Showing papers on "Substance abuse published in 2004"
TL;DR: Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States, suggesting that treatment for a comorbid mood or anxiety disorder should be withheld from individuals with substance use disorders.
Abstract: Background Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. Objective To present nationally representative data on the prevalence and comorbidity of DSM-IV alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). Design Face-to-face survey. Setting The United States. Participants Household and group quarters' residents. Main Outcome Measures Prevalence and associations of substance use disorders and independent mood and anxiety disorders. Results The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the US population were 9.21% (95% confidence interval [CI], 8.78%-9.64%) and 11.08% (95% CI, 10.43%-11.73%), respectively. The rate of substance use disorders was 9.35% (95% CI, 8.86%-9.84%). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant ( P Conclusions Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.
2,617 citations
01 Jan 2004
1,267 citations
TL;DR: The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice, while the control group did not find differences in substance use or psychiatric symptoms.
Abstract: Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms. (Am J Public Health. 2004;94:651‐656)
1,141 citations
TL;DR: Evidence is summarized that exposure to amphetamine, cocaine, nicotine or morphine produces persistent changes in the structure of dendrites and dendritic spines on cells in brain regions involved in incentive motivation and reward, and judgment and the inhibitory control of behavior.
1,055 citations
TL;DR: It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health.
Abstract: Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.
788 citations
TL;DR: In this paper, the authors evaluated the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders, including Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT and another that included family education and therapy components.
673 citations
TL;DR: The data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.
Abstract: Aims To test a prediction of the discounting model of impulsiveness that discount rates would be positively associated with addiction. The delay-discount rate refers to the rate of reduction in the present value of a future reward as the delay to that reward increases.
Design and measurements We estimated participants’ discount rates on the basis of their pattern of choices between smaller immediate rewards ($11–80) and larger, delayed rewards ($25–85; at delays from 1 week to 6 months) in a questionnaire format. Participants had a one-in-six chance of winning a reward that they chose on one randomly selected trial.
Participants and setting Heroin (n = 27), cocaine (n = 41) and alcohol (n = 33) abusers and non-drug-using controls (n = 44) were recruited from advertisements. They were tested in a drug abuse research clinic at a medical school.
Findings On average, the cocaine and heroin groups had higher rates than controls (both P 0.50).
Conclusions These data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.
662 citations
TL;DR: The relationship between ACEs and adolescent pregnancy is strong and graded and the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se.
Abstract: Objectives. Few reports address the im- pact of cumulative exposure to childhood abuse and fam- ily dysfunction on teen pregnancy and consequences commonly attributed to teen pregnancy. Therefore, we examined whether adolescent pregnancy increased as types of adverse childhood experiences (ACE score) in- creased and whether ACEs or adolescent pregnancy was the principal source of elevated risk for long-term psy- chosocial consequences and fetal death. Design, Setting, and Participants. A retrospective co- hort study of 9159 women aged >18 years (mean 56 years) who attended a primary care clinic in San Diego, Cali- fornia in 1995-1997. Main Outcome Measure. Adolescent pregnancy, psy- chosocial consequences, and fetal death, compared by ACE score (emotional, physical, or sexual abuse; expo- sure to domestic violence, substance abusing, mentally ill, or criminal household member; or separated/divorced parent). Results. Sixty-six percent (n 6015) of women re- ported >1 ACE. Teen pregnancy occurred in 16%, 21%, 26%, 29%, 32%, 40%, 43%, and 53% of those with 0, 1, 2, 3, 4, 5, 6, and 7 to 8 ACEs. As the ACE score rose from zero to 1t o 2, 3t o 4, and>5, odds ratios for each adult consequence increased (family problems: 1.0, 1.5, 2.2, 3.3; financial problems: 1.0, 1.6, 2.3, 2.4; job problems: 1.0, 1.4, 2.3, 2.9; high stress: 1.0, 1.4, 1.9, 2.2; and uncontrollable anger: 1.0, 1.6, 2.8, 4.5, respectively). Adolescent preg- nancy was not associated with any of these adult out- comes in the absence of childhood adversity (ACEs: 0). The ACE score was associated with increased fetal death after first pregnancy (odds ratios for 0, 1-2, 3- 4, and 5- 8 ACEs: 1.0, 1.2, 1.4, and 1.8, respectively); teen pregnancy was not related to fetal death. Conclusions. The relationship between ACEs and ad- olescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths com- monly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se. Pediatrics 2004;113:320 -327; adolescent pregnancy, child abuse, domestic violence, alcoholism, children of impaired parents, drug abuse.
