This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations, may have difficulty establishing their effectiveness. The factors involved are many and complex.

This article presents a model of case management with rural clients entering drug and alcohol treatment. As part of a larger treatment protocol called Structured Behavioral Outpatient Rural Therapy, behavioral contracting is combined with strengths perspective case management to help rural clients motivate themselves to engage and complete drug and alcohol treatment. This combined approach is designed to continually communicate and teach an "A-B-C" cognitive-behavioral approach to problemsolving and change. While not a panacea for addressing the myriad problems facing clients with drug use problems, such an approach promises to improve "treatment as usual" formats, which often ignore the formidable obstacles to human change experienced by rural clients and clinicians.

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations, may have difficulty establishing their effectiveness. The factors involved are many and complex.

In India, Cannabis Indica has been used for literally thousands of years in the worship of the god Shiva. Cannabis is used in an orally administered form called bhang which can be either the wet resinous leaves formed into pills of a drink made of milk, cannabis, and various spices consumed by worshipers of Shiva on festival days or by smoking the flowering buds of cannabis-a practice generally reserved for holy men who dedicate their lives to ascetic practice and the worship of Shiva. This practice is codified in the Vedas as well as in legends about the origin of cannabis and its relationship to Shiva.

A semistructured interview was administered to a purposive sample of 12 rural women early in substance misuser treatment in a gender specific, intensive outpatient treatment program from March 2001 through March 2003. The interview used open-ended questions about the women's state of mind before entering treatment, the experiences that helped them feel more comfortable with treatment, the experiences that caused them some discomfort in treatment, and any changes they would recommend to the program content or process in an attempt to gain understanding about factors that might facilitate a subjective comfort and engagement with the treatment experience. In approaching treatment, the women almost uniformly expressed a mixture of anxiety about the requirements of treatment and cynicism about its effectiveness. Although aware of the content and structure of the treatment program, the women focused on interper-sonal experiences as the critical factors in their level of comfort once in treatment. The most frequently mentioned factors adding to comfort with the treatment experience were the welcoming, accepting, and non-judgmental attitudes of the staff; having their perceptions of their problems taken seriously by the treatment staff; being with other women who shared much of their experiences; and a respectful and generally positive attitude on the part of both the staff and the patients. The only factor that consistently caused some of the women discomfort in treatment was a difficulty in trusting that some of the other women in treatment would keep the matters discussed in group sessions confidential. The women were not completely satisfied with the program content and structure, but this seemed of very little importance to them in relation to their experience of comfort with their treatment experience.

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations , may have difficulty establishing their effectiveness. The factors involved are many and complex.

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations , may have difficulty establishing their effectiveness. The factors involved are many and complex.

In India, Cannabis Indica has been used for literally thousands of years in the worship of the god Shiva. Cannabis is used in an orally administered form called bhang which can be either the wet resinous leaves formed into pills of a drink made of milk, cannabis, and various spices consumed by worshipers of Shiva on festival days or by smoking the flowering buds of cannabis-a practice generally reserved for holy men who dedicate their lives to ascetic practice and the worship of Shiva. This practice is codified in the Vedas as well as in legends about the origin of cannabis and its relationship to Shiva. Keywords cannabis, Shiva, bhang, India, sadhu. .. the ethereal images of natural forces and then shapes of souls, dance before the eyes of the initiate. The dead and the gods appear! In an even deeper Samadhi, all manifestations, all, appearances, cease, and it simply is. In total absorption, Shiva sits on Kailash, the holy mountain, the mountain of snow, the mountain of ash. (Storl, 1988, pp. 204-205) Gods focuses on substance use and misuse throughout history and in diverse cultures. Up until modern times, cultures throughout history have associated different substances with specific deities, incorporated them into specific myths, and used substances in specific rituals. Examining these associations is likely to give insight into how these substances were viewed in various cultures and the place that they had in those cultures. Substance Use and Misuse offers this new feature exploring these associations as a way of increasing understanding of the functions of substance use in different cultures over historical time. Contributions to this section are invited.

The use of tobacco by Native Americans in North America seems to have ancient origins and significant spiritual meaning. This article reviews archeological and anthropological data about the use of tobacco and its sacred significance. Keywords Native American, Lakota, tobacco, Nicotiana rustica, peace pipe, calumet, Native American ceremonies, smoking I am making sacred smoke; In this manner I make the smoke; May all the people behold it! I am making sacred smoke; May all be attentive and behold! May the wingeds and four-leggeds be attentive and behold it! In this manner I make the smoke; All over the universe there will be rejoicing!

The evidence is clear and substantial. The acute use of alcohol/drugs and interpersonal aggression readily mix. Many drugs are related to violent behavior and some provide insight into possible mechanisms. The list of drugs implicated is very inclusive and if case reports are considered, even some anti anxiety drugs list relevant pharmacopia warnings of increased aggression.