Showing papers in "American Journal on Addictions in 2014"

The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates.

Abstract: Background and Objectives Although various surveys have tracked the prevalence of anabolic-androgenic steroid (AAS) use in American teenagers and young adults, no recent surveys have assessed the lifetime prevalence of AAS use in Americans overall We therefore analyzed serial youth-survey data to derive estimates of the lifetime prevalence of AAS use in the current American general population Methods We first determined the distribution of age of onset of AAS use, based on pooled data from nine studies Using this distribution, we then developed equations to project the eventual lifetime prevalence of AAS use among young survey respondents, once they aged and completed the period of risk for initiating AAS We similarly calculated the denominator of lifetimes of risk for AAS use in the total American population We next applied these equations to four independent national youth datasets to derive current American general-population estimates for lifetime AAS use Finally, using data from 10 pooled studies, we estimated the lifetime prevalence of AAS dependence among AAS users Results Age-of-onset studies consistently showed that AAS use begins later than most drugs, with only 22% of users (95% confidence interval: 19–25%) starting before age 20 Applying the age-of-onset findings to national youth datasets, we estimated that among Americans currently age 13–50 years, 29–40 million have used AAS Within this group, roughly 1 million may have experienced AAS dependence Conclusions and Scientific Significance Although subject to various limitations, our estimation techniques suggest a surprisinigly high prevalence of AAS use and dependence among Americans (Am J Addict 2014;23:371–377)

Quality of life and smoking.

Abstract: Background and Objectives Smoking tobacco is the leading cause of preventable illness in the United States and around the world. However, much remains unknown about the factors that motivate individuals to smoke. Quality of life (QoL) has become an important measure of outcomes across all medical specialties, in both research and clinical settings. To date, there has not been a critical review of the research relevant to QoL in smokers. In this review, we describe which scales are used to quantify the QoL of smokers, the relationship between smoking and QoL and the positive impact of smoking cessation. Methods Fifty-four relevant studies are included in our review. Results Low QoL and depression are associated with higher odds of smoking initiation and lower odds of successful smoking cessation. There is a negative relationship between smoking and QoL and the magnitude of this association is related to the number of cigarettes smoked. Secondhand smoke also appears to be negatively associated with QoL. Smoking cessation significantly improves QoL. These findings have been replicated across populations with diverse socioeconomic and cultural groups around the world. Discussion and Conclusions QoL data promotes smokers and practitioners to become more sensitive to the sub-clinical adverse effects of cigarette smoking, thereby improving motivation to quit, cessation rates, and treatment outcomes. Scientific Significance Understanding the relationship between QoL and tobacco smoking is important for patients, clinicians, and researchers. (Am J Addict 2014;23:540–562)

Sex differences in smoking cue reactivity: craving, negative affect, and preference for immediate smoking.

Abstract: Department of Psychiatry, University of California, San Diego, CaliforniaBackgroundandObjectives:Femalesmokershavegreaterdifficultyquitting, possibly due to increased reactivity to smoking‐related cues.This study assessed sex differences in craving, affect, and preferencefor immediate smoking after cue exposure.Methods: Regular smokers (n ¼ 60; 50% female) were exposed tosmoking and neutral cues in separate, counterbalanced sessions.Outcomes included changes in craving and affect and preference forimmediate smoking following cue exposure.Results: Findings indicated that women exhibited greater preferencefor immediate smoking (p ¼ .004), and reported greater cue‐inducedincreases in cigarette craving (p ¼ .046) and negative affect(p ¼ .025).Discussion and Conclusions: These data suggest that women mayhavegreaterdifficultyinhibitingsmokingaftercueexposure,possiblyas a consequence of greater increases in craving and negative affect.Scientific Significance and Future Directions: Findings suggest amechanism that may contribute to greater cessation failure amongfemale smokers. (Am J Addict 2013;XX:1–7)

Nationwide dissemination of contingency management: The Veterans Administration initiative

Abstract: Background Contingency management (CM) is an empirically validated intervention but one not often applied in practice settings in the US. Objectives The aim of this article is to describe the veterans administration (VA) nationwide implementation of CM treatment. Methods In 2011, the VA called for integration of CM in its intensive outpatient substance abuse treatment clinics. As part of this initiative, the VA funded trainings and ongoing implementation support, and it provided direct funds for reinforcers and other intervention costs. Results Over 100 clinics received this funding in 2011, and CM has been implemented in over 70 substance abuse treatment clinics since August 2011. Conclusions This training and implementation experience has been highly successful and represents the largest scale training in evidence-based treatments for substance use disorders in the VA health care system to date. Scientific Significance This program may serve as a model for training in evidence-based treatments. (Am J Addict 2014;23:205–210)

