Trends and gender differences in substance use among children and adolescents admitted to an addiction treatment center in Turkey: years 2011-2013 Objective: In this study we aimed to examine the trends and gender differences in substance use behaviors and treatment seeking patterns of children and adolescents who were admitted to an addiction treatment center in Turkey. Method: Participants were 2718 children and adolescents who had been consecutively admitted to the 'Children and Adolescent Alcohol and Drug Dependency Treatment Center' in Istanbul between January 2011 and December 2013. A detailed drug use questionnaire was completed by all participants, and substance use characteristics were analyzed in terms of gender and substance types. The data regarding age of first use, age at referral, referral pattern, and type of the substances used were compared between three years (2011, 2012, and 2013) and between genders. Results: There was a statistically significant increase in the number of females (p<0.001) and in the total number of children and adolescents (p<0.001) seeking treatment for substance use through these years. The mean age of first use was 13.8 years (SD: 2.1) and the mean age at referral for treatment was 16.1 years (SD: 1.5) in the whole group. The mean age at referral for treatment was significantly lower in the female group (p<0.001). There was a statistically significant increase in the proportion of subjects admitted to the addiction treatment center alone or with their family (p<0.001) and in the number of subjects brought in by social services (p<0.001), while there was a statistically significant decrease in the number of non-voluntary referrals from forensic services through the years (p<0.001). There was a statistically significant increase in the rate of ecstasy, heroin, synthetic cannabinoid use and polysubstance use and a statistically significant decrease in the age of first use (p<0.0001) and inhalant/solvent use through the years. Use of solvents/ inhalants was more common among men (p<0.001), whereas ecstasy and cocaine use was more common among women (for each, p<0.001). Polysubstance use was present in 60.2% of the subjects, and there was a statistically significant increase in the mean number of substance types used in the last two years (p<0.001). Conclusion: As different and new illicit drugs rise and fall in popularity, it is important to reexamine the patterns of substance use and to reorganize the prevention policies and treatment strategies. Considering the decrease in the age of first use and the increase in the number of youth using multiple drugs and/or hard drugs, new and more effective preventive strategies should be developed targeting children and adolescents in Turkey.

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The term "attachment" is used to imply the bonding between mother and child or the relationship between parents and child. Establishment of secure attachment is the healthiest way for the mental and physical development of the child. Secure attachment system constitutes a protection mechanism from high levels of stress. Insecurely attached children are presented with mental and physical developmental delays and problems in identity formation and personality in the future. To avoid all these, all the requirements of the child by means of affection, nutrition, protection, shelter and health are required to be met in a consistent and healthy way by the caregiver. This review article discuss the term attachment; features associated with insecure attachment and its negative influences in adulthood. Key words: Attachment, secure attachment, outcome. ÖZÇocuk ve ebeveyni arasında kurulan bağ ilişkisine, "bağlanma" adı verilir. "Bağlanma" dendiğinde anne-çocuk arasındaki ilişki, ebeveyn-çocuk arasındaki ilişki veya temel bakım veren-çocuk arasındaki ilişki kast edilmektedir. Çocuğun ruhsal ve fiziksel gelişimi açısından en ideal ve sağlıklı olanı güvenli bir bağlanmanın temin edilmesidir. Güvenli bağlanma çocuğu yüksek düzey stresten koruyan bir mekanizma teşkil eder. Güvensiz bağlanma geliştirmiş olan bireyleri ilerleyen zamanda zihinsel ve fiziksel açıdan gelişimsel gerilikler, kimlik oluşmasında sorunlar, kişilik sorunları ve diğer ruhsal sorunlar beklemektedir. Güvenli bağlanma için, çocuğun temel şevkât, beslenme, korunma, barınma ve sağlık ihtiyaçlarının hepsinin sağlam, tutarlı şekilde karşılanması gereklidir. Bu gözden geçirme makalesinde, bağlanma kavramının özellikleri, çocukta güvensiz bağlanmanın özellikleri ve erişkin hayata olumsuz yansımaları ele alınacaktır. Anahtar kelimeler: Bağlanma, güvenli bağlanma, sonlanım.

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