High Rates Of Substance Abuse Research Articles

Study Suggests ADHD in Adults May Be Distinct Disorder

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessStudy Suggests ADHD in Adults May Be Distinct DisorderNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:6 Jul 2015https://doi.org/10.1176/appi.pn.2015.7a2AbstractAn analysis of over 1,000 New Zealanders finds only a fraction of adults with ADHD symptoms were diagnosed as children. ADHD adults also performed relatively normal on neuropsychological tests.A study published May 22 in AJP in Advance suggests that adults presenting with ADHD symptoms may not have a childhood-onset neurodevelopmental disorder. The study followed a cohort of 1,037 people who were born in Dunedin, New Zealand, in 1972 and 1973 and were followed for nearly four decades with comprehensive interviews and health evaluations—including psychiatric and neuropsychiatric tests—at periodic intervals.In line with other prevalence data, childhood ADHD was diagnosed in 61 study participants (about 6 percent), mostly in boys. Adult ADHD was diagnosed in 31 individuals (3 percent), with equal gender distribution. Those 31 people were not simply children who failed to manage their symptoms; only three of the 31 ADHD adults had a childhood ADHD diagnosis. “What’s more, the adults diagnosed with ADHD showed almost none of the neuropsychological deficiencies that are a hallmark of childhood ADHD,” said lead study author Terrie Moffitt, Ph.D., the Knut Schmidt Nielsen Professor of psychology and neuroscience at Duke University. “Their brains seemed to work just fine when taking IQ or working memory tests.”In comparison with test scores, however, those adults with ADHD did report cognitive problems, such as forgetting why they went to a store or having trouble finding words when speaking.Another difference was that the adult ADHD cases had much higher rates of substance abuse (around 48 percent) than those diagnosed as children. These are interesting discrepancies that Moffitt thinks will be subject to interpretation. “Hard-nosed types who view ADHD as an overdiagnosed condition might see the normal neuropsychological profiles and elevated substance use as evidence that adult ADHD is not a genuine disorder,” she told Psychiatric News.“Others would argue that since over half of the cases had no diagnosed disorder, it serves as evidence that adult ADHD is a real and distinct problem. And while we don’t fully understand it yet, the people who have it deserve mental health care.” No matter one’s interpretation of the findings, Moffitt hopes this study can fuel further research that may help clarify the matter in either direction. There are other longitudinal studies examining ADHD in different populations, so more population evidence should be available in the near future.And if these current findings are replicated, Moffitt believes changes should be made to the DSM-5 to categorize ADHD as a distinct, non-neurodevelopmental disorder. To help determine where this condition might fit, Moffitt’s team is moving forward and analyzing the genetic data collected from the Dunedin cohort. Their current study found that unlike childhood ADHD cases, people with adult-onset ADHD did not have a genetic profile associated with an elevated risk of ADHD, which suggests the two disorders are biologically distinct. She hopes to study this in more detail to see what genetic influences may contribute to an adult-onset ADHD and if these differences are shared among any other disorders.This study was funded by the National Institute on Aging, UK Medical Research Council, and Jacobs Foundation. The study participants were members of the Dunedin Multidisciplinary Health and Development Study. ■“Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study” can be accessed here. ISSUES NewArchived

Impulsivity in Adolescents with Bipolar Disorder

Introduction Impulsivity refers to a predisposition toward rapid and unplanned reactions to internal or external stimuli, without regard to the negative consequences. It is recognized to be a contributing factor to the high rate of substance abuse and suicide risk in bipolar patients. It is one of the most frequent typical symptoms in bipolar adolescents. Objectives The aim of this study was to examine aspects of impulsivity in adolescents with bipolar disorders Methods We assessed impulsivity in 30 euthymic adolescents with bipolar disorder and we evaluated its association with the following clinic characteristics: suicide attempts, childhood trauma history and substance use history. Impulsivity and childhood trauma history were respectively assessed using the Barratt Impulsiveness Scale (BIS-10), and Childhood Trauma Questionnaire (CTQ) in validated Arabic versions. Patients were compared with 30 age and gender matched healthy controls. Results The total impulsivity scores as well as subscores of motor and cognitive impulsivity in subjects with bipolar disorder were higher than in control subjects. There was a statistically significant difference between bipolar adolescent and controls regarding the CTQ total. Conclusion Our findings suggest that trait impulsivity is increased among adolescents with mood disorders and is associated with traumatic events in childhood. Therefore the dimension of impulsive aggression and childhood trauma should be systematically assessed in mood disorder patients to address the risk of suicide and addictive behavior.

