Alcohol And Other Drug Disorders Research Articles

Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study.

Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.

From working on recovery to working in recovery: Employment status among a nationally representative U.S. sample of individuals who have resolved a significant alcohol or other drug problem

Alcohol and other drug (AOD) use disorders exact a prodigious annual economic toll in the United States (U.S.), driven largely by lost productivity due to illness-related absenteeism, underemployment, and unemployment. While recovery from AOD disorders is associated with improved health and functioning, little is known specifically about increases in productivity due to new or resumed employment and who may continue to struggle. Also, because employment can buffer relapse risk by providing structure, meaning, purpose, and income, greater knowledge in this regard would inform relapse prevention efforts as well as employment-related policy. We conducted a cross-sectional, nationally representative survey of the U.S. adult population assessing persons who reported having resolved an AOD problem (n = 2002). Weighted employment, unemployment, retirement, and disability statistics were compared to the general U.S. population. Logistic and linear regression models tested for differences in employment and unemployment among demographic categories and measures of well-being. Compared to the general U.S. population, individuals who had resolved an AOD problem were less likely to be employed or retired, and more likely to be unemployed and disabled. Certain recovering subgroups, including those identifying as black and those with histories of multiple arrests, were further disadvantaged. Conversely, certain factors, such as a higher level of education and less prior criminal justice involvement were associated with lower unemployment risk. Despite being in recovery from an AOD problem, individuals continue to struggle with obtaining employment, particularly black Americans and those with prior criminal histories. Given the importance of employment in addiction recovery and relapse prevention, more research is needed to identify employment barriers so that they can be effectively addressed.

An Outcome Study of the CASA-CHESS Smartphone Relapse Prevention Tool for Latinx Spanish-Speakers with Substance Use Disorders

Background: Hispanic/Latinx persons with alcohol and other drug disorders (AOD) have limited access to culturally competent continuity of care. To address this, the evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Latinx Spanish-speakers with AOD, developing CASA-CHESS. Objectives: This study examined the AOD and mental health outcomes for Latinx Spanish-speaking clients using the CASA-CHESS smartphone tool over a 6-month period, post-residential treatment. This single group, pre-post study design included seventy-nine male and female Spanish-speaking Latinx clients, equipped with CASA-CHESS as they completed residential AOD treatment. Primary outcome measures at baseline and 6-month follow-up included substance use and other mental health symptoms. Results: While over 70% of the sample reported past heroin use and alcohol use, clients had low baseline rates of substance use, depression and anxiety and elevated social support scores as they graduated from residential treatment. Overall participants maintained their relatively low baseline rates during the 6-month post-residential period while using the CASA-CHESS relapse prevention tool. Those who discontinued using CASA-CHESS within the first 4 months after leaving residential treatment reported higher rates of substance use as well as anxiety and depression symptoms than those using it for 4 or more months, suggesting that continued use of CASA-CHESS may contribute to maintenance of successes gained in treatment. Conclusions/Importance: CASA-CHESS may reduce the risk of relapse for Latinx Spanish-speakers following residential services and extend needed access to culturally and linguistically competent aftercare services for those with AOD.

Clinician identification of elevated symptoms of depression among individuals seeking treatment for substance misuse

BackgroundDepression is common among those experiencing alcohol and other drug (AOD) disorders. It has been suggested that identifying depressive symptoms among this group is important for case management. Despite this, there is a lack of research examining how well clinicians perform this task within this setting. AimsTo determine the: (i) accuracy of clinician identified elevated symptoms of depression among clients seeking treatment for AOD misuse as compared to a standardized self-report psychiatric screening tool; and (ii) clinician and client characteristics associated with accurate identification of elevated symptoms of depression. MethodsThe study used a descriptive cohort design. Participants from two Australian AOD outpatient clinics reported demographic data and completed the Patient Health Questionnaire (PHQ-9) to identify elevated symptoms of depression. Clinicians were asked to indicate the presence or absence of depression for individual clients. Client and clinician data were compared. ResultsSensitivity of clinician identified elevated symptoms of depression, compared with the PHQ-9, was moderate at 73.0% (95% CI=63.7, 81.0) and specificity was low with 49.5% (95% CI=39.9, 61.2) accurately identified as not having elevated symptoms of depression. AOD clinicians’ years’ of experience, clients’ main substance and length of treatment were associated with accuracy of identification. ConclusionClinicians identify elevated symptoms of depression with moderate accuracy amongst individuals with AOD disorders. There is a tendency to over-identify which may contribute to inaccuracies. Routine screening may assist in improving identification of depressive symptoms and place greater focus on mental health comorbidities.

Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in‐depth semi‐structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre‐migration experiences of torture and trauma; familial factors of intergenerational conflict; post‐migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self‐medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre‐ and post‐settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psycho‐education.

Stopping the run-around? A study of services for people with comorbid mental health and substance use disorders in northern Adelaide.

Comorbidity between mental health and alcohol and other drug (AOD) disorders is common. This study aimed to identify and describe all of the local government and non-government (NGO) mental health and AOD services in a socially disadvantaged urban region in Adelaide, South Australia. Services were identified using telephone directories and the internet, and via information from workers employed by a wide range of mental health and AOD services. Local mental health and AOD services were difficult to locate, but eventually we identified a total of 70 services. Soon after this, reorganisation of the mental health services and a new NGO funding round changed the service configuration, with a decrease in the number of services. The available services were fragmented, and rarely addressed comorbidity specifically. Our real-world study demonstrates the lack of a clear pathway for people to access existing services. Further, changes occur frequently as government funded services generally reorganise every couple of years, and NGO services come and go according to funding. There is a need for a central, widely available database for mental health and AOD services. More services addressing comorbid mental health and AOD disorders are required.

Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature

This review describes the existing knowledge concerning mental health (MH) and drug and alcohol problems in young people of refugee background. We explore the extent to which comorbid MH and alcohol and other drug (AOD) conditions (comorbidity) are likely to be experienced by young people of refugee background and investigate what is known about engaging and supporting young refugees with comorbidity in health services. Much of the literature suggests that young refugees are at a high risk of developing MH and AOD disorders. While it has been established that significant barriers to service engagement and service provision exist for young people of refugee background with one disorder, we suggest the risk may be higher for those experiencing comorbidity as they not only face cultural and linguistic barriers but are also often required to effectively navigate two different service sectors. Directions for future research are discussed.

Identifying depression and anxiety disorders in people presenting for substance use treatment

To identify the type and proportion of depressive and related mental health disorders in a group of individuals seeking outpatient treatment at an alcohol and other drug (AOD) service. A cross-sectional study using diagnostic interviews with 95participants (56men, 39women) seeking treatment from an AOD service. Mental health and substance disorders were measured using the Composite International Diagnostic Interview, Posttraumatic Stress Disorder Checklist, Beck Depression Inventory, and State-Trait Anxiety Inventory (Trait Version). This was a complex group with addiction, mental health and physical health conditions; 76% had a depressive disorder and 71% had an anxiety disorder. Most were diagnosed with at least two mental health disorders and 25% were diagnosed with four or more different disorders. Alcohol and cannabis use were the most commonly diagnosed AOD disorders. Further, those diagnosed with a drug use disorder reported significantly higher levels of depression compared with those with an alcohol-only disorder. Finally, 60% of the sample reported chronic health conditions, with over one-third taking medication for a physical condition on a regular basis. Primary care providers such as general practitioners are likely to be increasingly called on to assess, treat and/or coordinate care of patients with AOD disorders. We show that this group will likely present to their GP with more than one mental health disorder in addition to acute and chronic physical health conditions.

Instruments to Detect Alcohol and Other Drug Misuse in the Emergency Department: A Systematic Review

Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important. To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients. Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR(+)) and negative (LR(-)) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity. Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR(+): 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR(+): 6.83). On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED.

Individuals receiving addiction treatment: are medical costs of their family members reduced?

To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members. Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without AOD disorders on age, gender and utilization, identifying family members of each group. Kaiser Permanente Northern California. Family members of abstinent and non-abstinent AOD treatment patients and control family members. We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size. AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2-5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls. Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health.

Predictors of Alcohol and Drug Problems in Rural African American Women

African American women report less alcohol and other drug (AOD) use than Caucasian women. However, health care professionals cannot afford to dismiss AOD use as significant problems for some African-American women. Although we know much more about AOD problems in women in general, we still lack information about AOD disorders and associated factors among rural African American women. Stepwise multiple regression was used to identify the best predictors of alcohol and drug problems among 142 rural African American women who took part in a study of risk factors for AOD disorders in rural women.