Cigarette smoking and drug use among a nationally representative sample of HIV‐positive individuals

Abstract: Background and Objectives Among HIV-positive populations, the prevalence of cigarette smoking remains disproportionately high and is associated with significant morbidity and mortality. Little is known about this topic among HIV-positive persons in the general population. Methods Data came from the 2005 to 2011 National Survey on Drug Use and Health (NSDUH) public use data files. Unadjusted and adjusted multinomial logistic regression analyses explored the associations between socio-demographic, drug and alcohol use, and drug and/or alcohol treatment characteristics with smoking status among HIV-positive individuals (n = 349). Results More than 40% of the sample was current smokers. In adjusted analyses, females (aRRR = .11, 95% CI = .03–.41) and participants who had never been married (aRRR = .19, 95% CI = .05–.58), were more likely to be former smokers than never smokers. Females (aRRR = .37, 95% CI = .14–.96) and individuals older than age 35 (aRRR = .37, 95% CI = .16–.89) were less likely to be current smokers than never smokers. Conversely, previously married persons (aRRR = 5.72, 95% CI = 1.40–23.31), participants reporting binge drinking (aRRR = 5.96, 95% CI = 2.27–15.64), and lifetime drug or alcohol treatment (aRRR = 5.12, 95% CI = 2.09–12.55) were more likely to be current smokers than never smokers. Conclusions Findings help confirm the high prevalence of smoking among HIV-positive persons suggesting the need for integrated substance use and smoking cessation treatment among HIV-positives. Scientific Significance The present findings have implications for the development and implementation of targeted smoking cessation programs for HIV-positive smokers. (Am J Addict 2014;23:582–590)

The waterpipe: a new way of hooking youth on tobacco.

Abstract: Background Tobacco smoking continues to be the number one preventable cause of morbidity and mortality worldwide. Several evidence-based interventions and policies have been successful in reducing cigarette smoking in developed countries. Globally, however, many beginning smokers are introduced to tobacco by means other than cigarettes. In particular, waterpipe smoking (a.k.a. hookah, narghile, shisha) has been dramatically increasing among youth worldwide. Methods In this short review, I will introduce the reader to this emerging tobacco use method and focus on its addictive properties, and how this pertains to the development of effective interventions to curb its spread. Results and Conclusions Waterpipe smoking is likely to be associated with much of the harmful effects of cigarette smoking, is addictive, and can serve as a bridge to cigarettes. Due to its unique features, waterpipe-specific interventions and policies are needed to curb the global waterpipe epidemic. (Am J Addict 2014;23:103–107)

The self-medication hypothesis and psychostimulant treatment of cocaine dependence: an update.

Abstract: Background: Stimulant medications have shown promise as a treatment for cocaine dependence (CD) for several decades, yet these treatments have not been widely studied and substantial barriers to clinical implementation remain. The “Self‐Medication Hypothesis,” posits that an individual’s choice to use a particular substance is to some degree based on the substance’s effect on subjective painful affects or unpleasant emotional states which may or may not be associated with a psychiatric disorder. Objectives: The Self‐Medication Hypothesis remains relevant, particularly when considering the scenario of cocaine dependence, both with and withoutandco‐occurringattention‐deficit/hyperactivitydisorder(ADHD). Methods: Two case studies (N ¼ 2) and a review of the relevant literature are provided in this clinical update on psychostimulant treatment of cocaine dependence. Results: Two case studies are presented in which psychostimulant treatment of cocaine dependence was associated with a good clinical outcome. Discussion: While the use of psychostimulant medication for the treatment of cocaine dependence is controversial, emerging evidence suggests potential utility for this approach. Conclusions: Cocaine use in individuals with CD may represent self‐ medication, and prescribed psychostimulants may have benefi ti n restoring dopaminergic function. Scientific Significance: Psychostimulant treatment of cocaine dependence is consistent with the Self‐Meidcation Hypothesis and is deserving of further study. (Am J Addict 2013;XX:000–000)

Predictive factors for relapse in patients on buprenorphine maintenance.

Abstract: Background and Objectives Despite the dramatic increase in the use of buprenorphine for the treatment of opioid dependence, clinical outcomes of this treatment approach continue to need evaluation. This study examines factors associated with relapse and retention during buprenorphine treatment in a sample of opioid dependent outpatients. Methods In a retrospective chart review of 62 patients with opioid dependence, relapse was determined by self-report, urine toxicology screens, and by checking the state controlled substance monitoring database. Data was analyzed using two-way tests of association and logistic regression. Results Patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy), or active alcohol abuse, were significantly more likely to relapse. Patients who relapsed were also more likely to be on a higher buprenorphine maintenance dose. Conclusion This study identifies relapse risk factors during buprenorphine treatment for opioid dependence. Future research is needed to determine whether modifying these factors may lead to improved treatment outcomes. (Am J Addict 2014;23:62–67)

Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment.

