Hazardous Drug Use Research Articles

Associations between positive memory count and hazardous substance use in a trauma-exposed sample: Examining the moderating role of emotion dysregulation.

Research has demonstrated links between autobiographical memory retrieval and hazardous substance use. However, limited work has examined relations between positive autobiographical memories and hazardoussubstance use, as well as moderating factors influencing these relations. Thus, we examined the potential moderating roles of negative and positive emotion dysregulation in the relations between count of retrieved positive memories and hazardous substance use (alcohol and drug use separately). Participants were 333 trauma-exposed students (Mage = 21.05; 85.9% women) who completed self-report measures assessing positive memory count, hazardous alcohol and drug use, negative emotion dysregulation, and positive emotion dysregulation. Positive emotion dysregulation significantly moderated the association between positive memory count and hazardous alcohol use (b = 0.04, 95% confidence interval [CI] [0.01, 0.06], p = 0.019), as well as the association between positive memory count and hazardous drug use (b = 0.02, 95% CI [0.01, 0.03], p = 0.002). Individuals with more positive emotion dysregulation had stronger associations between increases in positive memory count and increased hazardous substance use. Findings indicate that trauma-exposed individuals who retrieve more positive memories and experience difficulties regulating positive emotions report greater hazardous substance use. Positive emotion dysregulation may be an important target for memory-based interventions among trauma-exposed individuals who report hazardous substance use.

Religiosity and hazardous substance use: The moderating role of trauma-related shame.

Hazardous substance use is a major public health concern among individuals with a history of sexual victimization. Although increased religiosity has been known to serve as a protective factor against hazardous substance use, religious individuals with a history of sexual victimization may be at a greater risk for hazardous substance use due to difficulties reconciling sexual victimization with their religious beliefs. Individuals with greater trauma-related shame may engage in hazardous substance use as a means of coping with the traumatic event. The present study consisted of 614 participants (Mage = 34.57, 50% women). Results suggested that organizational, nonorganizational, and intrinsic religiosity were positively associated with hazardous alcohol use at higher, but not lower, levels of trauma-related shame. Organizational and intrinsic religiosity were positively associated with hazardous drug use at higher, but not lower, levels of trauma-related shame. This is the first study to examine the role of trauma-related shame in the relationship between religiosity and hazardous substance use. The findings underline the importance of targeting trauma-related shame in religious individuals with a history of sexual victimization.

Factors Associated with Simultaneous or Concurrent Use of Alcohol and Marijuana in Argentina

Background: The identification of factors promoting simultaneous alcohol and marijuana (SAM) use is important to promote early intervention efforts. The associations between impulsivity facets and SAM (or concurrent alcohol and marijuana, CAM) use have been analyzed in North American samples. These topics, however, remain unexplored in South American samples. This study assessed if internalizing symptoms, five impulsivity dimensions, and emotional regulation strategies differentiate between participants who reported last 2-month SAM use, CAM use, alcohol, or marijuana only use, or that reported no substance use. Methods: A sample of 1057 Argentinian citizens answered an online survey. A multinominal logistic regression was conducted on drug use membership. Results: Circa 25% of the sample reported SAM use. Higher sensation seeking differentiated between SAM use versus no substance use, and those with lower sensation seeking were more likely to be classified into the alcohol-only group or into the nonuse group, than into the SAM use group. Stress scores uniquely predicted membership into the alcohol-only category. Those with lower use of emotional suppression were more likely than nonusers to be classified in all drug use categories, except CAM use. Higher emotional suppression scores were associated with membership into the nonuse group or the alcohol-only group, when compared to the SAM use group. Hazardous drinking was significantly greater in SAM than in alcohol-only users. Conclusions: The study highlights the relevance of sensation seeking as a predictor of SAM use and pinpoints emotional suppression as common factor modulating hazardous drug use behaviors.