620 citations
TL;DR: Available evidence does not strongly support an important causal relation between cannabis use by young people and psychosocial harm, but cannot exclude the possibility that such a relation exists, and the lack of evidence of robust causal relations prevents the attribution of public health detriments to illicit drug use.
598 citations
TL;DR: Although older age is associated with higher rates of antiretroviral adherence, older participants who were cognitively impaired showed disproportionate difficulty in adequately adhering to their medication regimen, suggesting efforts to detect neuropsychological dysfunction, particularly among older patients, appear to be essential for the effective treatment of HIV-infected adults.
Abstract: Objective: To examine the predictors of antiretroviral adherence among HIV-infected adults, with a particular focus on advancing age, neuropsychological dysfunction, and substance abuse. Design: Prospective observational design. Methods: Participants were 148 HIV-infected adults between the ages of 25 and 69 years, all on a self-administered antiretroviral regimen. Medication adherence was tracked over a one-month period using an electronic monitoring device (medication event monitoring system caps). All participants completed a comprehensive battery of neuropsychological tests as well as a structured psychiatric interview. Results: The mean adherence rate for the entire cohort was 80.7%, with older patients (≥ 50 years) demonstrating significantly better medication adherence than younger patients (87.5 versus 78.3%). Logistic regression analyses found that older patients were three times more likely to be classified as good adherers (defined as ≥ 95% adherent). Neurocognitive impairment conferred a 2.5 times greater risk of poor adherence. Among the older patients, those who were classified as poor adherers performed significantly worse on neuropsychological testing, particularly on measures of executive function and psychomotor speed. Current drug abuse/dependence, but not current alcohol abuse/dependence, was also associated with sub-optimal medication adherence. Conclusion: Although older age is associated with higher rates of antiretroviral adherence, older participants who were cognitively impaired showed disproportionate difficulty in adequately adhering to their medication regimen. As such, efforts to detect neuropsychological dysfunction, particularly among older patients, and a thorough assessment of substance abuse, appear to be essential for the effective treatment of HIV-infected adults.
594 citations
TL;DR: The current view of separate addictions is similar to the view espoused during the early days of AIDS diagnosis, when rare diseases were not distinguished between alcohol dependence and pathological gambling.
Abstract: “The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them”Sir William Bragg (1862–1942)1It is common for clinicians, researchers, and public ...
TL;DR: Additional studies on the association of suicide and mixed drug use, heavy drinking, and alcohol use disorders in women augmented the findings of Harris and Barraclough, along with a novel estimate for intravenousdrug use, a byproduct of intensive research on HIV in the past decade.
TL;DR: An independent association of comorbid anxiety with greater severity and impairment in bipolar disorder patients was demonstrated, highlighting the need for greater clinical attention to anxiety in this population, particularly for enhanced clinical monitoring of suicidality.
Abstract: OBJECTIVE: The authors provide a detailed perspective on the correlates of comorbid anxiety in a large, well-characterized sample of bipolar disorder patients. METHOD: Anxiety and its correlates were examined in a cross-sectional sample from the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder, a multicenter project funded by the National Institute of Mental Health designed to evaluate the longitudinal outcome of patients with bipolar disorder. RESULTS: Lifetime comorbid anxiety disorders were common, occurring in over one-half of the sample, and were associated with younger age at onset, decreased likelihood of recovery, poorer role functioning and quality of life, less time euthymic, and greater likelihood of suicide attempts. Although substance abuse disorders were particularly prevalent among patients with anxiety disorders, comorbid anxiety appeared to exert an independent, deleterious effect on functioning, includi...
TL;DR: Despite the stability in the overall prevalence of marijuana use, more adults in the United States had a marijuana use disorder in 2001-2002 than in 1991-1992 and the results of this study underscore the need to develop and implement new prevention and intervention programs targeted at youth.
