High Rates Of Substance Use Disorders Research Articles

Cascade of care for substance use and mental health disorders for justice-involved populations

IntroductionJustice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade. MethodUsing Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment. ResultsThe study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures. ConclusionFocusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.

Mental Health Among Men Who Have Sex with Men Under the Influence of Psychoactive Substances: a Systematic Review

AbstractSex under the influence of psychoactive substances (SUIPS) has gained much attention in the press and scientific literature over the last years, especially among men who have sex with men (MSM). Concerns have thus far been expressed in relation to short-term physical health risks, like contracting bloodborne diseases, like viruses. However, much less is known about long-term mental health consequences of SUIPS, like depression, anxiety, and substance use disorders (SUD). Therefore, we systematically reviewed literature for evidence on mental health complications of SUIPS in MSM. SUIPS was associated with a lower general mental health status, and higher rates of depression, anxiety disorders and suicide ideation in 15 studies, and higher rates of SUD were found among MSM practicing SUIPS in four studies. Motives of SUIPS were increasing sexual performance, fear of rejection, anxiety, and low self-esteem among others. Furthermore, long-term mental health risks, as associated with some of the most frequently reported psychoactive substances in the context of SUIPS, include psychosis and substance dependence. Therefore, the present findings indicate that SUIPS is associated with mental disorders and that they are probably closely intertwined with motives for SUIPS and the long-term effects of using psychoactive substances. This underlines the need to address the presence of mental disorders in people practicing SUIPS, alongside the physical risks.

Retention and Overdose Risk among Patients Receiving Substance Use Disorder Treatment, Mental Health Care and Peer Recovery Support: A Longitudinal Analysis.

Drug overdose remains a major crisis in the United States. Expanding substance use disorder (SUD) treatment and recovery support services is critical for reducing overdose risk during disasters such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic. We evaluated the outcomes of an innovative multicomponent service, inclusive of medications for SUD, and peer support, colocated in an outpatient infectious disease clinic in Baltimore City. Our goal was to examine whether a multicomponent SUD program can support patients in recovery during a pandemic. One hundred five patients in the RESTORE service between 2019-2020 completed baseline, 3-month, and 6-month surveys. Telemedicine and phone-based support groups were implemented in March 2020 after statewide restrictions on face-to-face services due to SARS-CoV2. Data from surveys and electronic medical records were integrated and analyzed using mixed-effects regression models. At baseline, most patients (88%) reported using drugs/alcohol in the preceding 30 days; 48% of patients reported a history of drug overdose, as well anxiety (23%) and depression (28%) symptoms. Despite pandemic-related disruptions and procedural changes, retention in RESTORE was high (83% after 3 months, 76% after 6 months). Mixed-effects regression models indicated decreased anxiety, alcohol use, heroin use, and nonfatal overdose after 6 months of enrollment (all P < 0.05). Multicomponent SUD services that are colocated within infectious disease specialty services could help patients to successfully manage their overdose risk and mental health even during future disasters. This model of care could be implemented in other specialty settings that see high rates of SUD.

Prescription drug and alcohol simultaneous co-ingestion in U.S. young adults: Prevalence and correlates.

Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Substance-use disorders among child welfare and juvenile justice adolescents in residential care: The role of childhood adversities and impulsive behavior

BackgroundAdolescents in the child welfare and juvenile justice systems show high rates of substance-use disorders. Yet, little is known about the association between childhood adversities and impulsive behavior involving substance-use disorders in shared residential care in the child welfare and juvenile justice systems. ObjectiveThe aim of this study is to investigate the prevalence of substance-use disorders and their association with childhood adversities and impulsive behavior among child welfare-and juvenile justice-involved adolescents in residential care. MethodA total of 386 adolescents placed into Swiss residential care by the child welfare and juvenile justice systems (37.0% girls; age range = 10–18 years; mean age = 15.41 years) were studied. Substance-use disorders and childhood adversities were categorically assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version. Impulsive behavior was dimensionally measured with the Youth Psychopathic Traits Inventory. Statistical methods included descriptive analyses and logistic regression analyses. ResultsJuvenile justice-involved adolescents showed higher rates of any substance-use disorder compared to child welfare-involved counterparts (38% vs. 20%; χ2(1) = 22.21, p < 0.001). Higher numbers of childhood adversities were found among child welfare (U = 3039, p < 0.001) and juvenile justice (U = 309.5, p < 0.001) youths with substance-use disorders compared to those without substance-use disorders. Impulsive behavior was related to substance-use disorders among both the child welfare (B = 0.61, SE = 0.15, p < 0.001) and the juvenile justice groups (B = 0.40, SE = 0.17, p = 0.02). ConclusionConsidering the high rates of substance-use disorders in both the child welfare and the juvenile justice samples, this study highlights that treating impulsive behavior and incorporating trauma-informed care for childhood adversities may reduce substance-use disorders among youths in residential care. Implications for care system practice and avenues for future research are discussed.

