Changes In Substance Use Research Articles

Intervention effects on self-control decrease speed of biological aging mediated by changes in substance use: A longitudinal study of African American youth.

Biological aging is a common root for multiple diseases causing morbidity and mortality, and trajectories of aging may start early in life. This study was designed to examine whether a universal family-based substance use preventive intervention to enhance self-control and reduce substance use would also result in reductions in biological aging among Black youth from the rural South. The Adults in the Making (AIM) program is a randomized controlled trial with six 2-h sessions for Black youth. The 216 youths agreeing to provide blood at age 22 included 114 who had received the AIM intervention and 102 who assigned to the control group. We examined accelerated DNA methylation (DNAm)-based aging using a recently developed measure, "GrimAge," that has been shown to predict the risk of early mortality and that is known to be more strongly affected by substance use than other DNAm-based aging indices. Relative to those randomly assigned to the control group, those receiving the intervention demonstrated significantly enhanced self-control, slower increases in substance use, and reduced Grim aging at age 22. Using a bootstrapping method with 1000 replications, we found a significant indirect effect of AIM on reduced Grim aging through its effect on self-control and substance use. Sensitivity analyses examined effects using other indices of DNAm-based aging. These findings suggest that a family-based program designed to enhance rural Black youth's self-control can have beneficial effects on self-control, enhancing young adult health and health behavior, and ultimately decreased mortality risk.

Psychological Distress and Tobacco Use Among Hospital Workers During COVID-19.

Background and Aims: This work aims to assess the impact of the COVID-19 pandemic on hospital workers' psychological parameters and attitudes toward substance use, before and during the French COVID-19 lockdown.Methods: An online survey was proposed to the staff of the University Hospital of Nice and Sainte-Marie psychiatric hospital in France from May 18 to June 6, 2020 assessing changes in daily habits, psychological distress and changes in substance use, including smoking.Results: A total of 702 respondents (80.3% female) filled out the survey. Overall, most of the workers reported increased stress, irritability, sadness, decreased motivation, and a worse quality of sleep after the beginning of the COVID-19 lockdown. Additionally, hospital workers who were more likely to use tobacco during the COVID-19 lockdown reported increased sadness (OR = 1.23, p < 0.001), loss of motivation (OR = 0.86, p < 0.05), alcohol consumption (OR = 3.12, p < 0.001), lower incomes (OR = 1.69, p < 0.05), living alone (OR = 1.77, p < 0.001) and doing less physical activity (OR = 0.36, p < 0.001).Conclusion: During the first lockdown, significant psychological changes (sadness, distress, irritability) associated with changes in tobacco use and physical activity were reported. Such results should encourage hospital leaders to implement dedicated policies to better accompany hospital workers' psychological distress.

What treatment and services are effective for people who are homeless and use drugs? A systematic 'review of reviews'.

BackgroundPeople who experience homelessness and those vulnerably housed experience disproportionately high rates of drug use and associated harms, yet barriers to services and support are common. We undertook a systematic ‘review of reviews’ to investigate the effects of interventions for this population on substance use, housing, and related outcomes, as well as on treatment engagement, retention and successful completion.Methods and findingsWe searched ten electronic databases from inception to October 2020 for reviews and syntheses, conducted a grey literature search, and hand searched reference lists of included studies. We selected reviews that synthesised evidence on any type of treatment or intervention that reported substance use outcomes for people who reported being homeless. We appraised the quality of included reviews using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the Scale for the Assessment of Narrative Review Articles. Our search identified 843 citations, and 25 reviews met the inclusion criteria. Regarding substance use outcomes, there was evidence that harm reduction approaches lead to decreases in drug-related risk behaviour and fatal overdoses, and reduce mortality, morbidity, and substance use. Case management interventions were significantly better than treatment as usual in reducing substance use among people who are homeless. The evidence indicates that Housing First does not lead to significant changes in substance use. Evidence regarding housing and other outcomes is mixed.ConclusionsPeople who are homeless and use drugs experience many barriers to accessing healthcare and treatment. Evidence regarding interventions designed specifically for this population is limited, but harm reduction and case management approaches can lead to improvements in substance use outcomes, whilst some housing interventions improve housing outcomes and may provide more stability. More research is needed regarding optimal treatment length as well as qualitative insights from people experiencing or at risk of homelessness.

