembaga Pasca-Rehabilitasi Narkoba Di Kota Semarang). Konseli (Jurnal Bimbingan dan Konseling), 5(1), 73 - 84.Ibrahim, F., & Kumar, N. (2009). Factors Effecting Drug Relapse in Malaysia: An Empirical Evidence. Asian Social Science, 5(12), 37-44.Lindfors, P., Berntsson, L., & Lundberg, U. (2007). Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers. International Journal of Behavior and Medicine, 13, 131-137.Martin, R. A., MacKinnon, S., Johnson, J., & Rohsenow, D. J. (2011). Purpose in life predicts treatment outcome among adult cocaine abusers in treatment. Journal of Substance Abuse Treatment, 40, 183–188.Ryff, C. D. (2014). Psychological Well-Being Revisited: Advanced in the Science and Practice of Eudaimonia. Psychoterapy and Psychosmoatics, 83, 10-28.Ryff, C. D., Love, G. D., Miyamoto, Y., Markus, H. R., Curhan, K. B., Kitayama, S., . . . Karasawa, M. (2014). Culture and the promotion of well-being in East and West: Understanding varieties of attunement to the surrounding context. In G. A. Fava, & C. Ruini, Increasing psychological well-being in clinical and education settings: Interventions and cultural contexts (Vol. 8th, pp. 1-19). New York: Springer.Schaefer, S. M., Boylan, J. M., Reekum, C. M., Lapate, R. C., Norris, C. J., Ryff, C. D., & Davidson, R. J. (2013). Purpose in Life Predicts Better Emotional Recovery for Negative Stimuli. Plos ONE, 8(11), 1-9.Schwartz, R. P., Kelly, S. M., O’Grady, K. E., Mitchell, S. G., Peterson, J. A., Reisinger, H. S., . . . Brown, B. S. (2008). Attitudes toward buprenorphine and methadone among opioid-dependent individuals. American Journal of Addicton, 17, 396–401.Seligman, M. E. (2010). Flourish: Positive Psychology and Positive Intervention. Michigan: University of Michigan.Sharma, A. K., Upadhyaya, S. K., Bansal, P., Nijhawan, M., & Sharma, D. (2012). A Study of Factors Affecting Relapse in Substance Abuse. Indian Journal of Science and Technology, 2(1), 31-35.Siddiqui, S. (2015). Impact of self-efficacy on psychological well-being among undergraduate students. The International Journal of Indian Psychology, 2(3), 5-17.Strauser, D., Lustig, D., & Çıftçı, A. (2008). Psychological well-being: its relation to work personality, vocational identity, and career thoughts. Journal of Psychology, 142, 21–35.Vasquez, C., & Castilla, C. (2007). Emociones Positivas y Crecimiento Postraumatico en el Cancer de Mama. Psicooncologia, 4, 385-404.

<p class="abstract"><strong>Background:</strong> Pediatric dermatoses vary vastly from adult dermatoses in clinical presentation, treatment and prognosis and are more influenced by socioeconomic status, climatic exposure, dietary habits, external environment, thereby needing a special view in this field. The present study was carried to determine the clinico-epidemiological patterns of pediatric dermatoses.</p><p class="abstract"><strong>Methods:</strong> Consecutive 2581 children aged &gt;1 month to 12 years with 2661 dermatoses attending dermatology OPD in tertiary care hospital, Kakinada (May 2018 to June 2019) with clinical evidence of cutaneous disorder were studied. Complete history and cutaneous examination with necessary investigations are recorded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Infestations disorder in 39.68% followed by eczematous disorder 19.80%, infection in 13.71%, pigmentary disorder in 8.34%, papulosquamous disorder in 5.82%, appendageal disorder in 2.93%, nutritional disorder in 2.21% and drug reactions including toxic epidermal necrolysis in 1.12%, child abuse and sexually transmitted diseases in 0.37% was the pattern in the present study. Rare cases including aplasia cutis, cutis laxa, ectodermal dysplasia, monilethrix and griscelli syndrome, epidermolysis bullosa, ichthyosis, palmoplantar keratoderma and congenital syphilis were also observed. The most common cutaneous dermatoses are infection and infestations followed by eczemas and nutritional disorders. Surprisingly STD and child abuse contributed significantly which cannot be neglected. Genodermatosis were notable in the study probably due to the high incidences of consanguineous marriage</p><p class="abstract"><strong>Conclusions:</strong> The study reinforces features of tropical paediatric dermatology especially high prevalence of infections and infestations in school children (5-12 years) which highlights the need of proper counselling of caretaker regarding skin hygiene and establishment of specialized paediatric dermatology clinics.</p>

Introduction: Substance abuse is harmful or hazardous use of psychoactive substance including alcohol and illicit drugs. This study aimed to assess the prevalence and contributing factors for substance abuse among secondary school level students in Bharatpur Metropolitan. Methods: A cross sectional study was carried out among 495 students of grade 11 and 12 in secondary school setting in Bharatpur metropolitan from June to December, 2019. Data were collected using self-administered anonymous questionnaire. Chi-square test was performed to find out the association between dependent and independent variables and crude odd ratio was obtained to measure the strength of association. Results: The result of the study showed that 18.8% participants were currently involving in substance abuse. Alcohol was found to be most commonly abused substance by participants. Substance abuse was significantly associated with male students (OR=11.903, 95% CI: 6.395-22.157), high monthly household income abuse (OR=1.709, 95% CI: 1.085-2.691), time spent on internet more than one hour per day (OR=2.401, 95% CI: 1.388-4.153), no control over internet by others (OR= 2.578, 95% CI: 1.574-4.224), management students (OR= 1.678, 95% CI: 1.011-2.286), absence school more than 4 days in a month (OR= 2.401, 95% CI: 1.338-4.153), students living with others than family members (OR= 2.577, 95% CI: 1.339-4.958), substance abuser in family (OR= 2.701, 95% CI: 1.667-4.377), sibling abuse substances (OR= 4.757, 95% CI:1.467-15.248), substance abuser in close friend circle (OR= 11.204, 95% CI: 6.693-4.18.755), friends insisted/enforced to take substances (OR= 2.978, 95% CI: 1.409-6.294), substance abuser in neighborhood (OR= 2.866, 95% CI:1.777-4.621) and stressful events (OR= 2.434, 95% CI: 1.130-5.243). Conclusion: The study concluded that various socio-demographic, socio economic, technological, educational, environmental and psychological factors play significant role in substance abuse among secondary school students. It is recommended to observe and monitor activities of adolescents regularly, provide a suitable and supportive environment to adolescents and provide school, community and health facility based awareness, counselling and problem solving approaches for adolescents to solve the problem of substance abuse.

Background: Hepatitis B virus infection is considered a major worldwide public health problem. While adults that acquire acute infection usually recover, the chronic type is ultimately fatal both to them and their foetuses. In endemic areas, individuals are infected by vertical transmission or infection in early childhood. The seroprevalence rates of Hepatitis B in pregnancy vary according to the endemicity of a given area with very high prevalence rates mostly reported among developing nations in Asia and Africa. Objective: To determine the seroprevalence of hepatitis B surface antigen in pregnant women attending the antenatal clinic, identify the clinical and epidemiological correlates for hepatitis B in pregnancy and to make evidence based recommendations on screening protocols for our obstetric population at the Federal Medical Centre, Yenagoa. Methodology: This is a descriptive cross sectional study. Two hundred and twenty (220) consecutive healthy pregnant women attending the antenatal booking clinic of the hospital who met the inclusion criteria were recruited into this study after pretest counselling and obtaining consent from them. This was tested for HBsAg with commercially available in vitro diagnostic kits (one step test strips). Data was collected via a structured interviewer administered questionnaire. Data entry and analysis was done using SPSS (statistical package for social sciences) 22 statistical package (SPSS Inc., Illinois, U.S.A). P value less than 0.05 was European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 280 taken as being significant. Results: The mean age of the pregnant women studied was 28.8 years ± 5.2 while the mean parity was 1.20 ± 1.16. 220 pregnant women who came for antenatal booking were recruited into this study. Of these, 4.6% (n=10) were seropositive for hepatitis B surface antigen (HBsAg). Multiple sexual partners and Female circumcision were the significant risk factors for HBsAg seropositivity (p<0.05). There was no significant association with respect to a history of jaundice or contact with a jaundiced patient, previous blood transfusion, intravenous drug abuse or sharing of sharps, previous surgery, episiotomies or dilatation and curettage (p>0.05). Conclusion: The intermediate endemicity of Hepatitis B virus infection in this study according to WHO classification, justifies the need for routine screening in pregnancy to identify and treat the infection accordingly as this will reduce the mother to child transmission. Multiple sexual partners and female circumcision are significant risk factors associated with Hepatitis B virus infection in this environment. Active and passive immunization to infants of HBsAg seropositive mothers is advocated.

ABSTRAKLatar belakang penelitian ini adalah terjadinya permasalahan yang sangat kompleks pada remaja, bahwa sebanyak 28% remaja perempuan dan 24% remaja laki-laki meminum minuman beralkohol sebelum usia 15 tahun. Sekitar 2,8% remaja 15-19 tahun terlibat penyalahgunaan NAPZA. 0,7% perempuan dan 4,5% laki-laki umur 15-19 tahun melakukan seks pranikah. Sekitar 32,1% remaja perempuan dan 36,5% remaja laki-laki mulai pacaran saat mereka belum berusia 15 tahun, Dari data di Puskesmas Boyolali II, bahwa anak-anak yang duduk dibangku SMP masih sangat mudah untuk dipengaruhi terutama dari lingkungan(Puskesmas Boyolali II, 2019), SMP N 3 Boyolali merupakan wilayah kerja Puskesmas II Boyolali merupakan sasaran untuk program PIK R. Tujuan penelitian ini adalah untuk mengetahui hubungan program konseling PIK-R dengan perilaku menyimpang anak SMPN 3. Design penelitian ini adalah kuantitatif analitik dengan pendekatan cross sectional.Populasi berjumlah 224 responden.Pengambilan sampel menggunakan teknik random sampling dengan jumlah sampel 36 responden. Alat pengumpulan data menggunakan kuesioner dan dianalisis menggunakan analisis Univariatdan Bivariat. Hasil analisis data menggunakan Chi-Square dengan program komputer diperoleh hasil p-value 0.008 (<0.05). Didapatkan ada hubungan yang signifikan antara program konseling PIK-R dengan perilaku menyimpang anak SMPN 3. Kesimpulan bahwa program konseling PIK-R dilaksanakan terencana, terstruktur dengan materi yang mudah dipahami, responden yang memiliki perilaku menyimpang 44,4% baik dari anak laki-laki dan perempuan. Remaja yang masih memiliki perilaku menyimpang yaitu siswa-siswi yang mengikuti program konseling PIK-R <2x. Dari hasil penelitian ini diharapkan remaja dilingkungan SMPN3 Boyolali dapat menerima informasi yang baik melalui Program PIK-RKata Kunci : Program PIK-R, Perilaku menyimpang. COMPARATION PIK-R COUNSELLING PROGRAM WITH DEVIATE BEHAVIOR OF JUNIOR HIGH SCHOOL STUDENTABSTRACTThe Background of this research is the occurrence of a complex and diverse problem in adolescents, that as many as 28% of adolescent girls and 24% of adolescent boys drink alcoholic drink before the age of 15 years. Approximately 2,8% of adolescent 15-19 years are involved in drug abuse. 0,7% of woman and 4,5% of men aged 15-19 years had premarital sex. Around 32,1% of adolescent girl and 36,5% of adolescent boy start dating when they are not yet 15 years old. The aim to explore comparation of PIK-R counselig program with deviant behavior junior high school students. A cross sectional quantitative study was used to measured 36 respondens aged 11-13 years. Data collection tool using questionnaires and analyzed using univariat and bivariat analysis.The result of data analysis using Chi-Square with a computer program, obtained p-value 0.008 (<0.05). There is a significant relationship between the PIK-R counseling program with deviant behavior of junior high school students.So it can be concluded PIK-R counseling program carried out planned, structured with theory the easy in understand, respondent which has deviant behavior 44,4% of man and of woman. Adolescent still has deviant behavior that is student follow PIK-R counseling program <2x. The results of this study, it is expected that adolescents in Boyolali Junior High School can receive good information through PIK-R.Keywords : Program PIK-R, Deviate behavior.