Abstract: ContextAmong illicit substance use disorders, marijuana use disorders are the
most prevalent in the population. Yet, information about the prevalence of
current Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) marijuana use disorders
and how prevalence has changed is lacking.ObjectiveTo examine changes in the prevalence of marijuana use, abuse, and dependence
in the United States between 1991-1992 and 2001-2002.Design, Setting, and ParticipantsFace-to-face interviews were conducted in 2 large national surveys conducted
10 years apart: the 1991-1992 National Longitudinal Alcohol Epidemiologic
Survey ([NLAES] n = 42 862) and the 2001-2002 National Epidemiologic
Survey on Alcohol and Related Conditions ([NESARC] n = 43 093).Main Outcome MeasuresRates of past year marijuana use, abuse, and dependence.ResultsAmong the adult US population, the prevalence of marijuana use remained
stable at about 4.0% over the past decade. In contrast, the prevalence of DSM-IV marijuana abuse or dependence significantly (P = .01) increased between 1991-1992 (1.2%) and 2001-2002
(1.5%), with the greatest increases observed among young black men and women
(P<.001) and young Hispanic men (P = .006). Further, marijuana use disorders among marijuana users significantly
increased (P = .002) in the absence of increased
frequency and quantity of marijuana use, suggesting that the concomitant increase
in potency of delta-9-tetrahydrocannabinol (Δ9-THC) may have
contributed to the rising rates.ConclusionsDespite the stability in the overall prevalence of marijuana use, more
adults in the United States had a marijuana use disorder in 2001-2002 than
in 1991-1992. Increases in the prevalence of marijuana use disorders were
most notable among young black men and women and young Hispanic men. Although
rates of marijuana abuse and dependence did not increase among young white
men and women, their rates have remained high. The results of this study underscore
the need to develop and implement new prevention and intervention programs
targeted at youth, particularly minority youth.
TL;DR: Hyperactive children are at greater risk for antisocial activities and arrests by young adulthood that appear to be principally associated with illegal drug possession, use, and sale.
Abstract: Background: Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder.
Method: We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20–21 years; 13+ year follow-up) for a large sample of hyperactive (H; N = 147) and community control (CC; N = 73) children. Parent reports of childhood hyperactivity and conduct problems at study entry, parent and self-reports of ADHD and conduct disorder at adolescence, and parent reports of ADHD at young adulthood are examined for their contribution to antisocial behavior and drug use at adulthood.
Results: More of the H group committed a variety of antisocial acts and had been arrested for doing so (corroborated through official arrest records) than did the CC group. The H group also committed a higher frequency of property theft, disorderly conduct, assault with fists, carrying a concealed weapon, and illegal drug possession, as well as more arrests. These activities reduced to two dimensions corresponding to predatory-overt and drug-related antisocial conduct. The H group differed from the CC group only on the latter dimension. Childhood, adolescent, and adult ADHD predicted higher drug-related activities, as did childhood conduct problems. The H group with conduct disorder (CD) reported greater use of most substances than did the H only or CC groups, who did not differ from each other. Severity of teen ADHD and especially lifetime CD predicted use of hard drugs while just lifetime CD predicted marijuana/LSD use. Teen drug use seemed to potentiate increased drug-related antisocial activities beyond the contribution made by teen CD.
Conclusions: Hyperactive children are at greater risk for antisocial activities and arrests by young adulthood that appear to be principally associated with illegal drug possession, use, and sale. Those having CD, however, appear to engage in greater and more diverse substance use.
TL;DR: Tobacco, alcohol, and illicit substance use continue to result in substantial morbidity and mortality and significant societal economic costs despite considerable efforts to minimize use of licit substances and prevent use of illicit substances.
Abstract: Tobacco, alcohol, and illicit substance use continue to result in substantial morbidity and mortality and significant societal economic costs despite considerable efforts to minimize use of licit substances and prevent use of illicit substances. Each year, more than 400,000 Americans die from cigarette smoking, and one in every five deaths in the United States is believed to be smoking related (1). Consequences of alcohol and illicit substance abuse include, among others, cirrhosis, job loss, and criminal behavior related to the acquisition and sale of illicit drugs. The economic costs of addiction were estimated as $400 billion yearly in the United States in 1999 (2). Substance use is associated with a wide range of risk behaviors. For the more commonly used substances, risk behavior includes symptoms of both dependence (e.g., reducing important activities because of use of the substance) and abuse (e.g., driving a car more than once while intoxicated, getting into trouble with superiors or co-workers because of intoxication). For example, in 2002, 4.7 percent of the population reported driving under the influence of an illicit drug and 14.2 percent reported driving under the influence of alcohol at least once during the past year (3).
TL;DR: Data favoring foreign- born Mexican Americans with respect to mental health may extend to foreign-born non-Hispanic whites, and US-born Mexican Americans were at significantly lower risk of psychiatric morbidity than US- born non- Hispanic whites.