Perspectives on preconception health among formerly incarcerated women with substance use disorders

IntroductionWomen involved in the criminal justice system have high rates of substance use disorders (SUD) placing them at increased risk for unintended pregnancy and adverse pregnancy outcomes. Little is known about the factors that influence the decision-making of formerly incarcerated women with SUD prior to becoming pregnant, in the preconception period. The goal of this study is to understand formerly incarcerated women's perceptions of changing substance use behaviors before pregnancy. MethodsWe analyzed 33 semi-structured interviews with formerly incarcerated women in Saint Louis, Missouri. We asked questions about factors that influenced decision-making related to substance use and pregnancy. Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a grounded theoretical approach with ATLAS.ti software. ResultsFour main themes emerged: (1) participants' understanding of preconception behavior change was influenced by their experiences with unplanned pregnancies and lack of control over outcomes; (2) substance use created challenges for women in considering their reproductive wishes; (3) while pregnant, participants weighed the medical and legal risks in their decision-making about their substance use; and (4) participants described how the internal motivation necessary to stop substance use during pregnancy was influenced by factors such as hitting rock bottom and witnessing negative outcomes experienced by others. ConclusionsPreconception health services must be provided to women with SUD during opportunistic times such as during incarceration or while in SUD treatment. Services need to be non-judgmental and supportive rather than penalizing and should increase internal motivation to adopt behavior change.

Predicting changes in substance use following psychedelic experiences: natural language processing of psychedelic session narratives

ABSTRACT Background: Experiences with psychedelic drugs, such as psilocybin or lysergic acid diethylamide (LSD), are sometimes followed by changes in patterns of tobacco, opioid, and alcohol consumption. But, the specific characteristics of psychedelic experiences that lead to changes in drug consumption are unknown. Objective: Determine whether quantitative descriptions of psychedelic experiences derived using Natural Language Processing (NLP) would allow us to predict who would quit or reduce using drugs following a psychedelic experience. Methods: We recruited 1141 individuals (247 female, 894 male) from online social media platforms who reported quitting or reducing using alcohol, cannabis, opioids, or stimulants following a psychedelic experience to provide a verbal narrative of the psychedelic experience they attributed as leading to their reduction in drug use. We used NLP to derive topic models that quantitatively described each participant’s psychedelic experience narrative. We then used the vector descriptions of each participant’s psychedelic experience narrative as input into three different supervised machine learning algorithms to predict long-term drug reduction outcomes. Results: We found that the topic models derived through NLP led to quantitative descriptions of participant narratives that differed across participants when grouped by the drug class quit as well as the long-term quit/reduction outcomes. Additionally, all three machine learning algorithms led to similar prediction accuracy (~65%, CI = ±0.21%) for long-term quit/reduction outcomes. Conclusions: Using machine learning to analyze written reports of psychedelic experiences may allow for accurate prediction of quit outcomes and what drug is quit or reduced within psychedelic therapy.

Changing Patterns of Substance Use During the Coronavirus Pandemic: Self-Reported Use of Tobacco, Alcohol, Cannabis, and Other Drugs.

