Substance Abuse Group Research Articles

Substance use and abuse trajectories across adolescence: A latent trajectory analysis of a community-recruited sample of girls

We used data from a school-based study of 496 adolescent girls to identify qualitatively distinct substance use and substance abuse developmental trajectory groups and tested whether the problematic groups differed from the non-problematic groups on baseline and outcome validation variables. Results identified four substance use groups (late users, normative users, late-heavy users, early-heavy users) and four substance abuse groups (non-abusers, moderate-escalating abusers, moderate decreasing abusers, adolescent-limited heavy abusers). Problematic substance use and abuse trajectory groups, relative to non-problematic groups, showed elevations in baseline validation variables (age 14 delinquency, depressive symptoms, negative affectivity, parental support deficits, body dissatisfaction) and outcome validation variables (age 20 delinquency, depressive symptoms, social impairment, legal problems, school dropout, and substance abuse diagnosis), providing partial validation of this trajectory model.

Heroin as an attachment substitute? Differences in attachment representations between opioid, ecstasy and cannabis abusers

Earlier studies indicated a relation between fearful-avoidant attachment and substance abuse. This study compares attachment representations (Family Attachment Interview; Bartholomew & Horowitz, 1991) of three groups of substance abusers and non-clinical controls. Heroin abusers (N = 22) were mainly fearful-avoidant, ecstasy abusers (N = 31) were preoccupied, fearful-avoidant and dismissing-avoidant, cannabis abusers (N = 19) were mainly dismissing and secure, and controls (N = 22) were mainly secure. Groups did differ in their level of psychosocial functioning (GAF) (cannabis > ecstasy > opioids). Differences in attachment prevailed when GAF was controlled. Based on the self-medication hypothesis we understand the preferences for specific substances to be influenced by specific attachment strategies. Heroin seems to be used as an emotional substitute for lacking coping strategies. Cannabis seems to be used to support existing deactivating and distancing strategies. Ecstasy abuse was related to insecure attachment but not to a specific attachment strategy.

Minor structural brain changes in young drug abusers. A magnetic resonance study.

Twenty-three drug abusers and seventeen controls underwent clinical neurological examinations and magnetic resonance imaging (MRI) of the brain. The drug abuse encompassed cannabis, inhalants, opiates, psychedelics, amphetamines, and cocaine but not necessarily all drugs in all persons. The drug abuse was always combined with heavy alcohol consumption. One drug abuser had abnormal neurological findings which consisted of lower limb ataxia and 3 others had mild imbalance. MRI examinations did not show differences in width of the third, fourth or lateral ventricles nor the diameter of the cerebral aqueduct but the drug abusers had significantly smaller vermes cerebelli compared to controls. White matter changes also occurred more often in the drug abuser group. These findings are not consistent with known side-effects of the narcotic drugs but more probably a result of very high alcohol consumptions in parallel with drug abuse. Alcohol is clearly a much more potent brain toxic agent than are the most commonly abused narcotic drugs.

Personality Disorder Factors Predict Recovery of Employment Functioning Among Treated Cocaine Abusers

Background: Identifying treatments that produce specific benefits in nondrug psychosocial functioning areas such as employment functioning has been illusive. Examination of dimensions of clinical status that moderate such effects may be useful in planning more effective interventions. Objectives: The purpose of this study is to determine if life stress and four dimensions of personality and psychopathology previously found to predict early post-treatment relapse in diverse groups of substance abusers, predict less recovery in employment functioning among 240 cocaine dependent males after completion of residential treatment. Methods: Latent growth curve analysis was used to determine if antisocial, avoidant, dependent, paranoid-delusional personality dimensions, and life event stress predict employment problem severity evident at drug treatment discharge and change in employment problems over three 3-month follow-up intervals. Results: Individuals with higher employment severity at intake and those who spent less time in treatment tended to have greater employment problems at the predischarge. Two covariates were significant predictors of the linear growth component, and the set of covariates explained approximately 18% of the variation in the linear growth rates. Individuals with higher paranoid/delusional scores and lower educational attainment experienced less improvement in their employment status over follow-up. Conclusions: Current findings appear consistent with those of McLellan and colleagues who found that greater psychiatric severity predicts poor response to treatment across multiple psychosocial outcomes including employment status. Clinical Significance: More intensive and long-term psychiatric treatment and vocational-educational rehabilitative services may be required for improvement in employment functioning among those with relatively severe psychopathology.

