Concurrent Substance Abuse Research Articles

Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco, alcohol, cocaine use.

Cannabis use has increased among young individuals in recent years. Although dependent cannabis use disorder (CUD) has been associated with various cardiac events, its effects on young adults without concurrent substance use remain understudied. To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this cohort. We used the National Inpatient Sample (2016-2019) to identify hospitalized young individuals (18-44 years), excluding those with concurrent substance usage (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD-. Using International Classification of Diseases-10 codes, we examined the trends in MACCE hospitalizations, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS). Of 27.4 million hospitalizations among young adults without concurrent substance abuse, 4.2% (1.1 million) had co-existent CUD. In CUD+ group, hospitalization rates for MACCE (1.71% vs 1.35%), AMI (0.86% vs 0.54%), CA (0.27% vs 0.24%), and AIS (0.49% vs 0.35%) were higher than in CUD- group (P < 0.001). However, rate of ACM hospitalizations was lower in CUD+ group (0.30% vs 0.44%). From 2016 to 2019, CUD+ group experienced a relative rise of 5% in MACCE and 20% in AMI hospitalizations, compared to 22% and 36% increases in CUD- group (P < 0.05). The CUD+ group had a 13% relative decrease in ACM hospitalizations, compared to a 10% relative rise in CUD- group (P < 0.05). However, when adjusted for confounders, MACCE odds among CUD+ cohort remain comparable between 2016 and 2019. The CUD+ group had higher rates of MACCE, but the rising trends were more apparent in the CUD- group over time. Interestingly, the CUD+ group had lower ACM rates than the CUD- group.

Suicide Risk in Survivors of Acute Respiratory Distress Syndrome: A Nationwide Cohort Study in South Korea.

Objective We aimed to examine the prevalence and risk factors of suicide among patients with acute respiratory distress syndrome (ARDS). Methods Data were extracted from the National Health Insurance Service database in South Korea. This study included all adults admitted to intensive care units with a diagnosis of ARDS from January 1, 2010 to December 31, 2019, who survived ≥365. The primary endpoint in this study was suicide within 1 year of an ARDS diagnosis, which was determined as death by a suicide attempt or self-harm. Results Analysis included 9,928 patients identified as ARDS survivors. One-year all-cause mortality occurred in 5,021 patients, 186 (1.9%) of which died by suicide. In multivariable Cox regression, older age, continuous renal replacement therapy, cardiopulmonary resuscitation incidence, history of self-harm or attempted suicide and concurrent substance abuse were associated with a higher risk of death by suicide among ARDS survivors. Conclusion During the 1-year follow-up period, 1.9% of ARDS survivors died by suicide in South Korea, and some factors were identified as potential risk factors for death by suicide. Knowledge of the factors associated with suicide might allow for earlier intervention to potentially reduce the death by suicide among ARDS survivors.

Comparison of the Efficacies of Direct-Acting Antiviral Treatment for HCV Infection in People Who Inject Drugs and Non-Drug Users.

Background and Objectives: Hepatitis C virus (HCV) is a major cause of liver disease worldwide. People who inject drugs (PWIDs) constitute the majority of patients with HCV infection in the United States and Central Asia. There are several obstacles to treating HCV infection in PWIDs because PWIDs are often accompanied by concurrent infection, low compliance, substance abuse, and risky behavior. The aim of the study is to compare the efficacies of direct-acting antiviral (DAA) therapy for HCV infection in PWIDs and those without opioid injection. Materials and Methods: In this retrospective cohort study, we included 53 PWIDs with HCV infections treated on site in a methadone program and 106 age- and sex-matched patients with HCV infections who had no history of opioid injection (ratio of 1:2). All eligible subjects received anti-HCV treatment by DAA agents in our hospital from March 2018 to December 2020. The charts of these patients were carefully reviewed for demographic data, types of DAA agents, and treatment outcomes. The primary outcome measure was sustained virological response (SVR). Results: PWIDs and non-drug users had different HCV genotype profiles (p = 0.013). The former had higher proportions of genotype 3 (18.9% vs. 7.5%) and genotype 6 (24.5% vs. 14.2%) than the latter. The two patient groups had comparable rates of complete drug refilling (100.0% vs. 91.1%) and frequency of loss to follow-up (3.8% vs. 0.9%). However, PWIDs had a lower SVR rate of DAA treatment than non-drug users (92.2% vs. 99.0%; p = 0.04). Further analysis showed that both human immunodeficiency virus (HIV) coinfection and history of PWID were risk factors associated with treatment failure. The subjects with coinfection with HIV had lower SVR rates than those without HIV infection (50.0% vs. 96.5%; p = 0.021). Conclusions: PWIDs with HCV infections have higher proportions of HCV genotype 3 and genotype 6 than non-drug users with infections. DAA therapy can achieve a high cure rate (>90%) for HCV infection in PWID, but its efficacy in PWID is lower than that in non-drug users.