Ziprasidone monotherapy is ineffective for bipolar-associated anxiety

Anxiety disorders are common among patients with bipolar disorder. Bipolar patients with anxiety disorders have poorer treatment outcomes, greater numbers of suicide attempts, higher rates of substance abuse and lower...

Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder.

Many patients with post-traumatic stress disorder (PTSD) achieve but partial remission with current treatments. Patients with unremitted PTSD show high rates of substance abuse. Marijuana is often used as compassion add-on therapy for treatment-resistant PTSD. This open-label study evaluates the tolerance and safety of orally absorbable Δ(9)-tetrahydrocannabinol (THC) for chronic PTSD. Ten outpatients with chronic PTSD, on stable medication, received 5mg of Δ(9)-THC twice a day as add-on treatment. There were mild adverse effects in three patients, none of which led to treatment discontinuation. The intervention caused a statistically significant improvement in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms. Orally absorbable Δ(9)-THC was safe and well tolerated by patients with chronic PTSD.

Correlates of gang involvement and health-related factors among African American females with a detention history

BackgroundPrior studies have assessed relationships between gang membership and health-related factors. However, the existing literature has largely failed to consider how individual and broader social contextual factors might be related to such gang involvement among African American females. Thus, the aim of the present study was to identify empirically driven correlates of gang involvement and then better understand the relationship between gang membership and health-related behaviors for African American females, after controlling for covariates of gang involvement. MethodsData were collected from a convenience sample of detained African American adolescents females, between the ages of 13–17, currently incarcerated in a short-term detention facility in Atlanta, Georgia (n=188). After obtaining written informed assent and parental permission, participants answered survey questions using A-CASI procedures that assessed socio-contextual factors and health-related behaviors. ResultsMultiple logistic regression models controlling for age and SES documented that low self-esteem, emotional dysregulation, trauma history, deviant peers, low parental monitoring, infrequent parental communication, housing instability and poor neighborhood quality were correlates of gang involvement. In addition, multiple linear and logistic regression models, controlling for these constructs, revealed that gang involvement was independently associated with lower STD prevention knowledge, a higher likelihood of having a gang-involved boyfriend, a greater risk of having current casual sexual partnerships, higher rates of substance abuse, higher incidences of condom misuse and a lower likelihood of ever having been tested for HIV. ConclusionsThese results provide information that can help service providers target certain profiles of African American females who may be at risk for joining gangs and address the health risk behaviors that may be associated with such memberships.

Gender differences in early trauma and high-risk behaviors among street-entrenched youth in British Columbia

This work aimed to evaluate gender differences among the street-entrenched youth in British Columbia in terms of their demographics, experiences of childhood maltreatment, mental health issues, and substance use behaviors. Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), the Mini International Neuropsychiatric Interview (MINI) Plus and the National Survey of Homeless Assistance Providers and Clients (NSHAPC)-Health Chapter. Youth constituted 16.5% (n=82) of the homeless population. Females (55%) outnumbered males and engaged in survival sex more frequently (17.8%; p=0.03). Males had greater substance abuse of alcohol (81.1%) and cannabis (89.2%). Depression (p=0.02) and psychosis (p=0.05) were more common among females, while panic disorder was more common among males (p=0.04). Rates of childhood trauma were similar across genders. Our findings reflect trends among youth where illicit drug use may be similar among genders while males may report increased alcohol and cannabis use, possibly as a means to self medicate their panic-related symptoms. In any case, this population of street entrenched-youth frequently experiences several significant problems ranging from childhood abuse to high rates of substance abuse and mental illnesses.