Complications of Mandible Fractures Related to Substance Abuse

To analyze different epidemiologic factors related to patients who abuse legal and illegal substances, and the relationship between substance abuse and postsurgical complications of mandibular fractures. The study was performed over a 5-year period by the Division of Oral and Maxillofacial Surgery, State University of Campinas, São Paulo, Brazil. In total, 1,399 patients were analyzed via a data form covering age, gender, socioeconomic activity, etiology, and time lapse between trauma and medical attention. Patients were categorized according to whether they reported no substance abuse, smoking, chronic abuse of alcohol, or abuse of intravenous or nonintravenous drugs. Information on the complications presented and corresponding treatments was also included. Of 1,399 patients, 472 presented with 699 mandibular fractures, and 11.4% of these patients had postsurgical complications. The breakdown of subgroup size in terms of percentage of the total, and the corresponding incidence of postsurgical complications, were: for those reporting no substance abuse (52.5%), 8.5% of total complications; for smokers (35.3%), 14.9% of total complications; for patients who self-reported chronic alcohol abuse (30.9 %), 17.1% of total complications; for the nonintravenous drug user subgroup (6.1%), 14.2% of total complications; and for the intravenous drug user subgroup (1.8%), 37.5% of total complications. There is evidently a close correlation between substance abuse and postsurgical complications in patients with mandibular fractures, because of both physiologic alterations and patient behavior. Assault-related injuries were the primary cause of trauma in the substance abuse groups, and infections represented the predominant complication.

T08-O-08 Sexual re-pleasuring: male substance users and abusers working sexual pleasure as relapse prevention while living in a therapeutic community

Some drug users or abusers use illicit drugs a way to reach sexual enhancement. Rehabilitation is a lifelong process to prevent relapse. This work stresses on how a small male substance use and abuse group living in a therapeutic community is empowered through sex education, counseling and therapy to experience new ways of sexual enhancement so they may be able to be drug free on sexual encounters once they resume their life out of the therapeutic community, and, consequently, be able to see sex as a relapse prevention strategy. The process is divided into four phases: a) Playful Integration Phase devoted to build trust and group integration. It works Mourier/Herriot's sexual archetypes and PLISSIT's Permission modality to work and explore new sexual patterns; b) Socialization and Sexuality Phase to work their culture's view of male sexuality, and Ira Reis’concept of social scripts; c) Physiological/Psychological Phase to work the physiology of sex either on drugs or not, Masters and Johnson's ejaculatory control, the psychology of sex, and Zilbergeld's conditions for good sex theory to get participants to know which conditions fit their sexual needs the best; d) Enrichment/Sensory Phase which works The Institute for the Advanced Study of Human Sexuality's (IASHS) Sexual Enrichment and Education program and the Sensorium sexological programs to experience new, drug-free levels of sexual sensations. It also applies Carol Well's guided imagery and sexual creativity exercises along with PLISSIT's Permission. In a Rogerian sense the program aims to give participants an unconditional acceptance space.

Hospitalizations With Amphetamine Abuse Among Pregnant Women

To examine trends in pregnancy hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse hospitalizations were compared with cocaine-abuse hospitalizations and non-substance-abuse hospitalizations. A chi2 analysis was used to compare hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. From 1998 to 2004, the hospitalization ratio for cocaine abuse decreased 44%, whereas the hospitalization ratio for amphetamine abuse doubled. Pregnancy hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non-substance-abuse hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non-substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. As pregnancy hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population. III.

Association of Alcohol Abuse and Injection Drug Use with Immunologic and Virologic Responses to HAART in HIV-positive Patients from Urban Community Health Clinics

