Abuse Group Research Articles

The impact of child maltreatment on poly-victimization

증적으로 검증함을 목적으로 한다. 그리고 아동학대 효과를 보다 엄격하게 검증하기 위해 성향점수매칭(Propensity score matching) 분석 방법을 적용하고자 한다. 이를 위해 한국형사정책연구원에서 2014년 진행한 청소년 대상 범죄피해조사 에서 수집된 중, 고등학생 총 7,109명을 대상으로 수집한 횡단데이터를 활용하였다. 주요 분석 결과는 다음과 같다. 첫째, 전체 연구대상자 중 아동학대를 경험한 청소년은 전체의 약 6.9%(n=490)로 나타났다. 둘째, 성향점수매칭을 통해 외생변인을 통제한 이후, 순수 아동학대 효과가 다중피해에 미치는 위험은 7.42배로 검증되었다. 세부유형의 경우, 또래에 의한 성추행과 목격 및 간접피해를 제외한 모든 폭력 피해, 재산 피해, 성피해 등 직접 피해의 위험은 최소 5.98배에서 최대 16.58배 높은 것으로 검증되었다. 이는 청소년의 아동학대 피해는 거의 모든 유형의 직접적인 범죄 피해에 유의미한 영향을 미치는 것을 의미한다. 이러한 결과를 바탕으로 청소년의 아동학대 및 다중피해 예방을 위한 정책적 제언을 실시하였다.This study aims to examine the effect of intra-familiar child maltreatment on poly-victimization which includes various types of extra-familiar violence, crime victimization, by applying for propensity score matching (hereafter PSM). Cross-sectional data of a sample of 7,109 adolescents aged 15-18 years were obtained from the Juvenile Victimization in Korea in 2014 conducted by Korean Institute of Criminology. Main results are as follows. First, participants who exposed to child maltreatment occupied 6.9% (n=490). Second, after controlling for selection effects using PSM, child maltreatment group had 7.42 times higher effect on total poly-victimization score than those who control group. Specifically, the risk of direct victimization including physical assault and bullying, sexual and property victimization was higher ranged 5.98-16.58 times in child maltreatment group. Results suggested child maltreatment is strong predictor on almost all types of direct juvenile victimization even after applying for PSM method. Based on results, political and practical implications suggested.

Autobiographical memory as a latent vulnerability mechanism following childhood maltreatment: Association with future depression symptoms and prosocial behavior.

Childhood maltreatment is associated with altered neural reactivity during autobiographical memory (ABM) recall and a pattern of overgeneral memory (OGM). Altered ABM and OGM have been linked with psychopathology and poorer social functioning. The present study investigated the association between altered ABM and subsequent socio-emotional functioning (measured two years later) in a sample of adolescents with (N = 20; maltreatment group, MT) and without (N = 17; non-MT group) documented childhood maltreatment histories. At baseline, adolescents (aged 12.6 ± 1.45 years) were administered the Autobiographical Memory Test to measure OGM. Participants also recalled specific ABMs in response to emotionally valenced cue words during functional MRI. Adolescents in both groups underwent assessments measuring depressive symptoms and prosocial behavior at both timepoints. Regression analyses were carried out to predict outcome measures at follow-up controlling for baseline levels. In the MT group, greater OGM at baseline significantly predicted reduced prosocial behavior at follow-up and showed a trend level association with elevated depressive symptoms. Patterns of altered ABM-related brain activity did not significantly predict future psycho-social functioning. The current findings highlight the potential value of OGM as a cognitive mechanism that could be targeted to reduce risk of depression in adolescents with prior histories of maltreatment.

Perception of Elementary School Heads and Teachers on Child Protection Policy in Private Schools in Tanauan City Division