Risk and protective factors for whoonga use among adolescents in South Africa

BackgroundAntiretroviral therapy (ART) is publicly available in South Africa in response to the urgent need to address HIV and AIDS. Off-label use of ARV medication alone or in combination with other substances is known as “whoonga” and “nyaope” in South Africa. Diversion of ARVs for whoonga use is not well understood, especially among adolescents. This secondary analysis explores risk and protective factors for adolescent whoonga use in a community-based HIV endemic setting. MethodsData on whoonga use were derived from a baseline survey of N = 200 adolescents recruited for participation in a randomized controlled trail to reduce adolescent HIV risk behaviors and depression. Risk and protective factors for adolescent whoonga use were explored using an ecological systems framework using one-way ANOVAs, chi-squared tests and hierarchical regression. ResultsIndividual level factors increased the odds of whoonga use or known use such as child age OR:1.22 (95% CI, 1.03–1.43), hazardous drug use OR:1.62 (95% CI, 1.02–2.59), and hazardous alcohol OR:1.80 (95% CI, 1.05–3.09). Food insecurity appears to have a slightly protective effect on the odds of whoonga use or reports of use among people adolescents knew OR:0.649 (95% CI, 0.541–0.779). ConclusionsLarger epidemiological studies should expand the surveillance of hazardous alcohol use and illicit drug use, specifically for recreational use of prescription medication. Granular data is warranted to characterize the patters of use, especially among highly vulnerable populations. Future surveillance studies that explore these multi-level relationships are warranted to further understand this phenomenon among teens in South Africa.

Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BackgroundTo examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame. MethodsFrom 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame. ResultsEthnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001). ConclusionsAmong Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Awareness and prevention of substance among adolescents

Background: Substance Abuse is one of the world's biggest health issues. Adolescents are particularly vulnerable. The purpose of this research is to compare the reasons for initiating, maintaining, and abstaining from hazardous drug use among adolescents and young adults. Objectives: To investigate the prevalence and pattern of drug use among adolescents and young adults, as well as to raise awareness about and prevent substance usage. Conclusion: The processes of industrialization, urbanization, and migration have resulted in the loosening of traditional social control methods, making an individual vulnerable to the stresses and strains of modern life, and factors related to a child's socialization outside the family may also increase the risk of the drug. However, the successful execution of drug prevention plans, as well as the participation of parents, teachers, society, the media, and nurses in raising awareness of the health and other risks of substance abuse among adolescents, aid in the prevention of substance addiction.

The relationship between consumption of alcohol and other drugs and problematic Internet use among adolescents.

Alcohol and drug use among adolescents has been causing great concern for decades in Spain and in the European Union as a whole. In addition, the technology boom experienced over the last two decades has contributed to the emergence of a new public healthcare issue: problematic Internet use. The increasing importance that both problems have been gaining in recent years has led some authors to analyze the relationship between alcohol and the consumption of other drugs alongside problematic Internet use, and to provide relevant empirical evidence. Based on a sample of 3,882 Spanish adolescents aged between 12 and 18, the results obtained confirm that there is a relationship between the consumption of alcohol (measured by the AUDIT) and other drugs (measured by the CRAFFT and the CAST), and problematic Internet use (measured by the EUPI-a). Problematic Internet users among them not only have more significant levels of substance use, but also a three-times greater chance of developing hazardous drug use (39.4% vs 13.3%). This highlights the need to develop transversal prevention capable of acting on the common variables to both issues, beyond developing programs focused on specific behaviors. In this sense, values-based education and life skills training should be given priority in prevention.

Development of a Computer-Based Format for the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) With University Students

ABSTRACTBackground: The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid tool for the early detection of harmful and hazardous drug use in primary care settings when administered by interview in the general population. In university students, substance use is high, so a reliable and feasible screening instrument is needed. Objectives: To compare the computer-based ASSIST (ASSISTc) with the interview format (ASSISTi). Methods: A convenience sample with counterbalanced design was used alternating between the ASSISTi and ASSISTc with 15-day interval. Although this is not a traditional test–retest reliability study, the same statistical analysis was used: intraclass correlations (ICC), kappa (κ), and Cronbach's alpha (α) to compare the two formats. A satisfaction questionnaire was applied immediately after the second session. Results: Both formats were completed by the students (n = 809) over 15 days. The scores of involvement with all substances and with tobacco, alcohol, cannabis, and cocaine obtained with the two formats demonstrated excellent ICC (> .77). The level of agreement was considered substantial for tobacco (κ = .69) and cannabis (κ = .70) and moderate for alcohol (κ = .58). The consistency of the ASSISTc was considered satisfactory (α: .85 for tobacco, .73 for alcohol, and .87 for cannabis). The analysis of satisfaction and feasibility showed that the ASSISTi was easier to understand, but the two formats were considered similar when considering acceptability, ease of responding, and degree of intimidation. Conclusions/importance: The two formats are acceptable, the scores are comparable, and they can be used interchangeably.

