Concurrent Substance Use Disorders Research Articles

Substance use among individuals with cancer: A US population-based cohort study.

e23133 Background: The prevalence of concurrent substance use or comorbid substance use disorder (SUD) among individuals with a cancer diagnosis, and their participation in substance use treatment, has not yet been described in a large US population-based cohort. Methods: A population-based cohort study was conducted using cross-sectional survey data collected by the National Survey on Drug Use & Health (NSDUH) between 2015-2022. Descriptive statistics were calculated to describe two populations: those with any kind of cancer diagnosis within the preceding 12 months and either comorbid SUD as defined by the Diagnostic and Statistical Manual of Mental Illness (DSM)-5 or concurrent use of any of the following substances: alcohol, marijuana, cocaine, crack, heroin, methamphetamines, or misuse of prescription drugs. Chi-square tests were conducted to describe associations with the demographic and geographic characteristics of these individuals. Results: Between 2015-2022, 432,764 individuals (53% female) completed the survey. A total of 2,547 respondents had a cancer diagnosis in the preceding 12 months; the most common cancer types were breast cancer (17.0%), non-melanoma skin cancers (16.2%), and prostate or testicular cancer (11.0%). Among this cohort, 1,664 (65%) reported concurrent alcohol use, 354 (14%) reported marijuana use, and 82 (3%) reported illicit use of other substances. Among those with an active cancer diagnosis in the preceding 12 months, 103 (4%) met DSM-5 criteria for a comorbid SUD based on survey responses. Among individuals with a past-year cancer diagnosis, there was a statistically significant association between concurrent substance use and income bracket (X2 = 92.67, p < 0.001), concurrent substance use and race (X2=46.12, p< 0.001), and between concurrent substance use and population density (X2= 7.05, p = 0.029). Zero respondents with cancer and either concurrent substance use or comorbid SUD received outpatient treatment for substance use in the preceding year, three (0.002%) received inpatient treatment, and seven (0.004%) participated in a support group. Among respondents with comorbid SUD, many reported being recently asked by a healthcare professional about their alcohol (83%) or drug use (67%), while only 1.9% reported recently receiving information from a healthcare professional about substance use treatment. Conclusions: There is overlap between the population with a cancer diagnosis and that with concurrent substance use or comorbid SUD. Based on population-level survey data, these individuals have low rates of participation in outpatient or inpatient substance treatment, and report that they do not often receive information about substance use treatment from healthcare professionals. Describing this population may inform how providers approach their unique healthcare needs.

Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis

BackgroundAffecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations. MethodsAll adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes. ResultsOf ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70). ConclusionsConcurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.

PRACTICAL AND APPROPRIATE APPROACHES TO THE TREATMENT OF YOUTH WITH FIRST-EPISODE PSYCHOSIS AND SUBSTANCE USE DISORDERS

Introduction:Many young adults with first-episode psychosis also have substance use disorders (SUDs). For this population, persistent SUDs negatively impact symptomatic and functional outcomes and problem management.This review aims to identify and synthesize the best therapeutic approaches for the treatment of young adults with co-occurring disorders (FPE and SUD) and to present practical and tailored approaches for the assessment and follow-up of these individuals.of individuals with concurrent FPE and SUD. Method: This review of the literature used the following databases: PubMed science direct psychinfo. We used the following Results:Several studies demonstrate the utility of early intervention services for psychosis (EIS) in managing substance use disorders, with a decrease of approximately half of substance use disorders during the first year of follow-up.To date, clinical guidelines suggest tailored and integrated treatment of psychosis and substance use disorders and recommend the use of a variety of approaches such as case management, comprehensive assessment and feedback on substance use disorders and psychosis and their interaction, risk reduction interventions, motivational interviewing, cognitive behavioral therapy, and pharmacotherapy.It is proposed here that treatment be proactively adjusted to take into account the severity of the disorder, its impact on the various dimensions of psychosis outcomes, the youths developmental stage, and his or her stage of change with respect to substance use. Conclusion: Some approaches appear to have the potential to improve the clinical evolution of youth living with such disorders, particularly if tailored to this population. In addition, research and innovation, which is relatively limited, in the management of co-occurring disorders, must continue to provide more appropriate care for young adults with early psychosis and substance use disorders. Objective: The purpose of this work was to identify and synthesize the best therapeutic approaches for the treatment of young adults with co-occurring disorders (First Psychosis Episodeandsubstance use disorders),and to present practical and tailored approaches for the assessment and follow-up of these individuals. of individuals with concurrent psychaiatric disorders.