Child-friendly schools dramatically minimize or remove frequent physical threats and other types of violence occurring in and around schools and learning spaces, such as teachers' corporal punishment, student-on-student abuse, gang wars, bullying, sexual assaults, other forms of gender-based abuse and external group school assaults. Schools that are child-friendly need to collaborate with parents and local groups to avoid abuse. To protect children from physical damage and mental, physical, emotional and sexual violence, simple, transparently implemented policies and procedures and firm measures must be in place. The study's main objective was to evaluate the awareness rates of principals and educators’ engagement on the Child Protection Program at Tanauan City Division's Private Schools, Batangas. The argument is that officials in child-friendly schools should be vigilant in recognizing child violence and neglect, and should be prepared to act in compliance with national laws and policies on child safety, including compulsory reporting to police or other legal authorities. The school's position in serious child protection matters is not to investigate them but to identify cases that need attention and refer them to appropriate child care agencies. The descriptive method of research was used in this study using a survey questionnaire as the main instrument to gather data. The respondents of the study were 15 principals and 185 educators in the said Private Schools in Tanauan City Division. Statistical tools like weighted mean were used in determining the extent of implementation of Child Protection Program and level of perceptiveness of principals and educators. The non-significant differences between their perceptions were established using the t-test formula. Meanwhile, the Pearson r product-moment correlation and r-test were used to resolve the nonsignificant relationship between the extent of implementation of Child Protection Program and level of participation of principals and educators. The result indicated that the views of the two groups of respondents were not substantially different, although both stated that there was intense observance of involvement in the execution of the school manager's duties and responsibilities. It further revealed that there was no shared agreement between the heads of school and teachers about the school manager's roles and responsibilities in enforcing child protection policy. Child-friendly schools should be prepared to recognize, refer and evaluate vulnerable children, especially those who have suffered, suffered or are at risk of serious harm.

The impact of childhood sexual abuse on sleep in adulthood

BackgroundIt has been documented that people reporting a history of childhood sexual abuse (CSA) tend to report poor sleep quality as adults. However, there are many limitations to this research. ObjectiveThis study examines the relation of CSA to a range of sleep symptoms, addressing some of the limitations of prior research. Moreover, we examined several mechanisms through which CSA might be related to disturbed sleep. Participants and settingParticipants were a community sample of 234 U.S. residents, 124 who self-identified as women, 108 as men, 1 as genderqueer, and 1 who preferred not to say. Ages ranged from 21 to 71 (M = 35.19, SD = 10.42). MethodsParticiplants completed online measures of trauma, 21 different aspects of disturbed sleep, health behaviour, and sleep hygiene. ResultsMany of the variables did not meet the assumptions for parametric analyses; therefore, four groups were compared by means of Kruskal-Wallis omnibus tests: CSA, physical abuse (CPA), both CSA and CPA, no childhood trauma or abuse. There were no differences between those reporting CSA versus CPA while all abuse groups differed from those reporting no history of adverse experiences. Indirect effects were assessed using the PROCESS v3.5 Model 4 with 10,000 bootstrapped samples. Recent trauma, engaging in risky behaviours, and poor sleep hygiene all partially accounted for many of the relations between CSA and sleep complaints. ConclusionsThese findings suggest that CSA is a general, non-specific risk factor for sleep disorders; however, this risk might be partially mitigated through improved sleep hygiene and risk management.

Serotonin transporter protein in autopsied brain of chronic users of cocaine.

The long-held speculation that the brain serotonin system mediates some behavioral effects of the psychostimulant cocaine is supported in part by the high affinity of cocaine for the serotonin transporter (SERT) and by reports that the serotonin transporter (SERT), estimated by SERT binding, is increased in brain of human chronic cocaine users. Excessive SERT activity and consequent synaptic serotonin deficiency might cause a behavioral (e.g., mood) abnormality in chronic users of the drug. Previous studies focused on changes in SERT binding, which might not necessarily reflect changes in SERT protein. Therefore, we compared levels of SERT protein, using a quantitative Western blot procedure, in autopsied brain (striatum, cerebral cortices) of chronic human cocaine users (n = 9), who all tested positive for the drug/metabolite in brain, to those in control subjects (n = 15) and, as a separate drug of abuse group, in chronic heroin users (n = 11). We found no significant difference in protein levels of SERT or the serotonin synthesizing enzyme tryptophan hydroxylase-2 among the control and drug abuse groups. In the cocaine users, no significant correlations were observed between SERT and brain levels of cocaine plus metabolites, or with levels of serotonin or its metabolite 5-hydroxyindoleacetic acid. Our postmortem data suggest that a robust increase in striatal/cerebral cortical SERT protein is not a common characteristic of chronic, human cocaine users.

