Extensive Substance Use Research Articles

Attenuated psychotic symptoms, substance use and self-reported PTSD in adolescence

ABSTRACT Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD. Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use. Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p = .00002), more disturbed thought content (p = .000004), more perceptual disturbances (p = .002), more negative symptoms (p = .004) and more thought problems (p = .001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p = .86; R 2 = .04). Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy.

High Prevalence and Early Onsets: Legal and Illegal Substance Use in an Urban Cohort of Young Adults in Switzerland

Introduction: Debates about the legalization of illegal substances (e.g., cannabis) continue around the globe. A key consideration in these debates is the adequate protection of young people, which could be informed by current prevalence and age-of-onset patterns. For Switzerland, such information is limited, which is particularly true for women, despite advanced political efforts to legalize cannabis. The objective of the current study was to investigate substance use prevalence rates and ages of onset in a community-representative sample of female and male young adults in Switzerland. Methods: Data came from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso). In 2018, participants (N = 1,180, 50.8% females) were ∼20 years old. Lifetime and past-year use of alcohol, tobacco, cannabinoids, stimulants, hallucinogens, opioids, and benzodiazepines were assessed with an extensive substance use questionnaire. Additionally, ages of onsets of the respective substances were estimated by averaging participants’ self-reported ages of onsets from ages 13 to 20 (max. 4 assessments). Results: 57% of 20-year-olds had used cannabinoids, 16% stimulants, 15% opioids (mostly codeine), and 8% hallucinogens in the past year. Males had higher prevalence than females for most drugs; nevertheless, females’ prevalence rates were notably high. Legal substance use was typically initiated 1.3–2.7 years before legal selling age. Thus, almost half of the sample had consumed alcohol and tobacco by age 14. More than 40% of the total sample had smoked cannabis by age 16. Males initiated use of legal substances and cannabis earlier than females. Discussion: Our recent community-representative data suggested unexpectedly high levels and early onsets of substance use compared to a previous Swiss surveys and also the European average. Drug policy debates should consider urban substance use patterns when considering legalization efforts.

Utilization of substance use treatment among criminal justice-involved individuals in the United States

Over six million individuals are involved with the criminal justice system in the United States, of which a large proportion report extensive substance use. We examined the extent to which criminal justice-involvement affects substance use treatment utilization among participants from one of the largest annual surveys on substance use in the U.S., the National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression analyses indicated that criminal justice involvement was significantly associated with receiving substance use treatment in the past year (AOR 8.00, 95% CI: 6.23–10.27, p < 0.001). However, those with criminal justice histories continue to face barriers to treatment. Among individuals ages 12 and older who reported past year criminal justice involvement and met criteria for a substance use disorder, 18.9% reported receiving past year substance use treatment. After controlling for key demographic and drug use characteristics in a multivariable logistic regression model, Black criminal justice involved Americans were somewhat less likely to report receiving substance use treatment in the past year compared to White criminal justice involved Americans, although the association was not significant (AOR 0.87, 95% CI 0.58–1.29, p = 0.481). Treatment programs targeted to increase minority engagement and address persistent barriers to substance use treatment may be valuable for curbing substance use and recidivism among criminal justice-involved individuals.

Integrating a Co-occurring Disorders Intervention in a Rural Drug Treatment Court: Preliminary 6-Month Outcomes and Policy Implications

Little research has focused on systematically integrating clinical treatment within drug court settings (a type of specialty court, and the most popular type of alternative to incarceration program). This is particularly important for rural drug courts serving participants with both co-occurring mental health and substance use disorders, as these participants often have difficulty engaging in care which is compounded by limited access to treatment services in their communities. This article reports on the preliminary outcomes and policy implications of integrating MISSION-Criminal Justice (MISSION-CJ), a co-occurring mental health and substance use hybrid wraparound treatment and linkage intervention, within a rural Massachusetts drug court. In this open pilot, 73 participants completed an intake and 80% completed a 6-month follow-up assessment. The participants were primarily Caucasian (83.6%), male (57.5%), reported substantial criminal justice histories with an average of 13.93 prior arrests, had extensive substance use and mental health histories, with 71% reporting opioid use, 74% had anxiety, and 68.5% depression at intake. Six-month data indicate statistically significant reductions in nights spent in jail, number of arrests, acute behavioral health symptoms, illicit drug use, as well as an increase in employment and securing stable housing. These data suggest that MISSION-CJ was feasible to implement within a rural drug court. MISSION-CJ is a unique intervention as it offers co-occurring disorders treatment and linkage services that work both within a specialty court setting and in the community. These findings pose critical policy implications as integrated services and a hybrid treatment model are considered to be best practice and may be optimal for rural drug courts where there are limited treatment and service resources.