Abstract: Objectives: Chronic, frequent cannabis smokers may experience residual and offset effects, withdrawal, and craving when abstaining from the drug. We characterized the prevalence, duration, and intensity of these effects in chronic frequent cannabis smokers during abstinence on a closed research unit. Methods:Non‐treatment‐seekingparticipants(N ¼ 29onadmission, 66% and 34% remaining after 2 and 4 weeks) provided subjective effects data. A battery of five instruments was computer‐administered daily to measure psychological, sensory, and physical symptoms associated with cannabinoid intoxication and withdrawal. Plasma and oral fluid specimens were concurrently collected and analyzed for cannabinoids. Outcome variables were evaluated as change from admission (Day 0) with regression models. Results: Most abstinence effects, including irritability and anxiety were greatest on Days 0–3 and decreased thereafter. Cannabis craving significantlydecreasedovertime,whereasdecreasedappetitebeganto normalize on Day 4. Strange dreams and difficulty getting to sleep increased over time, suggesting intrinsic sleep problems in chronic cannabis smokers. Symptoms likely induced by residual drug effects were at maximum intensity on admission and positively correlated with plasma and oral fluid cannabinoid concentrations on admission but not afterward; these symptoms showed overall prevalence higher than cannabis withdrawal symptoms. Conclusions: The combined influence of residual/offset drug effects, withdrawal, and craving was observed in chronic cannabis smokers during monitored abstinence. Abstinence symptoms were generally more intense in the initial phase, implying importance of early interventionincannabisquitattempts.Sleepdisturbancepersistingfor an extended period suggests that hypnotic medications could be beneficial in treating cannabis dependence. (Am J Addict 2013;

A successful treatment of buprenorphine withdrawal with the dopamine receptor agonist pramipexole

Abstract: Background Buprenorphine, used for treating opioid dependence, may have a withdrawal syndrome requiring treatment. Modulation of the dopamine system, which has been implicated in opioid withdrawal, may be a target for withdrawal for opioids such as buprenorphine. Case Report A case is reported of a buprenorphine withdrawal syndrome with predominant symptoms of restlessness that were resistant to clonidine and benzodiazepines. It was successfully treated with the dopamine agonist pramipexole. Scientific Significance Dopamine receptor agonists may have a place in the treatment of restlessness associated with opioid withdrawal and may have value for the broader spectrum of opioid withdrawal symptoms. (Am J Addict 2014;23:475–477)

The Course of Sleep Disturbances in Early Alcohol Recovery: An Observational Cohort Study

Abstract: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MinnesotaIntroduction: Understanding the course and determinants of sleepdisturbances in alcoholic patients may help identify patients at highrisk of persistent sleep problems, relapse and guide treatmentinterventions.Methods: We prospectively administered the Pittsburgh SleepQuality Index (PSQI) to all patients (N ¼ 196) admitted to a 1‐month residential treatment program. Our analysis excluded patientswith active drug abuse/dependence. Demographic data, psychiatricdiagnoses, Patient Health Questionnaire‐9 (PHQ‐9), Alcohol UseDisorders Identification Test (AUDIT) and Inventory of Drug TakingSituations (IDTS) scores were obtained. Univariate and logisticregressionanalyseswereperformedusingsex,age,hazardousalcoholuse, PHQ‐9 scores, hypnotic use, and use of alcohol as a hypnotic ascorrelatestoadmissionPSQIscoresandimprovementinPSQIscores.Results:Atotalof119alcoholicpatientsmetinclusioncriteria(meanage 50.6 13.2 years). The rates of sleep disturbances at admissionand discharge were 69.3% and 49.1%, respectively. Self report ofusing alcohol to fall asleep and use of hypnotics were associated withelevated PSQI scores. Total PSQI scores improved over 4 weeks(p < .001).ChangeinPSQIscoreswasnoteffectedbygender,useofhypnotics, hazardous alcohol use, use of alcohol as a hypnotic or co‐morbid psychiatric diagnosis. Older age predicted improvement inPSQI scores in patients with sleep disturbances (p ¼ .004).Conclusion: While a large proportion of alcoholics had sleepdisturbances upon admission and at discharge from a residentialtreatment program, only older age was associated with improvementsin sleep disturbances during early alcohol recovery. (Am J Addict2014;23:21–26)

Genome-wide association discoveries of alcohol dependence.

Abstract: Objective To report the genome-wide significant and/or replicable risk variants for alcohol dependence and explore their potential biological functions. Methods We searched in PubMed for all genome-wide association studies (GWASs) of alcohol dependence. The following three types of the results were extracted: genome-wide significant associations in an individual sample, the combined samples, or the meta-analysis (p < 5 × 10−8); top-ranked associations in an individual sample (p < 10−5) that were nominally replicated in other samples (p < .05); and nominally replicable associations across at least three independent GWAS samples (p < .05). These results were meta-analyzed. cis-eQTLs in human, RNA expression in rat and mouse brains and bioinformatics properties of all of these risk variants were analyzed. Results The variants located within the alcohol dehydrogenase (ADH) cluster were significantly associated with alcohol dependence at the genome-wide level (p < 5 × 10−8) in at least one sample. Some associations with the ADH cluster were replicable across six independent GWAS samples. The variants located within or near SERINC2, KIAA0040, MREG–PECR or PKNOX2 were significantly associated with alcohol dependence at the genome-wide level (p < 5 × 10−8) in meta-analysis or combined samples, and these associations were replicable across at least one sample. The associations with the variants within NRD1, GPD1L–CMTM8 or MAP3K9–PCNX were suggestive (5 × 10−8 < p < 10−5) in some samples, and nominally replicable in other samples. The associations with the variants at HTR7 and OPA3 were nominally replicable across at least three independent GWAS samples (10−5 < p < .05). Some risk variants at the ADH cluster, SERINC2, KIAA0040, NRD1, and HTR7 had potential biological functions. Conclusion The most robust risk locus was the ADH cluster. SERINC2, KIAA0040, NRD1, and HTR7 were also likely to play important roles in alcohol dependence. PKNOX2, MREG, PECR, GPD1L, CMTM8, MAP3K9, PCNX, and OPA3 might play less important roles in risk for alcohol dependence based on the function analysis. This conclusion will significantly contribute to the post-GWAS follow-up studies on alcohol dependence. (Am J Addict 2014;23:526–539)

Cannabis and related impairment: the unique roles of cannabis use to cope with social anxiety and social avoidance.

Abstract: Background and Objectives Social anxiety appears to be a risk factor for cannabis-related problems. Socially anxious individuals are vulnerable to using cannabis to cope in social situations and to avoiding social situations if marijuana is unavailable. Yet, the relative impact of cannabis use to cope with social anxiety relative to use to cope with negative affect more broadly has yet to be examined. Methods The present study used the Marijuana to Cope with Social Anxiety Scale (MCSAS) to examine the incremental validity of using cannabis use to cope in social situations (MCSAS-Cope) and avoidance of social situations if cannabis is unavailable (MCSAS-Avoid) in a community-recruited sample of 123 (34.1% female) current cannabis users. Results After controlling for age of first cannabis use, gender, alcohol and tobacco use, other cannabis use motives, and cannabis expectancies, MCSAS-Cope remained significantly positively related to cannabis use frequency and cannabis-related problems. After controlling for age of first cannabis use, gender, alcohol and tobacco use, and experiential avoidance, MCSAS-Avoid remained significantly related to cannabis problems but not frequency. Discussion and Conclusions The present findings suggest that cannabis use to manage social forms of anxiety may be important to understanding cannabis use behaviors. Scientific Significance The current findings identify cognitive/motivational factors implicated in more frequent cannabis use and in cannabis-related impairment, which may be essential to inform efforts to further refine prevention and treatment efforts. (Am J Addict 2014;23:598–603)

Trends in the use of buprenorphine by office-based physicians in the United States, 2003-2013: Buprenorphine Use by Physicians in US, 2003-2013

Abstract: BACKGROUND AND OBJECTIVES Despite buprenorphine's promise as a novel therapy for opioid dependence, little is known about its clinical adoption. We characterized trends in ambulatory use of buprenorphine in the United States. METHODS Cross-sectional, descriptive analyses of buprenorphine utilization from 2003 to 2013 using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory care. The primary unit of analysis was an office visit where buprenorphine was used for opioid dependence (treatment visit). RESULTS Between 2003 and 2013, there was significant uptake of buprenorphine in ambulatory treatment visits, from 0.16 million [M] (95% confidence interval [CI] 0.10-0.20) visits in 2003 to 2.1M (CI 1.9-2.3M) treatment visits during 2013. Approximately 90% involved the use of brand name combination buprenorphine/naloxone (Suboxone), although this percentage decreased modestly to 80% by the last quarter of 2013. Buprenorphine prescribing increased among all specialties, but the proportion accounted for by primary care physicians increased significantly from 6.0% in 2003 to 63.5% in 2013 and decreased among psychiatrists from 92.2% to 32.8% over the same time period. CONCLUSIONS The use of buprenorphine products to treat opioid dependence has increased significantly in the past 10 years and has shifted to greater use by primary care physicians, indicating a rapidly changing face of opioid maintenance therapy in the United States. (Am J Addict 2014;XX:XX-XX).

Pharmacogenetics of naltrexone and disulfiram in alcohol dependent, dually diagnosed veterans.

Abstract: Background Disulfiram and naltrexone were evaluated in treatment of individuals with co-occurring alcohol dependence and other Axis I disorders (e.g., Major Depression). We explored pharmacogenetic interactions in genotyped subjects. Methods Alcohol dependent (AD) subjects received naltrexone alone, placebo alone, disulfiram with placebo or disulfiram with naltrexone. They were genotyped for OPRM1 rs1799971 (Asn40Asp), and DBH rs1611115 (C-1021T). N = 107 male European-American subjects were included. Results There were no significant interactions with OPRM1. DBH interacted with naltrexone on the primary outcome of abstinence from heavy drinking (χ2(1) = 5.23, p = .02). “T” allele carriers on naltrexone had more abstinence compared to “CC” subjects on naltrexone (FET, p = .01). “T” allele carriers on naltrexone had the highest overall rates of abstinence from heavy drinking (>90%). Also, DBH genotype interacted with disulfram (F(1,17) = 7.52, p = .01) on drinks per drinking day with less drinking for subjects with the “CC” genotype than for T allele carriers on disulfiram. Conclusions DBH*rs1611115*T associated with better response to naltrexone, while for those on disulfiram that drank, “CC” subjects drank less than T carriers. For rs1799971*G, we did not replicate findings from previous studies showing a more favorable response to NTX, possibly due to the small available sample. Scientific Significance Genotyping rs1611115 may be useful in understanding inter-individual differences in AD treatment response. Future Directions Further study of rs1611115 pharmacogenetics is warranted. (Am J Addict 2013;XX:000–000)

Ziprasidone versus clozapine in the treatment of dually diagnosed (DD) patients with schizophrenia and cannabis use disorders: A randomized study

Abstract: Background and Objectives Clozapine is considered to be particularly effective in the treatment of dually diagnosed (DD) patients with psychosis and substance use disorders. However, its use is restricted by potentially severe side effects. The aim of the present pilot study was to compare the effects of clozapine with the newer second generation antipsychotic (SGA) ziprasidone in DD-patients. Methods Thirty (n = 30) patients with schizophrenia and cannabis abuse/dependence were randomized to ziprasidone or clozapine and were followed up for up to 12 months. Results Cannabis use was reduced in both groups during follow-up. Clozapine treatment was associated with less positive symptoms of schizophrenia, more side effects and poorer compliance with treatment. Conclusions Results from this small pilot RCT suggest beneficial effects of both clozapine and ziprasidone in the treatment of cannabis use disorders in psychotic patients. Larger-scale RCTs are needed in order to assess advantages and disadvantages of the different SGAs in dually diagnosed populations. (Am J Addict 2014;23:308–312)

Prescription medication misuse among opioid dependent patients seeking inpatient detoxification: Prescription Misuse Among Opioid Dependent Patients

Abstract: BACKGROUND AND OBJECTIVES Opioid related morbidity and mortality is heightened in context to the concomitant use of psychotropic medications. The aim of this project was to examine the extent to which opioid dependent patients seeking detoxification are using and misusing specific psychotropic agents. METHODS As part of a quality assurance/improvement project, we systematically assessed prospectively consecutive admissions to a public detoxification program using a self-report questionnaire to query for specific psychotropic medication use. Patients were asked about having a current prescription, appropriate use, and/or medical misuse (higher doses, using without prescription) of amphetamine salts, clonazepam, clonidine, gabapentin, and pregabalin. RESULTS We had data on 196 admissions including 162 patients with opioid dependency. Patients receiving detoxification from opioids compared to alcohol had statistically significant higher rates of medication misuse (30% vs. 0%, respectively; χ2 = 12.8, p < .0003). Of opioid dependent patients receiving prescription medication, 28% reported using higher amounts of each medication than prescribed. Of opioid patients, 10% self-reported misusing clonidine, 22% gabapentin, 7% pregabalin, 25% clonazepam, 11% amphetamine salts, and 36% any of these medications. DISCUSSION AND CONCLUSIONS Despite the "nonaddictive nature" of some medications (eg, gabapentin, clonidine), high rates of medication misuse in opioid dependent patients admitted for detoxification was found and appeared similar to rates of misuse among controlled substances such as clonazepam and amphetamine salts. These data suggest that opioid dependent patients should be queried for the appropriate use of prescribed medications and that practitioners need to monitor for medication misuse in opioid dependent patients. (Am J Addict 2014;XX:1-5).

Indirect effects of 12-session seeking safety on substance use outcomes: Overall and attendance class-specific effects

Abstract: Objectives This study examined in- and post-treatment mediation effects of a 12-session dose of Seeking Safety (SS)—an integrative cognitive behavioral treatment for comorbid PTSD and SUDs—on alcohol and cocaine outcomes in comparison to Women's Health Education (WHE) in a seven-site randomized controlled effectiveness trial. Methods Women (n = 353) enrolled in outpatient substance abuse treatment, who had experienced multiple traumas in childhood and/or adulthood and who had comorbid PTSD, were randomly assigned to receive SS or WHE delivered in open enrollment groups for 12 sessions in 6 weeks (unlike the full 25-topic SS protocol). Data were analyzed under two forms of longitudinal mediation analysis, each accounting for changes over time in group membership and group context, respectively. Results Women in SS, compared to WHE, showed significantly steeper decreases in PTSD frequency and severity, which in turn, showed significant impact in reducing both cocaine and alcohol use. This pattern was strongest for those who completed most of the treatment sessions, which was the majority of patients in the trial; these patterns only emerged during the in-treatment phase. Conclusions Use of an integrated approach to PTSD/SUD such as SS can be helpful to more rapidly reduce PTSD, which consequently reduce SUD symptoms, particularly for those who attend most of the available treatment sessions. Scientific Significance This is one of the first studies to illustrate such effects in treating comorbid PTSD and SUD in the context of a highly impaired population delivered by community-based providers. (Am J Addict 2014;23:218–225)

Problematic alcohol use and sexual assault among male college students: The moderating and mediating roles of alcohol outcome expectancies

Abstract: BACKGROUND AND OBJECTIVES: Extant research shows a strong relationship between alcohol use problems and sexual aggression. However, less is known about the effect of intermediary factors (eg, alcohol expectations) that may increase the likelihood of and/or explain sexual aggression during alcohol-related incidents. The present study examined alcohol outcome expectancies' (OE) mediating and/or moderating influence on the relationship between problematic alcohol use severity and sexual aggression among male college students. METHODS AND RESULTS: One hundred and forty eight (n = 148) male college students volunteered for the study. Seventy-seven males self-reported committing at least one act of sexual aggression in their lifetime. Among those who sexually aggressed, 74% also reported symptoms of problematic drinking. RESULTS show that sexuality-related alcohol OE fully mediated the relationship between problematic alcohol use severity and sexual aggression. RESULTS also showed that aggression-related alcohol OE moderated the relationship between problematic alcohol use severity and sexual aggression. Specifically, aggression-related alcohol OE only influenced the relationship between problematic alcohol use and sexual aggression when alcohol problems were less severe. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Discussion implicates the possible role alcohol prevention may play in reducing sexual aggression on college campuses, particularly as it relates to adjusting alcohol OE among those most likely to perpetrate. (Am J Addict 2014;XX:1-8). Language: en

Cue-induced craving in dependence upon prescription opioids and heroin.

Abstract: Background and Objectives Cues associated with heroin use (eg, needles, powder) elicit robust craving responses in individuals dependent upon heroin. Elevated cue-induced craving may be a risk factor for relapse and can persist after periods of drug abstinence. Despite the growing prevalence of opioid dependence involving prescription opioids, published studies have yet to examine whether cue-induced craving is also present in prescription opioid dependence. Methods A sample of 50 adults diagnosed with opioid dependence (20 prescription opioid users, 25 heroin users, and 5 mixed opioid users) completed a cue reactivity assessment. Participants were administered a series of 90 pictures, including heroin-specific, prescription opioid-specific, and neutral images, and were asked to rate craving and cue salience after each image. Results Both the prescription opioid and heroin groups experienced significantly more craving to drug than to neutral stimuli. The prescription opioid group reported significantly less craving to prescription opioid stimuli than the heroin group to heroin stimuli; however, this effect was smaller and non-significant when controlling for group differences in cue salience. Discussion and Conclusions This study found evidence for cue-induced craving in individuals dependent upon prescription opioids. Further research is needed to better understand the role of cue reactivity in the course and treatment of opioid dependence involving prescription opioid use. Scientific Significance As elevated craving reactivity to drug cues may reflect a risk factor for relapse, understanding the nature of cue-induced craving in individuals with opioid dependence is important to improving treatments for this population. (Am J Addict 2014;23:453–458)

Preliminary survey of office-based opioid treatment practices and attitudes among psychiatrists never receiving buprenorphine training to those who received training during residency.