Attending Substance Abuse Groups and Identifying as Spiritual but not Religious

In recent years, the number of people who identify as “spiritual but not religious” has grown. At the same time, many addiction recovery programs such as Alcoholics Anonymous promote spiritual beliefs to help those suffering from alcohol use disorders. In this paper, we hypothesize and test to see whether individuals who have attended substance abuse groups such as Alcoholics Anonymous are more likely to identify as spiritual but not religious (SBNR). Using longitudinal data from the Midlife Development in the United States study ( N = 1711), we find that those who have attended substance abuse groups are more likely to identify as SBNR. Further, frequency of attendance in these groups is positively and significantly associated with being SBNR when compared to being both religious and spiritual. Implications for understanding the connections among religion, spirituality, and substance abuse recovery programs are discussed.

0465 Association Between Physical or Sexual Abuse and Sleep Reactivity in Patients with Insomnia

Abstract Introduction Physical and sexual abuse are common and have demonstrated associations with insomnia. A common factor predisposing individuals to the development of insomnia is sleep reactivity, yet no studies have determined the relationship between sleep reactivity and physical and/or sexual abuse. Methods Patients with DSM-5 insomnia disorder (N = 658; 519 F; mean age = 45.03) participated in an online randomized controlled trial of behavioral treatment of insomnia. Participants completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress Test (FIRST), and demographic information at baseline. Abuse history was assessed with a single 4-choice item asking participants if they had a history of physical or sexual abuse. One-way analysis of variance was used to determine the level of sleep reactivity in each of the 4 abuse groups (none, physical, sexual, both) controlling for insomnia (ISI). Post-hoc analyses also compared differences in self-reported difficulties falling and staying asleep. Results Compared to those with no abuse history (n = 465), patients who reported both physical and sexual abuse (n = 50) had significantly elevated FIRST scores (p < .001). Results remained significant after controlling for severity of insomnia, age, and gender. Post-hoc analyses showed group differences in sleep onset latency but not wake after sleep onset. Conclusion Combined physical and sexual abuse are associated with higher levels of sleep reactivity to stress, and that the effects may be most prominent for difficulties falling asleep and not sleep maintenance. Prospective studies are needed to determine the potential effects of abuse on sleep reactivity, and whether sensitization of the sleep system to stress constitutes an etiological pathway in the development of insomnia disorder in survivors of abuse. Future work should also investigate potential overlapping biological markers of abuse and sleep reactivity. Support This study was funded by the Robert Wood Johnson Foundation (PI: Drake).

Accuracy of ultrasound in the diagnosis of classic metaphyseal lesions using radiographs as the gold standard.

Diagnosis of classic metaphyseal lesions (CMLs) in children suspected for child abuse can be challenging. Ultrasound (US) can potentially help diagnose CMLs. However, its accuracy is unknown. To evaluate the accuracy of US in the diagnosis of CMLs using skeletal survey reports as the gold standard. US of the metaphysis was performed in three patient groups age <1year. Informed consent was obtained for patients scheduled for renal US (Group 1) and for patients scheduled for skeletal surveys for possible child abuse (Group 2). Targeted US was also performed in selected patients to evaluate for possible CML suspected on radiographs (Group 3). In Groups 1 and 2, US was performed of both distal femurs, and of either the right or left proximal and distal tibia. Two radiologists (Rad1 and Rad2) independently reviewed the US studies, blinded to history and other imaging. US sensitivity and specificity were calculated using the following gold standards: CML definitely seen on skeletal survey (positive), CML definitely not seen on skeletal survey or part of renal US group (negative). Cases where the skeletal survey was indeterminate for CML were excluded. Kappa statistics were used to evaluate interobserver variability. Two hundred forty-one metaphyseal sites were evaluated by US in 63 children (mean age: 5months; 33 males); 34 had skeletal surveys and 29 had renal US. Kappa for the presence of CML was 0.70 with 95.7% agreement. US sensitivity was 55.0% and 63.2% and the specificity was 97.7% and 96.7% for Rad1 and Rad2, respectively. US has low sensitivity and high specificity in CML diagnosis. Thus, negative US does not exclude CML, but when the radiographs are equivocal, positive US can help substantiate the diagnosis.