The purpose of the study was to highlight the factors associated with violence against women and girls and how they can benefit from therapy. The study was guided by the following objectives: to establish the factors associated with the occurrence of violence, determining the effectiveness of therapy in dealing with survivors of violence, exploring factors influencing or blocking effectiveness of therapy. A cross sectional research design was used in which questionnaires, an interviewing guide, focus group discussion and psychological assessment scale were used to collect study data. A sample of 75 women and girls was purposively selected from health facilities, counselling centres, chief camps, police station, NGOs and CBOs within Kibra Constituency. All respondents were females aged 18 years and above. The findings showed that all the respondents (100%) had been exposed to violence. The respondents who reported physical abuse were 30%, sexual abuse was reported by 10%, psychological and emotional abuse was reported by 16%, financial coercion was reported by 15%, neglect of children and duty by 13%, and verbal assault was reported by 16%. Further, the results showed that the most common victims of violence are expectant mothers and children who are under the care of irresponsible persons. The most reported people to perpetrate violence were cited to be men. The responses given by the respondents as factors that trigger violence are: Previous assaults (61%), cultural expectations (61%), alcohol abuse and other drugs (49%), poor communication skills (49%), poor problem solving skills (49%), perpetrator outstretched demands on resources (49%), infidelity(37%), unemployment (37%), peer pressure (37%), frustration emanating from blocked goals (24%), childlessness (24%) and personality traits (12%). Violence against women and girls impact negatively on their lives. The most common negative impact mentioned are depression by 75 respondents, children suffering cited by 65 respondents, family disintegration cited by 56 respondents, non-productivity, physical injury, and anxiety respectively cited by 46 respondents. The survivors of violence have knowledge of where they can access help in order to cope with the consequences of violence. Of the 75 respondents, 75 of them said that counselling is very helpful. Perseverance is another coping mechanism mentioned by 75 respondents. Separation and keeping quite are strategies mentioned by 65 respondents. Going to hospital is another support and help available mentioned by 56 respondents. The respondents who opted for spiritual intervention were 47 while those who opted to start a business for sustainability were 38. Those who preferred sharing with significant others as a coping mechanism were 28. Last but not least, 18 women indicated that support groups are helpful in dealing with violence. The study recommended that women and girls should be empowered financially and policies put into place to curb violence. The government and other stakeholders should partner to support women and girls to overcome violence in the society.

AbstractAdvances in the management of the multiple pregnancy and delivery must be accompanied by corresponding improvements in service access outside key centres and especially in the information families receive about what may happen during or after the pregnancy. A major review of birthing services in Victoria has focussed attention on four areas where the quality of information is often inadequate. 1) Prepregnancy and the standard of counselling about the incidence of multiples as a result of fertility drugs and in vitro fertilization procedures and about problems which may accompany a multiple birth. 2) Antenatal: At what stage of the pregnancy should parents be told of the multiple pregnancy and how should monitoring of the mother and procedures such as bedrest take into account what are often conflicting demands within the family? 3) Perinatal: Families are frequently illprepared for a cesarean delivery and for the procedures for premature multiples. The problem is often compounded by separation of the mother from one or both twins. While bereavement services are improving, much still needs to be learned about handling congenital abnormalities in one or more multiples. 4) Postnatal: Irrespective of the level of prenatal advice, families greatly underestimate the workload with multiples. The resulting stress contributes to the incidence of postnatal depression, child abuse and divorce now being reported from multiple birth families. Some suggestions are made from social psychology and genetic counselling about how families can best handle risk information to achieve the goal of neither under- nor overestimating the risks at these different stages of the multiple pregnancy.

Abstract Aim: The aim of the study was to determine the prevalence of high anxiety and substance use among university students in the Republic of Macedonia. Material and methods: The sample comprised 742 students, aged 18–22 years, who attended the first (188 students) and second year studies at the Medical Faculty (257), Faculty of Dentistry (242), and Faculty of Law (55) within Ss. Cyril and Methodius Universityin Skopje. As a psychometric test the Beck Anxiety Inventory (BAI) was used. It is a self-rating questionnaire used for measuring the severity of anxiety. A psychiatric interview was performed with students with BAI scores > 25. A self-administered questionnaire consisted of questions on the habits of substance (alcohol, nicotine, sedative-hypnotics, and illicit drugs) use and abuse was also used. For statistical evaluation Statistica 7 software was used. Results: The highest mean BAI scores were obtained by first year medical students (16.8 ± 9.8). Fifteen percent of all students and 20% of first year medical students showed high levels of anxiety. Law students showed the highest prevalence of substance use and abuse. Conclusion: High anxiety and substance use as maladaptive behaviours among university students are not systematically investigated in our country. The study showed that students show these types of unhealthy reactions, regardless of the curriculum of education. More attention should be paid to students in the early stages of their education. A student counselling service which offers mental health assistance needs to be established within University facilities in R. Macedonia alongside the existing services in our health system.

Over the counter (OTC) medications are the group of drugs that can be sold without the prescription of a registered medical practitioner to the consumers. Pharmacists are the most accessible health care professionals to the patient for the treatment of their minor illness. To provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counselling, community pharmacists need access to current and reliable information about medicines. A descriptive study was conducted on fifty pharmacists present in the community pharmacy of Kathmandu and Lalitpur districts. Predesigned validated questionnaire consisting of 16 questions were taken for the collection of data. Qualification of pharmacists, numbers of consumer asking for OTC medication in a week, most commonly dispensed OTC medicines by pharmacists, common symptoms told by consumers and average working hour of community pharmacists were recorded. The approval from the concerned authorities was taken. The study was a community based descriptive study done for 3 months. The data of the study was analyzed by using SPSS version 18. Out of 50 Pharmacists, 27 were males and 23 were females. Most of the study populations were qualified as assistant pharmacy. 82% of Community Pharmacy encountered more than ten consumers in a week. Analgesics and antipyretics, drugs for gastritis, antiprotozoals and antihistamines were the most commonly dispensed drugs by the pharmacies. The most common symptoms enquired by patients/consumers were fever (92%), common cold (90%) and headache (86%) as reported by pharmacists respectively. Average working hours of community pharmacists were 67 hours per week. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. There is increasing use of OTC medicines in Nepal. The study on community pharmacy practices regarding over the counter medicines can assist in evaluating pattern of use of OTC medicines by consumers thus help to reduce abuse and misuse of such medicines.

<p><span><em>The research on adolescence perception to their reproduction </em><span><em>health guidance in Wirobrajan District, Yogyakarta could give an illustration </em><span><em>on a very well, well or poor perception guidance variables. Adolescence </em><span><em>reproduction health guiding function was to guide and to direct adolescence </em><span><em>in order to avoid from a disadvantageous behaviour for their future lives such </em><span><em>as free association, pre-marriage sexual intercourse, sexual affected disease, </em><span><em>drugs abuse, drinking, criminal acts and soon. Adolescence reproduction </em><span><em>health program was conducted through several approaches were among </em><span><em>others: Firstly, family communication approach i.e. a program given through </em><span><em>interpersonal communication between parents and their adolescence phase </em><span><em>and learning/ teaching approach, aimed to give adolescence reproduction </em><span><em>health program in school through intra-curricular and extra-curricular. </em><span><em>Secondly, a counselling approach meant that given to the adolescence and </em><span><em>their parents in a school guidance activity form as well as society through </em><span><em>social group/ organization such as youth workshop, Family Wellness </em><span><em>Program (PKK), BKR, and soon. </em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><em>From the research result, it was known that adolescence perception to </em><em>reproduction health guidance was averagely good, except its perception </em><em>credibility was very good, adolescence concept or ways most liked on </em><em>adolescence health guidance was conducted a direct guidance using </em><em>demonstration tools. Viewed from an adolescence perception difference on </em><em>adolescence reproduction health guidance was based on sex, age, origin, </em><em>school, parent educational level and occupation. From the analysis result, </em><em>there was no respondent perception difference viewed from sex, age, origin, </em><em>school, parent educational level and occupation.</em></p>

The correctional officers in Sabah Prison have not received any specific training to treat drug abusers, even though they consist the highest percentages of inmates. The Adaptation of Motivational Interviewing, AMI Treatment Modules, has been used as the training module in this project. This project aims to transfer drug abuse counselling skills to 67 prison officers in Sabah. Participants were trained for 5 days with various training methods, and the instruments used were Counseling Response Questionnaires (CRQ), Confidence and Knowledge Scale (CKS), Behavior Change Counselling Index (BECCI) and Rosenberg Self-Esteem. This study uses a quasi-experimental design aimed at seeing the effectiveness of AMI's training. Result from Wilcoxon signed-ranks test showed that the mean for post-test ranks was higher than the mean pre-test ranks for empathy (z = -7.14, p .05, confidence ( z = -6.95, p .05), change behavior skill (z = -5.99, p .05) as well as self- esteem (z = -4.98, p .05). In other words, the study showed that the Drug Abuse Counselling Training: Adaptation of Motivational Interviewing Strategy can promote positive effects on subject’ empathy, confidence, change behavior skill and self-esteem. Therefore, the five-day workshop based on the AMI Treatment Modules can be used as a guideline for relevant authorities such as the Malaysia Prison Department for future training programmes particularly to correctional officers. In conclusion, this project has been able to enhance empathy, confidence and behavior-changing skills as well as self-esteem among prison officers in Sabah.

<p>This research was done in order to analyse the need for effective drug awareness training programs, to identify and analyse the key characteristics of effective drug prevention programs and to propose a framework for effective delivery of Drug Prevention Programs in schools of UAE. Hence, a survey was done to get to the findings of the research. As a result, a quantitative study among school children has been conducted across 4 schools involving 201 students. This research, with particular emphasis on the effectiveness of drug and substance abuse prevention programs among schools in Dubai Emirates. The findings of this study have shown that there is a need for effective drug awareness training programs, as the results have shown that 11.6% of all students have indeed used drugs. The results have also shown that there are three main characteristics which will make the drug prevention programs more effective. The three key characteristics are drug awareness training program through counselling, involving parents and community as well as using interactive program and multimedia in order to boost student’s confidence and increase resistance skills against the use of drugs. Hence, it is recommended that drug awareness programs alone will not be fully effective in reducing the use of drugs among students in Dubai, UAE.<strong></strong></p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0686/a.php" alt="Hit counter" /></p>

The study investigates a specific issue in the Czech prison system: the conflict between prison employment and therapeutic/counselling programmes offered. Drawing on 55 semi-structured interviews with specialized prison personnel from 10 Czech prisons, I argue that prison employment is disproportionately prioritized over the programmes, which undermines and, in some cases, makes it impossible for the personnel to work with inmates on rehabilitation. Since the Czech Prison Service itself declares that most inmates have serious problems involving psychological traumas, drug abuse, and housing insecurity, it would be beneficial to prioritize rehabilitation programmes and then try to employ inmates. The conflict also contributes to an unsuccessful re-entry/resettlement process, which is regarded as a major problem in the Czech prison system and society.

The study investigated the perceptions of the youth regarding Voluntary Counselling and Testing (VCT) and sexual aspects related to HIV and AIDS. The study was grounded in qualitative methodology, using 4 focus group interviews for data collection - triangulating the results with field notes and literature. The participants of the four focus groups proved to be well informed on the topic and had clear perceptions concerning several aspects. They were very positive regarding the advantages of VCT for the prevention and management of HIV and AIDS. The participants recognised the need for the youth to be better informed about VCT and HIV and AIDS. They were much concerned by the lack of parental involvement in sexual education as well as the permissiveness of the youth who partook in alcohol and drug abuse as well as prostitution. Participants of the study stated that this problem was exacerbated by poverty and poor socio economic conditions.