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans.

Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). Mental illness, SUD, medical multimorbidity. An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.

A Qualitative Assessment of the Treatment Needs of Women with Concurrent Eating and Substance Use Disorders in a Residential Setting

Objectives: Eating and substance use disorders (SUD) are generally treated separately, leaving eating disorders (ED) overlooked within substance use treatment. The frequent co-occurrence of SUD and ED is well documented. Despite their many similarities and frequent co-occurrence, these two disorder types continue to be largely treated separately–either sequentially, with the most severe disorder addressed first, or concurrently but in separate programs. Our study, therefore, responds to this lacuna of data on patient and provider treatment needs for integrated ED and SUD treatment, centering the perspectives of women with lived experience of ED and SUD to support the development of therapeutic groups for women in treatment programs. Methods: This study was designed as a needs and assets assessment to determine the needs and priorities of women with concurrent ED and SUD for developing group programs. Participants for the needs assessment included both staff members (n = 10) and women receiving treatment (n = 10) who were recruited from a 90-day residential treatment program for women with SUD in British Columbia, Canada. Interviews and focus groups conducted with participants were audio-recorded and transcribed verbatim. Data were thematically analyzed and coded using Dedoose software. Results: Six key themes emerged from the qualitative data and were organized into sections with sub themes. An overarching premise from both staff and program participants was the need for concurrent therapeutic programming, nutritional support, and medical monitoring. The six discrete themes that were elicited included the similarities between ED and SUD, gaps in treatment, community support, family involvement, program participant treatment suggestions, staff treatment suggestions, and family involvement. Conclusions: Throughout this qualitative study, the need for screening and assessment of both disorders along with integrated treatment was stressed by participants, both program participants and staff alike. These findings complement current literature and suggest that pursuing concurrent treatment design may be helpful in addressing unmet program participant needs and could provide a more holistic framework for recovery.

A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study

A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn.

Consensus international sur le dépistage, le diagnostic et le traitement des adolescents avec un trouble du déficit de l’attention avec ou sans hyperactivité en cas de comorbidité avec des troubles de l’usage de substances

BackgroundChildhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. ObjectiveThe aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. MethodA modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. ResultsAfter 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n=4), risk of developing SUD (n=3), screening and diagnosis (n=7), psychosocial treatment (n=5), pharmacological treatment (n=11), and complementary treatments (n=7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the firstline treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. ConclusionThis international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Comparative effectiveness of trauma-focused and non-trauma-focused psychotherapy for PTSD among veterans with comorbid substance use disorders: Protocol & rationale for a randomized clinical trial

BackgroundCo-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is common and concurrent treatment is recommended. Relatively little is known about which evidence-based psychotherapies for PTSD are most effective for patients with varying substance use profiles. We aim to examine the comparative effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) among Veterans with PTSD and SUD. TFT has been found to be effective among those with PTSD/SUD, though effects are smaller and rates of treatment non-completion are higher than in those without SUD. NTFTs suggested for the treatment of PTSD, such as Present Centered Therapy, (PCT) have not been examined among those with co-occurring SUD, despite lower rates of treatment dropout. We will also examine the comparative effectiveness of TFT and NTFT for patients with varying SUD severity, type of substances used, and patient treatment preference. Method420 Veterans with PTSD and SUD will be randomized in a prospective, pragmatic comparative effectiveness trial at 14 Veterans Health Administration facilities. Participants will receive either TFT (Prolonged Exposure or Cognitive Processing Therapy) or NTFT (PCT) after enrolling in concurrent SUD treatment-as-usual. Assessments will occur at baseline, posttreatment, 3- and 6 -months posttreatment. Main outcomes are PTSD symptom severity and PTSD treatment dropout. Clinician, patient, and leadership stakeholder panels advise study activities, and a process evaluation will identify strategies to enhance the implementation of evidence-based PTSD treatments in SUD care settings. ConclusionsResults will provide critical information to guide clinicians when recommending PTSD treatments to patients with comorbid SUD.ClinicalTrials.gov Identifier: NCT04581434.

Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders

Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09–7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2–3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors.

Substance Use Disorder Is Associated With Alcohol-Associated Liver Disease in Patients With Alcohol Use Disorder

Substance use disorder (SUD) commonly associates with alcohol use disorder (AUD), and certain substances have independently been shown to drive liver injury. In this work, we sought to determine if co-existing SUD in patients with AUD associated with the presence of alcohol-associated liver disease (ALD). We performed a cross-sectional analysis using the Mass General Brigham Biobank to identify patients based on ICD-10 codes. We performed multivariate analyses accounting for a wide range of demographic and clinical variables to evaluate the association between SUD and ALD. We subsequently used the same method to evaluate the association between SUD and hepatic decompensation. We identified 2848 patients with a diagnosis of AUD, 9.0% of which had ALD. 25.2% had a history of SUD. In multivariate analyses, patients with SUD were more frequently diagnosed with ALD compared to those without SUD (OR = 1.95, P = 0.001). Furthermore, the number of concurrent SUDs was positively associated with the diagnosis of ALD (OR: 1.33, P < 0.001). Independent of the presence of other SUDs, opioid use disorder in patients with AUD was associated with ALD (OR = 1.902, P = 0.02). In subsequent analyses, we found that sedative use disorder was associated with hepatic decompensation (OR: 2.068, P = 0.03). In patients with AUD, SUD, and in particular opioid use disorder, was independently associated with the diagnosis of ALD.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Emotional difficulties among individuals with alcohol use disorder: the mediating role of psychological mechanisms linked to mindfulness

ABSTRACT Background: Difficulties with emotion regulation (DER) and emotional distress (ED) are considered relevant clinical features of Alcohol Use Disorder (AUD) and other Substance Use Disorders (SUDs). Psychological mechanisms linked to mindfulness are involved in addressing DER and ED. This study aims at investigating the mediating role of mindfulness on relationship between DER and ED among individuals with AUD and concurrent SUDs. Methods: Eighty-seven individuals with a primary diagnosis of AUD, who completed a mindfulness-based treatment for this condition, were included. DER, ED, and mindfulness dimensions were self-report assessed. Results: The analyses showed significant and positive indirect effects of mindfulness dimensions (i.e., self-regulation of attention, non-reactive awareness). The direct effect of DER on ED was significant. Conclusion: The self-regulation of attention and non-reactive awareness linked to mindfulness are relevant and stable protective factors for emotional difficulties among individuals with AUD. Longitudinal studies are needed to empirically test the therapeutic role of these mindfulness dimensions in the treatment of SUDs and in relapse prevention.

Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study.

Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients' (N=46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants' autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients' consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.

The therapeutic role of emotion regulation and coping strategies during a stand-alone DBT Skills training program for alcohol use disorder and concurrent substance use disorders

Clinical trials on Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone intervention for alcohol use disorder (AUD) showed promising outcomes. Improvements in difficulties with emotion regulation (DER) played a mediating role on abstinence maintenance. However, the effect of DER, together with specific coping strategies, have not been considered yet in the treatment of clinical features associated to AUD and concurrent substance use disorders (CO-SUDs). The current study aims at investigating changes in the number of consecutive days of abstinence (CDA), severity of AUD and CO-SUDs (Shorter PROMIS Questionnaire; SPQ alcohol, prescription, illicit drugs subscale), DER (Difficulties in Emotion Regulation Scale; DERS) and coping strategies (DBT Way of Coping Checklist; DBT-WCCL) during a 3-month DBT-ST program for the treatment of AUD and CO-SUDs. Furthermore, four independent multiple parallel mediational models were estimated considering scores of CDA/SPQ, DERS and DBT-WCCL dimensions as dependent, independent and mediators variables respectively. One-hundred eight individuals with a primary diagnosis of AUD were consecutively admitted. The results showed significant and moderate to large improvements in CDA, severity of AUD, CO-SUDs and DER. The analyses detected significant improvements in the use of DBT Skills. The changes in DER predicted decreases in SPQ scores. The changes in DBT-WCCL scores were mediators of the previous relationships, considering SPQ alcohol and prescription drugs subscales. These findings support the implementation of DBT-ST as a stand-alone intervention for the treatment of AUD and CO-SUDs. DER together with coping strategies are relevant therapeutic mechanisms in the treatment of clinical features related to SUDs.