IMMUNE STATUS OF PATIENTS WITH LUNG TUBERCULOSIS AND ALCOHOL CONSUMPTION

Tuberculosis is a great medical and social problem. An important risk factor for tuberculosis progress is the systematic use of alcohol. The relationship between alcohol intake and TB has been clear after numerous studies and meta-analyzes. However, there are still open questions about whether alcohol is the direct cause of TB development, which doses of alcohol have the greatest trigger value in progress of TB process, what kind of immunological reactions are significantly associated with alcohol intake and what immune background can determining role of alcohol in progression of TB infection. The features of the immune response in TB patients with different value of alcohol use remain poorly understood. The aim of the research - to investigate the immune status in patients with firstly diagnosed pulmonary tuberculosis with various levels of alcohol consumption. Materials and methods. We selected for participating in the study 102 males with tuberculosis and alcohol consumption. Examination of the patients included: clinical methods, chest X-ray, sputum tests, Alcohol Use Disorders Identification Test and immunological blood analysis. Results. Patients with tuberculosis and alcohol consumption, have increase inflammatory response: higher level of stab neutrophils, CRP, ESR, as well as phagocyte activity, circulating immune complexes levels and medium molecular weight peptides levels. On the other hand we found decreasing of phagocytic number, index of phagocytosis completeness and differentiation clusters CD2+, CD3+, CD4+, CD8+ of T-lymphocytes` sub-populations. The highest changes were observed in the group of alcohol abusers. Conclusions. Patients with tuberculosis and alcohol intake, even at low levels of its consumption, have a dysregulation of their immune response. On the one hand, there is an increase of non-specific inflammatory reactions, and on the other - a situation, when antigen-presenting cells cannot adequately to process and present the antigen to phagocytes. This prevents the immune system from responding quickly, correctly evaluating and suppressing foreign agents.

Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis

ABSTRACT Purpose To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US). Methods This retrospective cross-sectional study used National ED Sample (NEDS) (2006–2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers. Results An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50–32.87]). Conclusions In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden.

Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness

Although there is extensive literature on the processes and outcomes of drug and alcohol dependence treatments, little is known about specific predictors of treatment effectiveness. The present study aims to identify the predictors of abstinence in outpatient drug and alcohol dependence treatments, as well as the predictors of treatment effectiveness, according to a biopsychosocial approach. The study followed a cross-sectional research design. Participants (n = 290) were recruited from an outpatient treatment of the Intervention Division in Addictive Behaviors and Dependencies (DICAD), in the northern region of Portugal. A convenience sample was used. Data was collected using questionnaires administered at the facilities of the DICAD, in a private, quiet room. Results indicate that predictors of abstinence were involvement in treatment, psychopathology symptoms, and treatment program (i.e., outpatient drug vs alcohol dependence treatments). The full model of logistic regression analysis was significantly reliable (χ2(3) = 33.93, p < 0.001), with 72.5% successfully predicted for the non-substance abuse group and a 53.1% accurate prediction rate for the substance abuse group. The predictors of treatment effectiveness, according to a biopsychosocial approach, were social support and the treatment program. The full model was significantly reliable (χ2(2) = 68.28, p < 0.001), with 33.0% successfully predicted for the treatment effectiveness group and a 91.1% accurate prediction rate for the non-treatment effectiveness group. Results suggest that interventions need to focus not only on reducing substance abuse, but also on decreasing psychopathology and promoting therapeutic involvement, acting as predictors of abstinence. Furthermore, interventions must focus on promoting social support and the treatment program, acting as predictors of treatment effectiveness, according to a biopsychosocial approach.

The FODRAT study (FOod addiction, DRugs, Alcohol and Tobacco): first data on food addiction prevalence among patients with addiction to drugs, tobacco and alcohol.

The main focus of this study was to evaluate the prevalence of food addiction (FA) in a population of 575 subjects, all affected by drugs, alcohol and/or tobacco addiction. Patients were enrolled in Addiction Service Centers and 25 items YFAS questionnaire was administered. Prevalence of FA was studied among patients who already have an addiction and then this prevalence was compared between groups of abusers (by type of substance), comparing mono abusers with polyabusers, as well as regressions by age, BMI, sex, through multiple regression analysis. Prevalence of FA in the sample is 20.17%. Risk of FA increases with the number of substances used (polyabuse). Results show a positive correlation, in addicted people, between BMI values and FA, with significant values (OR 1.08; 95% CI 1.04-1.13; p = 0.006). Age is inversely correlated with FA (OR 0.97; 95% CI 0.95-0.99; p = 0.01). Female sex is positively associated (OR 2.60; 95% CI 1.59-4.27, p = 0.000). No significant association appears with any substance, even if the highest prevalence is recorded among cannabis users (31.03%), and heroin (21.07%), followed by cocaine (18.53%), alcohol (14.49%) and tobacco (11.61%). A comparison between the FA prevalence in our study and that from another study in the Italian general population (11%) shows a significant difference (p < 0.001). Prevalence of FA among addicted people is greater than in the general population. Risk of FA increases with the increase in number of used substances (polyabuse). Age is inversely correlated with FA. There is a positive and significant correlation between BMI and FA among substance/tobacco abusers. Level V, observational cross-sectional descriptive study.