Impaired driving among rural female drug-involved offenders

Objective Very little is known about rural female impaired drivers despite disproportionate rates of impaired driving arrests and associated traffic fatalities in rural areas. The present study examined past-year impaired driving histories and impaired driving correlates in a sample of rural female drug-involved offenders. Methods Female drug-involved offenders (N = 400) from 3 rural jails completed a confidential interview focused on substance use and related risk behaviors. After removing cases with missing data (n = 23), participants self-reporting past-year impaired driving (n = 254) were compared to those who did not (n = 123) on demographic characteristics, substance use, mental health, and criminal histories. Impaired drivers also reported the substances involved in their past-year impaired driving episodes. Results A significantly higher percentage of impaired drivers reported past-year use of 8 of the 11 substances (including alcohol) examined when compared to other drug-involved offenders. Though symptoms of major depressive and posttraumatic stress disorders were similar, significantly more impaired drivers (49.6%) reported symptoms of generalized anxiety disorder than did other drug-involved offenders (35.0%). No differences in criminal histories were found. Nearly all (94.9%) impaired drivers reported driving under the influence of drugs in the past year; less than one-fourth reported driving under the influence of alcohol. Prescription opioids were the most prevalent substance type involved in impaired driving episodes (84.6%), followed by anti-anxiety medications (40.9%). Approximately one-third of impaired drivers reported driving under the influence of methamphetamine (33.9%), marijuana (31.5%), and alcohol (30.7%) in the past year. Conclusions Findings indicate that rural female impaired drivers may have more extensive substance use and mental health problems than other rural female drug-involved offenders. In addition, study results suggest that a recent history of impaired driving may serve as a marker for a more extensive substance use history. Other implications include that early identification of impaired drivers in at-risk groups may be an important opportunity to prevent future traffic injuries and fatalities.

Cognitive function in aging cocaine smokers.

Little is known about the functional status of older drug users, who may pose challenges to public health systems in coming years. Here, we assessed cognitive function in aging cocaine smokers compared to demographically matched controls. A total of 22 non-treatment-seeking aging (50-60 years old) cocaine smokers (⩾twice/week; ⩾15 years of weekly use) and 19 controls completed a comprehensive cognitive battery. Controls with cannabis, tobacco, and alcohol use were included to better match the cocaine users. All cocaine users, and current cannabis- or alcohol-using controls, completed testing after 4 drug-free inpatient days to better control for acute and residual drug effects. Cocaine users (52.9 ± 2.5 years old, four female; cocaine use 3.9 ± 1.4 days/week) and controls (52.7 ± 2.6 years old, four female) were well matched demographically, but cocaine users reported a more extensive substance use profile. Cocaine users showed marginally worse verbal learning than controls, recalling on average one word fewer across immediate and delayed word recall trials. Their performance was intact relative to controls across all other measures of cognitive function. Bayesian analysis indicated the absence of group differences was not due to power limitations. These data suggest that aging, long-term cocaine users have similar cognitive functioning to appropriately matched controls when tested under drug-free conditions, with only marginal decreases in verbal learning. Findings, although reassuring with regard to broad cognitive capacities in aging cocaine smokers, suggest that future investigations of cognitive function in aging drug users are warranted.

Synthetic cannabinoid use among a sample of individuals enrolled in community-based recovery programs: Are synthetic cannabinoids actually preferred to other drugs?