Update in Addiction Medicine for the Primary Care Clinician

The United States Preventive Services Task Force recommends that primary care clinicians assume a major role in screening, identification, treatment, and referral to treatment of unhealthy alcohol and other drug (AOD) use—the spectrum from use that risks health consequences to AOD disorders (abuse and dependence)—in generalist settings.1 In the United States, nicotine dependence, alcohol use, and drug use are the first, third, and ninth leading causes, respectively, of preventable deaths.2 Despite the harmful effects of addiction and improved options for office-based treatments and referral, not all primary care clinicians routinely address AOD use in their patients. The objectives of this paper are to identify and examine important recent advances in addiction medicine that have implications for primary care clinicians and that emphasize primary care clinicians’ role in the identification, treatment and/or referral of patients with addictions. We conducted an electronic database (PubMed) search to systematically identify recent (June 1, 2006 to January 1, 2008) human subject, English language, peer-reviewed, research publications that are relevant to generalist care for patients with addiction disorders. We also surveyed the publications that were reviewed by a NIH-funded newsletter that, in an attempt to identify articles that address the health impact of alcohol and drugs, systematically reviews the core general medical, infectious disease, public health, and addiction subspecialty journals.3 Similar to our prior review,4 authors (A.G., D.F., R.S.) were provided a title listing of articles with addiction-related key words within the reference time frame, and then secondary searches and consensus deliberations were used to identify articles that may impact the care provided by primary care clinicians in the categories of 1) alcohol use and disorders and 2) opioid use and dependence. Articles were categorized as impacting primary care clinicians if they studied primary care settings or could impact such settings and had practice-changing findings or implications.

Stress, Coping, and Alcohol Expectancies in Rural African-American Women

African-American women report less alcohol and other drug (AOD) use compared with Caucasian women. However, health care professionals cannot afford to dismiss AOD use as a significant problem for some African-American women. Although we know much more about AOD problems in women in general, we still lack information on AOD disorders and associated factors among rural African-American women. This article focuses on examining rural African-American women (n=142) with and without AOD disorders on the following variables: stressors, uplifts, coping, and alcohol expectancies.

Vulnerability to alcohol and other drug disorders in rural women

Alcohol and other drug disorders (AOD) are a growing problem among women, with estimates as high as 11 million U.S. women affected. This article is a report of the results from 2 studies investigating risk factors for AOD disorders in rural women. Samples of the 2 studies were combined for a total of 267 women. Analyses focused on victimization as a vulnerability factor for AOD disorders in rural women. Comorbid Axis I mental disorders and nursing implications are discussed. Copyright 2003, Elsevier Science (USA). All rights reserved.

Establishing the feasibility of performance measures for alcohol and other drugs

The Washington Circle (a multiple-disciplinary group of providers, researchers, managed care representatives, and public policy representatives) examined three performance measures for alcohol and other drug (AOD) services. These measures, which were developed and applied to managed care organizations' administrative data for their commercial enrollees, are: (a) identification, the percent of adult enrollees with AOD diagnoses; (b) initiation, the percent of adults with an inpatient AOD admission or with an index outpatient visit for AOD abuse or dependence and any additional AOD services within 14 days of identification; and (c) engagement, the percent of adults diagnosed with AOD disorders that receives two additional AOD services within 30 days of the initiation of care. We conclude that using administrative databases to compare managed care organizations' performance is feasible, meaningful and informative. The article discusses issues in interpreting performance measures in several areas: organizational structure of alcohol and other drug services, information available for measurement, and computational issues.

Alcoholism/Addiction as a Chronic Disease

Summary Although characterized as a chronic disease for more than 200 years, severe and persistent alcohol and other drug (AOD) problems have been treated primarily in self-contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a sustained recovery management model will require rethinking the natural history of AOD disorders; pioneering new treatment and recovery support technologies; restructuring the funding of treatment services; redefining the service relationship; and altering methods of service evaluation. Recovery-oriented systems of care could offer many advantages over the current model of serial episodes of acute care, but such systems will bring with them new pitfalls in the personal and cultural management of alcohol and other drug problems.