Abstract Background and Aims Potential kidney donors who actively smoke heavily or had intermittent illegal drug use (IIDU) are mostly excluded from donating a kidney. Tobacco use in kidney donor has been linked to worse outcomes for donors and while less evidence exists for IIDU as they mostly excluded from donation. We conducted a short survey about the suitability of these marginal living kidney donors. The purpose of this survey is to form a consensus on live kidney donor with using smoking or illegal drugs. Method This is a cross-sectional survey of nephrologists and transplant surgeons about suitability and acceptance of marginal live kidney donors. We asked physicians about accepting kidney donors who are actively smoking or using illegal drugs. The survey was mainly distributed through AST and ERA-EDTA. The role of these organization is limited to facilitate the distribution of the survey as an external study. We excluded in-training nephrologists or transplant surgeons. Results One hundred twenty-two physicians from 22 countries (80% nephrologists and 20% transplant surgeons (TS)) participated in the survey. Most physicians were experienced in pre-transplant evaluation (72% over 6 years’ experience and 68.5% of responders perform donors’ evaluation on weekly or monthly bases). Interestingly, most physicians would allow donation in active smoker with advice to quit later (56.2%) (62% of nephrologists versus only 29% of TS (p=0.002). TS would decline active smoker patients than nephrologists (42% versus 25%, p=0.09). Less physicians considered donors with IDU (after psychiatric counselling) than active smoking (30% versus 56.2%, p=0.00003). There was no difference in acceptance rate for donors with IIDU between TS and nephrologists (33.3% versus 29% respectively, p=NS) or in declining these donors (37.5% versus 45.3%, p=0.4). TS would accept more active smokers to donate if no alternative donor available than nephrologists (29.2% vs. 12.3%, p=0.04) but not IDU (29.2% vs. 25.8%, p=ns). Conclusion Active heavy smoking and intermittent illegal drug use are not viewed as solo contraindications for kidney donation by most physicians. Nephrologists and TS did not differ in attitude regarding donors with IIDU. Nephrologist seems more confident to accept donors who are actively smoking with advice to quit afterward while TS would accept them more if no alternative donor available or would decline them completely.

This explorative study is to enable the author to present results of the socio-epidemiological study, carried out during the period from 2002 to 2007, as a part of the regular work of the Counselling Office for Drug Addiction Prevention and Treatment, NGO ”Viktorija“, which involved 444 drug addicts, and that for the first time in Bosnia and Herzegovina. The standardized questionnaire of the POMPIDOU Group, the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), was applied in order to acquire relevant information. Majority of the addicts (90%) who addressed the Counselling Office for help were addicted to drugs while the minority of them (10%) only abused drugs. Heroin was the dominant drug abused (95%).

This study is a desk review of the social support and welfare of older adults in conflict situations with respect to the situations in the USA and Nigeria. It indicates that there are numerous facilities for meeting the counselling and psychological needs of older persons in all situations in America contrary to the situation in Nigeria. The elderly among victims of severely traumatic and stressful events such as religious and ethnic conflicts in Nigeria have various psychosocial, economic, financial, material, and counselling needs. The stress-coping strategies of the elderly conflict victims involve drinking and alcohol abuse. There is the scarcity of professional counsellors, social gerontologists, psychologists, social workers and other human service providers that can assist them cope effectively with the stress of conflict situations. The paper concludes that the services of counsellors, social gerontologists, social workers, and psychologists are imperative for older adults to cope successfully with stressful challenges without resorting to abuse of drugs and exacerbating their age-related problems. It therefore suggests how human service providers can respond effectively to the psychosocial needs of older adults in conflict situations in the country.

"Doctor, will I live longer if I give up alcohol and sex?" "No, but it will seem like it." The paradigm of the self as it is conceptualised in Western society includes an implicit assumption that one of the primary activities of the self is to engage in protective behaviours. This is a basic assumption in mass media promotion of healthy behaviours: 'Quit smoking' to protect yourself from lung cancer; 'Work safe' to protect yourself from injury, etc. Mass media social marketing campaigns inform the general population of the dangers to the self's existence of smoking, drink-driving, unsafe sex, over-eating, under-exercising and so on. These campaigns are based on models such as the Health Belief Model (Janz and Becker), the Fear Drive paradigm (Janis; McGuire), the Parallel Response Model (Leventhal), Thayer's Arousal Model, Roger's Protection Motivation Theory (Rogers & Mewborn; Maddux & Rogers), Ordered Protection Motivation Theory (Tanner, Hunt and Eppright) and the Extended Parallel Process Model (Witte). Fundamental to all these models is the assumption that people are motivated to protect themselves from harm. Information is provided that warns of the severity and likelihood of consequences of unhealthy behaviours. In some cases this information does motivate people to give up harmful behaviours and adopt safer options. However, worldwide, we see an increasing prevalence of diseases such as heart disease, diabetes and cancer that are related to preventable causes such as obesity, smoking and a sedentary lifestyle. To meet this challenge, the media strategy has generally focused on how to get health information across more effectively, that is, by making it more persuasive, more vivid, more salient, more imminent, more probable, and so on. Media exhortations to: 'say no to drugs', 'Quit because you can!', 'Respect yourself' etc. do not always achieve the desired change and may increase frustration, hopelessness and even depression (Henley & Donovan). It may be helpful to consider that this protection motivation paradigm does not take into account the prevalence of paradoxical behaviours, that is, behaviours that are harmful to the self (Apter). When talking about health, I think it is useful to divide paradoxical behaviours into two categories: thrill-seeking behaviours such as sky-diving and bungie-jumping where the individual enjoys the experience of being at risk without (usually) craving it; craved or 'addictive' behaviours (using the term loosely), such as smoking, binge-drinking, over-eating, drug-taking, where the individual craves a certain sensation and the gratification of the craving supersedes protective impulses. In both cases, the individual knows the behaviour is potentially harmful but chooses to engage in it. In the first case, there is a conscious choice that the enjoyment of the thrill experience outweighs the risk. The person feels in control of the decision (even if the decision is to abandon oneself to the feeling of being temporarily out of control). In the second case, there is a need to gratify the craving, regardless of the risk. The person is fully aware that it is not in their long term self-interest but feels out of control of the decision (Lowenstein). This second category of paradoxical behaviours consists of many unhealthy behaviours targeted by health practitioners. This paper discusses 1) the concept of the self in Western society; 2) the concept of paradoxical behaviour, distinguishing it from deviant behaviour; and 3) the suggestion that people may engage in addictive paradoxical behaviours to satisfy the 'empty self' (Cushman). Finally, the paper suggests that this attention to the empty self may be in a perverse way protective (though not healthy), and calls for a health promotion approach that directly addresses the needs of the 'empty self'. Concept of Self The concept of the self varies across cultures and time. Cushman (599) defined the concept of the self as 'the concept of the individual as articulated by the indigenous psychology of a particular cultural group.... the self embodies what the culture believes is humankind's place in the cosmos: its limits, talents, expectations, and prohibitions'. The Eastern concept of self extends 'beyond one's physical and psychosocial identity to include all other people in the world' (Westman & Canter 419) while the concept of self as it has developed in Western society 'has specific psychological boundaries, an internal locus of control, and a wish to manipulate the external world for its own personal ends' (Cushman 600). This Western concept of the self has been traced to Augustine's Confessions, identified by Weintraub (cited in Freeman 26) as the first reflective, autobiographical review of a life history in which selfhood is examined and understood. The concept of self encapsulates the most profound sense of cosmic place, worth and meaning. One of the aspects of the Western concept of self is a sense of mastery, of being able to act upon the world. Paradoxical vs Deviant Behaviour Apter makes a distinction between deviant behaviour, which is defined by social norms, and paradoxical behaviour, which is defined as any behaviour potentially harmful either to the individual or to society. Parachuting would be an example of behaviour potentially harmful to the individual, while celibacy, by threatening the survival of the social group, would be behaviour potentially harmful to society. Neither of these behaviours would be regarded as 'deviant'. Apter (10) calls this sort of behaviour paradoxical 'because it has the opposite effect to that which, from a biological and evolutionary point of view, one would expect behaviour to have'. While there will be considerable overlap in practice between deviant and paradoxical behaviour - child abuse, vandalism, drug and alcohol abuse, suicide, etc. would all be both deviant and paradoxical - there is a distinction in perspective between these two terms. Deviant behaviour, by definition, is always regarded by a society as anti-social (and therefore is often harmful); paradoxical behaviour is, by definition, always regarded by the individual's self-concept as harmful or potentially harmful (and therefore is also often anti-social). As our self-concept is socially learned, it is difficult to arrive at a true separation of these definitions but the following example may clarify the distinction: smoking was a widespread, socially acceptable activity in the 1950s, even glamorised by Hollywood. When the scientific evidence showed that it was harmful to the individual's health, that is, paradoxical behaviour, many people were sufficiently motivated to quit. Since the dangers of passive smoking