This insightful volume describes a sample of prevention demonstration projects of the Center for Substance Abuse Prevention (CSAP). Substance Abuse Prevention in Multicultural Communities illuminates various aspects of prevention theory, practice, and research with a focus on the design, implementation, adaptation, and outcome of specific demonstration programs. Researchers work with prevention professionals to describe, measure, and intensify effects of interventions upon both intermediate problems and the ultimate long-term goal of decreasing substance abuse. Chapters in Substance Abuse Prevention in Multicultural Communities demonstrate how the CSAP demonstration logic model works. The process of prevention program design begins with an analysis of the root causes of the problem as defined by the specific community and illuminated by theory. Comprehensive prevention programs that buttress community strengths and build on local resources are then designed to deal with these problems. The programs you'll learn from include: a leadership and substance abuse prevention program, based on the social influence model, for girls in grades 6-8 from four geographically and ethnically diverse communities a program intricately designed to build resiliency and protective factors within young at-risk American Indian children in a Head Start program which addresses school transition, school readiness, school attendance, and classroom-based prevention activities. a family skills training program for African American parents in substance abuse treatment, which evolved in response to client and evaluation feedback a program for Native American families, which uses a culturally oriented curriculum emphasizing traditional values, beliefs, and practices a coalition of neighborhood agencies, organized to provide a comprehensive array of school and community-based prevention services, which impacted gang membership in inner-city Latino youth. a prevention program specifically designed to serve the diverse needs of Asian-American youth from five different Asian ethnic communities a model substance abuse prevention program implemented to provide counseling, mentoring, and academic support to Hispanic and African-American students in an urban public middle school the nationally recognized FAST program which strengthens the family and brings parents and schools together in building up protective factors for high risk elementary students a program that combines several complementary strategies to develop personal and communal empowerment in Native American communities.Substance Abuse Prevention in Multicultural Communities illustrates the wealth of information generated by demonstration programs. Unlike a standard research protocol that imposes and tests a rigid, single-focused intervention under carefully controlled circumstances, these programs do science in real-life situations, documenting and measuring effects of multiple interventions.

Why do some young adults substantially change their patterns of smoking, drinking, or illicit drug use after graduating from high school? In this book, the authors show that leaving high school and leaving home create new freedoms that are linked to increases in the use of cigarettes, alcohol, marijuana, and cocaine. They also show that marriage, pregnancy, and parenthood create new responsibilities that are linked to decreases in drug use.
The research is based on more than 33,000 young people followed from high school through young adulthood by the nationwide Monitoring the Future project. Every two years, participants reported on their drug use, as well as their schooling, employment, military service, living arrangements, marriages, pregnancies, parenthood, and even their divorces.
The unique qualities of this research--large nationally representative samples, follow-ups extending up to 14 years beyond high school, and multiple approaches to analysis and data presentation--allowed the examination of several important influences simultaneously, while retaining much of the rich detail encountered in the real world. On the whole, the results are encouraging, suggesting that the potentials for change and improvement during the transition to adulthood are as important as the detrimental effects of problem behavior in adolescence. This research is a "must" read for anyone concerned with how new freedoms and responsibilities impact adolescents, young adults, and the use of licit and illicit drugs.

