Showing papers in "American Journal of Drug and Alcohol Abuse in 2018"
TL;DR: The structural and functional features of the AUDIT and methodological problems with the validation of the alcohol consumption questions (AUDIT-C) are described and the content, scoring, and rationale for a new version of theAUDIT, adapted to US standard drink size and hazardous drinking guidelines, is presented.
Abstract: Background. The US Preventive Services Task Force recommends that clinicians screen all adults for alcohol misuse and provide brief counseling to those engaged in risky or hazardous drinking. The W...
142 citations
TL;DR: Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily, and adolescent prevention programming should include focus on particular risks of simultaneous use.
Abstract: Background: Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use. Objectives: This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents. Methods: Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use. Results: A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no m...
86 citations
TL;DR: Ibogaine was associated with substantive effects on opioid withdrawal symptoms and drug use in subjects for whom other treatments had been unsuccessful, and may provide a useful prototype for discovery and development of innovative pharmacotherapy of addiction.
Abstract: Background: Ibogaine is a monoterpene indole alkaloid used in medical and nonmedical settings for the treatment of opioid use disorder. Its mechanism of action is apparently novel. There are no published prospective studies of drug use outcomes with ibogaine. Objectives: To study outcomes following opioid detoxification with ibogaine. Methods: In this observational study, 30 subjects with DSM-IV Opioid Dependence (25 males, 5 females) received a mean total dose of 1,540 ± 920 mg ibogaine HCl. Subjects used oxycodone (n = 21; 70%) and/or heroin (n = 18; 60%) in respective amounts of 250 ± 180 mg/day and 1.3 ± 0.94 g/day, and averaged 3.1 ± 2.6 previous episodes of treatment for opioid dependence. Detoxification and follow-up outcomes at 1, 3, 6, 9, and 12 months were evaluated utilizing the Subjective Opioid Withdrawal Scale (SOWS) and Addiction Severity Index Composite (ASIC) scores, respectively. Results: SOWS scores decreased from 31.0 ± 11.6 pretreatment to 14.0 ± 9.8 at 76.5 ± 30 hours posttre...
81 citations
TL;DR: It is suggested that regular cannabis use is associated with mild cognitive changes in addition to structural and functional alterations in the brain in adults, and the morphological alterations could ultimately affect brain organization and function.
Abstract: Background: Cannabis is the most used illicit drug worldwide. The long-standing consequences for the central nervous system associated with frequent cannabis use have not been well delineated and s...
79 citations
TL;DR: Ibogaine’s legal availability in New Zealand may offer improved outcomes where legislation supports treatment providers to work closely with other health professionals.
Abstract: Background: The psychoactive indole alkaloid ibogaine has been associated with encouraging treatment outcomes for opioid dependence. The legal status of ibogaine in New Zealand provides a unique opportunity to evaluate durability of treatment outcomes. Objective: To examine longitudinal treatment effects over a 12-month period among individuals receiving legal ibogaine treatment for opioid dependence. Method: This observational study measured addiction severity as the primary outcome in 14 participants (50% female) over 12 months post-treatment using the Addiction Severity Index-Lite (ASI-Lite) following a single ibogaine treatment by either of two treatment providers. Secondary effects on depression were assessed via the Beck Depression Inventory-II (BDI-II). The Subjective Opioid Withdrawal Scale (SOWS) was collected before and immediately after treatment to measure opioid withdrawal symptoms. Results: Nonparametric comparisons via Friedman Test between baseline and 12-month follow-up for partic...
61 citations
TL;DR: Healthcare providers should screen for marijuana and other substance use among older adults and provide education about associated injury risks, indicating that marijuana use increases the likelihood of ED visits through increased injury risk.
Abstract: Background: Despite increasing marijuana use among older adults, little research has been done on marijuana’s effects on their healthcare use. Objectives: To examine whether (1) marijuana use is associated with the likelihood of emergency department (ED) visits through increased injury risk, and (2) marijuana use patterns are associated with injury risk and ED visits among older adults. Methods: Using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Problems (N = 14,715 aged 50+; 6,379 men and 8,336 women), descriptive statistics were used to compare past-year marijuana users to nonusers on sociodemographic and physical/mental health characteristics. Structural equation modeling was used to simultaneously estimate whether injury mediates past-year marijuana use’s association with ED visits. Logistic regression analysis was used to examine associations of marijuana use patterns with injury and ED visits. Results: Past-year injury rates were 18.9% for nonusers and 28.8% for users (...
55 citations
TL;DR: DNA hypermethylation of the R2 region of the OPRM1 promoter in leukocytes of opium use disorder was demonstrated, demonstrating changes of epigenetic endpoints with substance use can be considered as potentially clinically useful biomarkers in identifying individuals who may warrant further diagnostic assessment of a substance use disorder.