Abstract 228: National Prevalence of Substance Use Disorders Among Hospitalized Heart Failure Patients

Background: Several cardiotoxic substances contribute to the development of heart failure (HF). The burden of comorbid substance use disorders (SUD) among patients with HF is under-characterized. Objectives: To describe the national burden of comorbid SUD (tobacco, alcohol, or drug use disorders) among hospitalized HF patients in the U.S. Methods: We used data from the 2014 National Inpatient Sample to calculate the proportion of hospitalizations for a primary HF admission with tobacco, alcohol, or drug use disorder diagnoses, accounting for demographic factors. Drug use disorder analysis was further sub-divided into specific illicit substance categories. Results: There were a total of 989,080 HF hospitalizations of which 35.3% (n=348,995) had a documented SUD. Tobacco use disorder (TUD) was most common (n= 327,220, 33.1%) followed by drug use disorder (DUD) (n=34,600, 3.5%) and alcohol use disorder (AUD) (n=34,285, 3.5%). Female sex was associated with less TUD (OR 0.59; 95% CI, 0.58-0.60), AUD (OR 0.23; 95% CI, 0.22-0.25) or DUD (OR 0.58; 95% CI 0.55-0.62). Tobacco, alcohol, cocaine, and opioid use disorders were highest among HF patients age 45 to 55, while cannabis and amphetamine use was highest in those &lt;45 years. Native American race (versus White) was associated with increased risk of AUD (OR 1.67; 95% CI 1.27-2.20). Black race was associated with increased risk of AUD (OR 1.09; 95% CI 1.02-1.16) or DUD (OR 1.63; 95% CI 1.53-1.74). Medicaid insurance (versus Medicare) was associated with greater TUD (OR 1.27; 95% CI 1.23-1.32), AUD (OR 1.74; 95% CI 1.62-1.87), and DUD (OR 2.15; 95% CI 2.01-2.30). Decreasing quartiles of median household income were associated with increasing SUD. Conclusions: Comorbid SUD disproportionately affects certain HF populations, including men, younger age groups, lower SES patients, and race/ethnic minorities. Further research on interventions to improve prevention and treatment of SUD among hospitalized HF patients are needed given the high rates of SUD in this population. Systematically screening hospitalized HF patients for SUD may reveal opportunities for treatment and secondary prevention.

A prospective look at substance use and criminal behavior in urban ADHD youth: what is the role of maltreatment history on outcome?

Children with attention-deficit/hyperactivity disorder (ADHD) are at heightened risk of antisocial behavior during adolescence/early adulthood. Here, we characterize the antisocial outcomes of a sample of urban, lower-socioeconomic-status, ethnically diverse ADHD youth and investigate the impact of maltreatment history on criminal and substance use disorder (SUD) outcomes. Ninety-eight participants diagnosed with ADHD in childhood were re-assessed 10years later and compared with controls. Regression analyses investigated the effect of maltreatment on antisocial outcomes among four groups based on ADHD and maltreatment status. ADHD subjects and controls did not differ in rates of arrest, conviction, incarceration, or recidivism. ADHD youth were younger at their first arrest with higher rates of SUDs when compared to controls. Controls and ADHD subjects with maltreatment had significantly higher rates of SUDs compared to the no-ADHD/no-maltreatment group. Only ADHD youth with maltreatment had significantly higher rates of arrest than the reference group. In contrast to prior studies, ADHD youth did not differ from controls on most measures of antisocial behavior. Maltreatment increased the rate of arrest only among ADHD youth, though increased the rate of SUD for ADHD youth and controls. This suggests that ADHD youth, in the absence of maltreatment, are at no greater risk of SUDs or arrest than controls without maltreatment.

Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD

High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex. Subjects were children and adolescents with (n = 268; mean age ± standard deviation = 10.9 ± 3.2 years) and without (n = 229; mean age 11.9 ± 3.3 years) DSM-III-R ADHD followed prospectively and blindly over a 10-year follow-up period onto young adult years. Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs. Over the 10-year follow-up period, ADHD was found to be a significant predictor of any SUD (hazards ratio 1.47; 95% confidence interval 1.07-2.02; p = .01) and cigarette smoking (2.38; 1.61-3.53; p < .01). Within ADHD, comorbid conduct disorder (2.74; 1.66-4.52; p < .01) and oppositional defiant disorder (2.21; 1.40-3.51; p < .01) at baseline were also found to be significant predictors of SUDs. Similar results were found for cigarette-, alcohol-, and drug-use disorders. There were few meaningful sex interaction effects. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors (p > .05 for all comparisons). These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes.