have been highlighted and smoking is becoming regarded as socially unacceptable, that is, deviant behaviour, many more people are trying to stop, and succeeding. For many people, motivation for change is successful when an activity is recognised as both deviant and paradoxical. Social marketing campaigns have targeted these two areas for years, informing of health risks and dispelling the glamorous image. Yet, people still smoke, even when they know the health dangers and daily experience the open disapproval of others. At the extreme is the person who lies in a hospital bed with both legs amputated, being told and believing that continued smoking will result in the loss of remaining limbs, but who is still not motivated sufficiently to quit; this person is clearly exhibiting extreme paradoxical behaviour. It is useful to call this behaviour paradoxical rather than deviant because it is defined primarily by the extreme injury to the individual rather than the degree to which it departs from social norms. Why an individual would persist in such irrational behaviour is a seemingly unanswerable question. As Menninger has said, 'the extraordinary propensity of the human being to join hands with external forces in an attack upon his own existence is one of the most remarkable of biological phenomena' (cited in Apter 10). In trying to understand it, we look at three alternatives: 1) what people say their reasons may be; 2) how people defend against knowledge of risk; and 3) the role of visceral influences. Van Deurzen-Smith (165-6), an existential counsellor, gives some insight into the complexity of one of her patient's reasons for smoking: The dangers of heart disease or lung cancer had, far from making her want to give up smoking, been a real secret attraction which had been hard to give up. She had experienced smoking as playing with fire and that was highly enjoyable.... smoking in this sense had represented her experience of her body as concretely her own. Inhaling smoke was like breathing fire and feeling extra-alive; exhaling smoke was like seeing her own body's power being projected out of her mouth. Carrying cigarettes and fire on her every minute of the day used to give her a sense of oneness with the substances of the natural world; it was like possessing the secret power of some magical ritual. When smoking she was in command of the physical world, she was master of her own destiny. In other words, smoking had become an integral part of this person's self-concept. An alternative viewpoint is that smokers simply defend against knowledge of the health risks. In an examination of 'psychic defences against high fear appeals', Stuteville identified three techniques which people use to reduce fear-arousal: a) they deny the validity of the information; b) they unconsciously assert 'I am the exception to the rule - it won't happen to me'; and c) they defuse the danger by making it laughable or ridiculous. He suggested that campaigns can be more effective if they involve a threat to significant others, especially children, or are made to seem 'offensive to small group norms' (45), that is, seen as deviant rather than paradoxical. Lowenstein attempted to understand the discrepancies between what people do and what it is in their self-interest to do by postulating the operation of 'visceral factors', drive states relating to hunger, fear, pain, sex and emotions. He suggested that the need to satisfy these drives can supersede virtually all other needs, and that people consistently fail to recognise the strength of the influence of visceral factors in themselves and in others, despite all previous experience and evidence to the contrary. One of the characteristics of visceral factors is the effect of time-shortening so that immediate gratification outweighs long-term goals. Attempts to exercise self-control are made when thinking long-term and usually at the expense of short-term gratification (Lowenstein 288). Although this concept of visceral influences explains some irrational behaviour, Lowenstein made little attempt to explain why some people seem to be more at the mercy of visceral factors than others. For this, it may be helpful to explore Cushman's concept of the 'empty self'. The Hungry 'Empty Self' Cushman (600) identified the configuration of the concept of self in the United States as having developed into an 'empty self ... a self that experiences a significant absence of community, tradition, and shared meaning. It experiences these social absences and their consequences 'interiorly' as a lack of personal conviction and worth, and it embodies the absences as a chronic, undifferentiated emotional hunger'. It is this notion of emotional hunger that may have particular relevance to a discussion of paradoxical behaviours generated by cravings. Cushman referred to a strong desire for consumer products to assuage this hunger, but it may be useful when thinking of health to consider the hunger more literally, as a need to ingest substances (drugs, alcohol, food etc) and experiences (shopping, sex, speed, etc) to fill up the emptiness. Emotional hunger may lead to a number of self-destructive but self-nourishing and addictive habits, identified by Firestone as psychological defences against anxiety. Cushman identified advertising as one of the two professions responsible for healing the empty self (the other was psychotherapy), while recognising that it is also one of the professions that perpetuates and profits from the psychopathology. Perhaps the responsibility falls to social marketing which is concerned with the marketing of ideas, attitudes and beliefs, including health and safety lifestyle issues. At present, it could be said that health promotion tends to make people feel bad (Henley & Donovan), with an emphasis on the dire consequences of unhealthy behaviours. Is it reasonable to suggest that social marketing could be used to try to heal the empty self? Interestingly, this is already happening to some extent. Mental health is a priority issue and a recent mental health campaign in Victoria, Australia, 'Together We Do Better', stresses the need for community and social connection. Western Australia is exploring whether to undertake a similar campaign. The campaign includes messages relating to friendship, parenting, talking about problems, bullying, sledging, and inter-generational communication (Campaign materials). The overall aim is to work towards a more inclusive, caring, connected and tolerant society. Conclusion This paper has discussed the apparent limitation of the current paradigm in health promotion that people are primarily motivated to protect themselves by considering the prevalence of paradoxical behaviours, that is behaviours that are harmful to the self, especially those that are generated by a need to satisfy cravings. One explanation for such paradoxical behaviours is that they are motivated by visceral factors relating to physical and emotional drives. However, this does not explain why some people are more susceptible than others. Cushman's concept of the hungry, empty self, alienated from community and disconnected from social traditions and meaning, may go further to explain why some people are more susceptible to cravings than others. Social marketing could play a helpful role in healing people's sense of isolation in mental health campaigns such as VicHealth's 'Together We Do Better'. Finally, it may be more intuitive to understand apparently paradoxical behaviour as an urgent attempt to heal the empty self. This would make it in a perverse way protective, though not healthy. This way, people are seen as doing the best they can to protect themselves against the most immediate threat to the self, a sense of hollowness and isolation. If so, the fact that this need is able to supersede other major health needs suggests that it is one of the most urgent imperatives of the self. References Apter, M.J. The Experience of Motivation: The Theory of Psychological Reversals. London: Academic Press, 1982. 'Campaign Materials.' Victoria Health 'Together We Do Better Campaign'. http://www.togetherwedobetter.vic.gov.au... [accessed 26 Aug. 2002]. Cushman, P. 'Why the Self is Empty: Toward a Historically Situated Psychology.' American Psychologist (1990, May): 599-611. Firestone, R. W. 'Psychological Defenses Against Death Anxiety.' Death Anxiety Handbook: Research, Instrumentation, and Application. Series in Death Education, Aging, and Health Care. Ed. R. A. Neimeyer. Washington, DC: Taylor & Francis, 1994. 217-241. Henley, N. & Donovan, R. Unintended Consequences of Arousing Fear in Social Marketing. Paper presented at ANZMAC Conference. Sydney, Nov. 1999. Janis, I. L. 'Effects of Fear Arousal on Attitude Change: Recent Developments in Theory and Experimental Research.' Advances in Experimental Social Psychology 3 (1967): 167-225. Janz, N. & M. Becker. 'The Health Belief Model: A Decade Later.' Health Education Quarterly 11 (1984): 1-47. Leventhal, H. 'Findings and Theory in the Study of Fear Communications.' Advances in Experimental Social Psychology 5. Ed. L. Berkowitz . New York: Academic Press, 1970. 119-86. Maddux, J. E. & R.W Rogers. 'Protection Motivation and Self-efficacy: A Revised Theory of Fear Appeals and Attitude Change.' Journal of Experimental Social Psychology 19 (1983): 469-79. Lowenstein, G. 'Out of Control: Visceral Influences on Behaviour.' Organisational Behaviour and Human Decision Processes. 65.3 (1996): 272-92. McGuire, W. J. 'Personality and Attitude Change: An Information-processing Theory.' Psychological Foundations of Attitudes. Ed. A. G. Greenwald, T. C. Brock, and T. M. Ostrom. New York: Academic Press, 1968. pp. 171-96. Rogers, R. W. & C.R. Mewborn. 'Fear Appeals and Attitude Change: Effects of a Threat's Noxiousness, Probability of Occurrence, and the Efficacy of Coping Responses.' Journal of Personality and Social Psychology 34.1 (1976): 54-61. Stuteville, J. R. 'Psychic Defenses against High Fear Appeals: A Key Marketing Variable.' Journal of Marketing 34 (1970): 39-45. Tanner, J. F., J.B. Hunt and D.R. Eppright. 'The Protection Motivation Model: A Normative Model of Fear Appeals.' Journal of Marketing 55 (1991): 36-45. van Deurzen-Smith, E. Existential Counselling in Practice. London: Sage Publications, 1988. Witte, K. 'Putting the Fear Back into Fear Appeals: The Extended Parallel Process Model.' Communication Monographs 59.4 (1992): 329-349. Links http://www.togetherwedobetter.vic.gov.au/resources/campaign.asp Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Henley, Nadine. "The Healthy vs the Empty Self" M/C: A Journal of Media and Culture 5.5 (2002). [your date of access] < http://www.media-culture.org.au/mc/0210/Henley.html &gt. Chicago Style Henley, Nadine, "The Healthy vs the Empty Self" M/C: A Journal of Media and Culture 5, no. 5 (2002), < http://www.media-culture.org.au/mc/0210/Henley.html &gt ([your date of access]). APA Style Henley, Nadine. (2002) The Healthy vs the Empty Self. M/C: A Journal of Media and Culture 5(5). < http://www.media-culture.org.au/mc/0210/Henley.html &gt ([your date of access]).