As in many other countries worldwide, the coronavirus pandemic prompted the implementation of an “intelligent lockdown” in the spring of 2020 in the Netherlands, including the closure of nightlife venues and cancellation of festivals. Such restrictions and social distancing could particularly affect people who use alcohol or other drugs in recreational settings and give rise to new challenges and additional needs in the field of addiction prevention and care. To monitor changes in substance use and provide services with practical directions for tailored prevention, an anonymous web survey was set up, targeting a convenience sample aged 16 years or older through various social media and other online channels. Between May and October 2020, a total of 6,070 participants completed the survey, mainly adolescents and young adults (16–24 years old). These data were used to explore and describe changing patterns in substance use. Overall results showed declined current use compared to “pre-corona,” but mask underlying variation in changing patterns, including discontinued (tobacco 10.4%, alcohol 11.3%, cannabis 16.3%, other drugs 30.4%), decreased (tobacco 23.0%, alcohol 29.1%, cannabis 17.4%, other drugs 20.7%), unchanged (tobacco 30.3%, alcohol 21.2%, cannabis 22.3%, other drugs 17.3%), increased (tobacco 29.6%, alcohol 32.1%, cannabis 32.9%, other drugs 25.3%), and (re)commenced use (tobacco 6.7%, alcohol 6.3%, cannabis 11.1%, other drugs 6.2%). Especially the use of drugs like ecstasy and nitrous oxide was discontinued or decreased due to the lack of social occasions for use. Increased use was associated with coping motives for all substance types. As measures combatting the coronavirus may need to be practiced for some time to come, possibly leading to prolonged changes in substance use with lingering “post-corona” consequences, timely and ongoing monitoring of changing patterns of substance use is vital for informing prevention services within this field.

Converging public health crises: substance use during the coronavirus disease 2019 pandemic.

Purpose of reviewThe international, public health crisis caused by the rapid spread of SARS-CoV-2 has resulted in unforeseen medical and psychiatric consequences. We reviewed publications from January 2020 to January 2021, given that earlier documents were not relevant, to review findings on changes in substance use and overdoses during the pandemic. Additionally, this review of the literature also documents advocacy efforts, health service modification and challenges, as well as COVID-related health complications associated with substance use.Recent findingsRecent work focused on identifying changes in the distribution and use of substances as well as the unique challenges to promoting the health of persons who use substances in the current pandemic. Although COVID-19 has triggered unprecedented innovations in the organizational and public policy, the use of certain substances (alcohol, cannabis, cigarettes, fentanyl, heroin, and opiates) is increasing internationally. Unique associations between substance use and pandemic-related adverse health outcomes were identified. In addition, the pandemic precipitated significant barriers and disruptions to care.SummaryGiven increased overdose rates and infections among people who use drugs, continued surveillance and vigilance are needed to assess changes and reduce use and adverse consequences during the continuing COVID-19 crisis. Changes are urgently needed to reduce adverse health outcomes because of treatment barriers and lack of adequate treatment options. Additionally, integrative approaches are necessary to promote the public health of persons who use substances.

Solution-Focused Brief Therapy for Substance Use: A Review of the Literature.

Substance use is a prevalent public health issue. Most social workers may encounter substance use in their work with clients and need effective therapeutic strategies for this issue. Since the 1980s, solution-focused brief therapy (SFBT) has been practiced with clients who have substance use problems, and clinical training materials have been developed to help practitioners learn and use SFBT in substance use treatment. Despite the longevity of the use of SFBT in practice, there are no published reviews of outcome studies to guide practitioners using SFBT. This article fills a gap in current literature on SFBT and substance use treatment by reviewing the published studies on SFBT where the focus was on substance use treatment. Five databases were searched to identify eligible studies. Experts and reference lists of relevant studies were also consulted. Nine studies were identified and included in the review. All studies reviewed found promising evidence on SFBT's effectiveness in improving substance use behaviors and related psychosocial problems. Five of the nine studies reviewed showed that SFBT can change substance use and comorbid mental health and psychosocial problems such as depression, trauma, and school- and work-related behavior problems. The article concludes with a discussion of the study results' implications for clinical practice and future research.

Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users

BackgroundSARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe.MethodsData were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances.ResultsAcross all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use.ConclusionsOur findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.