Illicit drugs, despite the "war" waged by the United States government, remain a tremendous drain on the American economy and continue to take their toll on the lives of countless Americans. A comprehensive text with an instructor's manual, Drug Abuse and Social Policy in America analyzes why current US policy on the use of licit and illicit mood-altering drugs has failed. This groundbreaking book addresses differences between decriminalization, legalization, and "zero tolerance"--areas and philosophies that are poorly understood--and suggests a multipronged approach to diminish inappropriate drug use. Physicians, health care providers, teachers, law enforcement officers, policymakers, social service providers, and students of public policy and health will gain a better understanding of substance abuse as a societal problem, rather than an individual problem, and see that the billions of dollars spent on law enforcement would be better spent on education, prevention, treatment, and providing alternatives to drug use.Currently the leading risk factor associated with the transmission of HIV, illicit drugs continue to destroy the fabric of life in many inner-city communities. Yet, drugs are a problem for Americans from every corner of society, from suburban teenagers to pro athletes to homeless people. Author Barry Stimmel demonstrates in Drug Abuse and Social Policy in America that the drug problem is not being addressed adequately because of a lack of commitment from the majority of Americans and government leaders. The issues Drug Abuse and Social Policy in America asks readers to confront include: Why do we provide insufficient treatment facilities and incarcerate users, yet wonder why more prison space is needed? Why do we readily agree to build more prisons rather than community centers that provide alternatives for youths? Why are we concerned with teenage smoking and drinking, yet allow advertising of these substances? Why do we advocate rehabilitation, but not hire people in recovery? Why do we ask pregnant women with drug problems to seek help, then try to take custody of their children rather than provide social support while they receive treatment?Drug Abuse and Social Policy in America challenges academics, practitioners, and future social service providers and policymakers to rethink their entire conception of the problem of substance abuse in America with a cutting question: "Have we made any substantial progress in diminishing the sue of nicotine, the excessive consumption of alcohol, or the inappropriate use of prescription drugs, all of which are responsible for more illnesses and societal costs than all illicit drugs combined?" Identifying this as the place where all efforts to curb drug use must start, Drug Abuse and Social Policy in America offers readers many ways that individuals, communities, organizations, and society can take action and be more effective in convincing both those who consume drugs and those who profit from their sale that their actions are inappropriate and unacceptable.

Using a broadened conceptualization of agenda setting, this volume's objective is to examine the drug issue from mid-1984 to mid-1991 to determine how drug-related issues and events -- both real and fabricated -- and the primary agendas drove the issue over time. Based on this objective, four questions are posed:
* How did the media structure interpretations of drug issues and events?
* How did the president structure public relations interpretations and presentations of issue and event information over time?
* What were the interactions of the drug-issue agendas, the president's public relations agendas, the media, and the public, while controlling the policy agenda and a real-world measure of the severity of the drug problem?
* How did the relationships of these agendas differ during the Reagan and Bush presidencies?
These questions were addressed with detailed content analyses of the media agenda over time, the presidential public relations agenda over time, and a multivariate ARIMA analysis of the time series agendas. No previous studies to date have addressed and modeled these agendas simultaneously with ARIMA modeling methods.

Find fresh perspectives on the treatment of addictions and effective methods for helping recovering alcohol and drug abusers in this valuable book Addiction in Human Development provides practical strategies based on theories of human development for working with clients recovering from alcoholism and drug addiction. An understanding of these theories will help therapists and addictions counselors recognize stages of recovery and better select appropriate interventions for every phase of treatment of addicted clients.Addiction in Human Development shows how a developmental perspective is particularly appropriate to the treatment of alcohol and substance abusers and the patterns involved in their addiction. Disruptions in clients'childhood or adolescent development, stemming from their own or a parent 's drug abuse, can influence their present recovery process. This informative book also describes the developmental course of addiction and provides tools designed to interrupt addictive patterns. In addition, stages in the developmental process of recovery are identified to help therapists select appropriate interventions.Some of the topics related to human development and addiction covered in this insightful volume include developmental deficits and developmental arrest in recovering clients, delayed reactions to sexual abuse and other childhood trauma, stages in recovery from alcoholism or drug addiction, developmental issues in the professional 's own life, and multi-problem families with a multigenerational history of substance abuse. Applying these developmental strategies to work with addicted individuals will significantly improve communication and rapport between helping professionals and recovering addicts and lead to more success in alcohol and drug addiction therapy.

This work describes a programme, "Creating Lasting Family Connections", which is based on COPE's demonstration programme, "Creating Lasting Connections" (CLC). CLC was designed as an ecumenical, community based programme that focused on increasing community, family and individual (youth) protective factors that would lead to delaying the onset and reducing the frequency of alcohol and other drug use among at-risk 12-14 year olds. CLC received the Center for Substance Abuse Pre vention's Exemplary Prevention Program Award for 1994; it has been included in the International Youth Foundation's YouthNet International, a directory of youth programmes worldwide; finally, it was selected as one of only seven model prevention programs by the Center for Substance Abuse Prevention for national dissemination. While the programme focuses on alcohol and other drug-related issues and outcomes, much of this approach is applicable to youth and families across a larger spectrum of issues and behaviours, including violence and inappropriate sexual behaviour.