The purpose of this study is to examine the association of alcohol abuse and injection drug use (IDU) with the immunologic and virologic responses to highly active antiretroviral treatment (HAART) in urban community health clinics. The medical records of 293 HIV-infected adult patients who visited either of two urban health clinics in New Haven, Connecticut, from June 2003 to December 2004 were retrospectively reviewed. Changes in mean CD4 lymphocyte counts and undetectable viral loads were compared before and after the initiation of HAART for patients categorized into one of four substance abuse groups: history of neither alcohol abuse nor IDU, alcohol abuse only, IDU only, or both. Unadjusted mean improvements in CD4 count for the four groups were 136, 97, 20, and 27, respectively. In a linear regression model adjusted for age, gender, and baseline CD4 count, history of IDU only (P = 0.037) and a combination of alcohol abuse and IDU (P = 0.038) were associated with a lesser increase in CD4 count after HAART compared with those with neither alcohol nor IDU. No significant associations were found between substance abuse history and changes in detectable viral load. Our results show that many patients at urban health clinics have a history of either injection drug use or alcohol abuse, and that injection drug use is negatively associated with the immunologic response to HAART in urban HIV-infected individuals. This study highlights the importance for clinicians of understanding the negative associations of substance abuse with the treatment response of HIV-infected patients at urban health centers.

The Texas Medication Algorithm Project Antipsychotic Algorithm for Schizophrenia

A panel of academic psychiatrists and pharmacists, clinicians from the Texas public mental health system, advocates, and consumers met in June 2006 in Dallas, Tex., to review recent evidence in the pharmacologic treatment of schizophrenia. The goal of the consensus conference was to update and revise the Texas Medication Algorithm Project (TMAP) algorithm for schizophrenia used in the Texas Implementation of Medication Algorithms, a statewide quality assurance program for treatment of major psychiatric illness. Four questions were identified via premeeting teleconferences. (1) Should antipsychotic treatment of first-episode schizophrenia be different from that of multiepisode schizophrenia? (2) In which algorithm stages should first-generation antipsychotics (FGAs) be an option? (3) How many antipsychotic trials should precede a clozapine trial? (4) What is the status of augmentation strategies for clozapine? Subgroups reviewed the evidence in each area and presented their findings at the conference. The algorithm was updated to incorporate the following recommendations. (1) Persons with first-episode schizophrenia typically require lower antipsychotic doses and are more sensitive to side effects such as weight gain and extrapyramidal symptoms (group consensus). Second-generation antipsychotics (SGAs) are preferred for treatment of first-episode schizophrenia (majority opinion). (2) FGAs should be included in algorithm stages after first episode that include SGAs other than clozapine as options (group consensus). (3) The recommended number of trials of other antipsychotics that should precede a clozapine trial is 2, but earlier use of clozapine should be considered in the presence of persistent problems such as suicidality, comorbid violence, and substance abuse (group consensus). (4) Augmentation is reasonable for persons with inadequate response to clozapine, but published results on augmenting agents have not identified replicable positive results (group consensus). These recommendations are meant to provide a framework for clinical decision making, not to replace clinical judgment. As with any algorithm, treatment practices will evolve beyond the recommendations of this consensus conference as new evidence and additional medications become available.

Substance abuse (SA) does not compromise significant improvements in spanish patients with schizophrenia treated with risperidone long-acting injection (RLAI)

Objectives:To determine if there are differences in 6 month outcomes in schizophrenia patients with and without a history of SA treated with RLAI.Methods:Spanish patients enrolled in e-STAR, a secure web-based, ongoing, international, long-term observational study of schizophrenia patients, who initiated RLAI have been followed up for 6 months.Results:Of 1,107 patients enrolled to date 40.1% had a history of SA, including alcohol, prescription medication, and recreational drugs. More males in the SA group (82.2%) than the non-SA group (49.3%); mean age 35.7 and 40.4 years, mean duration of illness 11.7 vs 13.9 years, respectively. At 6 months 92.3% of SA and 94.7% of non-SA patients were continuing RLAI. Baseline mean Clinical Global Impression-Severity (CGI-S) scores were similar (SA 4.77, non-SA 4.63) and 59.0% of SA and 55.0% of non-SA patients had a baseline CGI-S score of 5-7 (marked-very severe illness). At 6 months CGI-S scores had reduced significantly in each group (SA 3.97, non-SA 3.83; both p<0.001 vs baseline) and the proportion with CGI-S scores of 5-7 fell to 27.3% of SA and 22.9% of non-SA patients. Mean Global Assessment of Functioning scale scores significantly improved between baseline and 6 months in each group; SA 46.6 to 56.5, non-SA 46.8 to 56.6 (both p<0.001). Significant reductions in use of concomitant medication in both groups (p<0.001) accompanied these clinical improvements.Conclusion:Although a history of SA may predict poorer outcomes in schizophrenia, SA patients treated with RLAI are similarly compliant and improve equally well as non-SA patients.