Substitution behaviors among people who gamble during COVID-19 precipitated casino closures

ABSTRACT The COVID-19 pandemic triggered the closure of licensed casinos throughout the United States of America in March and April 2020. This study sought to examine how Americans who gamble responded to the COVID-19 lockdown, including migration to online gambling, and changes in substance use and use of other technologies. On 9 April 2020, we recruited an online sample of 424 Americans who gambled in the last three months via Amazon’s Mechanical Turk. Self-reported changes in online gambling and other addictive behaviors since the onset of COVID-19 and problem gambling severity were measured. Overall, online gambling decreased following the onset of COVID-19 casino closures, while alcohol, tobacco, and cannabis use increased. Among respondents who reported no online gambling involvement prior to COVID-19, 15% reported migrating to online gambling. These migrators had higher levels of problem gambling and lower income than respondents who had never gambled online. The response to COVID-19 is heterogeneous: the majority of people who gamble reported reducing their online gambling but increased their substance use. A minority of people who gamble substituted casino gambling with online gambling. Because these individuals are characterized by problem gambling symptoms and lower income, they may be considered a vulnerable group.

COVID-19 Testing and the Impact of the Pandemic on the Miami Adult Studies on HIV Cohort.

Background:Socioeconomic disadvantages and potential immunocompromise raise particular concerns for people living with HIV (PLWH) and other marginalized communities during the COVID-19 pandemic. In this study, we explored COVID-19 testing and the impact of the pandemic among participants from the Miami Adult Studies on HIV cohort, predominantly composed of low-income minorities living with and without HIV.Methods:Between July and August 2020, a telephone survey was administered to 299 Miami Adult Studies on HIV participants to assess COVID-19 testing, prevention behaviors, and psychosocial stressors. Health care utilization, antiretroviral adherence, food insecurity, and substance use during the pandemic were compared with those of their last cohort visit (7.8 ± 2.9 months earlier).Results:Half of surveyed participants had been tested for COVID-19, 8 had tested positive and 2 had been hospitalized. PLWH (n = 183) were 42% times less likely than HIV-uninfected participants to have been tested. However, after adjustment for age, employment, COVID-19 symptoms, mental health care, and substance use, the effect of HIV status was no longer significant. PLWH were more likely to have seen a health care provider, use face coverings, and avoid public transportation and less likely to be food insecure and drink hazardously. There were significant changes in substance use patterns during the pandemic when compared with those before.Conclusion:PLWH, compared with their HIV-uninfected peers, were more likely to engage in preventive measures and health care during the pandemic, potentially reducing their exposure to COVID-19. There were no reported changes in antiretroviral adherence or health care utilization, but there were changes in substance use; these need to be monitored as this crisis progresses.

Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study.

BackgroundLongitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence).ObjectiveThis study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth’s health behaviors in different developmental stages over extended follow-up.MethodsParticipants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements.ResultsThe mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times).ConclusionsmNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development.

Reported Changes in Adolescent Psychosocial Functioning during the COVID-19 Outbreak

What effect the outbreak of the COVID-19 pandemic has had on adolescents’ psychosocial functioning is currently unknown. Using the data of 1767 (50.2% female and 49.8 male) adolescents in Sweden, we discuss adolescents’ thoughts and behaviors around the COVID-19 outbreak, as well as reported changes in substance use, everyday life, relations, victimization, and mental health during the outbreak. Results showed that (a) the majority of adolescents have been complying with regulations from the government; (b) although most adolescents did not report changes in their psychosocial functioning, a critical number reported more substance use, conflict with parents, less time spent with peers, and poorer control over their everyday life; and (c) the majority of adolescents have experienced less victimization, yet poorer mental health, during the COVID-19 outbreak. Adolescent girls and adolescents in distance schooling were likely to report negative changes in their psychosocial functioning during the COVID-19 outbreak. Based on these findings, we suggest that society should pay close attention to changes in adolescents’ psychosocial functioning during times of crisis.