Abstract: Objective To compare the characteristics, attitudes, and current prescribing practices of recently graduating psychiatrists who completed buprenorphine training during residency to those who never completed any training. Methods A total of 359 psychiatrists completing residency training between 2008 and 2011 were recruited to complete an on-line survey. Results Responses from 93 psychiatrists were included for a response rate of 25.9%. Psychiatrists completing any buprenorphine training during residency were more likely to be male and report more favorable views of OBOT with buprenorphine than compared to those who never completed any training. Twenty (38.5%) of those psychiatrists who completed training during residency reported the current prescribing of buprenorphine. Conclusions Completion of buprenorphine training during residency may be a factor in shaping future attitudes towards OBOT and buprenorphine prescribing practices. Further research is needed to clarify the impact of buprenorphine training during residency. Scientific Significance Buprenorphine training during residency training may be a contributing factor in shaping future physician attitudes towards office-based opioid treatment and buprenorphine prescribing practices. (Am J Addict 2014;23:618–622)

Examining potential school contextual influences on gambling among high school youth.

Abstract: Background and Objectives Gambling is an increasing concern among adolescence, yet there has been limited investigation into school-level factors that may increase the risk for gambling. The current study examined the relationship between substance use and gambling, and explored the influence of school context on adolescent gambling. Methods Data come from 25,456 students in 58 high schools participating in the Maryland Safe and Supportive Schools Initiative. Youth-reports of socio-demographics, lifetime gambling, and past-month substance use (ie, alcohol, cigarette, marijuana, non-medical prescription drug) were collected. School-level characteristics were student suspension rate, student mobility, percentage of students receiving free/reduce-priced meals, percentage of African American students, urbanicity, gambling prevalence, gambling problem prevalence, and substance use prevalence. Weighted multilevel analyses were conducted. Results One-third (n = 8,318) reported lifetime gambling, and 10% (n = 2,580) of the full sample, or 31% of the gamblers, experienced gambling problems. Being male and alcohol, marijuana, and non-medical prescription drug use were associated with twice the odds of gambling. Among gamblers, being male, African American, and cigarette, marijuana, and non-medical prescription drug use were associated with higher odds of gambling problems. The school-level factors of suspension rate and percentage of African American had minimal, inverse associations with gambling; however, none were related to gambling problems. Conclusions Multilevel results indicated that adolescents that are male and use substances are more likely to gamble and have gambling problems. Scientific Significance The findings indicate a need for prevention programs targeting risky behaviors to also target gambling as such behaviors often co-occur among adolescents. (Am J Addict 2014;23:510–517)

High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: results from a population-level retrospective cohort study.

Abstract: Background and Objectives The non-medical use of prescription opioids (PO) has increased dramatically in North America. Special consideration for PO prescription is required for individuals in methadone maintenance treatment (MMT). Our objective is to describe the prevalence and correlates of PO use among British Columbia (BC) MMT clients from 1996 to 2007. Methods This study was based on a linked, population-level medication dispensation database. All individuals receiving 30 days of continuous MMT for opioid dependence were included in the study. Key measurements included the proportion of clients receiving >7 days of a PO other than methadone during MMT from 1996 to 2007. Factors independently associated with PO co-prescription during MMT were assessed using generalized linear mixed effects regression. Results 16,248 individuals with 27,919 MMT episodes at least 30 days in duration were identified for the study period. Among them, 5,552 individuals (34.2%) received a total of 290,543 PO co-prescriptions during MMT. The majority (74.3%) of all PO dispensations >7 days originated from non-MMT physicians. The number of PO prescriptions per person-year nearly doubled between 1996 and 2006, driven by increases in morphine, hydromorphone and oxycodone dispensations. PO co-prescription was positively associated with female gender, older age, higher levels of medical co-morbidity as well as higher MMT dosage, adherence, and retention. Conclusion and Scientific Significance A large proportion of MMT clients in BC received co-occurring PO prescriptions, often from physicians and pharmacies not delivering MMT. Experimental evidence for the treatment of pain in MMT clients is required to guide clinical practice. (Am J Addict 2014;23:257–264)

Biochemical marker of use is a better predictor of outcomes than self-report metrics in a contingency management smoking cessation analog study.

Abstract: Background and Objectives This investigation compared cotinine (primary metabolite of nicotine) at study intake to self-report metrics (eg, Fagerstrom Test of Nicotine Dependence [FTND]) and assessed their relative ability to predict smoking outcomes. Methods We used data from an analog model of contingency management for cigarette smoking. Non-treatment seeking participants (N = 103) could earn money in exchange for provision of a negative carbon monoxide (CO) sample indicating smoking abstinence, but were otherwise not motivated to quit. We used intake cotinine, FTND, percent of friends who smoke, and years smoked to predict longitudinal CO and attendance, time-to-first positive CO submission, and additional cross-sectional outcomes. Results Intake cotinine was consistently predictive (p < .05) of all outcomes (eg, longitudinal CO and attendance, 100% abstinence, time-to-first positive CO sample), while years smoked was the only self-report metric that demonstrated any predictive ability. Conclusions and Scientific Significance Cotinine could be more informative for tailoring behavioral treatments compared to self-report measures. (Am J Addict 2014;23:15–20)

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

Abstract: BACKGROUND AND OBJECTIVES: This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment. METHODS: Alcohol-dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly 1 year after discharge. RESULTS: Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning 1 year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes. (Am J Addict 2014;23:226-233). Language: en

Posttraumatic Stress Symptoms and Alcohol Problems: Self‐Medication or Trait Vulnerability?