Being bound and tied by the ropes of frugality: a case study on public management values and service integration

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices. This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively. The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services. Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Comparison of hospital claims and poison center data to evaluate health impact of opioids, cannabis and synthetic cannabinoids.

Over the past 10years, opioids and cannabis have garnered significant attention due to misuse and legalization trends. Different datasets and surveillance mechanisms can lead to different conclusions the due to a variety of factors. The primary objective of this study was to compare and describe trends of opioid, cannabis, and synthetic cannabinoid-related healthcare encounters and poison center (PC) cases in Colorado, a state that has legalized cannabis. This was a retrospective study comparing hospital claims data (Colorado Hospital Association (CHA)) and poison center cases to describe opioid, cannabis and synthetic cannabinoid-related healthcare encounters and exposures in Colorado from 2013 to 2017 using related genetic codes and International Statistical Classification of Disease codes. Both datasets observed increases in cannabis related encounters and exposures after recreational cannabis legalization in 2014. CHA reported an increase for cannabis-related ER visits from 14,109 in 2013 to 18,118 in 2017 while PC noted a 74.4% increase in cannabis-related cases (125 to 218). CHA inpatient visits associated with cannabis also increased (8311 in 2013 to 14,659 in 2017). On the other hand, Opioid-related exposures to the PC fell (1092 in 2013 to 971 in 2017) while both Opioid-related ER visits (8580 in 2013 to 12,928 in 2017) and inpatient visits in CHA increased (9084 in 2013 to 13,205). This study demonstrates the differences in surveillance methodology for concurrent drug abuse epidemics using hospital claims and PC data. Both systems provide incomplete reports, but in combination can provide a more complete picture.

Organisational and Professional Integration Between Specialist and Primary Healthcare Services: A Municipal Perspective.

Introduction:Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness.Objectives:By studying factors that influence integration in a Norwegian context, this study aims to investigate, from a municipal perspective, why care transitions are still tricky after the introduction of the key Coordination Reform.Methods:This study has an explorative approach based on interviews with managers and front-line professionals in primary care. We applied the conceptual framework of functional and normative integration of the Rainbow Model.Results:The municipal actors emphasise that integration is hampered by limited cooperation with general practitioners in referrals to hospital, challenges of communication and loss of meeting points. They experienced close cooperation with sociomedical polyclinics for substance abuse, while challenges in cooperation with district psychiatric centres indicated an interdependence of functional and normative integration. Questioning hospital discharge of patients to primary care was a recurring theme for the municipal actors. Thus, the governing framework of the Coordination Reform has coexisted with fragmentation in organisational structures and divided professional cultures.Conclusions:The coexistence of the new and the old regimes seems to hamper functional and normative integration in care transitions.

227. Does baseline substance use predict subsequent development of mental health disorders in adolescent idiopathic scoliosis patients?