Background: Over the past decade, availability and use of novel psychoactive substances such as synthetic cannabinoid receptor agonists (SCRA) have proliferated globally. However, the prevalence of SCRAs use remains uncertain, as does the degree to which individuals reporting SCRA use prefer SCRA to other drugs. Methods: In April 2017, a total of 500 anonymous surveys were completed by clients enrolled in a residential drug recovery program. Chi-square and t tests were used to examine significant differences between those who had ever used SCRA and those who had not. Logistic regression analysis was conducted in order to determine which other substances used within the past 12 months were significantly associated with past-12-month SCRA use. Results: About 69% (68.4%) of clients reported lifetime SCRA use. Those reporting SCRA use were predominantly younger ( = 32.5 vs. 40.7, P < .001), single (60.3% vs. 48.1%, P = .011), and white (87.1% vs. 77.7%, P = .008) and were more likely to have experienced past-12-month homelessness (6.5% vs. 3.2%, P = .004). This group had higher rates of probation/parole involvement (79.2% vs. 61.8%, P < .001) and incarceration (91.8% vs. 79.6%, P < .001). Individuals reporting SCRA use also showed extensive substance use histories and favored heroin, opioids, and amphetamines compared with SCRA. Only 5.2% of the SCRA-using group stated that SCRA was a preferred substance, and only 11.8% reported that they would try SCRA again. E-cigarettes (adjusted odds ratio [AOR] = 1.88), traditional cannabis (AOR = 3.87), amphetamines (AOR = 2.20), and synthetic cathinones (AOR = 3.51) were significantly associated with past-12-month SCRA use. Motivations for use included circumnavigating drug screens and peer influence. Approximately half of those who tried SCRA reported adverse effects associated with use. Conclusions: Prevalence of SCRA use among individuals with a history of substance misuse and criminal justice system involvement is high; however, SCRA are not indicated as a preferred drug.

Amphetamine-Induced Delusional Infestation

Amphetamine-Induced Delusional Infestation

The Relationship Between Non-Medical Use of Prescription Opioids and Sex Work Among Adults in Residential Substance Use Treatment

High rates of substance use (e.g., alcohol, cocaine, heroin) have been documented among individuals who engage in sex work (SW), and adults seeking substance use disorder (SUD) treatment frequently report prior engagement in SW. Non-medical use of prescription opioids (NMUPO) has increased over the last decade, but little is known about the relationship between NMUPO with sex exchange. The purpose of this study was to describe the prevalence of recent SW among patients at a large residential SUD treatment center and examine the association between NMUPO and SW. Approximately 14% of 588 adults reported involvement in SW in the month prior to treatment. NMUPO was more common among those with a history of SW (95% of sex workers vs. 74% of non-sex-workers), and this association remained statistically significant after controlling for demographic factors, other substance use and psychiatric symptom severity (odds ratio=3.38). SW is relatively common among patients in residential SUD treatment, and is associated with greater psychiatric severity and more extensive substance use, including alarming rates of NMUPO. Addiction treatment for individuals involved in SW may benefit from the addition of content related to NMUPO.

Characteristics of substance use disorder treatment patients using medical cannabis for pain

BackgroundThis study was designed to assess the prevalence and correlates of self-reported medical cannabis use for pain in a substance use disorder (SUD) treatment program. MethodParticipants (n=433) aged 18years and older were recruited from February 2012 to July 2014 at a large residential SUD treatment program. They completed a battery of questionnaires to assess demographics, usual pain level in the past three months (using the 11-point Numeric Rating Scale for pain), depression (using the Beck Depression Inventory), previous types of pain treatments, and lifetime and past-year use of substances (using the Addiction Severity Index). Using both adjusted and unadjusted logistic regression models, we compared those who reported medical cannabis use for pain with those who did not report it. ResultsOverall, 15% of the sample (n=63) reported using medical cannabis for pain in the past year. After adjusting for age, medical cannabis use for pain was significantly associated with past-year use of alcohol, cocaine, heroin, other opioids, and sedatives, but was not associated with usual pain level or depression. It was also associated with past year treatment of pain using prescription pain relievers without prescriptions. ConclusionsThese results indicate that medical cannabis use for pain is relatively common and is associated with more extensive substance use among SUD patients. Future work is needed to develop and evaluate strategies to assess and treat individuals who report medical cannabis for pain in SUD treatment settings.

A Comparison of First-Time and Repeat Rural DUI Offenders

The purpose of the current study was to examine whether the differences found between first-time and repeat rural DUI offenders were the same as those found previously in urban samples. A total of 118 rural DUI offenders were interviewed, approximately half (51.7%) of whom were repeat offenders. Although demographic and mental health characteristics were similar across the two groups, repeat offenders reported more extensive substance use and criminal histories. Results suggest that the pattern of differences between rural first-time and repeat DUI offenders may be different from the pattern found in prior urban-based studies. Treatment implications are discussed.