Find remarkable prevention and treatment strategies for preschool-age children of substance abusers in this informative volume. It provides an overview of the various problems exposure to substance abuse can cause for preschool children. Because of the strong influences parents have on their children, early childhood is a critical time for intervention to counteract the damaging effects of alcohol and drug abusing parents. Research shows that attitudes about alcohol and other drugs are already formed by junior high school level, and senior high school is too late for significant attitude change. Preschoolers and Substance Abuse promotes preschool age as the ideal time to apply strategies that will aid the family in building the self-esteem, trust, autonomy, and initiative necessary to protect the child from further problems caused by addictive parents. Intervention strategies are presented in a succinct manner, making them easy for practitioners, health officials, government officials, and family members to put into immediate practice.This book offers a unique approach to substance abuse, treating it as a community and societal problem rather than an individual problem. Intervention and treatment strategies are geared toward the substance abuse problem itself as well as how it impacts children and family systems. The harmful impact of alcohol or drug abusive parents is evaluated for all stages of childhood development, from pre-natal influences through infancy and the preschool years. Some of the harmful results of alcohol and drug abuse affecting preschool children addressed in this volume include violence, sexual abuse, Fetal Alcohol Syndrome, and intra-uterine exposure to drugs. The authors outline a comprehensive list of imperatives for a future agenda to protect preschool children from suffering the consequences of their parents'substance abuse. Public health officials, decision makers, practitioners, and legislators will find a series of policy recommendations including increased research, substance abuse training for child care workers, increased outreach and education for expectant mothers, and community-based outreach programs to insure ethnic or socioeconomic sensitivity and appropriateness.

Find remarkable prevention and treatment strategies for preschool-age children of substance abusers in this informative volume. It provides an overview of the various problems exposure to substance abuse can cause for preschool children. Because of the strong influences parents have on their children, early childhood is a critical time for intervention to counteract the damaging effects of alcohol and drug abusing parents. Research shows that attitudes about alcohol and other drugs are already formed by junior high school level, and senior high school is too late for significant attitude change. Preschoolers and Substance Abuse promotes preschool age as the ideal time to apply strategies that will aid the family in building the self-esteem, trust, autonomy, and initiative necessary to protect the child from further problems caused by addictive parents. Intervention strategies are presented in a succinct manner, making them easy for practitioners, health officials, government officials, and family members to put into immediate practice.This book offers a unique approach to substance abuse, treating it as a community and societal problem rather than an individual problem. Intervention and treatment strategies are geared toward the substance abuse problem itself as well as how it impacts children and family systems. The harmful impact of alcohol or drug abusive parents is evaluated for all stages of childhood development, from pre-natal influences through infancy and the preschool years. Some of the harmful results of alcohol and drug abuse affecting preschool children addressed in this volume include violence, sexual abuse, Fetal Alcohol Syndrome, and intra-uterine exposure to drugs. The authors outline a comprehensive list of imperatives for a future agenda to protect preschool children from suffering the consequences of their parents'substance abuse. Public health officials, decision makers, practitioners, and legislators will find a series of policy recommendations including increased research, substance abuse training for child care workers, increased outreach and education for expectant mothers, and community-based outreach programs to insure ethnic or socioeconomic sensitivity and appropriateness.

Feminism is a beneficial force in addictions therapy as they have the same goals--mending imbalances of power. A variety of important topics related to addictions treatment are addressed in this timely volume, accompanied by concrete clinical solutions for therapists and counselors to use in their own practice. Feminism and Addiction demonstrates the positive impact feminism can have on addictions treatment. Addictions treatment methods that have been developed primarily based on research with men are examined and questioned to determine what changes need to be made to meet the needs of women. The applicability of twelve-step treatment programs, for example, is investigated as to whether its required adoption of belief in powerlessness is concurrent with feminism's battle with female subjugation. This thought-provoking volume contains the most current theoretical, social, and clinical issues enmeshed in the debates between men's experiences and women's experiences of addiction. Critical issues addressed include advice for how to deal with issues of codependency; how to treat clients faced with physical or sexual abuse in addition to addiction; how to integrate cultural differences into treatment; and how to face the particular difficulties of gay and lesbian clients in addictions treatment. This valuable book will help you apply constructivist approaches to build therapy methods which are collaborative, internal, and organic, thus more appropriate to treating women's experience with addiction. Feminism and Addiction helps family therapists who work with women and their families strike a unique balance between the principles of feminism and family therapy's goal of repairing and healing relationships between men and women.