Abstract: Background There exist no national prevalence data on specific DSM-IV Axis I psychiatric disorders among foreign-born and US-born Mexican Americans and non-Hispanic whites. Objective To present nationally representative data on the prevalence of DSM-IV lifetime psychiatric disorders among foreign-born and US-born Mexican Americans and non-Hispanic whites. Design Face-to-face survey conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Setting The United States and District of Columbia, including Alaska and Hawaii. Participants Household and group-quarters residents, aged 18 years and older (n = 43 093). Main Outcome Measures Prevalence of DSM-IV substance use disorders and mood and anxiety disorders. Results With few exceptions, foreign-born Mexican Americans and foreign-born non-Hispanic whites were at significantly lower risk ( P DSM-IV substance use and mood and anxiety disorders compared with their US-born counterparts. Although the risk of specific psychiatric disorders was similar between foreign-born Mexican Americans and foreign-born non-Hispanic whites, US-born Mexican Americans were at significantly lower risk ( P Conclusions Data favoring foreign-born Mexican Americans with respect to mental health may extend to foreign-born non-Hispanic whites. Future research among foreign-born and US-born Mexican Americans and the foreign-born and US-born of other origins and descents is needed to understand what appears to be the protective effects of culture and the deleterious effects of acculturation on psychiatric morbidity in the United States.
TL;DR: Findings support the notion of an accelerated progression to treatment entry among opioid-, cannabis- and alcohol-dependent women, and suggest that there exists a gender-based vulnerability to the adverse consequences of these disorders.
TL;DR: The results do not support theories that attempt to explain the mediation of offending behaviors in schizophrenia by single factors, such as substance abuse, active symptoms, or characteristics of systems of care, but suggest that offending reflects a range of factors that are operative before, during, and after periods of active illness.
Abstract: OBJECTIVE: This study examined the pattern of criminal convictions in persons with schizophrenia over a 25-year period marked by both radical deinstitutionalization and increasing rates of substance abuse problems among persons with schizophrenia in the community. METHOD: The criminal records of 2,861 patients (1,689 of whom were male) who had a first admission for schizophrenia in the Australian state of Victoria in 1975, 1980, 1985, 1990, and 1995 were compared for the period from 1975 to 2000 with those of an equal number of community comparison subjects matched for age, gender, and neighborhood of residence. RESULTS: Relative to the comparison subjects, the patients with schizophrenia accumulated a greater total number of criminal convictions (8,791 versus 1,119) and were significantly more likely to have been convicted of a criminal offense (21.6% versus 7.8%) and of an offense involving violence (8.2% versus 1.8%). The proportion of patients who had a conviction increased from 14.8% of the 1975 coho...
TL;DR: Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning, a significant step toward closing the gap between treatment conducted in the laboratory and community clinic.
Abstract: Context: Adolescent depression is highly prevalent and has substantial morbidity, including suicide attempts, school dropout, and substance abuse, but many depressed adolescents are untreated. The school-based health clinic offers the potential for accessible and efficient treatment, although it is unknown whether school-based clinicians can be trained to implement evidence-based psychotherapies for depression in routine care. Objective: To assess the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in schoolbased mental health clinics.
TL;DR: Positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up and some of its sequelae were reduced.
Abstract: Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.
TL;DR: Antidepressant medication exerts a modest beneficial effect for patients with combined depressive- and substance-use disorders, and care should be exercised in the diagnosis of depression-either by observing depression to persist during at least a brief period of abstinence or through efforts by clinical history to screen out substance-related depressive symptoms.
Abstract: ContextDepression and substance abuse are common and costly disorders that
frequently co-occur, but controversy about effective treatment for patients
with both disorders persists.ObjectiveTo conduct a systematic review and meta-analysis to quantify the efficacy
of antidepressant medications for treatment of combined depression and substance
use disorders.Data SourcesPubMed, MEDLINE, and Cochrane database search (1970-2003), using the
keywords antidepressant treatment or treatment depressed in conjunction with each of the following alcohol dependence, benzodiazepine dependence, opiate dependence, cocaine
dependence, marijuana dependence, and methadone; a search of bibliographies; and consultation
with experts in the field.Study SelectionAmong inclusion criteria used for study selection were prospective,
parallel group, double-blind, controlled clinical trials with random assignment
to an antidepressant medication or placebo for which trial patients met standard
diagnostic criteria for current alcohol or other drug use and a current unipolar
depressive disorder. Of the more than 300 citations extracted, 44 were placebo-controlled
clinical trials, 14 of which were selected for this analysis and included
848 patients: 5 studies of tricyclic antidepressants, 7 of selective serotonin
re-uptake inhibitors, and 2 from other classesData ExtractionWe independently screened the titles and abstracts of each citation,
identified placebo-controlled trials of patients with both substance dependence
and depression, applied the inclusion criteria, and reached consensus. Data
on study methods, sample characteristics, and depression and substance use
outcomes were extracted. The principal measure of effect size was the standardized
difference between means on the Hamilton Depression Scale (HDS).Data SynthesisFor the HDS score, the pooled effect size from the random-effects model
was 0.38 (95% confidence interval, 0.18-0.58). Heterogeneity of effect on
HDS across studies was significant (P <.02), and
studies with low placebo response showed larger effects. Moderator analysis
suggested that diagnostic methods and concurrent psychosocial interventions
influenced outcome. Studies with larger depression effect sizes (>0.5) demonstrated
favorable effects of medication on measures of quantity of substance use,
but rates of sustained abstinence were low.ConclusionsAntidepressant medication exerts a modest beneficial effect for patients
with combined depressive- and substance-use disorders. It is not a stand-alone
treatment, and concurrent therapy directly targeting the addiction is also
indicated. More research is needed to understand variations in the strength
of the effect, but the data suggest that care be exercised in the diagnosis
of depression–either by observing depression to persist during at least
a brief period of abstinence or through efforts by clinical history to screen
out substance-related depressive symptoms.