Changes in Substance Use Among People Seeking Alcohol and Other Drug Treatment During the COVID-19 Pandemic: Evaluating Mental Health Outcomes and Resilience.

Background:Alcohol and other drug (AOD) use patterns have altered as a result of the coronavirus (COVID-19) pandemic restrictions. This study aimed to: (i) determine the impact of the pandemic on patterns of AOD use among individuals seeking treatment, (ii) identify which mental health and resilience factors were associated with changes in patterns of AOD use and (iii) evaluate changes in the contextual factors (eg, motivations) associated with use.Methods:Cross-sectional surveys were completed by clients (n = 325) who had sought AOD treatment from January 2020 onwards. We measured quantity and frequency of AOD use now compared to before the pandemic, mental health (depression, anxiety, trauma exposure), resilience and contextual factors related to AOD use.Results:Quantity of tobacco and cannabis use increased post-pandemic, while methamphetamine and alcohol did not change. Depression was associated with more frequent alcohol use now compared to before the pandemic, while anxiety and lower resilience were associated with less frequent cannabis use now. Lower resilience was associated changes in methamphetamine use. Depression was associated with using more frequently for enjoyment and to alleviate loneliness following the pandemic, and anxiety was associated with using earlier in the day and to alleviate boredom.Conclusions:The pandemic has led to increased frequency of AOD use for a subset of individuals seeking treatment. Depression, anxiety and resilience are important factors associated with altered AOD use, and changes in the motivations and control surrounding use. Special consideration of this should be considered during AOD treatment through the pandemic.

Effects of a Prosocial Skills Curriculum in an Afterschool Program

School-based substance use prevention and prosocial skills-based interventions have demonstrated promise, however, there is less known about the cognitive and behavioral benefits of such programs conducted in afterschool settings. A four-lesson, early intervention program focused on prosocial behavior development and facilitated by community substance use prevention coalition members was delivered to early elementary-aged participants in an afterschool program. Participant prevention knowledge as measured by brief pre-post quiz improved significantly (p &lt; 0.001), but their mentor-observed prosocial behaviors as measured by pre-post behavioral attribute scale did not. A brief afterschool early prevention intervention can change substance use knowledge among early elementary participants. Prosocial behavior change, though, still warrants future investigation in the afterschool setting.

Explaining the rise and fall of psychological distress during the COVID-19 crisis in the United States: Longitudinal evidence from the Understanding America Study.

It has been shown that psychological distress rose rapidly as the COVID-19 pandemic emerged and then recovered to pre-crisis levels as social lockdown restrictions were eased in the United States. The aim of the current study was to investigate psychosocial and behavioural factors that may explain the rise and fall of distress during the initial months of the COVID-19 crisis. This study examined six waves of longitudinal nationally representative data from the Understanding America Study (UAS) collected between March and June 2020 (N=7,138, observations=34,125). Mediation analysis was used to identify whether changes in distress (PHQ-4) during the COVID-19 pandemic were explained by the following factors: perceived infection risk and risk of death, perceived financial risks, lifestyle changes resulting from the virus, perceived discrimination related to the virus, and changes in substance use and employment status. All mediating factors played a role in explaining changes in distress and together accounted for 70% of the increase in distress between 10-18 March and 1-14 April and 46.4% of the decline in distress between 1-14 April and early June 2020. Changes in perceived health risks were most important in explaining changes in distress followed by changes in lifestyle and the perceived financial risks associated with COVID-19. This study provides longitudinal population-based evidence detailing the mediating factors explaining changes in distress during the COVID-19 crisis. Perceived health risks associated with the virus may play a key role in explaining rising and falling levels of psychological distress during the COVID-19 pandemic.

