자연주의적 탐구조사(Naturalistic Inquiry)

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

This Pulse Check is a report of national trends in illicit drug abuse and drug markets in the United States. The report draws on conversations with ethnographers and epidemiologists working in the drug field, law enforcement agents, and drug treatment providers across the United States. Information from each of these sources is summarized in narrative form broken down by drug type and presented in detailed tables at the end of the report. The four groupings of drugs are heroin, cocaine, marijuana, and emerging drugs. Results show that the market for heroin and cocaine remains fairly stable. Marijuana continues to be popular among young people and is frequently used with alcohol, hallucinogens, cocaine, or methamphetamines. Among the emerging drugs, methamphetamine continues to be a problem in the West and parts of the South, its low price making it an easily accessible drug. "Club drugs," such as Lysergic Acid Diethylamide (LSD) and Ketamine, are part of the drug scene in most areas, with many young people using a combination of these substances. (RJM) ******************************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. ******************************************************************************** Office of National Drug Control Policy PULSE CHECK National Trends in Drug Abuse Executive Office of the President Office of National Drug Control Policy Barry R. McCaffrey, Director

Office of national drug control policy

Linking Research and Service Delivery: The Unique Mission of the Substance Abuse and Mental Health Services Administration: (495882006-006)

Summary s-1
1 introduction 1-1

PART I Pain management and research
2 Pain management and the intersection of pain and opioid use disorder 2-1
•	The scope of the problem of pain, 2-1
•	Opioid analgesics, 2-4
•	Nonopioid pharmacologic treatments, 2-16
•	Interventional pain therapies, 2-25
•	Nonpharmacologic treatments, 2-27
•	Differences in pain experiences and treatment effectiveness among
•	Subpopulations, 2-33
•	The intersection between pain and opioid use disorder, 2-36
•	References, 2-36

3 Progress and future directions in research on pain and opioid use disorder 3-1
•	Basic pain research, 3-1
•	The neurobiology of the reward pathway and the intersection of pain and opioid
•	Use disorder, 3-10
•	Preclinical and translational research, 3-13
•	Clinical research, 3-18
•	Intersection of pain and opioid use disorder, 3-26
•	Support for research, 3-33
•	Summary and recommendation, 3-34
•	References, 3-34

PART II Addressing the opioid epidemic
4 Trends in opioid use, harms, and treatment 4-1
•	Trends in prescription opioid use and misuse, 4-1
•	Heroin use and its relation to prescription opioid use, 4-15
•	Illicit opioid markets, 4-25
•	The current state of surveillance systems, 4-32
•	Recent developments in pharmaceutical treatment of opioid use disorder, 4-35
•	Trends in treatment of opioid overdose with naloxone, 4-46
•	Summary and recommendations, 4-48
•	References, 4-49

5 Evidence on strategies for addressing the opioid epidemic 5-1
•	Nature of the Evidence, 5-2
•	The Need for a Systems Approach, 5-4
•	Strategies for Restricting Supply, 5-10
•	Strategies for Influencing Prescribing Practices, 5-21
•	Strategies for Reducing Demand, 5-39
•	Strategies for Reducing Harm, 5-46
•	Summary and Recommendations, 5-58
•	References, 5-60

6 Opioid approval and monitoring by the U.S. Food and drug administration 6-1
•	Overview of the FDA’s regulatory process for prescription drugs and its application to opioids, 6-2
•	Public health dimensions of FDA drug regulation, 6-17
•	Key elements of an integrated decision-making framework for opioid
•	Regulation,6-22
•	Implementation of an integrated framework for opioid regulation, 6-25
•	Summary and recommendations, 6-40
•	References, 6-44
•	Annex table 6-1: extended-release(er)/long-acting (la) opioid post-marketing
•	Study requirements, 6-49

Appendixes
A Data sources and methods a-1
B Biographical sketches of committee members and consultants b-1
C Existing data sources on opioid use, misuse, overdose, and other harms c-1

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Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use

Serosorting is commonly employed by MSM to reduce HIV risk. We hypothesize that MSM perceive serosorting to be effective, and that serosorting is predicted by resilience and inversely related to syndemic characteristics. Surveys included 504 substance-using MSM. Logistic regression models examined syndemic and resilience predictors of serosorting, separately by serostatus. For HIV-positive men, positive coping behaviors (P = .015) and coping self-efficacy (P = .014) predicted higher odds, and cognitive escape behaviors (P = .003) lower odds, of serosorting. For HIVnegative men, social engagement (P = .03) and coping self-efficacy (P = .01) predicted higher odds, and severe mental distress (P = .001), victimization history (P = .007) and cognitive escape behaviors (P = .006) lower odds, of serosorting. HIV-negative serosorters reported lower perceptions of risk for infection than non-serosorters (P < .000). Although high risk HIV-negative men may perceive serosorting to be effective, their high rates of UAI and partner change render this an ineffective risk reduction approach. Relevant public health messages are urgently needed.

Resilience, syndemic factors, and serosorting behaviors among hiv-positive and hiv-negative substance-using msm

Using a sample of 482 ethnically diverse current substance using men who have sex with men who reported recent unprotected anal intercourse, this study compared health risk behaviors—substance use and sexual HIV risk—and one health protective factor—prosocial activities—between men who live in a gay neighborhood and those who do not. Data are drawn from comprehensive health and social risk assessments administered in South Florida. In a multivariate logistic regression model, methamphetamine use, high rates of receptive unprotected anal intercourse, and lower levels of prosocial engagement were found to be risk factors associated with gay neighborhood residence. Compared with living elsewhere, gay neighborhood residence appeared to be protective against cocaine use and substance dependence. Implications of the findings for prevention interventions are discussed, as is the need for further research regarding decisions about neighborhood residence and how neighborhood risk and protective factors emerge and ...

https://journals.sagepub.com/doi/pdf/10.1177/1557988312458793

Risk and Protective Factors Associated with Gay Neighborhood Residence

Health and social disparities are widespread among men who have sex with men (MSM). Although literature indicates that Black MSM (BMSM) are no more likely than other MSM to report sexual risk behaviors, such as unprotected anal intercourse, studies have reported that buying and trading sex appear to be important risk factors for BMSM. Substance use generally is not significantly greater among BMSM than other MSM, studies have found that BMSM report more powder and crack cocaine use than other MSM. The lack of adequate coping skills and social support for BMSM has also been documented. This paper examines differences in substance use, sexual risk behaviors and social support among Black and non-black MSM, in a sample of 515 men participating in a randomized intervention trial. BMSM reported higher rates of substance dependence (72.2 vs. 59.5 %, P = .015) and buying sex (49.1 vs. 17.4 %, P < .000) than non-Black MSM. BMSM also reported lower levels of social support than other MSM on all measures included in the study; e.g., getting help and emotional support from others (38.0 vs. 52.8 %, P < .006). Mediation analyses showed that BMSM’s higher rates of substance dependence and buying sex are partially mediated by lower levels of social support. Our data appear to show that lack of social support is an important influence on risk behaviors among BMSM. Qualitative data also supported these findings. Sexual risk and substance use prevention interventions should address BMSM’s capacity to build adequate and supportive relationships.

Substance Use and Sexual Risk Mediated by Social Support Among Black Men

https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=6561&context=open_access_pubs

Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone.

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics (“syndemics”) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0–3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2–9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

Mance E. Buttram

Papers

Resilience, syndemic factors, and serosorting behaviors among hiv-positive and hiv-negative substance-using msm

Risk and Protective Factors Associated with Gay Neighborhood Residence

Substance Use and Sexual Risk Mediated by Social Support Among Black Men

Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone.

HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida.