Showing papers in "Substance Use & Misuse in 2013"
TL;DR: This study provides an applied synthesis of addiction treatment no- show research and suggests future directions for no-show research and practice.
Abstract: Addiction appointment no-shows adversely impact clinical outcomes and healthcare productivity. During 2007–2010, 67 treatment organizations in the Strengthening Treatment Access and Retention program were asked to reduce their no-show rates by using practices taken from no-show research and theory. These treatment organizations reduced outpatient no-show rates from 37.4% to 19.9% (p = .000), demonstrated which practices they preferred to implement, and which practices were most effective in reducing no-show rates. This study provides an applied synthesis of addiction treatment no-show research and suggests future directions for no-show research and practice.
122 citations
TL;DR: Population-based Department of Defense health behavior surveys were examined for binge and heavy drinking among U.S. active duty personnel from 1998-2008, showing significant increases in heavy drinking and binge drinking.
Abstract: Population-based Department of Defense health behavior surveys were examined for binge and heavy drinking among U.S. active duty personnel. From 1998–2008, personnel showed significant increases in heavy drinking (15% to 20%) and binge drinking (35% to 47%). The rate of alcohol-related serious consequences was 4% for nonbinge drinkers, 9% for binge drinkers, and 19% for heavy drinkers. Personnel with high combat exposure had significantly higher rates of heavy (26.8%) and binge (54.8%) drinking than their counterparts (17% and 45%, respectively). Heavy and binge drinking put service members at high risk for problems that diminish force readiness and psychological fitness.
118 citations
TL;DR: It is demonstrated that masculine norms were associated with peer pressure and general conformity and alcohol use for both adolescent girls and boys, though the relationship between masculine norms and alcoholUse was stronger for boys.
Abstract: Peer pressure and general conformity to adult norms have been found to be strongly associated with alcohol use among adolescents; however there is limited knowledge about the sociocultural factors that might influence this relationship. Theory and research suggest that masculine norms might directly and indirectly contribute to alcohol use through peer pressure and general conformity to adult norms. Whereas being male is typically identified as a risk factor for alcohol use, masculine norms provide greater specificity than sex alone in explaining why some boys drink more than others. There is growing evidence that girls who endorse masculine norms may be at heightened risk of engaging in risky behaviors including alcohol use. Data were provided by adolescents living in a rural area in the Northeastern United States and were collected in 2006. This study demonstrated that masculine norms were associated with peer pressure and general conformity and alcohol use for both adolescent girls (n = 124) and boys (...
113 citations
TL;DR: There is a need for fuller consideration of the influences of demographics and environmental and social contexts on research findings, and it is recommended that alcohol intake measures should be standardized to a greater degree in future research.
Abstract: To assess the validity of the research into alcohol-related outcome expectancies a systematic review of 80 articles published between 1970 and 2013 was conducted. Participant gender, age, and contextual influences are highlighted as possible causes of the observed variations in research findings. There is a need for fuller consideration of the influences of demographics and environmental and social contexts on research findings. It is recommended that alcohol intake measures should be standardized to a greater degree in future research. Contextual influences on expectancies also require extensive future investigation to increase the validity of research and improve alcohol-related interventions.
70 citations
TL;DR: Three focus groups with 18 pregnant and postpartum women at an urban substance use treatment clinic found women identified motivational, family, friend, romantic, and agency characteristics as facilitative or challenging to their recoveries.
Abstract: Little is known about treatment for pregnant and postpartum women with co-occurring substance use and depression. Funded by the National Institute of Drug Abuse, we conducted three focus groups with 18 pregnant and postpartum women in 2011 at an urban substance use treatment clinic. A semi-structured discussion guide probed for factors impacting treatment outcomes and needs. Data were analyzed using grounded theory. Women identified motivational, family, friend, romantic, and agency characteristics as facilitative or challenging to their recoveries, and desired structure (group treatment, a safe environment, and transportation) and content (attention to mental health, family, and gender-specific issues) of treatment.
68 citations
TL;DR: This online panel study used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010 and showed that the higher the cognitive test anxiety, the lower the use frequencies were during the previous six months.
Abstract: This online panel study (nt1 = 5,882; nt2 = 3,486 (randomly selected)) used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010. Rare events logistic regression revealed that increased cognitive test anxiety increased the prevalence of medication use over various time windows. Negative binomial regression models showed that the higher the cognitive test anxiety, the higher the use frequencies were during the previous six months. The models controlled for expected side effects, risk attitudes, self-attributed competencies, prior medication use, sex, and age. We also discuss the study's implications.
65 citations
TL;DR: Compared to GDC, women in WRG more frequently endorsed feeling safe, embracing all aspects of one's self, having their needs met, feeling intimacy, empathy, and honesty, and group cohesion and support allowed women to focus on gender-relevant topics supporting their recovery.
Abstract: The present study of women with substance use disorders used grounded theory to examine women's experiences in both the Women's Recovery Group (WRG) and a mixed-gender Group Drug Counseling (GDC). Semi-structured interviews were completed in 2005 by 28 women in a U.S. metropolitan area. Compared to GDC, women in WRG more frequently endorsed feeling safe, embracing all aspects of one's self, having their needs met, feeling intimacy, empathy, and honesty. In addition, group cohesion and support allowed women to focus on gender-relevant topics supporting their recovery. These advantages of single-gender group therapy can increase treatment satisfaction and improve treatment outcomes.
64 citations
TL;DR: This analysis focuses on the 24 interviews with emergency department providers, substance use treatment providers, pain specialists, and generalist/family medicine practitioners regarding support and concern about naloxone prescription for pain patients and drug users.
Abstract: Poisonings are the leading cause of adult injury death in the United States. Over 12 weeks in 2011, 143 key informant interviews were conducted using a structured interview guide in three study sites in New England. This analysis focuses on the 24 interviews with emergency department providers, substance use treatment providers, pain specialists, and generalist/family medicine practitioners. Using an iterative coding process, we analyzed statements regarding support and concern about naloxone prescription for pain patients and drug users. The study's implications and limitations are discussed and future research suggested. The Centers for Disease Control and Prevention funded this study.
63 citations
TL;DR: Assessment of qualitative data from a Rapid Policy Assessment and Response project to assess the feasibility of a potential pharmacy-based naloxone intervention to reduce opioid overdose mortality among injection drug users found several barriers were identified, including misinformation about naloxin, interpersonal relationships between IDUs and pharmacy staff, and costs of such an intervention.
Abstract: This study analyzed qualitative data from a Rapid Policy Assessment and Response project to assess the feasibility of a potential pharmacy-based naloxone intervention to reduce opioid overdose mortality among injection drug users (IDUs). We conducted in-depth, semistructured interviews with 21 IDUs and 21 pharmacy staff (pharmacists and technicians). Although most participants supported the idea of a pharmacy-based naloxone intervention, several barriers were identified, including misinformation about naloxone, interpersonal relationships between IDUs and pharmacy staff, and costs of such an intervention. Implications for future pharmacy-based overdose prevention interventions for IDUs, including pharmacy-based naloxone distribution, are considered. The study's limitations are noted.
58 citations
TL;DR: Examining the pathways to misuse among a sample of US veterans who recently returned from Iraq and Afghanistan to low-income, predominately minority sections of New York City found veterans that misused POs were more likely to have other reintegration problems including drug and alcohol use disorders, traumatic brain injury, unemployment, and homelessness.
Abstract: Prescription opioid (PO) misuse represents a major health risk for many service members and veterans. This paper examines the pathways to misuse among a sample of US veterans who recently returned from Iraq and Afghanistan to low-income, predominately minority sections of New York City. Recreational PO misuse was not common on deployment. Most PO misusers initiated use subsequent to PO use for pain management, an iatrogenic pathway. However, most PO users did not misuse them. Veterans that misused POs were more likely to have other reintegration problems including drug and alcohol use disorders, traumatic brain injury (TBI), unemployment, and homelessness.
53 citations
TL;DR: Data collected from 152 academic institutions that participated in the National College Health Assessment during the 2008–2009 academic year was analyzed to examine associations between mental health and waterpipe tobacco smoking among college students.
Abstract: Associations between the emerging trend of waterpipe tobacco smoking and mental health among college students have not been sufficiently explored. This study analyzed data collected from 152 academic institutions that participated in the National College Health Assessment during the 2008-2009 academic year to examine associations between mental health and waterpipe tobacco smoking among college students (N = 100,891). For comparison, cigarette smoking was also examined. Associations with mental health variables were very strong for cigarette smoking but only moderate for waterpipe smoking. Study implications and limitations are noted.
TL;DR: Way in which spirituality is delineated is examined, variables that might mediate the relations between spirituality and recovery from substance abuse disorders are identified, distinctions between spiritual and nonspiritual facets of addictions treatment are described, and means to assist in further clarification of this construct are suggested.
Abstract: Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.
TL;DR: Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment, and the practice of harm reduction was overwhelmingly endorsed by participants.
Abstract: Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample (N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The study's implications and limitations are noted and future research is suggested.
TL;DR: Lagged General Linear Modeling analyses indicated that spiritual change as measured by the Religious Background and Behavior (RBB) self-report questionnaire were predictive of increased abstinence and decreased drinking intensity, and that the magnitude of this effect varied across different RBB scoring algorithms.
Abstract: This National Institutes of Health funded study investigated spiritual growth as a change mechanism in 12-step programs. A total of 130 people, early 12-step affiliates with limited Alcoholics Anonymous (AA) histories, were recruited from 2007 to 2008 from AA, treatment, and community centers in a Southwestern city in the United States. A majority of the sample was alcohol dependent. Participants were interviewed at baseline and at 3, 6, and 9 months. Lagged General Linear Modeling analyses indicated that spiritual change as measured by the Religious Background and Behavior (RBB) self-report questionnaire were predictive of increased abstinence and decreased drinking intensity, and that the magnitude of this effect varied across different RBB scoring algorithms. Future research should address study limitations by recruiting participants with more extensive AA histories and by including assessments of commitment to, and practice of, AA prescribed activities. The study's limitations are noted.
TL;DR: Club drug use may be more normalized within the lesbian and gay scene than elsewhere, particularly among young men, although the study's limitations are noted.
Abstract: This study aimed to determine whether the lesbian and gay “scene” of bars and nightclubs is a more common site for club drug use than other bars and clubs. A cross-sectional, online survey was conducted with 254 same-sex attracted women and 318 men aged 18–25 in Sydney, Australia. Drug use was more likely in those who attended any venue type more frequently. Men, but not women, were more likely to report drug use in lesbian and gay venues than other venues. Club drug use may be more normalized within the lesbian and gay scene than elsewhere, particularly among young men. The study's limitations are noted.
TL;DR: The role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011, is analyzed.
Abstract: This systematic review analyzes the role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011. Ten papers examined gender as a moderating variable. Results on gender differences were mixed. When studies that found no gender effects were compared with studies that did identify gender effects, differences in measurement, sample composition, and developmental timing of outcomes were identified. This review also examines how gender effects are assessed. Implications and limitations of these findings are discussed. Areas for future research are identified.
TL;DR: Increased FTP was found to be protective against drug use for all substances except alcohol, and any past 30-day use of alcohol, tobacco, marijuana, or hard drugs among continuation high school students in a large urban area.
Abstract: We examined whether a bidirectional, longitudinal relationship exists between future time perspective (FTP), measured with the Zimbardo Time Perspective Inventory, and any past 30-day use of alcohol, tobacco, marijuana, or hard drugs among continuation high school students (N = 1,310, mean age 16.8 years) in a large urban area. We found increased FTP to be protective against drug use for all substances except alcohol. While any baseline use of substances did not predict changes in FTP 1 year later. The discussion explores why alcohol findings may differ from other substances. Future consideration of FTP as a mediator of program effects is explored.
TL;DR: How challenges to the civilian readjustment process such as homelessness, unemployment, and posttraumatic stress disorder can render veterans at increased risk for negative health consequences is illustrated and veterans’ perspectives as they outline several innovative solutions to these obstacles are presented.
Abstract: This paper describes veterans’ overdose risks and specific vulnerabilities through an analysis of qualitative data collected from a sample of recently separated, formerly enlisted OEF/OIF veterans in the New York City area. We illustrate how challenges to the civilian readjustment process such as homelessness, unemployment, and posttraumatic stress disorder can render veterans at increased risk for negative health consequences and then present veterans’ perspectives as they outline several innovative solutions to these obstacles. We conclude by discussing several overdose prevention efforts currently underway and how they might be adapted to meet the opioid and substance misuse challenges veterans face.
TL;DR: The ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a “recovery” focus as the organizing concept for British drugs policy are explored are explored.
Abstract: Based on documentary analyses and interviews with twenty key informants in 2012, this paper analyses the shift in British drugs policy towards “recovery” from the perspectives of major stakeholders. The processes involved in reopening the debate surrounding the role of substitution treatment and its re-emergence on to the policy agenda are examined. Drawing on Kingdon's work on agenda-setting, the ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a “recovery” focus as the organizing concept for British drugs policy are explored. Study limitations are noted.
TL;DR: Preliminary evidence from a Substance Abuse and Mental Health Services Administration-funded evaluation suggests that significant improvements in posttraumatic stress disorder and substance use are just a few of the positive outcomes that these courts may help veterans achieve.
Abstract: After a decade of war, there is a great need for treatment and alternatives to incarceration for justice-involved veterans. U.S. military service members are returning from combat with substantial mental health challenges, which increase the potential for justice involvement. Veteran Treatment Courts are starting across the nation to meet this need for therapeutic justice. These problem solving courts provide access to treatment and motivation for engagement. Preliminary evidence from a Substance Abuse and Mental Health Services Administration-funded evaluation suggests that significant improvements in posttraumatic stress disorder and substance use are just a few of the positive outcomes that these courts may help veterans achieve.
TL;DR: Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse.
Abstract: This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber-pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted. Year of data collection: 2012 SETTING: Rural Appalachia Data Collection Instruments: Prescriber- and pharmacist-specific survey instruments Data Analysis Techniques: Independent samples t-test; Mann-Whitney U test.
TL;DR: Findings suggest an expansion of wound care facilities to mitigate the self-treatment of abscesses, with special consideration to Latinos.
Abstract: This study aimed to identify the prevalence and determinants of soft tissue infections and self-treatment among injection drug users (IDUs) in California. The study interviewed 864 IDUs in California using computer-assisted personal interview (CAPI) from 2003 to 2005. Multiple logistic regression analyses were performed to examine adjusted associations for recent abscess and abscess self-treatment. In these analyses, Latinos had higher odds than African Americans to self-treat, while IDUs reporting a usual place of health care had lower odds of self-treatment. Findings suggest an expansion of wound care facilities to mitigate the self-treatment of abscesses, with special consideration to Latinos.
TL;DR: Sadness, anger, and guilt were significant mediators and the significant pathways differed based on coping style, and the structural equation modeling framework detected stress-related drinking only in the adult sample.
Abstract: The stress-negative affect model for alcohol use was examined. The mediating roles of different components of negative affect were tested in the context of coping style. Data from 1,057 drinking adults (Mage = 44.45) and 352 drinking college students (Mage = 19.07) collected during 2001–2005 and in 2010, respectively, were examined separately. Participants completed self-administered measures of alcohol use, coping strategies, negative life events, and negative affect. A structural equation modeling framework detected stress-related drinking only in the adult sample. Sadness, anger, and guilt were significant mediators and the significant pathways differed based on coping style. The implications and limitations of the study are discussed.