This current study has emerged from two decades of the author's investigations in related areas: alcoholism and domestic relations. Its canvas is broadly comparative, drawing on interviews and data gathered in the United States and Finland. The domestic drama of "The Other Half "is played out both in the private scene of the home and the more public scene of the workplace, and against these two differing national backgrounds. Despite the many expected and perceived cultural differences between the countries, the effects of alcoholism on the family are shown to be the same.

Dr. Wiseman's study offers theoretical insights gleaned from its perspective on alcoholism as an interactive phenomenon, to which the concepts of G.H. Mead and Blumer can be applied to illuminate the carefully presented data and go beyond them. New terrain in studies of alcoholism is thereby explored, including such themes as the social construction by the subjects of their husbands' drinking, their marriage and their self-images; the strategy of coping mechanisms; and the effects of the crisis of alcoholism on gender, sex roles, and power differentials.

"The Other Half "complements Dr. Wiseman's prize-winning work on the treatment of Skid Row alcoholics, "Stations of the Lost, "while involving issues of greater complexity on both the methodological and theoretical plane.

Written by researchers at a federally funded outreach program to combat the spread of AIDS, this book analyzes the efforts of the Miami Community Outreach Project to intervene in AIDS-related risk behavior among intravenous drug users and their sexual partners. The work provides background information on the history of AIDS, the risk behaviors of drug abusers, and federal intervention programs. It discusses the prevalence of the HIV virus in the Miami area and gives a detailed description of the project, discussing the theoretical basis for the project, the intervention strategies used, the rationale behind those strategies, and the results achieved. Appendixes provide information on the health of the subjects, the material used, and the Belle Glade Community Outreach Project modeled after the Miami project. The book begins with background information on the history of AIDS, the risk behaviors of drug abusers and their sexual partners, and federal attempts to combat the spread of AIDS. It then discusses the prevalence of the HIV virus in the Miami area, drug abusers in the community, and the Miami Community Project. Providing a detailed description, the authors discuss the theoretical basis for the Project, the intervention strategies used, the rational behind those strategies, and the results achieved. Appendixes provide information on the health of the subjects, the research manual and educational materials used, and the Belle Glade Community Outreach Project modeled after the Miami project. The book will be of interest to drug abuse and AIDS researchers as well as to clinicians and counselors.

Feminism is a beneficial force in addictions therapy as they have the same goals--mending imbalances of power. A variety of important topics related to addictions treatment are addressed in this timely volume, accompanied by concrete clinical solutions for therapists and counselors to use in their own practice. Feminism and Addiction demonstrates the positive impact feminism can have on addictions treatment. Addictions treatment methods that have been developed primarily based on research with men are examined and questioned to determine what changes need to be made to meet the needs of women. The applicability of twelve-step treatment programs, for example, is investigated as to whether its required adoption of belief in powerlessness is concurrent with feminism's battle with female subjugation. This thought-provoking volume contains the most current theoretical, social, and clinical issues enmeshed in the debates between men's experiences and women's experiences of addiction. Critical issues addressed include advice for how to deal with issues of codependency; how to treat clients faced with physical or sexual abuse in addition to addiction; how to integrate cultural differences into treatment; and how to face the particular difficulties of gay and lesbian clients in addictions treatment. This valuable book will help you apply constructivist approaches to build therapy methods which are collaborative, internal, and organic, thus more appropriate to treating women's experience with addiction. Feminism and Addiction helps family therapists who work with women and their families strike a unique balance between the principles of feminism and family therapy's goal of repairing and healing relationships between men and women.

This helpful book underscores the importance of working with both the individual and family as part of a comprehensive biopsychosocial approach in assessment, intervention, and treatment of chemical addiction. With many case studies highlighting the treatment guidelines, Chemical Dependency is an ideal guide for professionals and students in addictions studies, mental health, and other human service related fields intent on working with and providing services to individual and family addiction.