Examining the relationship between self-reported executive cognitive functioning and substance misuse in university students

Substance misuse is highly prevalent among university students. One possible risk factor is dysfunction in Executive Cognitive Functions (ECF). Barkley and Fischer criticized traditional ECF neuropsychological tests, claiming that ratings of ECF in daily life are more ecologically valid. Barkley’s Deficits in Executive Functioning Scale (BDEFS), a novel self-report measure of ECF, was used to assess to assess the relationship between ECF and substance misuse in 154 university students. In this sample, 38.8% met criteria for hazardous alcohol use while 18.7% met criteria for hazardous drug use. Problematic alcohol users differed from non-problematic users in overall ECF impairment as well as on Self-Management to Time and Self-Restraint subscales. Problematic drug users differed from non-problematic users on Self-Restraint. These results suggest that the BDEFS may be a valuable tool to assess ECF impairment in substance misusers.

National Indicators for Quality of Drug Therapy in Older Persons: the Swedish Experience from the First 10 Years

Inappropriate drug use is an important health problem in elderly persons. Beginning with the Beers’ criteria in the early 1990s, explicit criteria have been extensively used to measure and improve quality of drug use in older people. This article describes the Swedish indicators for quality of drug therapy in the elderly, introduced in 2004 and updated in 2010. These indicators were designed to be applied to people aged 75 years and over, regardless of residence and other characteristics. The indicators are divided into drug specific, covering choice, indication and dosage of drugs, polypharmacy, drug–drug interactions (DDIs), drug use in decreased renal function and in some symptoms; and diagnosis specific, covering the rational, irrational and hazardous drug use in common disorders in elderly people. During the 10 years since introduction, the Swedish indicators have several applications. They form the basis for recommendations for drug therapy in older people, are implemented in prescribing supports and drug utilisation reviews, are used in national benchmarking of the quality of Swedish healthcare and have contributed to initiatives from pensioner organisations. The indicators have also been used in several pharmacoepidemiological studies. Since 2005, there have been signs of improvement of the quality of drug prescribing to elderly persons in Sweden. For example, the prescribing of drugs that should be avoided in older persons decreased by 36 % between 2006 and 2012 in persons aged 80 years and older. Similarly, drug combinations that may cause DDIs decreased by 26 % and antipsychotics by 41 %. The indicators have likely contributed to this.

Effects of baseline problematic alcohol and drug use on internet-based cognitive behavioral therapy outcomes for depression, panic disorder and social anxiety disorder.

PurposePatients’ problematic substance use prevalence and effects were explored in relation to internet-based cognitive behavioral therapy (ICBT) outcomes for depression, panic disorder and social anxiety disorder.MethodsAt baseline and treatment conclusion, 1601 ICBT patients were assessed with self-rated measures for alcohol and drug use (AUDIT/DUDIT), depressive symptoms (MADRS-S), panic disorder symptoms (PDSS-SR) and social anxiety symptoms (LSAS-SR).ResultsProblematic substance use (AUDIT ≥8 for men, ≥6 for women; DUDIT ≥1) occurred among 32.4% of the patients; 24.1% only alcohol, 4.6% only drugs, and 3.7% combined alcohol and drug use. Hazardous alcohol use and probable alcohol dependence negatively affected panic disorder outcomes, and hazardous drug use led to worse social anxiety outcomes. Depression outcomes were not affected by substance use. Treatment adherence was negatively affected by problematic drug use among men and 25–34 year olds; combined substance use negatively affected adherence for women and 35–64 year olds.ConclusionProblematic substance use does not preclude ICBT treatment but can worsen outcomes, particularly problematic alcohol use for panic disorder patients and hazardous drug use for social anxiety patients. ICBT clinicians should exercise particular caution when treating men and younger patients with problematic drug use, and women or older patients with combined substance use.

Development of a self-report format of ASSIST with university students

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a reliable and valid tool to early detection in the harmful and hazardous drug use in primary care settings when administered by interview in the general population. As the risk of substance related problems in university students is high, it is necessary to have screening instruments that can be used beyond the health care settings. Thus, we compared a self-report adaptation of ASSIST with the validated interview format in a convenience sample of university students. A counter-balance design was chosen with students alternating between the interview and the self-report formats. Both formats were completed by all students (n=170) over 30days. The scores for total involvement, tobacco, alcohol, cannabis and cocaine obtained from the two formats demonstrated good intra-class correlation coefficient (ICC >0.60). The agreement assessed by kappa between questions of the two formats was considered moderate for tobacco (0.76) and cannabis (0.69) and discrete for alcohol (0.47). The consistency of the self-report questionnaire was also good to moderate (Cronbach's alpha of 0.90 for tobacco, 0.71 for alcohol, 0.86 for cannabis and 0.89 for cocaine) and showed acceptable sensitivity (66.7–100%) and specificity (83.5–97.1%) for tobacco, alcohol, cannabis and cocaine when compared to the ASSIST interview format (gold standard). The findings suggest that self-report version is as acceptable as the interview and that the scores on the two formats are comparable. However, the participants reported more motivation for change behavior and more concern about substance use when they were interviewed.