Abstract: Background: The mu-opioid receptor, encoded by mu-opioid receptor gene (OPRM1), has an important role in the development of addiction to opioids. Its aberrant reduction on the cell membrane is responsible, at least in part, for tolerance and physical dependence. Objectives: The present study was designed to identify the relationship between opium consumption and epigenetic mechanisms involved in opium addiction. Methods: Genomic DNA was extracted from the peripheral blood of 66 men with opium use disorder and 57 healthy men as a control group. Genomic DNAs were treated with sodium bisulfite to convert the un-methylated cytosine to uracil, while methylated cytosine remained unaffected. Nested methylation-specific PCR (MSP) was used for analyses of region 1 (R1) and region 2 (R2) of the OPRM1 promoter DNA methylation. Results: All participants were 19–56 years old, and there was no significant difference in the mean age of both groups (P = 0.082). After Bonferroni correction, results showed that the...
47 citations
TL;DR: The findings of ecological momentary assessment support sex-based tailoring of treatment, but because not all participants conformed to the overall pattern of sex differences, any such tailoring should also consider person-level differences.
Abstract: Background: Responses to stress and drug craving differ between men and women. Differences in the momentary experience of stress in relation to craving are less well-understood. Objectives: Using e...
42 citations
TL;DR: Limited evidence of a relationship between gender, substance use treatment modality, and alcohol use is found and it is found that both formal and informal treatment approaches are similarly effective across both men and women.
Abstract: Background: Although many formal and informal substance use treatment programs were originally designed for men, no studies have investigated how gender affects the use of substance use treatment m...
41 citations
TL;DR: Neurostimulation with the BRIDGE is associated with a reduction in opioid withdrawal scores during the induction phase of opioid withdrawal therapy and allowed for effective transition to medication assisted therapy (MAT).
Abstract: Background: Finding an effective, non-pharmacological approach to treat opioid withdrawal could remove some of the barriers associated with pharmacotherapy. The BRIDGE® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. Objectives: This pilot study aimed to determine (1) the effects of the BRIDGE on withdrawal scores during the induction phase of opioid withdrawal therapy, (2) the percentage of subjects who successfully transitioned to medication assisted therapy (MAT). Methods: Adult patients treated with the BRIDGE during medically supervised withdrawal were included in this open label, uncontrolled, and retrospective study. The clinical opioid withdrawal scale (COWS) scores were prospectively recorded at different intervals (20, 30, and 60 min) and analyzed retrospectively. A subset of patients had scores recorded 5-days post-BRIDGE. Those who returned to the clinic and received their first dose of maintenance medication were considered to be successfully...
40 citations
TL;DR: The current dilemmas and questions regarding the use of medication-assisted treatment among youth with opioid use disorder are outlined and some potential solutions based on the current evidence are proposed.
Abstract: The prevalence of risky opioid use, opioid use disorder, and related harms continue to rise among youth (adolescents and young adults age 15-25) in North America. With an increasing number of opioid overdoses, there remain significant barriers to care for youth with opioid use disorder, and there is an urgent need to expand evidence-based care for treatment of opioid use disorder among this population. Based on the extensive literature on treatment of opioid use disorder among adults, medicated-assisted treatment is likely to be an important or even essential component of treatment of opioid use disorder for most youth. In this article, we outline the current dilemmas and questions regarding the use of medication-assisted treatment among youth with opioid use disorder and propose some potential solutions based on the current evidence.
TL;DR: The limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders are described and how the two approaches can be employed together to improve clinical outcome are assessed.
Abstract: Background: People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be ...
TL;DR: Ecological Momentary Assessments can be used to predict drug use among homeless youth and should be addressed to address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use.
Abstract: Background. Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examin...
TL;DR: There are continued barriers to SUD service use for homeless women despite high motivation for treatment, and willingness to be asked about SUD and mental health problems in primary care.
Abstract: Background: Homeless women are at high risk for substance use disorder (SUD), and are a growing proportion of the homeless population. However, homeless women experience barriers to engaging in sub...
TL;DR: RHSs have significantly beneficial effects on substance use and school absenteeism after 6 months for adolescents treated for SUDs, according to the first quasi-experimental outcome study to determine RHS effectiveness relative to students in non- RHSs.