The Emerging Risks and Developmental Challenges to Children and the Youth in Ethiopia: the Case of Arba Minch Town

This study is about the developmental challenges and adversities to children and the youth in Arba Minch which is one of the emerging towns of Ethiopia. Primary data for the study was collected through case stories, in-depth interview with key informants from families, experts in concerned organizations, FGD and observation methods. The purpose of the research was to explore how the emerging risk situations in the family, community and school environments are threatening the socio-economic and intellectual developments of children and the youth in the town. It is identified that there are adverse situations for thousands of children and the youth in the family, school and community environments. Risk factors in the community include high rate of substance abuse, crime and violence, unemployment, idleness and absence of children and youth recreational centers. The presence of shops that show pornographic and action video, drug centers around schools, shortage of educational inputs or teaching-learning facilities, absence of variety of learning styles, students’ misbehaviors, and low academic achievements have made schools ineffective. The family environment is also not comfortable for positive child development due to the prevalence of child abuse, child neglect, poverty and family disorganization. Key words : risks to child development, child abuse, drug abuse, unemployment, youth delinquency

Cost Drivers of Prescription Opioid Abuse in Commercial and Medicare Populations

Growth in the number of patients with pain conditions, and the subsequent rise in prescription opioid use for treatment, has been accompanied by an increase in diagnosed opioid abuse. Understanding what drives the incremental healthcare costs of members diagnosed with prescription opioid abuse may assist in developing better screening techniques for abuse. This retrospective analysis examined costs, resource use, and comorbidities 365 days pre- and postdiagnosis in prescription opioid users diagnosed with abuse (cases) vs. their matched nondiagnosed controls. Inclusion criteria for cases were diagnosis of opioid abuse (ICD-9-CM: 304.0x, 304.7x, 305.5x, 965.0x). Multivariate analysis used generalized linear modeling with log-transformed cost as dependent variable, controlling for comorbidities. Final sample sizes were 8,390 cases and 16,780 matched controls. Postindex abuse-related costs were $2,099 for commercial members, $539 for Medicare members aged < 65, and $170 for Medicare members aged ≥ 65. A higher percentage of cases had pain conditions (82.0% vs. 57.4% commercial, 95.9% vs. 87.5% Medicare members aged < 65, 92.9% vs. 82.4% Medicare members aged ≥ 65, P < 0.0001), and a higher numbers of cases had multiple opioid prescribers (3.7 vs. 1.4 commercial, 3.3 vs. 2.2 Medicare < 65, 2.2 vs. 1.6 Medicare ≥ 65, P < 0.0001) than controls preindex. Cases had higher rates of substance abuse and psychiatric diagnoses pre- and postindex (P < 0.0001, all comparisons). Adjusted costs were 28% higher for cases than for controls (P < 0.0001). Costs of members diagnosed with prescription opioid abuse are driven by higher pain and psychiatric comorbidities relative to nonabuse controls.

Survey of factors related to criminal behavior in a sample of Iranian substance abusers

ObjectivesMany countries including Iran have a high rate of substance abuse. It is essential for public health and law enforcement strategies to know the causes and consequences of substance abuse and its relation to crimes. MethodsIn a prospective case–control study, covering a period of one year starting from March 21, 2010, 125 cases with criminal behavior and 125 cases with no history of criminal behavior were studied. ResultsEight percent of our studied population had a previous history of psychological disorder. Most of our cases were cigarette users (78.4%). Forty-two cases had a history of alcohol abuse (16.8%). Modern drugs were the most common type of drugs (56%) being used. Multivariate analysis using logistic regression revealed that criminal behavior was correlated with divorce (RR = 5.35; 95% CI = 1.59–16.01; P = 0.023), history of alcohol use (RR = 2.63; 95% CI = 1.11–6.22; P = 0.027), history of psychological disorder (RR = 4.97; 95% CI = 1.44–17.20; P = 0.011), Modern drug use (RR = 4.86; 95% CI = 2.01–11.76; P = 0.001) and starting drug abuse at an early age (RR = 0.94; 95% CI = 0.88–0.99; P = 0.03). ConclusionsRisk factors for criminal behavior among substance abusers include being divorced, history of alcohol abuse, history of psychological disorder, modern drug abuse and starting drug abuse at an early age.