BACKGROUND CONTEXT MHD prevalence in patients with substance abuse history has been well-described. However, the impact of current or historical substance abuse/dependence in adolescent idiopathic scoliosis (AIS) patients on risk of subsequent development of new-onset mental health disorders (MHDs) is unknown. PURPOSE This study evaluated the: (1) demographics and (2) new-onset diagnosis of MHD among AIS patients with baseline substance abuse/dependence. The goal of this study was to determine whether substance abuse among AIS patients increases the odds of subsequent new-onset development of a MHD. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Using the NYS Statewide Planning and Research Cooperative System (SPARCS), we identified age, gender, race, and Charlson/Deyo-index propensity-score matched cohorts of AIS patients with or without prior/current substance abuse. AIS patients with comorbid substance abuse were included from 2009-11, with minimum 2-year follow-up. A total of 386 AIS patients (n=193 in each group) were included. OUTCOME MEASURES Demographic information, length of stay, hospital charges, new-onset MHD diagnosis at 2-year follow-up METHODS The NYS Statewide Planning and Research Cooperative System was reviewed to identify all 10-25 year-old AIS patients with prior or concurrent substance abuse (AIS-Sub: alcohol, tobacco, cannabis, amphetamine, opioid or polysubstance) from 2009-11 to ensure two-year follow-up. Patients with prior or concurrent MHD(s) were excluded. AIS-Sub were 1:1 propensity score-matched by age, sex, race and Charlson/Deyo index to AIS patients without substance abuse (AIS-NoSub). Cohorts were compared for subsequent incidence/development of individual and overall MHDs (depressive, anxiety, stress, sleep and/or eating disorder). Binary stepwise logistic regressions were utilized to calculate odds ratios (OR) of developing individual or any MHDs based on baseline substance abuse. RESULTS A total of 386 AIS patients were included (n=193 each in AIS-Sub and AIS-NoSub). AIS-Sub and AIS-NoSub patients had comparable age (both 20.8 years), sex (62.2 vs 62.7% male), race (54.9 vs 52.8% white), insurance (55.4 v 45.6% Medicaid), and Charlson-Deyo (0.29 vs 0.37) respectively. AIS-Sub patients had higher rates of new-onset subsequent overall MHDs (16.1% vs 3.6%), with only depressive disorder higher among individual MHDs (10.9% vs 0.5%), both p CONCLUSIONS AIS patients with prior or current substance abuse/dependence were at increased two-year risk of developing any new-onset MHD, specifically depressive disorders. This data may guide preoperative screening and optimization efforts for scoliosis surgeons, as MHDs have been associated with poor outcomes following spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Rates, determinants and outcomes associated with the use of community treatment orders in young people experiencing first episode psychosis

BackgroundCommunity treatment orders (CTOs) are a controversial form of involuntary treatment for individuals affected by mental health disorders and yet little is known about the use of CTOs in first presentations. Therefore, this study aimed to determine the rates, determinants and outcomes associated with the use of CTOs in young people with a first episode of psychosis (FEP). MethodsThis epidemiological cohort study included all individuals aged 15–24 who presented with a FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 01.01.2011 and 31.12.13. ResultsA total of 544 young people presented with a FEP during the study period and of these, 93 (17.3%) were subject to a CTO during their episode of care. A total of 69.7% of CTOs were commenced after the first three months of treatment and the median duration of CTOs was 168.5 days. Males, a diagnosis of a schizophrenia spectrum disorder and a concurrent substance abuse disorder were associated with the use of CTOs. Additionally, young people with more severe positive psychotic symptoms were more likely to be subject to a CTO. At the time of discharge, only 38.7% of those subject to a CTO were in education or employment compared to 65.4% of those who had not been subject to a CTO. ConclusionsThe majority of CTOs are commenced after at least three months of treatment, however the optimal timing of CTO implementation needs to be determined. The poor functioning of young people on a CTO should be the focus of future interventional studies.