Substance abuse and first‐episode schizophrenia‐spectrum disorders. The Danish OPUS trial

To evaluate whether integrated treatment (given by OPUS), in comparison with standard treatment, significantly reduced the number of patients with substance abuse and improved clinical and social outcome in the group of substance abusers after 2 years. A total of 547 patients with first-episode schizophrenia-spectrum disorders were included in the study, 275 randomly assigned to OPUS treatment and 272 to standard treatment. OPUS treatment consisted of assertive community treatment with family involvement and social skills training. Standard treatment offered contact with a community mental health centre. Main outcome measure was reduction in comorbid substance abuse. At 2-year follow up, 42 (17.3%) patients from OPUS and 40 (20.7%) patients from standard treatment met criteria for substance abuse (odds ratio=0.5, 95% confidence interval 0.3-1.0). OPUS treatment compared with standard treatment significantly reduced negative and disorganized symptoms in the substance abuser group. Patients with substance abuse in the OPUS treatment spent significantly fewer days in hospital during the 2-year period than patients given standard treatment (109 days vs. 167 days) and adhered to treatment significantly more often. Results from this trial indicate that integrated treatment given by OPUS reduced substance abuse and improved clinical outcome in the substance abuser group. Supplementing the OPUS treatment with therapeutic programmes for patients with a comorbid substance abuse would probably further improve outcome.

N-3 Polyunsaturated Fatty Acids Decrease Anxiety Feelings in a Population of Substance Abusers

There is mounting evidence that low levels of n-3 polyunsaturated fatty acids (PUFAs) play a role in the pathophysiology of a number of psychiatric disorders. Preclinical studies have shown that n-3 PUFAs decrease anxietylike behaviors, but there is a paucity of information about their effects on anxiety in humans. In light of our observation that substance abusers have poor dietary habits and the strong association between anxiety disorders and substance use disorders, the possibility that the administration of supplements of n-3 PUFAs would decrease the anxiety level of a group of substance abusers was explored. Thirteen patients were given on a daily basis capsules containing 3 g of n-3 PUFAS (eicosapentaenoic acid + docosahexaenoic acid). Eleven patients received similarly looking placebo capsules containing vegetable oil. The trial was double-blind, randomized, and lasted 3 months. A scale assessing anxiety feelings was administered at baseline and on a monthly basis thereafter. Six PUFA group patients and 8 placebo group patients were followed for an additional 3 months after treatment discontinuation and administered the same questionnaire monthly. Patients who received n-3 PUFAs for 3 months showed a progressive decline in anxiety scores. This was not the case for patients who received placebos. A comparison of the 2 groups was significant (P = 0.010). Anxiety scores remained significantly decreased in the PUFA group for 3 months after treatment discontinuation. A comparison of the 2 groups followed for 6 months was also significant (P = 0.042). In conclusion, these preliminary data indicate that n-3 PUFA supplementation could be beneficial in the treatment of some patients with anxiety disorders.

Relapse to Opioid Use After Treatment of Chronic Hepatitis C With Pegylated Interferon and Ribavirin

Relapse to Opioid Use After Treatment of Chronic Hepatitis C With Pegylated Interferon and Ribavirin

TO PROFIT FROM THE VARIABILITY OF THE SYSTEM: COMMENTS ON BÜHRINGER (2006)

TO PROFIT FROM THE VARIABILITY OF THE SYSTEM: COMMENTS ON BÜHRINGER (2006)

Social and psychological context of childbearing

The transition to motherhood is an emotional watershed which is punctuated by feelings of loss as well as gain. Not surprisingly, it is a period that is associated with significant social and psychological changes and upheavals that may give rise to feelings of uncertainty and self-doubt. The National Services Framework for Children, Young People and Maternity Services (Department of Health 2004) acknowledges the demands of parenthood and identified clear standards for promoting health and wellbeing of women, children, partners and families as a whole, placing emphasis on supporting and helping parents prepare and adjust to their parenting role. Furthermore, it outlines a number of vulnerability factors that may have adverse consequences for maternal and neonatal outcomes. This, for example, takes account of social deprivation/social exclusion, teenage pregnancy, substance abuse, domestic violence and minority ethnic groups. To comprehend the enormity of childbearing on women’s lives this paper considers the social and psychological context of motherhood as a major life event.