Screening for Sexually Transmitted Diseases in Short-Term Correctional Institutions

Young persons entering US jails and youth detention facilities have high rates of sexually transmitted diseases (STDs). The Centers for Disease Control and Prevention added STD screening guidelines specific to correctional settings to the 2010 STD Treatment Guidelines. This article summarizes published evidence from 1990 to 2009 used to develop the recommendations. The literature supports routine screening of adolescents and young women (aged ≤35 years, or on the basis of local institutional prevalence data) for chlamydia and gonorrhea because of high prevalence and the subsequent risk of adverse reproductive outcomes. Chlamydia positivity among young women (aged <20 years) in juvenile detention facilities and adult facilities is more than 14%. Men in correctional settings are also at high risk for chlamydia and gonorrhea. Among boys in juvenile detention facilities, chlamydia positivity is estimated at 6.6%; among young men in adult facilities, positivity is 16.6%. Screening men (to reduce sequelae among women) should be considered based on local epidemiology and resource availability. Syphilis screening is not strongly supported in published literature because of low prevalence and is not routinely recommended; however, some screening may be warranted based on local prevalence. Although there is a great diversity in the organization of correctional facilities, implementation of screening recommendations is possible owing to improvements in test technology (urine specimens) and through integration of a standard screening protocol. Based on the high burden of disease and substantial opportunities to reach a high-risk population, correctional facilities are important venues to target efforts to control STDs.

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning(LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents,have higher rates of depression and suicidal ideation, high errates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them,and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

IntroductionThe Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence.MethodsData were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event.ResultsAlthough there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables.ConclusionWe assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units

BackgroundADHD is a common childhood onset mental health disorder that persists into adulthood in two-thirds of cases. One of the most prevalent and impairing comorbidities of ADHD in adults are substance use disorders. We estimate rates of ADHD in patients with substance abuse disorders and delineate impairment in the co-morbid group.MethodScreening for ADHD followed by a research diagnostic interview in people attending in-patient drug and alcohol detoxification units.ResultsWe estimated prevalence of undiagnosed ADHD within substance use disorder in-patients in South London around 12%. Those individuals with substance use disorders and ADHD had significantly higher self-rated impairments across several domains of daily life; and higher rates of substance abuse and alcohol consumption, suicide attempts, and depression recorded in their case records.ConclusionsThis study demonstrates the high rates of untreated ADHD within substance use disorder populations and the association of ADHD in such patients with greater levels of impairment. These are likely to be a source of additional impairment to patients and represent an increased burden on clinical services.

Understanding Risk Factors Contributing to Substance Use Among MTF Transgender Persons

Results from community-based research studies have shown that male-to-female transgender (MTF) persons have high rates of substance abuse. Multiple and unique psychological, economic, and societal factors contribute to this elevated rate of drug use. Cofactors, such as substance abuse and multiple environmental risk factors (e.g., discrimination, unemployment, homelessness), may contribute to the poor health outcomes observed in the MTF transgender community. In this article the authors review existing alcohol and other drug use (AOD) research and examine risk factors for AOD use in MTF transgender persons. Implications for counselors working with members of the MTF transgender community are explored and recommendations for future research are presented.

648 The Complex Problems of Children and Families with a Child with Disorders of Sexual Development

BackgroundThe diagnose of DSD is a challenge for medical staff, family and society.Material and methodWe study 15 patients with DSD, between 2005–2011. The study protocol included anamnesis, clinical examination: auxiological...