Introduction I think the Privacy Act is a huge edifice to protect the minority of things that could go wrong. I’ve got a good example for you, I’m just trying to think … yeah the worst one I’ve ever seen was the Balga Youth Program where we took these students on a reward excursion all the way to Fremantle and suddenly this very alienated kid started to jump under a bus, a moving bus so the kid had to be restrained. The cops from Fremantle arrived because all the very good people in Fremantle were alarmed at these grown-ups manhandling a kid and what had happened is that DCD [Department of Community Development] had dropped him into the program but hadn’t told us that this kid had suicide tendencies. No, it’s just chronically bad. And there were caseworkers involved and … there is some information that we have to have that doesn’t get handed down. Rather than a blanket rule that everything’s confidential coming from them to us, and that was a real live situation, and you imagine how we’re trying to handle it, we had taxis going from Balga to Fremantle to get staff involved and we only had to know what to watch out for and we probably could have … well what you would have done is not gone on the excursion I suppose (School Principal, quoted in Balnaves and Luca 49). These comments are from a school principal in Perth, Western Australia in a school that is concerned with “at-risk” students, and in a context where the Commonwealth Privacy Act 1988 has imposed limitations on their work. Under this Act it is illegal to pass health, personal or sensitive information concerning an individual on to other people. In the story cited above the Department of Community Development personnel were apparently protecting the student’s “negative right”, that is, “freedom from” interference by others. On the other hand, the principal’s assertion that such information should be shared is potentially a “positive right” because it could cause something to be done in that person’s or society’s interests. Balnaves and Luca noted that positive and negative rights have complex philosophical underpinnings, and they inform much of how we operate in everyday life and of the dilemmas that arise (49). For example, a ban on euthanasia or the “assisted suicide” of a terminally ill person can be a “positive right” because it is considered to be in the best interests of society in general. However, physicians who tacitly approve a patient’s right to end their lives with a lethal dose by legally prescribed dose of medication could be perceived as protecting the patient’s “negative right” as a “freedom from” interference by others. While acknowledging the merits of collaboration between people who are working to improve the wellbeing of students “at-risk”, this paper examines some of the barriers to collaboration. Based on both primary and secondary sources, and particularly on oral testimonies, the paper highlights the tension between privacy as a negative right and collaborative helping as a positive right. It also points to other difficulties and dilemmas within and between the institutions engaged in this joint undertaking. The authors acknowledge Michel Foucault’s contention that discourse is power. The discourse on privacy and the sharing of information in modern societies suggests that privacy is a negative right that gives freedom from bureaucratic interference and protects the individual. However, arguably, collaboration between agencies that are working to support individuals “at-risk” requires a measured relaxation of the requirements of this negative right. Children and young people “at-risk” are a case in point. Towards Collaboration From a series of interviews conducted in 2004, the school authorities at Balga Senior High School and Midvale Primary School, people working for the Western Australian departments of Community Development, Justice, and Education and Training in Western Australia, and academics at the Edith Cowan and Curtin universities, who are working to improve the wellbeing of students “at-risk” as part of an Australian Research Council (ARC) project called Smart Communities, have identified students “at-risk” as individuals who have behavioural problems and little motivation, who are alienated and possibly violent or angry, who under-perform in the classroom and have begun to truant. They noted also that students “at-risk” often suffer from poor health, lack of food and medication, are victims of unwanted pregnancies, and are engaged in antisocial and illegal behaviour such as stealing cars and substance abuse. These students are also often subject to domestic violence (parents on drugs or alcohol), family separation, and homelessness. Some are depressed or suicidal. Sometimes cultural factors contribute to students being regarded as “at-risk”. For example, a social worker in the Smart Communities project stated: Cultural factors sometimes come into that as well … like with some Muslim families … they can flog their daughter or their son, usually the daughter … so cultural factors can create a risk. Research elsewhere has revealed that those children between the ages of 11-17 who have been subjected to bullying at school or physical or sexual abuse at home and who have threatened and/or harmed another person or suicidal are “high-risk” youths (Farmer 4). In an attempt to bring about a positive change in these alienated or “at-risk” adolescents, Balga Senior High School has developed several programs such as the Youth Parents Program, Swan Nyunger Sports Education program, Intensive English Centre, and lower secondary mainstream program. The Midvale Primary School has provided services such as counsellors, Aboriginal child protection workers, and Aboriginal police liaison officers for these “at-risk” students. On the other hand, the Department of Community Development (DCD) has provided services to parents and caregivers for children up to 18 years. Academics from Edith Cowan and Curtin universities are engaged in gathering the life stories of these “at-risk” students. One aspect of this research entails the students writing their life stories in a secured web portal that the universities have developed. The researchers believe that by engaging the students in these self-exploration activities, they (the students) would develop a more hopeful outlook on life. Though all agencies and educational institutions involved in this collaborative project are working for the well-being of the children “at-risk”, the Privacy Act forbids the authorities from sharing information about them. A school psychologist expressed concern over the Privacy Act: When the Juvenile Justice Department want to reintroduce a student into a school, we can’t find out anything about this student so we can’t do any preplanning. They want to give the student a fresh start, so there’s always that tension … eventually everyone overcomes [this] because you realise that the student has to come to the school and has to be engaged. Of course, the manner and consequences of a student’s engagement in school cannot be predicted. In the scenario described above students may have been given a fair chance to reform themselves, which is their positive right but if they turn out to be at “high risk” it would appear that the Juvenile Department protected the negative right of the students by supporting “freedom from” interference by others. Likewise, a school health nurse in the project considered confidentiality or the Privacy Act an important factor in the security of the student “at-risk”: I was trying to think about this kid who’s one of the children who has been sexually abused, who’s a client of DCD, and I guess if police got involved there and wanted to know details and DCD didn’t want to give that information out then I’d guess I’d say to the police “Well no, you’ll have to talk to the parents about getting further information.” I guess that way, recognising these students are minor and that they are very vulnerable, their information … where it’s going, where is it leading? Who wants to know? Where will it be stored? What will be the outcomes in the future for this kid? As a 14 year old, if they’re reckless and get into things, you know, do they get a black record against them by the time they’re 19? What will that information be used for if it’s disclosed? So I guess I become an advocate for the student in that way? Thus the nurse considers a sexually abused child should not be identified. It is a positive right in the interest of the person. Once again, though, if the student turns out to be at “high risk” or suicidal, then it would appear that the nurse was protecting the youth’s negative right—“freedom from” interference by others. Since collaboration is a positive right and aims at the students’ welfare, the workable solution to prevent the students from suicide would be to develop inter-agency trust and to share vital information about “high-risk” students. Dilemmas of Collaboration Some recent cases of the deaths of young non-Caucasian girls in Western countries, either because of the implications of the Privacy Act or due to a lack of efficient and effective communication and coordination amongst agencies, have raised debates on effective child protection. For example, the British Laming report (2003) found that Victoria Climbié, a young African girl, was sent by her parents to her aunt in Britain in order to obtain a good education and was murdered by her aunt and aunt’s boyfriend. However, the risk that she could be harmed was widely known. The girl’s problems were known to 6 local authorities, 3 housing authorities, 4 social services, 2 child protection teams, and the police, the local church, and the hospital, but not to the education authorities. According to the Laming Report, her death could have been prevented if there had been inter-agency sharing of information and appropriate evaluation (Balnaves and Luca 49). The agencies had supported the negative rights of the young girl’s “freedom from” interference by others, but at the cost of her life. Perhaps Victoria’s racial background may have contributed to the concealment of information and added to her disadvantaged position. Similarly, in Western Australia, the Gordon Inquiry into the death of Susan Taylor, a 15 year old girl Aboriginal girl at the Swan Nyungah Community, found that in her short life this girl had encountered sexual violation, violence, and the ravages of alcohol and substance abuse. The Gordon Inquiry reported: Although up to thirteen different agencies were involved in providing services to Susan Taylor and her family, the D[epartment] of C[ommunity] D[evelopment] stated they were unaware of “all the services being provided by each agency” and there was a lack of clarity as to a “lead coordinating agency” (Gordon et al. quoted in Scott 45). In this case too, multiple factors—domestic, racial, and the Privacy Act—may have led to Susan Taylor’s tragic end. In the United Kingdom, Harry Ferguson noted that when a child is reported to be “at-risk” from domestic incidents, they can suffer further harm because of their family’s concealment (204). Ferguson’s study showed that in 11 per cent of the 319 case sample, children were known to be re-harmed within a year of initial referral. Sometimes, the parents apply a veil of secrecy around themselves and their children by resisting or avoiding services. In such cases the collaborative efforts of the agencies and education may be thwarted. Lack of cultural education among teachers, youth workers, and agencies could also put the “at-risk” cultural minorities into a high risk category. For example, an “at-risk” Muslim student may not be willing to share personal experiences with the school or agencies because of religious sensitivities. This happened in the UK when Khadji Rouf was abused by her father, a Bangladeshi. Rouf’s mother, a white woman, and her female cousin from Bangladesh, both supported Rouf when she finally disclosed that she had been sexually abused for over eight years. After group therapy, Rouf stated that she was able to accept her identity and to call herself proudly “mixed race”, whereas she rejected the Asian part of herself because it represented her father. Other Asian girls and young women in this study reported that they could not disclose their abuse to white teachers or social workers because of the feeling that they would be “letting down their race or their Muslim culture” (Rouf 113). The marginalisation of many Muslim Australians both in the job market and in society is long standing. For example, in 1996 and again in 2001 the Muslim unemployment rate was three times higher than the national total (Australian Bureau of Statistics). But since the 9/11 tragedy and Bali bombings visible Muslims, such as women wearing hijabs (headscarves), have sometimes been verbally and physically abused and called ‘terrorists’ by some members of the wider community (Dreher 13). The Howard government’s new anti-terrorism legislation and the surveillance hotline ‘Be alert not alarmed’ has further marginalised some Muslims. Some politicians have also linked Muslim asylum seekers with terrorists (Kabir 303), which inevitably has led Muslim “at-risk” refugee students to withdraw from school support such as counselling. Under these circumstances, Muslim “at-risk” students and their parents may prefer to maintain a low profile rather than engage with agencies. In this case, arguably, federal government politics have exacerbated the barriers to collaboration. It appears that unfamiliarity with Muslim culture is not confined to mainstream Australians. For example, an Aboriginal liaison police officer engaged in the Smart Communities project in Western Australia had this to say about Muslim youths “at-risk”: Different laws and stuff from different countries and they’re coming in and sort of thinking that they can bring their own laws and religions and stuff … and when I say religions there’s laws within their religions as well that they don’t seem to understand that with Australia and our laws. Such generalised misperceptions of Muslim youths “at-risk” would further alienate them, thus causing a major hindrance to collaboration. The “at-risk” factors associated with Aboriginal youths have historical connections. Research findings have revealed that indigenous youths aged between 10-16 years constitute a vast majority in all Australian States’ juvenile detention centres. This over-representation is widely recognised as associated with the nature of European colonisation, and is inter-related with poverty, marginalisation and racial discrimination (Watson et al. 404). Like the Muslims, their unemployment rate was three times higher than the national total in 2001 (ABS). However, in 1998 it was estimated that suicide rates among Indigenous peoples were at least 40 per cent higher than national average (National Advisory Council for Youth Suicide Prevention, quoted in Elliot-Farrelly 2). Although the wider community’s unemployment rate is much lower than the Aboriginals and the Muslims, the “at-risk” factors of mainstream Australian youths are often associated with dysfunctional families, high conflict, low-cohesive families, high levels of harsh parental discipline, high levels of victimisation by peers, and high behavioural inhibition (Watson et al. 404). The Macquarie Fields riots in 2005 revealed the existence of “White” underclass and “at-risk” people in Sydney. Macquarie Fields’ unemployment rate was more than twice the national average. Children growing up in this suburb are at greater risk of being involved in crime (The Age). Thus small pockets of mainstream underclass youngsters also require collaborative attention. In Western Australia people working on the Smart Communities project identified that lack of resources can be a hindrance to collaboration for all sectors. As one social worker commented: “government agencies are hierarchical systems and lack resources”. They went on to say that in their department they can not give “at-risk” youngsters financial assistance in times of crisis: We had a petty cash box which has got about 40 bucks in it and sometimes in an emergency we might give a customer a couple of dollars but that’s all we can do, we can’t give them any larger amount. We have bus/metro rail passes, that’s the only thing that we’ve actually got. A youth worker in Smart Communities commented that a lot of uncertainty is involved with young people “at-risk”. They said that there are only a few paid workers in their field who are supported and assisted by “a pool of volunteers”. Because the latter give their time voluntarily they are under no obligation to be constant in their attendance, so the number of available helpers can easily fluctuate. Another youth worker identified a particularly important barrier to collaboration: because of workers’ relatively low remuneration and high levels of work stress, the turnover rates are high. The consequence of this is as follows: The other barrier from my point is that you’re talking to somebody about a student “at-risk”, and within 14 months or 18 months a new person comes in [to that position] then you’ve got to start again. This way you miss a lot of information [which could be beneficial for the youth]. Conclusion The Privacy Act creates a dilemma in that it can be either beneficial or counter-productive for a student’s security. To be blunt, a youth who has suicided might have had their privacy protected, but not their life. Lack of funding can also be a constraint on collaboration by undermining stability and autonomy in the workforce, and blocking inter-agency initiatives. Lack of awareness about cultural differences can also affect unity of action. The deepening inequality between the “haves” and “have-nots” in the Australian society, and the Howard government’s harshness on national security issues, can also pose barriers to collaboration on youth issues. Despite these exigencies and dilemmas, it would seem that collaboration is “the only game” when it comes to helping students “at-risk”. To enhance this collaboration, there needs to be a sensible modification of legal restrictions to information sharing, an increase in government funding and support for inter-agency cooperation and informal information sharing, and an increased awareness about the cultural needs of minority groups and knowledge of the mainstream underclass. Acknowledgments The research is part of a major Australian Research Council (ARC) funded project, Smart Communities. The authors very gratefully acknowledge the contribution of the interviewees, and thank *Donald E. Scott for conducting the interviews. References Australian Bureau of Statistics. 1996 and 2001. Balnaves, Mark, and Joe Luca. “The Impact of Digital Persona on the Future of Learning: A Case Study on Digital Repositories and the Sharing of Information about Children At-Risk in Western Australia”, paper presented at Ascilite, Brisbane (2005): 49-56. 10 April 2006. http://www.ascilite.org.au/conferences/brisbane05/blogs/proceedings/ 06_Balnaves.pdf>. Dreher, Tanya. ‘Targeted’: Experiences of Racism in NSW after September 11, 2001. Sydney: University of Technology, 2005. Elliot-Farrelly, Terri. “Australian Aboriginal Suicide: The Need for an Aboriginal Suicidology”? Australian e-Journal for the Advancement of Mental Health, 3.3 (2004): 1-8. 15 April 2006 http://www.auseinet.com/journal/vol3iss3/elliottfarrelly.pdf>. Farmer, James. A. High-Risk Teenagers: Real Cases and Interception Strategies with Resistant Adolescents. Springfield, Ill.: C.C. Thomas, 1990. Ferguson, Harry. Protecting Children in Time: Child Abuse, Child Protection and the Consequences of Modernity. London: Palgrave Macmillan, 2004. Foucault, Michel. Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Ed. Colin Gordon, trans. Colin Gordon et al. New York: Pantheon, 1980. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. Rouf, Khadji. “Myself in Echoes. My Voice in Song.” Ed. A. Bannister, et al. Listening to Children. London: Longman, 1990. Scott E. Donald. “Exploring Communication Patterns within and across a School and Associated Agencies to Increase the Effectiveness of Service to At-Risk Individuals.” MS Thesis, Curtin University of Technology, August 2005. The Age. “Investing in People Means Investing in the Future.” The Age 5 March, 2005. 15 April 2006 http://www.theage.com.au>. Watson, Malcolm, et al. “Pathways to Aggression in Children and Adolescents.” Harvard Educational Review, 74.4 (Winter 2004): 404-428. Citation reference for this article MLA Style Kabir, Nahid, and Mark Balnaves. "Students “at Risk”: Dilemmas of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>. APA Style Kabir, N., and M. Balnaves. (May 2006) "Students “at Risk”: Dilemmas of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>.