LIETUVOS MOKSLEIVIŲ PSICHOTROPINIŲ MEDŽIAGŲ (NARKOTIKŲ) VARTOJIMO, PASEKMIŲ IR PRIEŽASTINIŲ RYŠIŲ TYRIMAS

Objective. To assess prevalence and social dimensions (family, school and peers) of substance use among Lithuanian adolescents and to provide effective recommendations of substance use prevention. Methods. A survey using a standard questionnaire was administered in three biggest cities of Lithuania (Vilnius, Klaipeda and Kaunas) twice: in 2006 and 2008. The target population was students of the age group 15-16 years old. Totally 14,155 students were enrolled. Results. 46 percent of respondents had no experience of any substance use. The most consumed drug was cannabis (hashish and marihuana) – 24 percent, followed by sleeping pills - 20 percent. Age of the substance use debut was directly related to further substance, especially cannabis (hashish or marihuana), use (r=0.891, p&lt;0.001). Substance use had especially negative impact on the learning progress and perspectives of further studies and was related to the attitudes towards learning/school: the less interest in studies, the more extensive substance use (r=-0.151, p≤0.001). Parceived parental support and free time spent with parents were significantly related to the children attitudes towards substance use. Children without parental attachment were more prone to substance use and more submissive to the peer pressure. Cigarette smoking, alcohol and drug use were concurrent: students, who smoked cigarettes more often (r=0.425, p&lt;0.001), consumed beer (r=0.323, p&lt;0.001) more often, consumed low percentage drinks (r=0.255, p&lt;0.001) and strong alcohol more often (r=0.313, p&lt;0.001), were also more intensely immersed drug users. Conclusions. Adolescents engaged in the free-time activities with their parents were less prone to smoke cigarettes or marihuana and consume alcohol. Having friends who use drugs was one of the great potential risk factors for personal drug use. Strengthening of relationships among parents, school, community and adolescents is an important measure in helping adolescents to abstain from substance use.

357 – Characteristics of earliest and most recent injection drug use in a canadian low-threshold methadone maintenance treatment sample

Introduction Despite evidence that the majority of injection drug users (IDU) are polysubstance users and tend to have extensive substance use histories at time of first injection, little is known about the patterns of substance use associated with injection initiation. Aims/objectives To determine how injection drug use was associated with specific patterns of multiple substance use. Both concurrent (any use during a defined time period) and simultaneous (same session) polysubstance use patterns were assessed. Methods IDU receiving treatment at a low-threshold methadone maintenance clinic in Halifax, Nova Scotia, Canada completed structured interviews regarding their substance use histories. Results Injection coincided with: concurrent heavy alcohol use; increasing use of stimulants such as cocaine; and the introduction of misused prescription medications. During their most recent injection session, participants were significantly less likely to inject a stimulant, and were significantly more likely to identify an opioid as their primary drug of injection, when compared to injection initiation. Moreover, alcohol was more likely to be co-administered at time of first-ever injection, whereas prescription sedatives and crack cocaine were more likely to be co-administered during the most recent injection. Conclusions Initiation into injection tended to occur after an extensive and relatively consistent sequence of substance use. First ever and most recent injection drug use often occurred within a polysubstance context; however, the specific patterns of substance use changed with time. Findings suggest that specific patterns of multiple substance use may be appropriate targets for treatment and prevention of injection drug use.

Hotel workers’ substance use and abuse

This study investigates the usage of tobacco, alcohol, and cannabis among hotel employees in the resort city of Eilat. Data obtained from a sample of 458 respondents, drawn from three hotel chains, provides evidence of workers’ substance consumption in light of their socio-demographic backgrounds and specific job characteristics. The results indicate a higher rate of substance use among study participants in comparison to the average in Israeli society. Substance use was found to be the most prevalent among young, single male employees with relatively low levels of education. In terms of job characteristics, front-of-the-house employees were more prone to binge drinking than back-of-the house employees. It is suggested that work-related programs and policies, such as sensible drinking workshops and smoking cessation programs, may help prevent alcohol misuse and reduce extensive substance use among hotel staff.