604. Impact of Substance and Alcohol Abuse on Smoking-Related Behaviors When Using a Smoking Cessation Decisional Algorithm Among People Living with HIV (PLWH)

BackgroundCompared with the general population, PLWH have higher rates of tobacco use. We performed a prospective single-arm pilot study of the real-world feasibility of integrating an ambulatory smoking cessation decisional algorithm in our HIV clinic. We hypothesized that patients with drug and alcohol abuse would have a smaller change in smoking related behaviors.MethodsParticipants were PLWH attending our clinic and smoking at least 5 cigarettes/day regardless of their motivation to quit (N = 60). Each participant had an initial visit and two phone visits (+1 and +3 months). Participants completed surveys via computer during the first visit and by phone in the follow-ups. Additional clinical data were collected via chart review.ResultsParticipants had a mean age of 48, were mostly African-American (72%) and male (67%) with well-controlled HIV (mean CD4 622, undetectable viral load in 70%). The mean AUDIT score to assess for alcohol abuse did not change over the. three time points (7.1;7.2;7.6, median 4;5;5). A score of 8 or higher indicates harmful alcohol consumption and 23% of patients met the criteria. Lifetime self-reported treatment for substance abuse was high (35%). DAST score for assessing substance abuse was used and mean scores decreased slightly over time (2.3;1.2;0.93, median 2;0;0). A score of 6 or higher indicates a substance use disorder and 15% met that criterion at baseline, 3% at 3 months. Chart review had similar results with 18% having a diagnosis of substance abuse and 20% with alcohol abuse. Overall participants (n = 60) showed a decrease in tobacco use, with an average of 14 cigarettes/day at baseline and 7 cigarettes/day at 3 months (P = 0.001). Patients with a diagnosis of substance abuse had a baseline average of 12 cigarettes/day and 6 cigarettes/day at 3 months (reduction 6). For those with an alcohol abuse diagnosis, baseline was 16 cigarettes/day and at 3 months, 10 cigarettes/day (reduction 6). The change over time was not significantly different between the groups.ConclusionPeople living with HIV who smoke are a complex group of patients who commonly have concurrent or historical substance and alcohol abuse. A substance and alcohol abuse diagnosis did not impact the decrease in tobacco use seen with implementation of a decisional algorithm.Disclosures All authors: No reported disclosures.

Assessment of Cognition in Schizophrenia Using Trail Making Test: A Meta-Analysis.

ObjectiveThe present meta-analysis aimed to analyze the cognitive performance of schizophrenia patients measured by Trail Making Tests (TMT) and the contribution of socio-demographic factors to cognitive impairments. MethodsPubMed and PsycARTICLES databases were searched for the studies published between January 1985 and November 2017. Data were drawn from 19 studies encompassing 1095 patients and 324 controls. The effect size and heterogeneity were assessed with Comprehensive Meta-Analysis version 2 using random-effect model. ResultsOverall, the results showed that the schizophrenia patients performed significantly (p<0.001) worse than healthy controls in both TMT-A and B. However, concurrent substance abuse, clinical status (inpatient or outpatient), duration of education and duration of illness were not associated with cognitive impairment among the schizophrenia patients. ConclusionThe present meta-analysis confirmed the cognitive processing speed and flexibility of schizophrenia patients were impaired. However, their duration of education, duration of illness and clinical status (inpatient or outpatient) were not the risk factors.

Neuraxial versus Peripheral Nerve Block for Postoperative Pain Management in Drug Abusers Undergoing Orthopedic Surgeries