Abstract: Background and Objectives Posttraumatic stress symptoms (PTSD) and problem alcohol use (ALC) commonly co-occur, but the nature of this co-occurrence is unclear. Self-medication explanations have been forwarded, yet traits such as tendency toward negative emotionality and behavioral disconstraint also have been implicated. In this study we test three competing models (Self-Medication, Trait Vulnerability, Combined Dual Pathway) of PTSD–ALC prospectively in a college sample. Method Participants (N = 659; 73% female, M age = 18) provided data at college matriculation (Time 1) and 1 year later (Time 2). Results Structural equation models showed disconstraint to meditate the path from PTSD symptoms to alcohol problems, supporting a trait vulnerability conceptualization. Findings regarding negative emotionality and self-medication were more mixed. Negative emotionality played a stronger role in cross-sectional than in prospective analyses, suggesting the importance of temporal proximity. Conclusions and Scientific Significance Self-regulation skills may be an important focus for clinicians treating PTSD symptoms and alcohol misuse disorders concurrently. (Am J Addict 2014;23:108–116)

Prevalence of psychiatric disorders among heroin users who received methadone maintenance therapy in Taiwan.

Abstract: Background Many patients under methadone maintenance treatment are present with comorbid psychiatric symptoms. Objective We wish to examine the prevalence of psychiatric disorders among heroin users who received methadone maintenance therapy (MMT) in Taiwan. Methods By combining the National Health Insurance Research database and Center for Disease Control database, 18,271 heroin users who received MMT were defined as the subject group and after matching age and sex, 73,084 patients were randomly selected as the control group. Results The 1 year prevalence of any psychiatric disorder, any psychotic disorder, neurotic and other nonpsychotic disorder among MMT patients and control group were 13.14% versus 2.50% (OR 5.89, CI 5.53–6.27), 4.21% versus 1.29% (OR 3.38, CI 3.07–3.72), and 9.89% versus 1.31% (OR 8.25, CI 7.62–8.94), respectively. Conclusion The prevalence of any co-morbid psychiatric disorder among MMT patients is almost six times higher than the control group. Scientific Significance A thorough psychiatric screening and appropriate aggressive intervention should be incorporated into an effective methadone treatment program. (Am J Addict 2014;23:249–256)

Gender differences in drug-addicted patients in a clinical treatment center of Spain.

Abstract: This study was supported by a grant from the Health Department of the Government of Navarra, Spain (Res. 359/2012).

Antiretroviral medication: an emerging category of prescription drug misuse.

Abstract: Background and Objectives Prescription drug abuse has been a focus of public health concern over the past two decades with many studies addressing patterns of narcotic analgesic abuse and diversion. Most research in this domain has centered on controlled substances with known abuse liability. However, the scientific literature has been virtually silent regarding other prescribed medications with previously undocumented addictive potential, such as antiretroviral medications (ARV) for treatment of HIV.

Clinical correlates of attentional bias to drug cues associated with cocaine dependence

Abstract: Background and Objective Preoccupation (attentional bias) related to drug-related stimuli has been consistently observed for drug-dependent persons with several studies reporting an association of the magnitude of measured attentional bias with treatment outcomes. The major goal of the present study was to determine if pre-treatment attentional bias to personal drug use reminders in an addiction Stroop task predicts relapse in treatment-seeking, cocaine-dependent subjects. Methods We sought to maximize the potential of attentional bias as a marker of risk for relapse by incorporating individualized rather than generalized drug use cues to reflect the personal conditioned associations that form the incentive motivation properties of drug cues in a sample of cocaine-dependent subjects (N = 35). Results Although a significant group Stroop interference effect was present for drug versus neutral stimuli (ie, attentional bias), the level of attentional bias for cocaine-use words was not predictive of eventual relapse in this sample (d = .56). A similar lack of prediction power was observed for a non-drug counting word Stroop task as a significant interference effect was detected but did not predict relapse outcomes (d = .40). Conclusions and Scientific Significance The results of the present study do not provide clear support for the predictive value of individual variation in drug-related attentional bias to forecast probability of relapse in cocaine-dependent men. (Am J Addict 2014;23:478–484)