Explorations of the intersecting terrain between the resources (or mining) sector and gendered socialisation are gaining currency (Laplonge and Albury; Lahiri-Dutt). Some argue that mine workers and their families are particularly vulnerable to divorce, suicide, drug and alcohol abuse, injury, violence and worksite conflict, mental health struggles, financial over-extension, isolation, and loss of familial and community connection (Ashby; Paddenburg 14). Others contradict anecdotal evidence to support these concerns (Clifford 58; BHP Billiton 11-5). Substantive research on the emotional cost of mining remains sparse and contested (Windsor 4). Of concern to some, however, is that mining companies may be placing pressure on employees to generate a profit (Brough 10), while failing to acknowledge the cost of “hypermasculinised” mechanisms of domination that characterise mining cultures (Laplonge, Roadshow). I refer to these characteristic mechanisms of domination throughout this paper as “malestream norms” (O’Brien 62). In this paper, I argue that mining cultures have become prime examples of unsustainable practices. They forfeit relationally and ecologically sensitive modes of production that would otherwise celebrate and indeed prioritise a holistic level of care for the Earth, mining cultures, work colleagues and the self. Here, the term “sustainable” refers to a broader spectrum of social, cultural, psychological and ecological needs of mine workers, mining culture, and the environment upon which mining profits depend. I posit that mining communities that tend to the psycho-social needs of mine workers beyond malestream norms are more likely to implement sustainable mining practices that are not only considerate of the broader needs of mine workers, not only profitable for mining companies, but care for the Earth as well. Granted, employee assistance mechanisms do include substantial support services (such as health and wellness programmes, on-site counselling and therapy, mining family support networks, shorter rosters, improved access to family contact from site, etc.). However, these support services—as they may be offered by individual mining companies—do not adequately address the broader psycho-social impact of mining on mine site communities, the relational integrity of mine workers with their families, or how mine workers are faring within themselves in light of the pressures that abound both on-swing and off (Lahiri-Dutt 201). Discussions of a “softer” approach to mining fail to critically analyse malestream norms (Laplonge, Roadshow). In other words, attempts to make mining more sustainable have at-best been superficial by, for example, seeking to increase numbers of women on-site but then “jamming” these new women into cultures of hypermasculinism in hopes that a “trickle-down affect” of softening mining communities of practice will ensue (Laplonge, "You Can't Rely"). A comprehensive approach to sustainable mining practices must begin with deeper psycho-social care for mine workers (both women and men), and shift mining culture towards environmental care as well—an approach to mining that reflects a holistic and integrated model for pursuing profitable company development that is more caring than is currently the norm throughout the corporate world (Anderson). To accomplish this, we must specifically challenge malestream norms as they manifest in mining (Laplonge, Roadshow). In response, I introduce ecological masculinism as a relational approach to softening the malestream norms that pervade mining. To begin, it is recognised that mining masculinities—like all practices of masculinity—are pluralised social constructions that are not fixed but learned (Connell). Ecological masculinism is explored as a path towards fresh systemic practices that can steer men in mining towards masculine identities that are relationally attuned, emotionally articulate, and environmentally aware. It is argued that the approach to mining masculinities introduced here can help the resources sector become more sustainable for men, more conducive to greater numbers of women, more profitable for mining companies over longer periods of time, and gentler on the Earth. Where Are All the Ecomasculinists in Mining? Ecology as a science of relationships can serve as a guide towards the order that emerges among complex systems such as those that pervade mining (Capra). I suggest that Ecology can assist us to better understand and redefine the intricacies of gender dynamics in mining. It would be easy to presume that Ecology is oppositional to mining. I argue that to the contrary, the relational focus of Ecology has much to teach us about how we might reconfigure malestream norms to make it possible for mining cultures to demonstrate deeper care for others and the self at work and at home. An ecological analysis of malestream norms (and their impacts on Earth, community, others and the self) is not new. Richard Twine initiated some of the earliest explorations of the intersecting terrain between men, masculinities and the Earth. This discourse on the need for an “ecologisation” of masculinities grew out of the “broad church” of ecological feminism that explored so called Logics of Dualism that malestream norms construct and maintain (Plumwood 55-59). For more than 40 years, ecological feminism has served as a specialised discourse interrogating the mutual oppression of women and Nature by the male-dominated world. In his contribution to the Essex Ecofem Listerv, Twine posted the following provocative statement: Where are all the ecomasculinists? … there does not seem to be any literature on how the environmental and feminist movements together form a strong critique of the dominant Western masculine tradition. Does anyone know of any critical examinations … of this position, particularly one that addresses masculinity rather than patriarchy? (Twine et al. 1) Twine highlighted the need for a new discourse about men and masculinities that built on the term “ecomasculinity.” This term was originally coined by Shepherd Bliss in his seminal paper Revisioning Masculinity: A Report on the Growing Men's Movement (1987). I suggest that this intersecting terrain between Ecology and masculinities can guide us beyond the constraints of malestream norms that are entrenched in mining and offer us alternatives to mining cultural practices that oppress women and men as well as the environment upon which mining depends. However, these early investigations into the need for more nurturing masculinities were conceptual more so than practical and failed to take hold in scholarly discourses on gender or the pluralised praxes of modern masculinities. Coupled with this, the dominating aspects of malestream norms have continued to characterise mining cultures resulting in, for example, higher than average injury rates that are indicators of some negative consequences of a hypermasculinised workplace (Department of Health, WA 18; Laplonge, Roadshow). Further, the homophobic elements of malestream norms can give many men cause to hesitate seeking out emotional support if and where needed for fear of peer-group ridicule. These are some of the ways that men are subject to “men’s oppression” (Smith; Irwin et al.; Jackins; Whyte; Rohr), a term used here not to posit men as victims but rather as individuals who suffer as a result of their own internalised sense of superiority that drives them to behave inequitably towards other men, women and the Earth. Men’s Oppression Men’s oppression is a term used to illuminate the impact of malestream norms on men’s lives. Richard Rohr noted that: Part of our oppression as men ... is that we are taught to oppress others who have less status than we do. It creates a pecking order and a sense of superiority. We especially oppress racial minorities, homosexuals, the poor and women. (28) Men’s oppression is harmful to men, women and the ways that we mine the Earth. It is consequently of great importance that we explore the impacts of men’s oppression on mining masculinities with an emphasis on deconstructing the ways that it shapes and maintains malestream norms in mining culture. Men’s oppression pressures men to behave in ways that can constrain the spectrum of permissible behaviours that they adopt. Men’s oppression is ego-driven, based in comparing and competing against each other and pressure them to work tirelessly towards being better, higher, stronger, more virile, smarter, richer, more powerful, outwardly composed and more adored by others through status and material wealth often acquired at the expense of others and indeed the compromising of their own capacities to care for others and the self. These products of malestream norms validate an inner sense of feeling good about oneself at the expense of relational connection with others, including the Earth. As mentioned previously, malestream norms enable men to acquire socioeconomic and political advantages. But this has occurred at what has proven to be a terrible cost for all others as well as men themselves. Many men, especially those most strongly immersed in malestream norms, don’t even know that they are subject to this internalise superiority nor do they recognise it as an oppression that afflicts them at the same time and through the same mechanisms that assures their primacy in a world.. Notably, the symptoms of men’s oppression are not unique to mining. However, this form of oppression is intensely experienced by miners precisely because of the isolated and hypermasculine nature of minthat men (and increasing numbers of women) find themselves immersed in when on-site. Unfortunately, perceiving and then countering men’s oppression can undermine men’s primacy (Smith 51-52). As a consequence many men have little reason to want to take a stand against malestream norms that can come to dominate their lives at work and home. But to refuse to do so can erode their health and well-being and set them on a path of perpetration of oppressive thoughts, words and deeds towards others. Pathways to Ecological Masculinism The conceptual core of ecological masculinism is constructed on five precepts (that I refer to as the ADAMN model). These precepts help guide modern Western men towards greater care for others and the self in tangible ways (Pulé). Accompanying these precepts is the need for a plurality of caring behavioural possibilities for men to emerge. Men are encouraged to pursue inner congruency (aligning head with heart and intuition) as a pathway to their fuller humanness so that more integrated and mature masculinities can emerge. In this sense, ecological masculinism can be adapted to any work or home situation, providing a robust and versatile model that redresses gendered norms amongst mining men despite the diversity of individuals and resistances that might characterise some mining cultures. The ADAMN model draws on the vernacular encouragement for men to “give a damn” about all others and themselves. The five key instructions of masculine ecologisation are: A: Accept the central premise that you were born good and have an infinite capacity to care and be caring D: Don’t separate yourself from others; instead strengthen and rebuild your sense of connection with others and yourself A: Amend your own past hurts and any you have caused to others M: Model mature modern masculinity. Construct your masculine identity on caring thoughts, words and actions that nurture the relational space between yourself and others by seeking a life of service for the common good N: Normalise men’s care; support all men to show their care as central features of being a mature modern man Collectively, these key instructions of the ADAMN model are designed to raise men’s capacities to care for others and the self. They are aspects of ecological masculinism that are introduced to men through large group presentations, working with teams and at the level of one-on-one coaching in order to facilitate the recovering of the fuller human self that emerges through masculine ecologisation. This aspect of ecological masculinism offers tangible alternatives to malestream norms that dominate mining cultures by subverting the oppressive aspects of malestream norms in mining with more integrated levels of care for all others and the self. The ADAMN model is drawn as a nested diagram where each layer of this work forms the foundations of and is imbedded within the next, taking an individual man on a step-by-step journey that charts a course towards a heightened relational self and in so doing shifts the culture of masculinities within which he is immersed (see Figure 1). Trials of the ADAMN model over the past three years have applied ecological masculinism to groups of miners, at first in larger groups where hypermasculinised men can remain anonymous. From there masculine ecologisation drills down into the personal stories of individual men’s lives to uncover the sources of individual adherence to malestream norms—interrogating the pressures at play for them to have donned the “armour” that malestream norms demand of them. Stepping further towards the self, we then explore group and team dynamics for examples of hypermasculinism in the context of its benefits and costs to individual men’s lives in a support group type setting, and finally refine the transformational elements of this exploratory in one-on-one coaching of men across the spectrum from natural leaders to those in crises. At this final level of intensive personal reflection, an individual man is coached towards integrative alignment of his head, heart and intuition so that he can discover fresh perspectives for accessing his caring self. The project’s hope is that from this place of heightened “inner congruency” the ecologised man can more easily awaken and engage his care for others and himself not only as a man, but as an active and engaged citizen whose life of service to his employer, community, family, friends, and himself, becomes a central fixture of the ways he interacts with others at work and at home. Effectively, ecological masculinism reaches beyond the constraints of hypermasculinism as it commonly pervades mining by “peeling the onion” of malestream norms in a step-wise manner. It is hoped that, if the ADAMN model is successful, that the emerging “ecomen” become more sensitive to the needs, wants and intrinsic rights of others, develop rich emotional vocabularies, embrace the value of abstract thinking and a strong and engaged intuition concurrently, engage with others compassionately, educate themselves about their world at work and home, willingly assume leadership on the job, within their families and throughout their communities and grow proactively through the process. Such men embody a humanistic worldview towards all of life. They are flexible, responsive, and attentive to the value of others and themselves. Such is the ecoman I suggest might best benefit resource companies, mining cultures, mining families and miners.Figure 1 Conclusion Central to a more gender-aware future for men in mining is hope—hope that we will adapt to the challenges of mining culture swiftly by reaching beyond engineered solutions to the problems that many mine workers face; hope that our responses will be humanistic, creative and transgress malestream norms; hope that those responses are inclusive of softer and more caring approaches mining masculinities. This hope hinges on the willingness of resource companies to support such a shift in mining culture towards greater care for all others and the self. One path towards this fresh future for mining is through ecological masculinism as I have introduced it here. This new conversation for mining men and masculinities gives priority to the ending of men’s oppression for the benefit of individual mining men as well as all those with whom they share their lives at work and at home. In this paper, my intention has been to emphasise a more caring approach to mining. It is my earnest belief that through such work, mining will become more sustainable for men, women and the Earth. The ecologised mining man will have an important role to play in such a transformation.ReferencesAnderson, Ray. Our Sustainability Journey – Mission Zero. 2008. 29 April 2013 ‹http://www.interfaceglobal.com/Sustainability/Interface-Story.aspx›. Ashby, Nicole. The Need for FIFO Families. Personal Interview. 11 Dec 2012. BHP Billiton. Global Workplace, Unique Opportunities. 2013. 22 April 2013 ‹http://www.bhpbilliton.com/home/people/workplace/Pages/default.aspx› Bliss, Shepherd. “Revisioning Masculinity: A Report on the Growing Men's Movement.” In Context: A Quarterly of Humane Sustainable Culture Spring (1987): 21. [First Published in Yoga Journal (Nov./Dec. 1986).] Brough, Paula. “FIFO Work Hits Families Hardest.” The Morning Bulletin [Rockhampton, Queensland] 12 Apr. 2013: 10. Capra, Fritjof. The Web of Life: A New Scientific Understanding of Living Systems. New York: Anchor Books, 1996. Connell, Raewyn. Masculinities. Berkeley: University of California Press, 1995. Clifford, Susan. The Effects of Fly-in/Fly-out Commute Arrangements and Extended Working Hours on the Stress, Lifestyle, Relationship and Health Characteristics of Western Australian Mining Employees and Their Partners (Research Report). School of Anatomy and Human Biology: University of Western Australia, 2009. Department of Health, WA. The Epidemiology of Injury in Western Australia, 2000-2008. Epidemiology Branch Public Health Division: Department of Health WA, 2011. Gent, Vanessa. "The Impact of Fly-In/Fly-Out Work on Well-Being and Work-Life Satisfaction." Honours thesis. School of Psychology: Murdoch University, 2004. Irwin, John, Harvey Jackins, and Charlie Kreiner. The Liberation of Men. Seattle: Rational Island Publishers, 2006. Jackins, Harvey. The Human Male: A Men's Liberation Draft Policy. Seattle: Rational Island Publishers, 1999. Lahiri-Dutt, Kuntala. “Digging Women: Towards a New Agenda for Feminist Critiques of Mining.” Gender, Place and Culture 19.2 (2012): 193-212. Laplonge, Dean. Roadshow Report: Toughness in the Workplace. Department of Mines and Petroleum, 2011. ———. “You Can’t Rely on Women to Tame Men.” 2012. 3 May 2013 ‹http://www.factive.com.au/›. ———, and Kath Albury. “Practices of Gender in Mining.” AUSIMM (Feb. 2012): 80-84. News Limited. “Brutal Hours, Drug Issues and Family Pressures Force Miners to Abandon Industry in Droves, Inquiry Told.” The Sunday Times 14 Apr. 2012. O'Brien, Mary. The Politics of Reproduction. Boston: Routledge & Kegan Paul, 1981. Paddenburg, Trevor. "Alcohol, Drugs, Poor Nutrition and a Dirt Floor: Life within Sight of the Boom Time." The Sunday Times [Perth, WA] 17 Mar. 2013: 14. Plumwood, Val. Feminism and the Mastery of Nature. London: Routledge, 1993. Pulé, Paul. A Declaration of Caring: Towards Ecological Masculinism. Doctoral Dissertation. Murdoch University, 2013. Rohr, Richard. From Wild Man to Wise Man: Reflections on Male Spirituality. Cincinnati: St. Anthony Messenger Press, 2005 [1990]. Smith, M.S.W. “Men's Liberation: The Oppression of Masculine Instincts in Western Society.” Canadian Family Physician 18.3 (1972): 51-52. Slote, Michael. The Ethics of Care and Empathy. London: Routledge, 2007. Twine, Richard, et al. “Ecofem Listserv: Where Are All the Ecomasculinists?” The Essex Ecofem Listserv, 10-21 Nov. 1995. 12 Dec. 2010 ‹http://www.mail-archive.com/ecofem@csf.colorado.edu/msg00852.html›. Windsor, Tony. “Fly-In Fly-Out Needs an Overhaul: Windsor MP.” The Morning Bulletin [Rockhampton, Queensland] 26 Mar. 2013: 4. Whyte, Paul. Introduction: The Human Male. 1998. 7 July 2010 ‹http://www.peerleadership.com.au/MENDOCUM.NSF/504ca249c786e20f85256284006da7ab/2d899401b7ee3708ca2566d8007c2960!OpenDocument›.