How to achieve greater comparability-suggested ways to improve the determination of treatment gap and treatment lag

PurposeThe aim of this paper is to reveal these problems and to derive recommendations for improvement. In the field of alcohol use disorders (AUDs), two common complaints are the large treatment gap that exists because only a small percentage of people with an AUD are in treatment; and the prolonged lag that typically exists between the emergence of problematic symptoms and actual on set of treatment. However, there also are no clear definitions for these terms – “treatment gap” and “treatment lag” – and, therefore, no consensus regarding how to quantify them. For this reason, it is difficult to compare the results of studies assessing either of these measures.Design/methodology/approachA non-systematic literature search and logical-analytical investigation was performed of immanent problems related to definitions and measurements aiming to enhance understanding in this area and derive suggestions for improvement.FindingsThe following four fundamental questions were identified: How does one operationalise the need to change substance use behaviours? Which interventions can justifiably be called treatment? Is treatment always necessary? and How regularly do patients need to be in contact with a treatment system to be considered “in treatment”? Potential approaches to answering these questions are discussed and recommendations made for future studies to determine how the treatment gap and treatment lag should be derived.Originality/valueThe derived recommendations should make the calculation of treatment gap and treatment lag more transparent and comparable between studies. They also may serve as checklists for future studies on the treatment gap and lag in the AUD field.

Drug testing in biological samples vs. maternal surveys for the detection of substance use during whole pregnancy

Background Early diagnosis of nicotine, ethanol and drug use during pregnancy is critical in order to provide adequate care. Current screening procedures show limitations in terms of reliability and short windows of detection. Objectives To investigate the prevalence and identify biomarkers of substance use and changes in substance use during pregnancy. To compare drug testing results in different types of biological samples (maternal hair, meconium, placenta, umbilical-cord) with self-reported data. Participants and setting Prospective cohort study using data from pregnant women and their newborns. Methods Biological matrices were collected at birth and analyzed by liquid chromatography tandem mass spectrometry. A paper survey was provided to determine substance use habits. Results 867 mother-newborn pairs were included. According to the analysis of biological samples, 29.1% cases were positive for one or more substances (13.6% nicotine, 8.4% ethanol, 8.3% cocaine, 6.4% cannabis, 5.7% opioids). The profile of the substance-using mother was a single woman, <28 years-old, with no higher education and unemployed. Segmental maternal hair analysis showed a decrease in tobacco, cannabis and cocaine use throughout pregnancy (p < 0.001). The level of concordance between results from interviews and from biological analyses was weak for opioids, cocaine, and cannabis (kappa coefficient < 0.40). Maternal hair detected the highest number of cases, followed by meconium and by placenta and/or umbilical-cord. Conclusions Maternal survey was not a reliable screening technique. Analysis of maternal hair detected the highest number of cases with the broadest detection window (whole pregnancy).

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs

Objectives Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men. Method National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences. Results Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women (R = 0.33; p = .01) and men (R = 0.44, p < .0001) with no significant gender difference. Conclusion No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.

Problematic Substance Use, Help-Seeking, and Service Utilization Trajectories among Seniors: An Exploratory Qualitative Study

ABSTRACT Problematic substance use has a significant impact on the health of a large proportion of people aged 65 years and older. Along with population growth, there is an increase in seniors enrolling for treatment in Québec (Canada). This study explores the perspectives of older adults related to their substance use experiences, help-seeking and utilization of addiction treatment services. In-depth interviews were conducted with 11 seniors receiving addiction treatment in two area in Québec. Thematic analysis highlight that seniors’ experiences, life contexts, and social participation influence their substance use. Help-seeking process can be triggered by realizing the extent of substance use, while barriers and facilitators shape this experience. Utilization of addiction treatment services was mainly perceived positively. Several characteristics and components of services enable seniors to have positive experiences. Substance use can be employed as an adaptation strategy to get through hardships or ease loneliness and boredom. Talking to people, such as family, friends or professionals, is important to older adults’ developing trust and engaging in a process to change substance use habits. Based upon these results, clinical recommendations to take into account the complex needs of seniors seeking treatment and related to their social environment are formulated.