This excellent book is a concise yet thorough examination of the important and emerging field of the study of biological risk factors in drug abuse. Historically, drug abuse research has concentrated on the contributions of environmental and behavioral factors as the major influences on addiction. The revelatory studies in this volume examine the genetic contributions to drug taking behavior through the use of animal models, cellular experiments and human clinical studies. Behavioral and Biochemical Issues in Substance Abuse provides for the first time in one volume, up-to-date, easily digested reviews of topics concerning biological and genetic factors in drug abuse. Medical researchers in all areas of alcoholism and drug abuse, researchers in pharmacology, psychology, psychiatry and neuroscience, and clinicians interested in biological approaches to alcoholism and drug abuse problems will benefit greatly from this valuable resource. Authoritative contributors clearly demonstrate the capability of genetic factors to modulate the reinforcing or rewarding effects of drugs, thereby altering their addictive potential. In addition to gaining comprehension of the biological factors affecting addiction, a greater understanding of genetics related to drug abuse will enable future research to control biological factors, leading to more accurate studies of behavioral and environmental influences on drug and alcohol abuse.

The history of drug abuse prevention campaigns suggests limitations in producing measurable changes in behavior. In the past, there was concern over the possibility of such publicity actually encouraging interest in drug use, rather than discouraging such behavior. Although little or no scientifically sound empirical evidence has been found to support such a view, several social science textbooks still refer to this as something of which to be wary. Reviews of early research appear to indicate inadequate methods and a lack of rigor in theory testing. In recent years, however, research in communication and its uses in drug abuse prevention has become considerably more sophisticated, and communication is being used far more effectively. In this book, the editors bring together some of the most successful drug abuse prevention researchers in the country -- along with other experts in this field or in persuasive communication -- to address use and effects of both mass media and interpersonal strategies. This collection illustrates just how far the study of public influence through mass media has come, especially regarding such a vital, relevant issue as drug abuse prevention.

A collection of essays on the theme of the nature and control of drug abuse in Britin, past, present and future. This book analyzes and appraises the two strands of that which has been termed as the "British system" of control, namely, prescription to, and rehabilitation of, registered users and enforcement action against illegal users. It also examines issues of contemporary relevance in the drug control debate, including the economics of drug control, drug education, the impact of AIDs, new trends in legislation and de-criminalization.

Because of the special needs of IV drug abusers and their sexual partners, an AIDS intervention program designed for this population should address multiple objectives and requires multilevel, highly integrated interventions. This book suggests that the intervention should be community-based to be effective in reaching the greatest numbers of the target population, particularly any hidden population such as the IV drug abuse treatment programs. Such interventions should be designed to: (a) prepare various members of the community for forthcoming AIDS preventitive efforts, (b) overcome barriers to high-risk-behaviour change, and (c) bring about high-risk behaviour change among those in the community.

Nick Manning tells the story of the therapeutic community movement, analyses the leading British community, the Henderson Hospital and examines the development of therapeutic communities in Australia. This book should be of interest to students and professionals in sociology, social policy, medicine, psychology.

What is 'addiction'? What does it say about us, our social arrangements and our political preoccupations? Where is it going as an idea and what is at stake in its ongoing production? Drawing on ethnographic research, interviews and media and policy texts, this book traces the remaking of addiction in contemporary Western societies.

Based on findings from a sample of nearly 1,100 Puerto Ricans living in the New York area, this book posits that adhering to traditional cultural values (for example, the family) has the socially desirable consequence of discouraging such deviant behaviors as substance abuse. The authors conclude that promoting specific values will not prevent certain individual and social ills; rather, promoting a sense of tradition' itself is needed.

The dangers of illegal drugs are well known and rarely disputed, but how harmful are alcohol and tobacco by comparison? What are we missing by banning medical research into magic mushrooms, LSD and cannabis? Can they be sources of valuable treatments? The second edition of Drugs without the hot air looks at the science to allow anyone to make rational decisions based on objective evidence, asking: *What is addiction? Is there an addictive personality? *What is the role of cannabis in treating epilepsy? *How harmful is vaping? *How can psychedelics treat depression? *Where is the opioid crisis taking us?