Chapter 26 - Addiction among women and sexual minority groups

Gender-related alcohol and drug abuse problems are related not only to biologic differences but also to social and environment factors, all of which can influence the clinical presentation, consequences of use, and treatment approaches. The number of women becoming addicted to alcohol or drugs of abuse has significantly increased with women becoming the fastest-growing group of substance abusers in the United States. Given that women experience a more rapid progression of their addiction than men, it is important that we understand and address the differences to help develop prevention and treatment programs that are tailored for women, incorporating trauma assessment and management, comorbidities, financial independence, pregnancy, and child care.

Questionnaire and biomarker-based risk assessment of alcohol abuse among persons receiving various levels of medical professional education

Aim. To compare the results of the questionnaire and biomarker-based risk assessment of alcohol abuse among persons receiving higher and mid-level medical professional education.&#x0D; Methods. Among students of mid-level and higher medical education age 18 to 27 years (77 and 124 subjects, respectively), activity of indicator enzymes was measured in blood serum, and with the help of questionnaires the risk of alcohol abuse (CRAFFT, CAGE, AUDIT) and psychological features of the person were determined [A.G. Zverkovs and E.V. Eidmans questionnaires of willpower and self-control, R. Baumeisters self-control questionnaire, hardiness survey (Maddi S.R.) adapted by D.A. Leontyev, Barratt Impulsiveness Scale Test, test for revealing risk groups of psychoactive drug abuse in the educational institution]. Statistical significance was assessed with the use of nonparametric statistics.&#x0D; Results. The activity of enzymes (aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase) in the blood of the subjects did not have significant intergroup differences. Additionally (beyond this study), we characterized the database of laboratory tests of the students aged 18 to 27 years seeking medical care in the academic center of laboratory diagnosis of Omsk State Medical University. Among 646 subjects, 52 (8.1%) had laboratory analyses exceeding the reference so the differences were expected. Absence of results exceeding reference values of the activity of the studied enzymes was necessary in our study to confirm the absence of pathology associated with cytolysis as well as the signs of chronic alcohol abuse with harmful consequences, which is equivalent to meeting the inclusion criteria (absence of pathology according to medical professional consultation report 086/u and to the results of periodic health examination). Among all surveyed, the CRAFFT questionnaire showed a 2.7-fold higher number of groups at risk of alcohol abuse than CAGE and 1.4 times more than AUDIT. The results of CAGE and CRAFFT test questionnaires showed a greater prevalence of the risk of alcohol abuse among students of higher medical education programs compared to those receiving mid-level medical education (CAGE by 2.7 times; CRAFFT by 1.68 times) . The AUDIT test revealed no statistically significant differences between the groups (p=0.093). Analysis of the results of psychological testing to identify the propensity for addictive behavior, showed a weak correlation with self-control (r=0,406, p=0,014 and r=0,313, p=0,016 for CRAFFT and AUDIT, respectively). Correlation between the self-control violation and risk of alcohol abuse was quite weak according to the results, hence, the students with disordered self-control are not alwaysa characterized by alcohol motivation. In the context of our received data, psychological survey for monitoring the risk of abuse cannot substitute CRAFFT and AUDIT tests.&#x0D; Conclusion. The CRAFFT questionnaire is most effective in assessing the risk of alcohol abuse in a population of young people; the results of the questionnaires used weakly correlated with tests that reflect the psychological characteristics of the person; the activity of the studied enzymes in the blood serum of did not correlate with the results of surveys and is within the population reference interval.

Gonadal and Cortisol Hormone Profile among Male Chronic Khat, Marijuana, and Heroin Abuses.