TL;DR: It is suggested that spirituality and, to a far lesser degree, religious coping may serve to protect for substance use and abuse among this high-risk population of Salvadoran youth.
Abstract: Little is known about the relationship between religious coping, spirituality, and substance use in developing nations such as El Salvador. Collected in 2011, the sample consists of 290 high-risk and gang-involved adolescents (11–17 years) and young adults (18–25 years) in San Salvador, El Salvador. Structural equation modeling and logistic regression are employed to examine the associations between the Measure of Religious Coping (RCOPE), the Intrinsic Spirituality Scale, and substance use and abuse. Results suggest that spirituality and, to a far lesser degree, religious coping may serve to protect for substance use and abuse among this high-risk population of Salvadoran youth.
TL;DR: There was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use and spirituality was a significant moderator of the relationship betweentraumatic life events and cocaine use.
Abstract: This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.
TL;DR: Religiosity/spirituality was inversely associated with substance use and that it was more strongly associated than denomination, and RD, particularly having no denomination, was independently associated with the use of most substances.
Abstract: We examined the influence of religious denomination (RD) and religiosity/spirituality on licit and illicit substance use beyond the potential impact of parental variables. Data from a representative sample of Swiss men (n = 5,387) approximately 20 years old were collected between August 2010 and November 2011. We asked single item questions about RD and religious self-description (RSD) (including aspects of spirituality). Alcohol use, smoking, and illicit drug use was measured as outcome variables. Logistic regressions (adjusting for parenting and socioeconomic background) revealed that religiosity/spirituality was inversely associated with substance use and that it was more strongly associated than denomination. RD, particularly having no denomination, was independently associated with the use of most substances. The study's limitations, and the implications for future work are noted.
TL;DR: After the divorce, youth have an increased risk of using alcohol and marijuana, with the effect for marijuana being 12.1 percentage points in the two years right after the divorce.
Abstract: This article examines how the parental divorce process affects youth substance use at various stages relative to the divorce. With child-fixed-effect models and a baseline period that is long before the divorce, the estimates rely on within-child changes over time. Youth are more likely to use alcohol 2-4 years before a parental divorce. After the divorce, youth have an increased risk of using alcohol and marijuana, with the effect for marijuana being 12.1 percentage points in the two years right after the divorce (p = .010). The magnitudes of the effects persist as time passes from the divorce.
TL;DR: This longitudinal study aims to provide new insight into the long-term post-deployment outcomes of Army members by combining service member data from the Military Health System and Veterans Health Administration.
Abstract: The Substance Use and Psychological Injury Combat Study (SUPIC) will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N = 643,205), and self-reported alcohol use and health problems from the subsample with matched post-deployment health assessments (N = 487,600). This longitudinal study aims to provide new insight into the long-term post-deployment outcomes of Army members by combining service member data from the Military Health System and Veterans Health Administration.
TL;DR: Persistent smokers had the highest demographic and mental health risks, reported higher craving compared to light smokers, and were more likely to endorse smoking to reduce negative affect, for state enhancement motives.
Abstract: This study examined trajectories of smoking during pregnancy among low-income smokers and differences on demographics, psychopathology, and smoking outcome expectancies among women with different smoking trajectories. The sample consisted of 215 urban pregnant smokers living in the United States. Results indicated four trajectories of smoking and significant changes over time within each trajectory. Persistent smokers had the highest demographic and mental health risks, reported higher craving compared to light smokers, and were more likely to endorse smoking to reduce negative affect, for state enhancement motives. Implications for intervention are discussed. The study was funded by the National Institute on Drug Abuse.
TL;DR: Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use Disorder, and substance use disorder were 28%, 18%, and 32%, respectively.
Abstract: Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use disorder, and substance use disorder were 28%, 18%, and 32%, respectively. Only about 40% of veterans with any diagnosed disorder received some form of treatment. For alcohol use disorder, the estimate of unmet treatment need was 84%, which is particularly worrisome given that excessive alcohol use was the greatest substance use problem.