Barriers to Receiving Substance Abuse Treatment Among Rural Pregnant Women in Kentucky

Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

Salvia divinorum use and phenomenology: results from an online survey

Salvia divinorum is a hallucinogenic plant with ethnopharmacological and recreational uses. It differs from classic serotonergic hallucinogens such as LSD and psilocin in both phenomenology and potent agonist activity of the active component salvinorin A at κ-opioid receptors. Awareness of S. divinorum has grown recently, with both an increase in its public representation and concern over its potential harmful effects. This discussion is particularly relevant as S. divinorum is legal to use in many countries and regions and easily available through online retailers. Drawing upon previous investigations of S. divinorum and other hallucinogens, this study surveyed 154 recent users and questioned them on their use behaviours, consequences of use and other attitudinal measures. Although reporting an extensive substance use history, and considering the limitations of online surveys, there was little evidence of dysfunctional S. divinorum use, and few reports of troubling adverse consequences of use. Furthermore, there was no evidence that users exhibited increased schizotypy. Respondents reported that S. divinorum produced mixed hallucinogenic and dissociative effects, which lends support to assertions that it phenomenologically differs from other hallucinogens with primary serotonergic activity. The functions of use changed with greater experiences with the drug, and although many respondents reported use of S. divinorum as an alternative to illegal drugs it, was apparent that legal proscription would be unlikely to dissuade them from use. These results are discussed with reference to psychopharmacologically informed public health responses to substance use.

Influences Affecting Maintenance and Cessation of Narcotics Addiction

A sample of 354 narcotics addicts remanded to the California Civil Addict Program (CAP) in 1962–64 was followed for over twenty-four years. Self-report data collected at initial treatment admission and in two follow-up interviews (1974–75 and 1985–86) included information on family history, patterns of drug use and criminal involvement, and other behaviors. The sample was classified into four exclusive groups: Winners (N=59), who had been abstinent from narcotics and other serious drug use and had not been involved in criminal activity during the thirty-six-month period prior to interview; Striving addicts ( N=46), who had been abstinent from narcotics use, but not necessarily other drugs, and had no incarceration for a period of twelve months prior to interview; Enduring addicts ( N=146), who had used narcotics and typically other drugs within the prior 12-month period, but had avoided incarceration; and Incarcerated addicts ( N=103), incarcerated at some time during the twelve-month period, and whose drug use was varied. Winners had generally negative familial experiences including little encouragement from parents, who in the main had adverse relationships, higher rates of sexual molestation, and were least happy in childhood. Despite this environment Winners evidenced early independence and self-confidence. Striving addicts were characterized by usually non-substance-using, church-going parents. Most had ceased narcotics use, but remained heavily involved with alcohol and marijuana. Enduring addicts, mostly from lower socioeconomic status families that exhibited extensive substance use and physical arguments, commonly accessed methadone treatment and avoided incarceration while persisting in narcotic addiction and crime. Incarcerated addicts, typically raised in dysfunctional, substance-using families, received the most parental caring along with the most severe punishment. They exhibited persistent involvement in crime, violence, and drug use.

Alcoholics also dependent on cocaine in treatment: Do they differ from “pure” alcoholics?

Although individuals who exhibit both alcohol and cocaine dependency are seen increasingly in traditional alcoholism rehabilitation settings, their comparability with “pure” alcoholics is unclear. Sociodemographic, psychological, cognitive, and substance abuse status were, therefore, monitored in a group of alcoholics ( n = 64) versus a group of cocaine dependent alcoholics ( n = 82) on admission and just prior to discharge from 28-day multimodal treatment settings. At admission, cocaine-dependent alcoholics were younger, more likely to be unmarried, have more extensive substance use histories as well as more frequent prior treatments than “pure” alcoholics. Additionally, members of both groups exhibited abnormalities on psychological indices. Both psychological and cognitive indices revealed significant between-group differences which subsequent analyses found to be a confound of the marked age discrepancy between groups. From admission to discharge, scores on both psychological and cognitive indices declined significantly in both groups. Urine assay data revealed a greater tendency for cocaine-dependent alcoholics to relapse during treatment. While the psychological and cognitive data largely argue for the comparability of groups of patients classified as “pure” alcoholics with those who are dependent on both alcohol and cocaine, the latter group may have more difficulty in achieving abstinence during treatment. The interpretability of behavioral indices gathered only at treatment admission is questioned.