Sleep Architecture in Infants of Substance-Abusing Mothers.

This longitudinal, year-long study compared sleep-wake state organization in two groups of infants-infants whose mothers abused substances during their pregnancies and nonexposed, typically developing, age-matched comparison infants-to determine whether differences in sleep-wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent-infant residential treatment program for substance abuse were enrolled. Their sleep-wake state organization over the first year of life was compared to that of 17 age-matched comparison infants. The intent was to follow each infant on five occasions over the first year of life using established methods of time-lapse videosomnography to record sleep-wake state organization; however, attrition in the substance-abusing group was problematic. Some sleep-wake variables (i.e., Active Sleep%, Quiet Sleep%, Awake%, number of nighttime awakenings) were similar for both groups of infants at comparable ages across the first year. Total sleep time and the longest sustained sleep period (sleep continuity variables) differed significantly at some of the ages measured. Although overall sleep architecture appears highly resilient and well organized, some indications of sleep fragmentation and shortened nighttime sleep periods were observed in the substance-exposed infants. More research is needed to explain why sleep-continuity variables and not sleep-state proportion variables differed between the two groups.

Clinical Diagnosis and SCID-II Assessment of DSM-III-R Personality Disorders

Aim: To assess the diagnostic concordance of SCID-II and clinicians' estimation of DSM-III-R personality disorders of substance abusers. Method: Clinical diagnoses of substance abusers in inpatient treatment were compared with SCID-II diagnoses (N = 138). Findings: The overall prevalence of personality disorder was 79% for clinical diagnosis and 80% for SCID-II diagnosis. Substantial agreement was found for borderline personality disorder, and moderate agreement was found for presence of any personality disorder, and antisocial personality disorder. All other disorders had slight to fair agreement. Antisocial personality disorder was overdiagnosed by clinical diagnosis but schizotypal, obsessive-compulsive, passive-aggressive, and masochistic personality disorders were reported more often by SCID-II. Selecting only the primary clinical diagnosis and omitting additional clinical diagnoses, reduced agreement with SCID-II diagnoses. Implications: Clinical diagnosis and structured interviews are not interchangeable, and produce somewhat different profiles of diagnoses for a group of substance abusers, but the two methods for diagnosing personality disorders converge for the two most common personality disorders in substance abusers. Rare and less-known diagnoses tend to be underreported whereas common and well-known disorders tend to be slightly overdiagnosed by clinical diagnosis as compared with a semistructured interview, especially if only one clinical diagnosis is noted.

Recovery Processes in a Treatment Program for Women

ABSTRACT Recovery processes of 32 women were explored in six focus groups following completion of treatment in a community based women-specific substance abuse group program. Grounded theory analysis yielded an over-arching theme of Building a House of Recovery and several sub-themes describing women's perceptions of the processes that were central to their recovery.

A Qualitative Analysis of Inaccurate Responses on the Hooper Visual Organization Test

The present study investigated the types of inaccurate responses, i.e., Don't Know, Semantic, Visual (nonlinguistic), Phonological, Circumlocutory, and Perseverative, made on the Hooper Visual Organization Test by a heterogeneous sample of 68 brain-damaged and 63 substance abuse patients. The mean age of the brain-damaged and substance abuse groups were 46.0 (SD=13.5) and 43.7 (SD=12.9) yr., respectively. Analysis showed that the brain-damaged group made significantly more visual and perseverative responses than the substance abuse group. There was significantly more variance in the Visual responses than the Semantic responses for the brain-damaged group. The authors conclude that visuospatial ability is the primary factor for successful performance on this test.

Familiar Yet Strange: Involving Family Members in Adolescent Drug Rehabilitation in a Chinese Context

The efficacy of family therapy treatment in adolescent drug abuse is widely attested. Though the family is recognized as the most fundamental unit in a modern Chinese society like Hong Kong, the role of the family has not been adequately explored and systematically integrated into adolescent drug treatment. This paper explores the role of family therapy in adolescent drug treatment in Hong Kong based on the reports of a group of adolescent drug abusers and their social workers. Preliminary results show that family therapy is useful for changing family communication and interactional patterns in adolescent drug rehabilitation. Some recommendations are made in view of cultural considerations.