Sources of Prescription Medication Misuse Among Young Adults in the United States: The Role of Educational Status.

This study examined prescription drug misuse (PDM), sources of PDM, and substance use disorder (SUD) symptoms as a function of educational status among US young adults based on a large nationally representative sample. Data from the 2009-2014 National Survey on Drug Use and Health came from a sample of 106,845 young adults aged 18-25 years. Respondents were categorized by educational status and PDM, sources of PDM, other substance use, and SUD symptoms, with analyses performed separately for prescription opioids, stimulants, and sedatives/tranquilizers. Prescription opioid (past-year: 11.9%) and sedative/tranquilizer (past-year: 5.8%) misuse were most prevalent among young adults not attending college, especially among high school dropouts. In contrast, full-time college students and college graduates had the highest rates of prescription stimulant misuse (past-year: 4.3% and 3.9%, respectively). Obtaining prescription medications from friends/relatives for free was the most common source of PDM, especially among college students/graduates. Prescription drug misusers who obtained medications from theft/fake prescriptions, purchases, or multiple sources were more likely to report past-year SUDs and had the most severe overall risk profile of concurrent substance use and SUD. More than 70% of past-month prescription drug misusers who reported multiple sources for PDM had at least 1 past-year SUD. Sources of PDM vary by educational status among US young adults, and the college environment is associated with sharing prescription medications. Clinicians can help assess an individual's risk for SUD by determining whether the individual engaged in PDM and the source of prescription medication the individual is misusing.

Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study

Aims: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. Methods: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. Results: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group – a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. Conclusion: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study.

BackgroundConcurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce.MethodsThe study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months.ResultsThe baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables – the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits – improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups.ConclusionSpecialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.

Risky use and misuse of alcohol and cigarettes in psychiatric inpatients: a screening questionnaire study

BackgroundMental disorders are associated with an increased prevalence of substance use disorders (SUDs). Despite this comorbidity being firmly established, alcohol and nicotine risky use and misuse are not routinely and systematically assessed in clinical practice. ObjectiveThe aim of this study is to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking, and nicotine use disorder in people with psychiatric diagnoses and their association with age, gender, and occupational functioning. MethodParticipants were 210 patients from an inpatient psychiatric ward. Three self-reporting questionnaires were used: the Alcohol Use Disorders Identification Test (AUDIT), the Lübeck Alcoholism Screening Test (LAST), and the Fagerström Test for Nicotine Dependence (FTND). ResultsRisky alcohol use or AUD was found in more than one third of patients and was more common in males than in females (p<0.01) and in young people as compared to older adults (p=0.04). Current nicotine consumption concerned over a half participants and was significantly associated with risky alcohol use and AUD (p<0.01). Patients with current SUD had the highest prevalence of both smoking (80%) and alcohol misuse (80%). Low occupational functioning was associated with both alcohol use (p=0.02) and concurrent alcohol and SUDs (p=0.03). ConclusionsBoth alcohol and nicotine risky use and misuse are highly prevalent in people with psychiatric disorders and their concurrent abuse is common. The simultaneous use of different screening questionnaires allows the identification not only of people with frank use disorders, but also those with harmful use, facilitating early detection of people at risk.

Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults.

Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19-2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21-3.45) and amphetamine (OR = 1.96; 95% CI: 1.26-3.06) as well as significantly increased risk of moderate (3-4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.