Background: While all surgical procedures are associated with some degree of pain, it is a well-accepted fact that orthopedic surgeries are some of the most painful. Despite the increasing interest and continuous advancement in postoperative pain management, more than half of the patients who undergo orthopedic surgeries experience inappropriate level of postoperative pain. Poorly treated pain can have negative impact on recovery especially owing to disruption in physiotherapy resulting in stiffness of joints and slow progress in mobility. In order to achieve good quality of postoperative analgesia, careful history should be taken from the patients about any coexisting medical conditions such as substance abuse or withdrawal, anxiety disorder, affective disorder, hepatic or renal impairment and any past history of poor pain management. Aim of the Work: The purpose of this study was to compare efficacy, side effects, opiate consumption and hemodynamic effects of neuraxial blocks versus peripheral nerves blocks placed under ultrasound guidance, for postoperative pain management in drug abusers undergoing orthopedic surgeries. Patients and Methods: Sixty patients presenting to Ain Shams University hospitals for orthopedic surgeries were enrolled in this prospective randomized controlled study after providing written consents. Participants were instructed about the study protocol and visual analogue scale (VAS). Approval was obtained from the research ethics committee of anesthesia and intensive care department, at Ain Shams University. In this study, all patients were preoperatively assessed for evaluation of their medical status, mode of trauma, post-traumatic critical symptoms or signs, hemodynamic stability, evidence of coagulopathy and any previous history or concurrent drug abuse. Results: This study included 60 drug-abuser patients, undergoing orthopaedic surgeries, starting from January 2018 till May 2018 at Ain Shams University Hospitals and randomly distributed within 2 groups, 30 patients each: Group A: EPI group, Group B: PNB group. As regard to age, gender, body weight, height, ASA and duration of surgery, there were no statistically significant differences between both groups (P-value>0.05). Regarding effects on hemodynamics and intraoperative ephedrine administration, the present study found statistically significant difference in the mean arterial blood pressure measured intra operatively with more drop in group A (EPI) than group B (PNB) with a (P value 0.05). Conclusion: The choice of continuous femoral and sciatic block technique placed under ultra-sound guidance for postoperative pain control provides equivalent analgesia, opioid consumption, postoperative rehabilitation and hospital stay with a lower incidence of hemodynamic side effects when compared to continuous epidural analgesia in drug-abuser patients undergoing orthopedic surgeries. It was also associated with decreased risk of postoperative side effects as sedation, dizziness, nausea and\or vomiting and urinary retention.

How meaningful activities influence the recovery process

PurposeThe purpose of this paper is to explore two research questions: how do people with concurrent substance abuse and mental health disorders (concurrent conditions) experience and describe meaningful activities? And how do meaningful activities influence the recovery process?Design/methodology/approachThis qualitative study uses an explorative and interpretive design in a phenomenological-hermeneutic approach. Transcribed interviews are analysed using a phenomenological-hermeneutic method for researching lived experience. The study was submitted to the Norwegian Center for Research Data where it was approved (Case No. 54661).FindingsStructural analysis resulted in three overarching themes: achieving a positive identity through actions and feeling worthwhile; physically outside but inside the norms of society, and idleness, isolation, and obstacles on the road to recovery. Meaningful activities, considered a cornerstone in the recovery process, vary widely and are primarily described in social contexts, thereby confirming the significance of social aspects of recovery in addition to recovery as an individual journey. The findings also show that experiencing meaningful activities contributes to recovery capital and the development of recovery-promotive identities.Research limitations/implicationsThe study consisted of a small sample size, recruited at one location which served as a primary research limitation.Practical implicationsThis paper provides insights for health care practitioners and health care decision makers regarding the importance of meaningful activities viewed through a recovery perspective.Originality/valueFew studies to date have used a comprehensive approach to describe the influence of experiencing meaningful activities on the recovery process.

Coordination of services for dual diagnosis clients in the interface between specialist and community care.

PurposeThe aim of this article is to study the coordination of comprehensive services for clients with concurrent substance abuse and mental health disorders (dual diagnosis), which is a very complex client group. In order to achieve comprehensive care and treatment, the service providers need to cooperate and coordinate, but the questions here, are how this is done and how appropriate the coordination is.Data and methodsData were collected from group interviews during a 1-day workshop with clients, relatives, and employees from the various services involved.ResultsInformation exchange between the services was generally in writing. Coordination between substance abuse and mental health services was experienced as fragmented. Employees had an unclear perception of the work and expertise of the other service providers involved. There were examples of disparity between the services a municipality could offer and client needs. A coordinator, if available, was emphasized by both clients and service providers as serving an important function in coordination and relationship building.ConclusionPredominantly written communication and unclear division of responsibilities and duties resulted in employees creating stereotypes of each other, both within specialist health services and between specialist and municipal health services. A coordinator was able to coordinate various inputs, often through informal contact, with a view to establishing appropriate services for individual clients. Coordination in interagency meeting points, such as “responsibility teams”, was the most successful solution, but this will involve a greater degree of networking than is common today.