Bacchus in Romantic England describes real drunkenness among writers and ordinary people in the Romantic age. It grounds this 'reality' in writings by doctors and philanthropists from 1780 onwards, who describe an epidemic of drunkenness. These commentators provide a context for the different ways that poets and novelists of the age represent drunkards. Wordsworth writes poems and essays evaluating the drunken career of his model Robert Burns. Charles Lamb's essays and letters reveal a real and metaphorical preoccupation with his own drinking as a way of disguising his personal suffering; his companion Coleridge writes drinking songs, essays about drunkenness, and meditations about his own weakness of will that show both festive inebriety and consciousness of an inward abyss; Coleridge's son Hartley, whose fate his father had prophesied, experiences drunkenness as the life-long humiliation described in his poems and letters. Keats's complex dionysianism runs through 'Endymion' and the late odes, setting him at odds with his temperate hero Milton. Men in the Romantic age, such as Sheridan, Byron, Moor, and Clare, celebrate rowdy friendship with tales and songs of drinking; Romantic women novelists such as Smith, Edgeworth and Wollstonecraft depict these men stumbling home to abuse their wives. Although excessive drinking is real in the period, observers and participants can still maintain ambivalence about its power to release or to debase the human being.

Should marijuana be legalized? Since 2012 four US states have legalized commercial for-profit marijuana production and use, while Washington DC has legalized possession, growth and gifting of limited amounts of the plant. Other states, and even cities, have decriminalized possession, allowed for medical use, or reduced possession to a misdemeanor. While marijuana is forbidden by international treaties and by national and local laws across the globe, polls show that public support for legalization has continued to increase steadily over time. So why does the issue of marijuana legalization continue to be so controversial? One short answer is that it is an extremely complicated business, with approaches toward legalization just within the United States varying widely. What's more, not all supporters of "legalization " agree on what it is they want to legalize: Just using marijuana? Growing it? Selling it? Advertising it? If sales are to be legal, what regulations and taxes should apply? Different forms of legalization have demonstrated very different results. This second edition of Marijuana Legalization: What Everyone Needs to Know (R) provides readers with a non-partisan primer covering everything from the risks and benefits of using marijuana to what is happening with marijuana policy in the United States and abroad. The authors discuss the costs and benefits of legalization at the state and national levels and explore the "middle ground " of policy options between prohibition and commercialized production. The book also considers the personal impact of marijuana legalization on parents, heavy users, medical users, employers, and even drug traffickers.

The appetite for illicit drugs in the UK continues to grow and diversify. Young Britons consume more drugs than their peers anywhere else in Europe. Why and how has this happened and why have all official efforts to stem drug 'abuse' so far failed. Will the new UK drugs strategy fair any better? This unique collection of contemporary studies from the frontline by a leading social research group describes the drugs landscape in an accessible and authoritative way.

.In Our Right to Drugs, Thomas Szasz shows that our present drug war started at the beginning of this century, when the American government first assumed the task of protecting people from patent medicines. By the end of World War I, however, the free market in drugs was but a dim memory, if that. Instead of dwelling on the familiar impracticality or unfairness of our drug laws, Szasz demonstrates the deleterious effects of prescription laws which place people under lifelong medical tutelage. The result is that most Americans today prefer a coercive and corrupt command drug economy to a free market in drugs.

Throughout the book, Szasz stresses the consequences of the fateful transformation of the central aim of American drug prohibitions from protecting us from being fooled by misbranded drugs to protecting us from harming ourselves by self-medication--defined as drug abuse. And he reminds us that the choice between self-control and state coercion applies to all areas of our lives, drugs being but one of the theaters in which this perennial play may be staged. A free society, Szasz emphasizes, cannot endure if its citizens reject the values of self-discipline and personal responsibility and if the state treats adults as if they were naughty children. In a no-holds-barred examination of the implementation of the War on Drugs, Szasz shows that under the guise of protecting the vulnerable members of our society--especially children, blacks, and the sick--our government has persecuted and injured them. Leading politicians persuade parents to denounce their children, and encourage children to betray their parents and friends--behavior that subverts family loyalties and destroys basic human decency. And instead of protecting blacks and Hispanics from dangerous drugs, this holy war has allowed us to persecute them, not as racists but as therapists--working selflessly to bring about a drug-free America. Last but not least, to millions of sick Americans, the War on Drugs has meant being deprived of the medicines they want-- because the drugs are illegal, unapproved here though approved abroad, or require a prescription a physician may be afraid to provide. The bizarre upshot of our drug policy is that many Americans now believe they have a right to die, which they will do anyway, while few believe they have a right to drugs, even though that does not mean they have to take any. Often jolting, always stimulating, Our Right to Drugs is likely to have the same explosive effect on our ideas about drugs and drug laws as, more than thirty years ago, The Myth of Mental Illness had on our ideas about insanity and psychiatry.