Abstract: Background: Recovery high schools (RHSs) provide post-treatment education and recovery support for young people with substance use disorders (SUDs). This is the first quasi-experimental outcome study to determine RHS effectiveness relative to students in non-RHSs. Objectives: To examine effects of RHS attendance on academic and substance use outcomes among adolescents treated for SUDs 6 months after recruitment to the study. Methods: A quasi-experimental design comparing outcomes for adolescents with treated SUDs who attended RHSs for at least 28 days versus a propensity-score balanced sample of students with treated SUDs who did not attend RHSs. The sample included 194 adolescents (134 in RHSs, 60 in non-RHSs) enrolled in Minnesota, Wisconsin, or Texas schools (M age = 16; 86% White; 49% female). Multilevel linear regression models were used to examine the effect of RHS attendance on students’ outcomes, after adjusting for a range of potential confounders. Results: Adolescents attending RHSs were...
TL;DR: A single session of rTMS applied to the DLPFC may not reduce cue-elicited craving in heavy cannabis users, and treatment is well tolerated.
Abstract: Background: Cannabis use disorder (CUD) is a common condition with few treatments. Several studies in other substance use disorders have found that applying repetitive transcranial magnetic stimula...
TL;DR: This study suggests that functional polymorphisms related to synaptic dopamine or serotonin levels may predict dropout rates during methadone treatment and may require additional treatment to improve their chances of completing addiction treatment.
Abstract: Background: Currently, no pharmacogenetic tests for selecting an opioid-dependence pharmacotherapy have been approved by the US Food and Drug Administration. Objectives: Determine the effects of va...
TL;DR: Clinicians should consider screening patients for alcohol consumption, particularly if patients have comorbid medical conditions, suboptimal antiretroviral adherence, and/or detectable viral load.
Abstract: Background: Alcohol use is common among persons living with HIV (PLWH). It is unclear how alcohol consumption changes over time and if these changes are associated with clinical profiles.Objective:...
TL;DR: Findings highlight the importance of impulsive urgency (both positive and negative) in emerging adult problematic alcohol use, and support the generalizability of college samples to broader emerging adult populations.
Abstract: Background: Alcohol use and related problems reach a peak in emerging adulthood Impulsivity is a multifaceted construct known to be involved in emerging adult alcohol use Few studies have examine
TL;DR: The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.
Abstract: Background: The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treat...
TL;DR: It is recommended that referring to pharmacotherapy for SUD as simply “medication,” as it does for other chronic medical disorders, will bring both clarity and precision to this effective treatment approach.
Abstract: The gap between treatment utilization and treatment need for substance use disorders (SUDs) remains a significant concern in our field. While the growing call to bridge this gap often takes the form of more treatment services and/or better integration of existing services, this perspective proposes that more effective labels for and transparent descriptions of existing services would also have a meaningful impact. Adopting the perspective of a consumer-based health-care model (wherein treatments and services are products and patients are consumers) allows us to consider how labels like Addiction-focused Medical Management, Medication-Assisted Treatment, Medication-Assisted Therapy, and others may actually be contributing to the underutilization problem rather than alleviating it. In this perspective, "Medication-Assisted Therapy" for opioid-use disorder (OUD) is singled out and discussed as inherently confusing, providing the message that pharmacotherapy for this disorder is a secondary treatment to other services which are generally regarded, in practice, as ancillary. That this mixed message is occurring amidst a nationwide "opioid epidemic" is a potential cause for concern and may actually serve to reinforce the longstanding, documented stigma against OUD pharmacotherapy. We recommend that referring to pharmacotherapy for SUD as simply "medication," as we do for other chronic medical disorders, will bring both clarity and precision to this effective treatment approach.
TL;DR: Overall, cocaine and methamphetamine users share similar neuropsychological profiles, however, cocaine seems to be more associated with working memory impairments, which are typically frontally mediated, while methamphetamine appears to beMore associated with memory impairment that is linked with temporal and parietal lobe dysfunction.
Abstract: Background: Previous meta-analytical research examining cocaine and methamphetamine separately suggests potentially different neuropsychological profiles associated with each drug. In addition, neuroimaging studies point to distinct structural changes that might underlie differences in neuropsychological functioning. Objectives: This meta-analysis compared the effect sizes identified in cocaine versus methamphetamine studies across 15 neuropsychological domains. Method: Investigators searched and coded the literature examining the neuropsychological deficits associated with a history of either cocaine or methamphetamine use. A total of 54 cocaine and 41 methamphetamine studies were selected, yielding sample sizes of 1,718 and 1,297, respectively. Moderator analyses were conducted to compare the two drugs across each cognitive domain. Results: Data revealed significant differences between the two drugs. Specifically, studies of cocaine showed significantly larger effect-size estimates (i.e., poorer...
TL;DR: More psychometric work is needed to determine the reliability and validity of using the CUDIT-R to screen for CUD among military veterans who use medicinal cannabis and other subpopulations of cannabis users.
Abstract: Background: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R) is an 8-item measure used to screen for cannabis use disorders (CUD). Despite widespread use of the tool, assessments of...