Hopelessness Scores and Urine Tests in Patients With Methadone Maintenance Therapy

Background: Feelings of hopelessness could be a potential sign of relapse in opiate addiction. Objectives: We investigated statistical relationship of self-reports of hopelessness by patients in methadone maintenance treatment (MMT) to concurrent drug abuse. Patients and Methods: Fifty-two MMT outpatients (34 men, 18 women, mean age 33.6, SD = 9.7) completed the Beck Hopelessness Scale (BHS) to describe how they felt within the last 7 days. Results of urine screening tests for opiates, cocaine, oxycodone, and benzodiazepines were also recorded for the last 7 days. Results: 67.3% of the patients scored within the normal BHS range (scores 14). On urine tests, 23.1% of the patients tested positive for opiates at least once in the last 7 days, 19.2 % for cocaine, and 17.3% for oxycodone. These three urine tests were neither significantly correlated (P > 0.05) with hopelessness scores, nor with gender or age. Only 4 patients tested positive for benzodiazepines (7.7 %). Conclusions: Mild to moderate reports of hopelessness among MMT patients were unrelated to their concurrent abuse of opiates, cocaine, and oxycodone.

Clinical characteristics of primary psychotic disorders with concurrent substance abuse and substance-induced psychotic disorders: A systematic review

BackgroundDistinguishing between a primary psychotic disorder with concurrent substance abuse (PPD+SA) and a substance-induced psychotic disorder (SIPD) can be diagnostically challenging. We aimed to determine if these two diagnoses are clinically distinct, particularly in relation to psychopathology. In addition, we aimed to examine the specific clinical features of cannabis-induced psychotic disorder (CIPD) as compared to primary psychotic disorder with concurrent cannabis abuse (PPD+CA) and also to SIPD associated with any substance. MethodsA systematic review of SIPD literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ResultsUsing strict inclusion criteria, a total of six studies examining SIPD were included in the review (two of which only considered psychosis induced by cannabis alone). The findings did not reveal many consistent differences in psychopathology. However, we did find that that compared to PPD+SA, individuals with SIPD have a weaker family history of psychotic disorder; a greater degree of insight; fewer positive symptoms and fewer negative symptoms; more depression (only in CIPD) and more anxiety. ConclusionThere remains a striking paucity of information on the psychopathology, clinical characteristics and outcome of SIPD. Our review highlights the need for further research in this area.

The 10-year course of adult aggression toward others in patients with borderline personality disorder and axis II comparison subjects

This study had two aims. The first was to assess and compare various types of aggressive behavior toward others reported by borderline patients and axis II comparison subjects over time. The second was to determine the best baseline and time-varying predictors of aggressive behavior in these borderline patients. At baseline, a series of interviews and self-report measures were administered to 290 borderline patients and 72 axis II comparison subjects. Measures assessing aggression toward others, axis I and II disorders as well as adult adversity were re-administered every two years over the course of ten years. It was found that borderline patients reported significantly higher rates of verbal, emotional, and physical aggression toward others than comparison subjects but the rates of these forms of aggression toward others declined significantly for those in both study groups. Multivariate analyses indicated that the strongest predictors of adult aggression towards others were severity of adult adversity and a substance use disorder. Taken together, these results suggest that borderline patients commonly report aggression toward others but that this aggression declines significantly over time. These results also suggest that this aggression toward others is most strongly associated with adult experiences of adversity and concurrent substance abuse.

Anxiety and depression as predictors of long term abstinence among stimulant dependent outpatients in a clinical trial of concurrent smoking cessation and substance abuse treatment

Anxiety and depression as predictors of long term abstinence among stimulant dependent outpatients in a clinical trial of concurrent smoking cessation and substance abuse treatment

The Influence of Childhood Adversity on Rural Black Men's Sexual Risk Behavior.