TL;DR: The cumulative evidence from experimental and quasi-experimental research supports integrating outpatient mental health and substance abuse treatments into a single, cohesive package and suggests that integrated residential treatment, especially long-term treatment, is helpful for individuals who do not respond to outpatient dual disorders interventions.
Abstract: Several interventions for people with co-occurring severe mental illnesses and substance use disorders have emerged since the early 1980s. This paper reviews 26 controlled studies of psychosocial interventions published or reported in the last 10 years (1994-2003). Though most studies have methodological weaknesses, the cumulative evidence from experimental and quasi-experimental research supports integrating outpatient mental health and substance abuse treatments into a single, cohesive package. Effective treatments are also individualized to address personal factors and stage of motivation, e.g., engaging people in services, helping them to develop motivation, and helping them to develop skills and supports for recovery. Accumulating evidence from quasi-experimental studies also suggests that integrated residential treatment, especially long-term (one year or more) treatment, is helpful for individuals who do not respond to outpatient dual disorders interventions. Current research aims to refine and test individual components and combinations of integrated treatments.
TL;DR: A historical review of basic research on opiate and cocaine addiction is presented and the current challenges are to translate increasingly impressive knowledge of the basic neurobiology of addiction to human addicts, and to identify the specific genes that make some individuals either particularly vulnerable or resistant to addiction.
TL;DR: This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing.
Abstract: Aim To test whether a single session of motivational interviewing (discussing alcohol, tobacco and illicit drug use) would lead successfully to reduction in use of these drugs or in perceptions of drug-related risk and harm among young people
Design Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing (n = 105) or non-intervention education-as-usual control condition (n = 95)
Setting Ten further education colleges across inner London
Participants Two hundred young people (age range 16–20 years) currently using illegal drugs, with whom contact was established through peers trained for the project
Intervention The intervention was adapted from the literature on motivational interviewing in the form of a 1-hour single-session face-to-face interview structured by a series of topics
Measurements Changes in self-reported cigarette, alcohol, cannabis and other drug use and in a range of drug-specific perceptions and other indicators of risk and harm Measurement at recruitment and follow-up interview 3 months later
Findings A good follow-up rate (895%; 179 of 200) was achieved In comparison to the control group, those randomized to motivational interviewing reduced their of use of cigarettes, alcohol and cannabis, mainly through moderation of ongoing drug use rather than cessation Effect sizes were 037 (015–06), 034 (009–059) and 075 (045–10) for reductions in the use of cigarettes, alcohol and cannabis, respectively For both alcohol and cannabis, the effect was greater among heavier users of these drugs and among heavier cigarette smokers The reduced cannabis use effect was also greater among youth usually considered vulnerable or high-risk according to other criteria Change was also evident in various indicators of risk and harm, but not as widely as the changes in drug consumption
Conclusions This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing The targeting of multiple drug use in a generic fashion among young people has also been supported
TL;DR: Teenage drinking patterns and other health risk behaviours in adolescence predicted alcohol dependence in adulthood, and prevention and early intervention initiatives to reduce longer-term alcohol-related harm need to be addressed.
Abstract: Aim To determine whether adolescent alcohol use and/or other adolescent health risk behaviour predisposes to alcohol dependence in young adulthood.
Design Seven-wave cohort study over 6 years.