TL;DR: This secondary analysis provides evidence that for participants maintained on opioid agonist therapy, clonidine minimized the behavioral impact of moderate levels of negative affect and craving.
Abstract: Background: In a recent clinical trial (NCT00295308), we demonstrated that clonidine decreased the association between opioid craving and moderate levels of stress and affect in patients receiving buprenorphine-based opioid agonist therapy. Objectives: To examine the relationship between illicit opioid use and craving and affect during the evaluation of clonidine as an adjunct medication in buprenorphine treatment for opioid use disorder. Secondarily, to examine whether those relationships are driven by within- or between-participant factors. Methods: This was a secondary data analysis from our original trial. Participants (N = 108, female: n = 23, male n = 85) receiving buprenorphine were randomized to receive adjunct clonidine or placebo. Participants used portable electronic devices to rate stress, mood, and craving via ecological momentary assessment (EMA) four times randomly each day. To associate the EMA data with illicit opioid use, each EMA report was linked to participants’ next urine dru...
TL;DR: A retrospective chart review suggests the feasibility of a novel protocol for medically supervised opioid withdrawal and transition to relapse prevention strategies, including injectable ER naltrexone, which does not utilize opioid agonists or other controlled substances.
Abstract: Background: The clinical feasibility of a novel non-opioid and benzodiazepine-free protocol was assessed for the treatment of medically supervised opioid withdrawal and transition to subsequent rel...
TL;DR: Substantial reductions in HIU among an SUD population will likely require treatment approaches that target patients with less-severe mental health conditions in addition to SMI, and interventions designed to target issues and/or conditions that lead to HIU may be critical to reducing HIU.
Abstract: Background. Substance-use disorders (SUDs) are common and costly conditions. Understanding high inpatient utilization (HIU) among patients with SUD can inform the development of treatment approaches designed to reduce healthcare expenditures and improve service quality. Objectives. To examine the prevalence, type, and predictors of HIU among patients with SUD and co-occurring mental health conditions. Methods. Service utilization and demographic and clinical variables were extracted from a national sample of Veterans Health Administration (VA) patients with SUD-only [n = 148,960 (98.3% male)], SUD plus serious mental illness ([i.e. schizophrenia- and/or bipolar-spectrum disorders; SUD/SMI; n = 75,913 (91.6% male)], and SUD plus other mental illness [SUD/MI; n = 245,675 (94.6% male)]. Regression models were used to examine HIU during a follow-up year. Results. Prevalence of HIU among the SUD-only group was 6.2% (95% confidence interval (CI): 6.1%–6.3%) compared with 22.7% (95% CI: 22.4%–23.0%) and ...
TL;DR: The results suggest that although a significant subset shows concern for the above obstacles, the majority of Chiefs of Police believe that the benefits of equipping officers with naloxone outweigh the risks.
Abstract: Background: Recent legislation in Pennsylvania allows police officers to administer naloxone to individuals in an opioid overdose. Pressure has subsequently been placed on police departments to adopt naloxone programs. Objective: To survey Pennsylvania Chiefs of Police regarding potential obstacles to officer-administered naloxone, and their overall opinion toward such programs. Methods: A confidential survey was administered at the Annual Conference for the Pennsylvania Chiefs of Police Association and online over the organization’s listserv. Respondents rated their level of concern toward four potential obstacles on a Likert scale from 1 to 5. A fifth question asked the degree to which they agree that the benefits of naloxone programs outweigh the risks. Results: Of 180 attendees, 36 Chiefs of Police responded at the conference and 48 to the online survey. The potential agitation of revived victims was their largest reported concern, with 60% responding either a 4 or 5; this was followed by offi...
TL;DR: Ibogaine is an indole alkaloid that comes from the root of the West African shrub Tabernanthe iboga as discussed by the authors, and has been used for centuries in spiritual celebrations, coming of age rituals, and heali...
Abstract: Ibogaine is an indole alkaloid that comes from the root of the West African shrub Tabernanthe iboga. Ibogaine has been used for centuries in spiritual celebrations, coming of age rituals, and heali...
TL;DR: Findings highlight how college students in Greek life may be at high risk for blackouts, and the need for programs focusing on substance use, depression, and preventing sexual assault.
Abstract: Background: Alcohol-related blackouts are a common consequence of heavy drinking, and these blackouts pose risk for injury and other adverse health outcomes. Objective: To examine the prevalence an...
TL;DR: While bi/multiracial youth in general exhibit elevated levels of substance use, substantial heterogeneity exists among this rapidly-growing demographic.
Abstract: Background: Bi/multiracial youth face higher risk of engaging in substance use than most monoracial youth. Objectives: This study contrasts the prevalence of substance use among bi/multiracial yout...