Background Drugs of abuse could interfere with the hypothalamic-pituitary-gonadal axis, causing impaired functions of the gland and associated functions of target organs. Drugs of abuse tend to cause changes in the endocrine system, and these changes could be physiological, molecular, biochemical, genetic, and cellular. Method A case-control study design was conducted from a total of 171 male consented study participants (148 drug abusers and 23 controls). The serum gonadal and cortisol hormone levels were assayed using the electrochemiluminescence immunoassay method. Socio-demographic variables were collected using a semi-structured questionnaire by the interview method. Nonparametric statistical tools (Mann–Whitney test and median) were used to compare the groups. In all cases, P < 0.05 was considered statistically significant. Result The median age for drug abusers and control groups was 27, and the age difference between drug abusers and control group was not statistically important. The median estradiol levels among chronic khat chewers (39.4 pg/ml), marijuana (44 pg/mL), and users of heroin (40.2 pg/mL) were significantly higher than control groups (23 pg/mL), P < 0.003. However, the median luteinizing hormone levels among chronic khat chewers (5 IU/L), marijuana users (5 IU/L), and heroin users (5.6 IU/L) were significantly lower than those of control groups (6.2 IU/L), P < 0.02. The median testosterone levels among chronic khat chewers (6.1 ng/mL), marijuana users (6.3 ng/mL), and heroin users (6.6 ng/mL) were significantly lower than control groups (8.0 ng/mL), P < 0.003. However, cortisol and follicle stimulating hormone did not show statistically significant difference between users of khat, marijuana, and heroin compared with the control group. Conclusion The drug abuser group had significantly lower testosterone and luteinizing hormone levels compared with control groups. Drug abuse has been shown to affect gonadal hormones in an unusual physiological phenomenon. These findings reveal the need for intervention programs to solve these problems.

Attachment and Substance Use Disorders-Theoretical Models, Empirical Evidence, and Implications for Treatment.

Introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). Based on attachment theory, substance abuse can be understood as “self-medication,” as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD and, on the other hand, a negative impact of substance abuse on attachment security. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups. Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results: All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment, results mainly point toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful–avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood. Discussion: The last decades have seen a substantial growth in studies on attachment and SUDs. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to the understanding and treatment of SUDs in a significant way. But to do so, a lot of open questions have to be answered. We will need more carefully designed longitudinal studies, more studies connecting psychological data with brain processes, and more clinical trials.

Health Care Utilization and Payments of Postoperative and Drug Abuse-Related Spinal Infections.

Retrospective analysis of data extracted from the MarketScan database (2000-2016) using International Classification of Diseases (ICD)-9, ICD-10, and Current Procedural Terminology-4 codes. Evaluate the economic costs and health care utilization associated with spine infections. Spinal infections (SI) are associated with significant morbidity and mortality. A recent spike in SI is attributed to the drug abuse epidemic. Management of SI represents a large burden on the health care system. We assessed payments and outcomes at the index hospitalization, 1-, 3-, 6-, and 12-month follow up. Outcomes assessed included length of stay, complications, operation rates, and health care utilization. Outcomes were compared between cohorts with spinal infections: (1) with prior surgery, (2) drug abuse, and (3) without previous exposure to surgery or drug abuse, denoted as control. We identified 43,972 patients; 15.6% (N = 6847) of patients underwent prior surgery, 3.8% (N = 1,668) were previously expose to drug abuse while 80.6% fell into the control group. Both the postsurgical and drug abuse groups longer hospital stay compared with the control cohort (5 d vs. 4 d, P < 0.0001). Exposure to IV drug abuse was associated with increased risk of complications compared with the control group (43% vs. 38%, P < 0.0001). Payments at 1-month follow-up were significantly (P < 0.0001) higher among the postsurgical group compared with both groups. However, at 12-months follow-up, payments were significantly (P < 0.0001) higher in the drug abuse group compared with both groups. Only postsurgical infections were associated with higher number of surgical interventions both at presentation and 1 year follow up. SI following surgery or IV drug abuse are associated with higher payments, complication rates, and longer hospital stays. Drug abuse related SI are associated with the highest complication rates, readmissions, and overall payments at 1 year of follow up despite the lower rate of surgical interventions. 3.

Drug Abuse-Related Neuroinflammation in Human Postmortem Brains: An Immunohistochemical Approach.