Identifying and managing problematic substance use in outpatient psychiatric care: a national survey in Sweden

About 25% of psychiatric patients are known to have problematic substance use. The National Board of Health and Welfare in Sweden recommends that treatment providers of psychiatric care systematically identify patients with problematic substance use, and provide Brief Intervention (BI) for them. It is not known to what extent these recommendations are followed. Two surveys were designed, one for directors of outpatient psychiatric clinics, the second for clinical staff at these clinics. The survey to clinic directors focused on guidelines at the clinic for identifying substance use during the assessment phase, and for offering BI to patients with problematic substance use. The survey to staff focused on identification of problematic substance use during the assessment phase and personal experiences in identifying such use as well as offering BI. The response rate for clinic directors was 60% (n=137). Most clinics had guidelines for always asking patients about substance use in the assessment phase (92% for alcohol; 80% for drugs). Guidelines existed for offering BI for hazardous alcohol use at 49%; for hazardous drug use at 42%. The response rate for staff in participating clinics was 40% (n=481), 66% stated that they always ask about alcohol use during the assessment phase. Corresponding figure for drug use was 58%. 36% reported using BI for hazardous alcohol and drug use. Guidelines for identifying problematic substance use had been formulated at almost all outpatient psychiatric clinics, but among staff, only two out of three reported applying them. Guidelines for using BI had been formulated at less than half of the clinics. Actual BI provision by staff to patients was even more rare. During 2013-14, directors and staff participating in this survey will be involved in design and implementation of e-interventions (internet self-help sites, IVR, mobile applications) for problematic substance use.

Use of alcohol and other drugs among Brazilian college students: effects of gender and age

To assess the frequency of drug use among Brazilian college students and its relationship to gender and age. A nationwide sample of 12,721 college students completed a questionnaire concerning the use of drugs and other behaviors. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) criteria were used to assess were used to assess hazardous drug use. A multivariate logistic regression model tested the associations of ASSIST-WHO scores with gender and age. The same analyses were carried out to measure drug use in the last 30 days. After controlling for other sociodemographic, academic and administrative variables, men were found to be more likely to use and engage in the hazardous use of anabolic androgenic steroids than women across all age ranges. Conversely, women older than 34 years of age were more likely to use and engage in the hazardous use of amphetamines. These findings are consistent with results that have been reported for the general Brazilian population. Therefore, these findings should be taken into consideration when developing strategies at the prevention of drug use and the early identification of drug abuse among college students.

Stress, Substance Use and Sexual Risk Behaviors Among Primary Care Patients in Cape Town, South Africa

We assessed the relationship between stress, substance use and sexual risk behaviors in a primary care population in Cape Town, South Africa. A random sample of participants (and over-sampled 18-24-year-olds) from 14 of the 49 clinics in Cape Town's public health sector using stratified random sampling (n = 2,618), was selected. We evaluated current hazardous drug and alcohol use and three domains of stressors (Personal Threats, Lacking Basic Needs, and Interpersonal Problems). Several personal threat stressors and an interpersonal problem stressor were related to sexual risk behaviors. With stressors included in the model, hazardous alcohol use, but not hazardous drug use, was related to higher rates of sexual risk behaviors. Our findings suggest a positive screening for hazardous alcohol use should alert providers about possible sexual risk behaviors and vice versa. Additionally, it is important to address a broad scope of social problems and incorporate stress and substance use in HIV prevention campaigns.

Health Professionals' Perceptions of Drug Use Problems of the Elderly

ABSTRACTMany elderly in Canada are living independently and managing their own medication use. Since the elderly are more susceptible to the ill-effects of drugs, non-prescription drug use may pose a hazard. In order to conduct a survey to determine the extent of hazardous self-medication with non-prescription analgesics and the factors that contribute to such use, a valid measurement of hazardous use was needed. To determine items for this measurement, a survey was conducted with health professionals in a position to detect problems with drug use by the elderly. Nurses and physicians were asked their perceptions of drug use problems and of their elderly clients' concerns about their health and drug use. Results indicated that eight items should be included in a measurement to reflect hazardous drug use seen in practice by more than 50% of the health professionals surveyed. Nurses and physicians differed in their perceptions of certain problems and of their elderly clients' concerns.