Young Black men living in resource-poor rural environments are disproportionately affected by both adverse childhood experiences and HIV/STIs. The influence of childhood adversity on sexual risk behavior remains to be examined among this vulnerable population. In this study, we investigated the influence of overall adversity as well as three subcomponents, abusive parenting, parental neglect, and witnessing family violence, on men's engagement in sexual risk behavior. We hypothesized that adverse experiences would predict engagement in sexual risk behaviors including multiple sexual partnerships, inconsistent condom use, frequent sexual activity, and concurrent substance abuse and sexual activity. We tested formally the extent to which defensive relational schemas mediated these associations. Hypotheses were tested with data from 505 rural Black men (M age = 20.29, SD = 1.10) participating in the African American Men's Health Project. Participants were recruited using respondent-driven sampling. Self-report data were gathered from participants via audio computer-assisted self-interviews. Bi-factor analyses revealed that, in addition to a common adversity factor, neglect independently predicted sexual risk behavior. Men's defensive relational schemas partially mediated the influence of the common adversity factor as well as the neglect subcomponent on sexual risk behavior. The present research identified a potential risk factor for sexual risk behavior in an understudied and vulnerable population. Adverse childhood experiences in general, and neglect in particular, may place many young Black men at risk for engaging in sexual risk behavior due in part to the influence of these experiences on men's development of relational schemas characterized by defensiveness and mistrust.

Active Polysubstance Abuse Concurrent With Surgery as a Possible Newly Identified Infection Risk Factor in Inflatable Penile Prosthesis Placement Based on a Retrospective Analysis of Health and Socioeconomic Factors.

Since the introduction of inflatable penile prostheses (IPPs), risk of infection has decreased. However, concurrent substance abuse has not been investigated in prosthetic urology. To determine whether substance abuse would stand out as a relevant risk factor for infection in patients undergoing IPP implantation. This retrospective study was conducted on charts from the past 12 years at our institution, where a single surgeon completed 602 primary IPP surgeries, with only 12 cases (2%) resulting in postoperative infection. Five of these patients (42%) were actively misusing at least one substance at the time of operation (ie, alcohol, marijuana, cocaine, heroin, other illicit substances, and prescription narcotics). Substance abuse was identified in the medical chart by International Classification of Diseases, Ninth Revision code or by clear documentation by a provider. Multivariate logistic regression analysis was used to estimate the probability of infection as a function of demographic, physical, and treatment variables. Logistic regression analysis was used to determine statistically significant correlations between risk factors and IPP infection. Polysubstance abuse, poorly controlled blood sugar, and homelessness at the time of procedure positively correlated with postoperative infection. Use of the mummy wrap correlated with decreased infection. Active polysubstance abuse, poor glycemic control, and homelessness increase infection risk at IPP implantation. We encourage other implanters to discuss active polysubstance abuse with their patients and to tread cautiously because of the increased risk of infection.

The Relationship of Reflective Functioning to Parent Child Interactions in a Sample of Fathers With Concurrent Intimate Partner Violence Perpetration and Substance Abuse Problems.

This study is the first to examine reflective functioning (RF) and direct parent-child interactions of fathers with concurrent intimate partner violence (IPV) perpetration and substance abuse (SA) problems. Twenty-four fathers, with children between the age of one and seven, completed a structured interview to assess RF, self-report measures of hostile-aggressive parenting behaviors, IPV perpetration severity, SA severity, and a coded play session with their children. Results of three simultaneous multiple regressions revealed that RF in fathers was not associated significantly with observed parenting behaviors. However, fathers' SA severity emerged as a significant predictor for child avoidant behavior and dyadic tension, and fathers' IPV perpetration severity contributed unique variance to child avoidant behavior and dyadic constriction. These results suggest that fathers' SA severity and IPV perpetration behaviors may be more salient factors in predicting their father-child interactions than paternal RF.