The aim of the study was to investigate blood-brain barrier alterations, neuroinflammation, and glial responses in drug abusers. Five immunohistochemical markers (CD3, zonula occludens-1 [ZO-1], intracellular adhesion molecule 1 [ICAM-1], vascular cell adhesion molecule [VCAM-1], and glial fibrillary acidic protein [GFAP]) were assessed on postmortem brain samples collected from drug abusers who died from acute intoxication of cocaine, heroin, or a combination of both, compared with controls. CD3 and ICAM-1 immunopositivity were significantly stronger in drug abusers than in controls. VCAM-1 immunopositivity was similar across drug abuser and control groups. In heroin abusers, significantly lower ZO-1 immunopositivity was observed relative to controls. GFAP positivity did not show significant differences between groups, but its distribution within the brain did differ. Both cocaine and heroin abuse promoted neuroinflammation, increasing expression of ICAM-1 and recruiting CD3+ lymphocytes. Heroin affected the molecular integrity of tight junctions, as reflected by reduced ZO-1 expression. The outcomes of the present study are, overall, consistent with prior available evidence, which is almost exclusively from studies conducted in vitro or in animal models. These findings provide important information about the downstream consequences of neuroinflammation in drug abusers and may help to inform the development of potential therapeutic targets.

Parental substance use disorder and child abuse: risk factors for child maltreatment?

Although the literature consistently shows an association between parental substance use disorders (SUDs) and child abuse, it is unknown what factors discern non-abusive and abusive parents with SUDs. This study aims to investigate which specific risk factors are associated with child abuse in clinically treated parents with SUDs in the Netherlands. It examines two groups of parents with SUDs in a clinical setting, with and without known instances of child abuse. These groups were compared on SUD-related factors such as the type and severity of the SUDs, and variables addressing psychological disability such as comorbid diagnoses and quality of life. Other than a marginally significant difference in severity of addiction and a lower mean age of the parents in the child abuse group, no significant differences were found. The small sample size and the inherent difficulty of studying SUDs in a clinical sample is likely to have affected the results.

P4134Impaired left ventricular systolic function in alcohol abusers expressed by both 3D calculated ejection fraction and longitudinal strain by AFI

Abstract Aim Despite knowledge regarding the existence of alcohol cardiomyopathy the exact impact of alcohol abuse in consecutive subject is poorly examined. We aimed to evaluate the left ventricle (LV) function in chronic abusers group and compared classical and novel echocardiography parameters in alcohol abusers (ALC) and control group (C). Methods We compared 75 adults (mean age 48±12, 60 male) without other overt heart disease, coronary artery disease excluded, but with alcohol abuse history: average alcohol intake 32 alcohol unit per week (AUW) with control group consisted of 40 subjects without history of excessive drinking, abstinents or drinking ≤8 AUW (mean age 50±4, 16 men). One unit was defined as 10 grams of pure etanol. All patients underwent TTE examination including ejection fraction (EF) calculation with 3D and longitudinal strain assessment by AFI method. Results ALC group showed LV systolic dysfunction expressed as EF 48±14 vs 60±9%, global longitudinal strain (AFI GLS) −15.6±6.6 vs −18.7±3.4; p&lt;0.0001 and p 0.0064, respectively. On the other hand the LV and left atrial diameters as well as diastolic function were similar in both groups, indicating on relatively low advancement of heart remodeling. ALC vs Control group comparison ALC N75 C N40 p value Age 48±12 50±4 ns BMI 24±6 28±6 0.0009 LVd 48±13 47±4 ns LVs 34±15 32±4 ns LA 38±9 38±3 ns EF 48±14 60±9 &lt;0.0001 E/A 1.1±0.6 1.1±0.3 ns E' lateral 10.6±3.9 10.6±2.9 ns AFI 2ch −15.9±6.9 −18.8±4.8 0.0143 AFI 3ch −15.9±6.9 −18.9±3.6 0.0116 AFI 4ch −15.2±7.1 −18.6±3.5 0.0053 AFI GLS −15.6±6.6 −18.7±3.4 0.0064 Conclusions Chronic alcohol abuse revealed harmful effect on LV systolic function which can be assessed quantitatively by both decreased EF and absolute values of myocardial longitudinal strain. This systolic function impairment seems to anticipate the overt remodelling of the heart.