Change in Parent- and Child-Reported Internalizing and Externalizing Behaviors Among Substance Abusing Runaways: The Effects of Family and Individual Treatments

Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study compared three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically-Based Family Therapy (EBFT) with 179 substance abusing runaway adolescents (47% female, 74% minority) and their primary caretaker recruited through a Midwestern runaway crisis shelter. Examining both child and primary caretaker reports, each treatment was associated with significant reductions in internalizing and externalizing behaviors to 24months post-baseline. However, the trajectory of change differed among the treatments. Adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to evidence improvements to 24months. The findings provide support for continued evaluation of these treatments for use with this vulnerable population of adolescents.

Overall Health and Health Care Utilization Among Latino American Men in the United States

Although the Latino American male population is increasing, the subgroup Latino men's health remains underinvestigated. This study examined the overall pattern of Latino male health and health care utilization in major subgroups, using a nationally representative sample (N = 1,127) from the National Latino and Asian American Study. The authors evaluated rates of chronic, behavioral, and mental health service utilization in this first nationally representative survey. The results identified significant cross-subgroup differences in most physical and chronic conditions with Puerto Rican American men having high rates in 8 of 15 physical ailments, including life-altering conditions such as cardiovascular diseases. Despite differences in racial/ethnic, socioeconomic, and cultural factors, Cuban American men shared similar rates of heart diseases and cancer with Puerto Rican American men. In addition, Puerto Rican American men had higher rates of substance abuse than other Latinos. For health providers, the authors' findings encourage awareness of subgroup differences regarding overall health issues of Latino American men to provide culturally appropriate care.

Community Partnership to Affect Substance Abuse among Native American Adolescents

Background: Substance abuse is one of the nation’s primary health concerns. Native American youth experience higher rates of substance abuse than other youth. There is little empirical evidence that exists concerning the use of culturally-based interventions among Native American adolescents. Objectives: This study used a community-based participatory research approach to develop and evaluate an innovative school-based cultural intervention targeting substance abuse among a Native American adolescent population. Methods: A two-condition quasi-experimental study design was used to compare the Cherokee Talking Circle (CTC) culturally-based intervention condition (n = 92) with the Be A Winner Standard Education (SE) condition (n = 87). Data were collected at pre-intervention, immediate post-intervention, and 90-day post-intervention using the Cherokee Self-Reliance Questionnaire, Global Assessment of Individual Needs – Quick, and Written Stories of Stress measures. Results: Significant improvements were found among all measurement outcomes for the CTC culturally-based intervention. Conclusions: The data provide evidence that a Native American adolescent culturally-based intervention was significantly more effective for the reduction of substance abuse and related problems than a noncultural-based intervention. Scientific Significance: This study suggests that cultural considerations may enhance the degree to which specific interventions address substance abuse problems among Native American adolescents.

Fatherhood Roles and Drug Use among Young American Indian Men

Background: High rates of substance abuse among young American Indian (AI) fathers pose multigenerational challenges for AI families and communities. Objective: The objective of this study was to describe substance use patterns among young AI fathers and examine the intersection of substance use with men’s fatherhood roles and responsibilities. Methods: As part of a home-visiting intervention trial for AI teen mothers and their children, in 2010 we conducted a descriptive study of fatherhood and substance use on three southwestern reservations. Substance use and parenting data were collected from n = 87 male partners of adolescent mothers using audio computer-assisted self-interviews. Results: Male partners were on average 22.9 years old, primarily living with their children (93%), unmarried (87%), and unemployed (70%). Lifetime substance use was high: 80% reported alcohol; 78% marijuana; 34% methamphetamines; 31% crack/cocaine; and 16% reported drinking binge in the past 6 months. Substance use was associated with history of alcohol abuse among participants’ fathers (but not mothers); participants’ poor relationships with their own fathers; unemployment status; and low involvement in child care. Conclusion: Drug and alcohol abuse may be obstructing ideal fatherhood roles among multiple generations of AI males. Scientific Significance: Targeting drug prevention among young AI men during early fatherhood may provide special opportunity to reduce substance use and improve parenting. Intergenerational approaches may hold special promise.