In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. This figure of the self-treating “gambler addict” can be seen to be a template for, and prototype of, a more generalised and universalised self-governing citizen: one that no longer needs or makes demands on the state but who can help themselves and manage their own harm. Paradoxically, there is the potential for new risks and harms to the very same users that accompanies this shift: their outright exclusion as a result of deprivation from basic and assumed digital access and literacy, the further stigmatisation of gamblers, the elimination of opportunities for proximal support and their exclusion from everyday spaces. References Albarrán-Torres, César. “Gambling-Machines and the Automation of Desire.” Platform: Journal of Media and Communication 5.1 (2013). Australian Communications and Media Authority. “Australians Cut the Cord.” Research Snapshots. Sydney: ACMA (2013) Berry, David. Critical Theory and the Digital. Broadway, New York: Bloomsbury Academic, 2014 Berry, David. Stunlaw: A Critical Review of Politics, Arts and Technology. 2012. ‹http://stunlaw.blogspot.com.au/2012/03/code-foucault-and-neoliberal.html›. Caldwell, G. “Some Historical and Sociological Characteristics of Australian Gambling.” Gambling in Australia. Eds. G. Caldwell, B. Haig, M. Dickerson, and L. Sylan. Sydney: Croom Helm Australia, 1985. 18-27. Cervini, E. “High Stakes for Gambling Students.” The Age 8 Nov. 2013. ‹http://www.theage.com.au/national/education/high-stakes-for-gambling-students-20131108-2x5cl.html›. Deleuze, Gilles. "Postscript on the Societies of Control." October (1992): 3-7. Foucault, Michel. “Technologies of the Self.” Eds. Luther H. Martin, Huck Gutman and Patrick H. Hutton. Boston: University of Massachusetts Press, 1988 Hastings, E. “Online Gamblers More at Risk of Addiction.” Herald Sun 13 Oct. 2013. ‹http://www.heraldsun.com.au/news/online-gamblers-more-at-risk-of-addiction/story-fni0fiyv-1226739184629#!›.Hayatbakhsh, Mohammad R., et al. "Young Adults' Gambling and Its Association with Mental Health and Substance Use Problems." Australian and New Zealand Journal of Public Health 36.2 (2012): 160-166. Hing, Nerilee, and Helen Breen. "A Profile of Gaming Machine Players in Clubs in Sydney, Australia." Journal of Gambling Studies 18.2 (2002): 185-205. Holdsworth, Louise, Margaret Tiyce, and Nerilee Hing. "Exploring the Relationship between Problem Gambling and Homelessness: Becoming and Being Homeless." Gambling Research 23.2 (2012): 39. Humphry, Justine. “Demanding Media: Platform Work and the Shaping of Work and Play.” Scan: Journal of Media Arts Culture, 10.2 (2013): 1-13. Humphry, Justine. “Homeless and Connected: Mobile Phones and the Internet in the Lives of Homeless Australians.” Australian Communications Consumer Action Network. Sep. 2014. ‹https://www.accan.org.au/grants/completed-grants/619-homeless-and-connected›.Lee, Timothy Jeonglyeol. "Distinctive Features of the Australian Gambling Industry and Problems Faced by Australian Women Gamblers." Tourism Analysis 14.6 (2009): 867-876. Lupton, D. “The Digitally Engaged Patient: Self-Monitoring and Self-Care in the Digital Health Era.” Social Theory & Health 11.3 (2013): 256-70. Markham, Francis, and Martin Young. “Packer’s Barangaroo Casino and the Inevitability of Pokies.” The Conversation 9 July 2013. ‹http://theconversation.com/packers-barangaroo-casino-and-the-inevitability-of-pokies-15892›. Markham, Francis, and Martin Young. “Who Wins from ‘Big Gambling’ in Australia?” The Conversation 6 Mar. 2014. ‹http://theconversation.com/who-wins-from-big-gambling-in-australia-22930›.McMillen, Jan, and Katie Donnelly. "Gambling in Australian Indigenous Communities: The State of Play." The Australian Journal of Social Issues 43.3 (2008): 397. Ohtsuka, Keis, and Thai Ohtsuka. “Vietnamese Australian Gamblers’ Views on Luck and Winning: Universal versus Culture-Specific Schemas.” Asian Journal of Gambling Issues and Public Health 1.1 (2010): 34-46. Scull, Sue, Geoffrey Woolcock. “Problem Gambling in Non-English Speaking Background Communities in Queensland, Australia: A Qualitative Exploration.” International Gambling Studies 5.1 (2005): 29-44. Tanasornnarong, Nattaporn, Alun Jackson, and Shane Thomas. “Gambling among Young Thai People in Melbourne, Australia: An Exploratory Study.” International Gambling Studies 4.2 (2004): 189-203. Thompson, Angela, “Live Gambling Odds Tipped for the Chop.” Illawarra Mercury 22 May 2013: 6. Metherell, Mark. “Virtual Pokie App a Hit - But ‘Not Gambling.’” Sydney Morning Herald 13 Jan. 2013. ‹http://www.smh.com.au/digital-life/smartphone-apps/virtual-pokie-app-a-hit--but-not-gambling-20130112-2cmev.html#ixzz2QVlsCJs1›. Worthington, Andrew, et al. "Gambling Participation in Australia: Findings from the National Household Expenditure Survey." Review of Economics of the Household 5.2 (2007): 209-221. Young, Martin, et al. "The Changing Landscape of Indigenous Gambling in Northern Australia: Current Knowledge and Future Directions." International Gambling Studies 7.3 (2007): 327-343. Ziolkowski, S. “The World Count of Gaming Machines 2013.” Gaming Technologies Association, 2014. ‹http://www.gamingta.com/pdf/World_Count_2014.pdf›.