Participant A community sample of almost two thousand individuals followed from ages 14–15 to 20–21 years.
Outcome measure Diagnostic and Statistical Manual volume IV (DSM-IV) alcohol dependence in participants aged 20–21 years and drinking three or more times a week.
Findings Approximately 90% of participants consumed alcohol by age 20 years, 4.7% fulfilling DSM-IV alcohol dependence criteria. Alcohol dependence in young adults was preceded by higher persisting teenage rates of frequent drinking [odds ratio (OR) 8.1, 95% confidence interval (CI) 4.2, 16], binge drinking (OR 6.7, 95% CI 3.6, 12), alcohol-related injuries (OR 4.5 95% CI 1.9, 11), intense drinking (OR 4.8, 95% CI 2.6, 8.7), high dose tobacco use (OR 5.5, 95% CI 2.3, 13) and antisocial behaviour (OR 5.9, 95% CI 3.3, 11). After adjustment for other teenage predictors frequent drinking (OR 3.1, 95% CI 1.2, 7.7) and antisocial behaviour (OR 2.4, 95% CI 1.2, 5.1) held persisting independent associations with later alcohol dependence. There were no prospective associations found with emotional disturbance in adolescence.
Conclusion Teenage drinking patterns and other health risk behaviours in adolescence predicted alcohol dependence in adulthood. Prevention and early intervention initiatives to reduce longer-term alcohol-related harm therefore need to address the factors, including alcohol supply, that influence teenage consumption and in particular high-risk drinking patterns.
TL;DR: Findings continue to support the value of integrated treatment for co-occurring conditions, especially the importance of training counseling staff to handle psychotic symptoms when needed.
Abstract: The Methamphetamine Treatment Project (MTP) offers the opportunity to examine co-occurring psychiatric conditions in a sample of 1016 methamphetamine users participating in a multisite outpatient treatment study between 1999-2001. Participants reported high levels of psychiatric symptoms, particularly depression and attempted suicide, but also anxiety and psychotic symptoms. They also reported high levels of problems controlling anger and violent behavior, with a correspondingly high frequency of assault and weapons charges. Findings continue to support the value of integrated treatment for co-occurring conditions, especially the importance of training counseling staff to handle psychotic symptoms when needed.
TL;DR: The AUDIT has reasonable psychometric properties in sample of college students using student health services and supports the use of the AUDIT in this population of students.
Abstract: Background: High-risk alcohol use among college students is associated with accidents, partner violence, unwanted sexual encounters, tobacco use, and performance issues. The identification and treatment of high-risk drinking students is a priority for many college campuses and college health centers. The goal of this study was to test the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) in college students. Methods: A convenience sample of students coming into a college health clinic was asked to complete the 10-question AUDIT and then participate in a research interview. The interview focused on assessing students for alcohol abuse and dependence by using the Composite International Diagnostic Interview Substance Abuse Module and timeline follow-back procedures to assess a 28-day drinking history. Results: A total of 302 students met the eligibility criteria and agreed to participate in the study. The sample consisted of 185 females (61%) and 117 males (39%), with a mean age of 20.3 years. Forty students were abstinent, 88 were high-risk drinkers, and 103 met criteria for a 12-month history of dependence. Receiver operator curves demonstrated that the AUDIT had the highest area under the cure for detecting high-risk alcohol use (0.872) and the lowest for identifying persons with a lifetime history of alcohol abuse or dependence (0.775). An AUDIT cutoff score of 6 or greater demonstrated a sensitivity of 91.0% and a specificity of 60.0% in the detection of high-risk drinkers. Conclusions: The AUDIT has reasonable psychometric properties in sample of college students using student health services. This study supports the use of the AUDIT in this population.
TL;DR: Clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die, because BPD is frequently complicated by suicidal behavior.
Abstract: Suicidal behavior is frequent in patients with borderline personality disorder (BPD); at least three-quarters of these patients attempt suicide and approximately 10% eventually complete suicide. Borderline patients at greatest risk for suicidal behavior include those with prior attempts, comorbid major depressive disorder, or a substance use disorder. Comorbidity with major depression serves to increase both the number and seriousness of the suicide attempts. Hopelessness and impulsivity independently increase the risk of suicidal behavior, as does a turbulent early life and the presence of antisocial traits. In summary, because BPD is frequently complicated by suicidal behavior, clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die. Clinicians have an important role in preventing suicide attempts and completed suicides by understanding the risk factors.
TL;DR: The results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.
Abstract: Objective: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. Method: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N= 70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Results: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Conclusions: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.