IntroductionEmpathy: the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another, either in the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also: the capacity for this. (Merriam-Webster, “Empathy”)Compassion: sympathetic consciousness of others’ distress together with a desire to alleviate it. (Merriam-Webster, “Compassion”)After thirty years of being a vegetarian, my eyes were opened to the inherent cruelty in animal-use industries. I became vegan and spoke out on these issues at animal rights events, rallies and ethical leadership forums. My private psychology practice attracted a significant number of vegans who presented with symptoms of anxiety and depression. However, unlike many of my non-vegan clients who were unclear as to what caused their symptoms, vegans reported it as being directly related to their discovery of systematised animal misuse in society. It was as if they had extended their compassion beyond their own species.Despite these issues being increasingly discussed in open circles, this extension of compassion seems to be limited to veganism. Why is veganism increasing as a compassionate centre, with animal social justice being at its core? Drawing on key emotional experiences of vegans, based on a survey conducted in 2018 and observational data from a private psychology practice, this article explores the experiences of compassion and empathy of vegans, and the impact such experiences can have on social change.The Increase in VeganismVeganism has noticeably increased over the past decade, with greater public debate in the media. A 2016 Roy Morgan poll indicated that the number of strict vegetarian adults in Australia was 2.1 million; an increase of nearly half a million people over four years, and likely to grow (Roy Morgan). Internationally, veganism was the biggest trend of 2018, with over three times the level of interest online as “vegetarian” or “gluten-free” (The Vegan Society).I believe there are a number of reasons for this, including greater awareness through social media, increased social mobility, and people becoming aware of international practices (Oberst). Photos and videos of animal suffering are more easily accessible via mobile devices, and can be shared at a faster rate than mainstream media could traditionally share news (Forgrieve). Small budget Indie films have also shared unknown information with the public, such as Earthlings, Dominion, Cowspiracy, and Kangaroo. In addition to this, I believe there is a greater propensity for people to challenge authority and previous direction from doctors or politicians in what is known as “the era of respect” (Mowat, Corrigan, and Long).These circumstances and more have led to an increase in people making more informed, kinder choices with regard to veganism; suggesting the opening of a new era of compassion beyond one’s own species. However, living in a world where the majority of people’s consumer choices facilitates animal abuse behind closed doors, the vegan is left struggling with “the burden of knowing”; knowledge of the facts of animal mistreatment and the inability to change it or successfully induce others to acknowledge it (Mann, Vystopia).Case Study ResearchBetween 2013 and 2018 I held individual psychological counselling sessions with over 100 self-selected vegans. For these case studies, the definition of “vegan” means someone who has chosen to live their life underpinned by the philosophy of the non-use and non-exploitation of animals and informs what they eat, wear, use and are involved in. These individuals reached out to me because of the trauma they reported experiencing since learning of the ubiquitous nature of animal cruelty in society. They claimed to feel more comfortable with a vegan professional who they felt understood their anguish.From these sessions, using the qualitative research methodology of hermeneutics (Rennie), I began to notice a pattern relating to the nature and enormity of the typical vegan’s distress. Almost every vegan who came to see me presented with symptoms related to their awareness of the systemised cruelty towards animals. Their distress was compounded when they shared this information with their friends and family, whom they were sure would be equally upset by it. Instead, many people responded with indifference, criticism, and anger, saying that everyone has a right to choose what to eat. These feelings of frustration and powerlessness left them unable to reconcile competing beliefs; that the people they loved were capable of turning their eyes away from the suffering their consumer choices were financing. The typical symptoms they reported included (fig. 1):Complicated griefMental anguishDepressionAnxietySelf-medicationAnger and despairSelf-harmSuicidal thoughtsHopelessnessLonelinessPost-Traumatic Stress Disorder (PTSD)Fig. 1: Typical symptoms reported by vegans in individual counselling sessions, 2013–2018.After over 1,300 hours of one-to-one sessions with vegans around the world, plus anecdotal stories from vegans I met at numerous events, I came to believe that the vegan’s pain is unique to being vegan and warrants a specific definition.It is imperative to me that vegans do not become labelled as mentally ill or chronically dysfunctional, for which the only solution is medication. As a fellow sufferer of the “burden of knowing”, I wanted to create a term to validate our experience and avoid medicalising our plight. Only then can the vegan’s experience be examined from a humane perspective and solutions be found to help us. Then, we can become part of the rising tide of social action that says human superiority and animal abuse is unacceptable. Because I believe that this experience and associated symptoms are existential in nature, I called this “Vystopia” (Mann, Vystopia).VystopiaThe Existential crisis experienced by vegans, arising out of an awareness of the trance-like collusion with a dystopian world and the awareness of the greed, ubiquitous animal exploitation, and speciesism in a modern dystopia. (Mann, “Suffer”)Vystopia is the anguish a vegan feels, knowing about the systematised cruelty towards animals in society, and the further distress they experience with the unconscious collusion of non-vegans, and their resistance or criticism of this information. Many of my clients experienced a range of symptoms of vystopia (fig. 2): Feelings of alienation from non-vegansMisanthropyGuilt over past consumption of animalsGuilt that they are not doing enough to save animalsInability to enjoy normal aspects of lifeFrustration with non-vegans who don’t ask more questionsAnger with the “burden of knowing”Powerlessness when health professionals tell them “it’s normal”Fig. 2: Symptoms of VystopiaMisdiagnosis of the Vegan’s ConditionMany doctors have referred patients to me for mental health symptoms of eating disorders, social adjustment disorder, and self-harm. It is my opinion that vegans referred to me with these symptoms do not suffer from traditional eating or self-harm disorders.As I learned from working in a psychiatric teaching hospital in the UK, clients with these conditions are often deeply unaware of the reasons influencing their symptoms. Their symptoms become an outward sign of hidden or unconscious distress which is too painful to confront directly. The vegans sent to me are deeply distressed due to the horror they’ve witnessed or now know about in the animal industries.I discovered that regularly viewing graphic videos of animal abuse was linked with vegan clients diagnosed as having self-harm tendencies (Klonsky). They view these as they feel guilty if they don’t know about all aspects of the animal’s suffering. It’s only by knowing all the details that they can be informed and act to change it. Vegan clients who have told their doctors they “can’t eat around people who are consuming animals” are often diagnosed as having eating disorders, although they lack the typical medical symptoms of eating disorders. While it is possible for vegans, like anyone else, to suffer from these conditions, I believe that many clients have been misdiagnosed. For many, their symptoms are indicative of a normal, feeling human’s way of dealing with vystopia: The truth is that it is not a pathology, but the distress a vegan feels when they look at the state of the world and the cruelty and suffering and it’s an absolutely rational response any feeling human being should feel; a dystopian reaction to what they are seeing. (Klaper)Survey ResearchBetween February and July 2018, I conducted an anonymous online survey of 820 vegans. The survey comprised 26 multiple-choice questions covering 7 main areas:How long someone has been veganLength they have experienced vystopiaWhen vystopia was most experiencedWhere people seek help for vystopiaWhat they do to reduce symptomsFamily and relationships where significant others are not veganWhat support is most needed to help vystopiansResultsWhilst an in-depth analysis of the results is outside the scope of this article, some of the key responses are as follows (figs. 3–6):How long have you been vegan?1–5 years48%Less than 6 months16%6–12 months14%5–10 years12%10 years plus10%Fig. 3: Length of time as vegan.How long have you suffered from vystopia?1–5 years39%5–10 years21%6–12 months15%Less than 6 months13%10 years plus12%Fig. 4: Length of time suffering from vystopia.When do you most experience vystopia?Others around you eat animals79%Seeing images of animal cruelty78%Other people refuse to hear about animal cruelty78%Grocery shopping69%People laugh at you for being vegan56%Family celebrations55%Holidays40%At work events39%All the time37%When away from vegan friends30%Other8%NB: Participants invited to tick all that apply Fig. 5: When vystopia is experienced.What do you do to reduce your vystopia?Remove yourself from the world58%Increase animal advocacy55%Talk to friends34%Self-medicate (e.g. alcohol, drugs, food)24%Other16%See a doctor2%Fig. 6: Actions taken to reduce vystopia.Explaining the Differences in Adoption of VeganismWhy do some people extend their compassion towards animals whilst others are unaware of the need to do so, or believe it is anthropomorphic or sentimental? Research is needed to examine this more, but my own research and anecdotal experience suggests some factors:Social ConformityMany people are strongly influenced by what they perceive as socially normal (Mallinson and Hatemi). Cultural and family traditions, media, and community behaviour all influence the food and lifestyle choices of society. Most people are unaware that their consumer choices play a role in the mistreatment and abuse of animals.Social conditioning influences whether people choose to investigate new information further or continue with the status quo for the sake of fitting in. The need to fit in creates a social trance whereby people continue to collude with animal cruelty through their inaction, and in fact their willful ignorance means they are not likely to change their actions, as they don’t know any differently.The vegan is one who has chosen to find out the truth about animal exploitation and extend their compassion towards other species by abstaining from anything related to animal abuse.Personal and Social Defense MechanismsSimilar to social conformity, the concept of being “different” from the perceived norm is enough for many people to continue with their actions, regardless of the consequence for animals. Similarly, those who are suddenly privy to new information may feel judged by the messenger, and resistance is easier than change. The vegan is one who chooses to adjust their actions, despite the judgement or ridicule which may accompany it.Personality VariablesOn the Myers-Briggs Type Indicator (Myers and Myers), my anecdotal experience suggests that individuals with preferences for “feeling” over “thinking” are more likely to become vegan. The vegan community consists of many different personality types, with those who are strong “feeling” types more inclined to display empathy and empathetic action.Avoidance of Existential Anxiety When a person’s understanding of the world is challenged, this can create anxiety, where one is compelled to ask, “What else don’t I know?” If animal cruelty can occur at such a widespread rate—with most of society oblivious to it—what else is going on behind closed doors? For some, the reality of facing the truth can create enough angst that they will resist knowing and changing. The vegan may still experience such angst, but is compelled to change for the sake of the animals. Differing Capacity to Encompass Novel IdeasIdeas which vary from a widely believed ideology are often rejected, simply because the new idea is too radical to believe or comprehend. Consider the Law of Gravity or the concept of germs, both initially shunned by experts. Some people are more willing to delve into a new concept and explore the possibilities which come with it. Others are firmly tied to conformist ideology and will only jump on the bandwagon once others are driving it.Differing Levels of ConsciousnessIn the original book on Spiral Dynamics, Beck and Cowan talk about the magnetic forces that attract and repel individuals, the webs that connect people within organisations, and influence the rise and fall of nations and cultures. The book tracks our historic emergence from clans and tribes to networks and inter-connected networks. It identifies seven variations on how change occurs in individuals, society and leadership.Its relevance for veganism is in appreciating that there are different levels of consciousness in society. For example, a vegan passionate about the ethical treatment of animals would be faced with resistance from a hunter with a more tribal level of consciousness, according to the Spiral Dynamics model. It would be like two people from different planets communicating. Another example would be a community outraged by the influence of veganism on local employment, as demand for dairy reduces. By understanding where other people or groups are coming from, we can adapt the way in which we communicate. If vegans talk ethics and non-speciesism to people focused primarily on job security, they will face resistance.Tipping PointsIn marketing, the uptake of products and services follows a certain pattern. For example, in the 1990s, few people believed that the mobile phone market would explode to such a point. The same goes for changes in collective beliefs and ideas in society, such as the early protagonists for the Abolition of Slavery. These early innovators and adopters faced enormous resistance by those who benefited from the trade. As the movement gathered momentum, it reached what Gladwell has called the “Tipping Point”, “the moment of critical mass, the threshold, the boiling point” (12). As Gladwell stresses here, “ideas, products, messages and behaviours spread like viruses do” (7).In The Empathetic Civilization, Rifkin discusses society being wired for empathy. This occurs when the neurons in the brain mirror those of people around them, and can be likened to the psychological concept of “entrainment”. This phenomenon suggests that vegans have the ability to influence others through showing empathy and compassion.Increasingly, teenage vegans are referred to me who say, “I just had this awareness and know it is wrong to eat animals”. Many of them hadn’t seen anything on veganism or spoken to anyone about animal exploitation. I believe that this is an example of what Jung has called the “Collective Unconscious”; the structures of the unconscious mind which are shared among beings of the same species. This is encouraging for vegans who often feel helpless and cannot see how a vegan world will happen in their lifetime.ConclusionThose who are vegan for ethical reasons appear to feel compelled to take action to end animals’ plight. This may be because of the ubiquitous nature of the problem, but also because other people’s non-veganism is contributing to their vystopia.The extended compassion of vegans leaves them feeling depressed, wondering how enough people are going to change in order for veganism to become the new norm. The concept of entrainment is an encouraging one for vegans, reminding us of the importance of playing our part in being the example we want others to “entrain” to.It is my experience that empathy alone will not alleviate vystopia for these ethically-driven vegans. Vystopia can only be alleviated through action. A person may feel compelled to take action to end the suffering of refugees, children, the homeless and when they tell people, their efforts are applauded. The vegan who changes their everyday consumer choices to end animal suffering is often met with resistance, derision or criticism, as the non-vegan insists they have choice or that animals are inferior to humans. Another person may disagree with animal cruelty and yet refuse to change their consumer habits which finance the cruelty. One’s food choices are powerful political actions, and disagreeing with animal cruelty yet eating animals fuels the vegan’s vystopia. By shifting our focus from how awful the world is to taking action every day to mirror the vegan world we seek, we are creating a new norm to which others will entrain.With the increase in veganism trending upwards, the changes we are seeing across the world might mirror our compulsion to act. While the depth of animal empathy and vystopia is full of real anguish, I believe it also provides what we need to propel the world towards a vegan norm.ReferencesBeck, Don Edward, and Christopher Cowan. Spiral Dynamics: Mastering Values, Leadership and Change. New York: Wiley-Blackwell, 2005.Cowspiracy: The Sustainability Secret. Dirs. Kip Anderson and Keegan Kuhn. Appian Way, A.U.M. Films, First Spark Media, 2014.Dominion. Dir. Chris Delforce. Aussie Farms, 2018.Earthlings. Dir. Shaun Monson. Libra Max and Maggie Q, 2005.Forgrieve, Janet. “The Growing Acceptance of Veganism.” Forbes 2 Nov. 2018. 29 Mar. 2018 <https://www.forbes.com/sites/janetforgrieve/2018/11/02/picturing-a-kindler-gentler-world-vegan-month/#331421342f2b>.Gladwell, Malcolm. The Tipping Point: How Little Things Can Make a Big Difference. London: Abacus, 2000.Jung, Carl G. The Structure and Dynamics of the Psyche. 1969.Kangaroo: A Love-Hate Story. Dirs. Michael McIntyre and Kate Clere-McIntyre. Hopping Pictures, 2017.Klaper, Michael. “Interview with Dr. Michael Klaper.” YouTube 17 Aug. 2018. 29 Mar. 2019 <https://www.youtube.com/watch?time_continue=87&v=8EQOUODlq2c>.Klonsky, E. David. “The Functions of Deliberate Self-Injury: A Review of the Evidence.” Clinical Psychology Review 27.2 (2007): 226–39. Mallinson, Daniel J., and Peter K. Hatemi. “The Effects of Information and Social Conformity on Opinion Change.” Plos One 13.5 (2018). 29 Mar. 2019 <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196600>.Mann, Clare. “Do You Suffer from Vystopia? The Discovery of Systemised Cruelty.” Blog post. No date. 5 Apr. 2019 <https://www.veganpsychologist.com/do-you-suffer-from-vystopia/?platform=hootsuite>.———. Vystopia: The Anguish of Being Vegan in a Non-Vegan World. Sydney: Communicate31, 2018.Mowat, Andrew, John Corrigan, and Douglas Long. The Success Zone: 5 Powerful Steps to Growing Yourself and Leading Others. Mt. Evelyn: Global Publishing Group, 2009.Myers, Isabel Briggs, and Peter B. Myers. Gifts Differing: Understanding Personality Type. 2nd ed. Mountain View: Consulting Psychologists Press, 1995.Oberst, Lindsay. “Why the Global Rise in Vegan and Plant-Based Eating Isn’t a Fad (600% Increase in U.S. Vegans + Other Astounding Stats).” Food Revolution Network 18 Jan. 2018. 20 Mar. 2019 <https://foodrevolution.org/blog/vegan-statistics-global/>. Rennie, David L. “Methodical Hermeneutics and Humanistic Psychology.” The Humanistic Psychologist 35.1 (2007): 1-14.Rifkin, Jeremy. The Empathic Civilization: The Race to Global Consciousness in a World in Crisis. Cambridge: Polity, 2010.Roy Morgan. “The Slow But Steady Rise of Vegetarianism in Australia.” Roy Morgan 15 Aug. 2016. 29 Mar. 2019 <http://www.roymorgan.com/findings/vegetarianisms-slow-but-steady-rise-in-australia-201608151105>.The Vegan Society. “Statistics.” The Vegan Society, 2019. 20 Mar. 2019 <https://www.vegansociety.com/news/media/statistics>.