Prevalence of substance use disorders among prisoners in Al- Diwania governorate, Iraq

Background: Substance use disorders (SUDs) are among the common psychiatric disorders and constitute a major public health concern. Iraqi’s were exposed to widespread violence and wars in the last decades. High prevalence of alcohol and substance use was reported recently in Baghdad. Research literature documented the association of SUDs with exposure to trauma events e.g. wars, terrorist attacks and natural disaster. Published articles on SUDs among prisoners in Iraq are scarce. Therefore, this work was carried out to report on SUDs among prisoners in Al-Diwania governorate and its relation to antisocial activity.Methods: A total of 1200 prisoners in Al-Diwania civilian prison were included in the study during the period from 2nd January to 2nd May 2010. A questionnaire using ICD 10 characteristics of SUDs was used. The requested data in addition to characteristics of SUDs were demographic data and type of crime. In order to study the association of SUDs with criminal act, a control group (150 prisoners out of 1050) was selected randomly from the prisoners without SUDs.Results: The study revealed a rate of (12.5%) of SUDs The peak age of abuse was at age 31 – 35 years. More than half of the sample which was composed of male prisoners was in age 25 to 35 years. Fifty three (35.3%) of the abusers were illiterate, and 70 (46.7%) finished the primary school. Only 2 of the abusers (1.3%) had higher education. Thirty (20%) of the abusers were unemployed, 100 (66.67%) were self-employed and only 18 (12%) were employed. Criminal act was significantly associated with SUDs.Conclusion: High rate of SUDs was revealed among prisoners. SUDs were significantly associated with criminal behavior.

Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders

&lt;p&gt;Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders &lt;/p&gt; &lt;p&gt;Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems. Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder. The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively. Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months. &lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHORS&lt;/h4&gt; &lt;p&gt;Ihsan Salloum, MD, MPH; and Lauren Williams, MD, are with the Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine. Antoine Douaihy, MD, is with the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.&lt;/p&gt;&lt;p&gt; Address correspondence to: Ihsan M. Salloum, MD, MPH, 1120 NW 14th Street, Miami, FL 33136; fax 305-243-1682; or e-mail &lt;a href="mailto:isalloum@med.miami.edu"&gt;isalloum@med.miami.edu&lt;/a&gt;.&lt;/p&gt;&lt;p&gt; Dr. Salloum and Dr. Williams have disclosed no relevant financial relationships. Dr. Douaihy has disclosed the following relevant financial relationship: AstraZeneca: Research grant recipient.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt;Develop knowledge about the frequency and clinical significance of bipolar disorder and substance use disorders comorbidity. &lt;/li&gt; &lt;li&gt;Demonstrate the diagnostic considerations in patients with co-occurring bipolar disorder and substance use disorder &lt;/li&gt; &lt;li&gt;Identify the latest research-based psychotherapy and pharmacotherapy treatments for this comorbidity. &lt;/li&gt; &lt;/ol&gt;

Relationship of substance use disorder to aggression in male subjects with antisocial personality disorder

Objective:Aggression is a particular problem commonly observed in personality disorders, especially in antisocial personality disorder (APD). It is well known that APD is closely related to substance use disorder (SUD). Individuals with higher aggression levels have also been suggested to have higher rates of SUD. The aim of this study is to investigate aggression levels and substance use characteristics of APD subjects with and without violent criminal behavior.Method:A total of 124 male subjects with APD consecutively admitted to the Forensic Psychiatry Department of GATA Haydarpasa Training Hospital were involved in the study. All subjects were evaluated with an assessment battery using a semi-structured interview for socio-demographic, APD, and substance use characteristics, APD section of SCID-II, SCID-I, and Aggression Questionnaire. The sample was divided into 2 groups in terms of having a history of violent criminal behavior and compared correspondingly.Results:Of the APD subjects, 90.3% reported a lifetime history of substance abuse and 75% had a current co-diagnosis of SUD. APD subjects with violent criminal behavior were more likely to be diagnosed with SUD as compared to those without violent crimes. Moreover, APD subjects with SUD had higher aggression levels than those without SUD.Conclusion:Our results indicate that substance use may mediate the association between APD and aggression. Therefore, the treatment of SUD in APD subjects is an important target particularly for prevention of violent criminal behaviors.

Introduction: Current Research on Co-occurring Substance-Use Disorder in Schizophrenia

The 5 excellent articles in this section stand on their own as scientific contributions and together highlight important progress in schizophrenia research. The first 2 articles, by Caton and colleagues and by Mueser and colleagues, clarify unique features of 2 co-occurring disorders subgroups and may help us to understand the development and heterogeneity of co-occurrence in ways that lead to prevention and treatment. Caton documents that many individuals who appear to present with substance-induced psychosis also have some traditional risk factors for schizophrenia and are at high risk for psychosis 1 year later and for converting to a diagnosis of primary psychosis. Like the research of Caspi and colleagues, 1 her article suggests that genetic vulnerability can combine with substance use in important ways to increase the likelihood of primary psychosis. Mueser’s article suggests that childhood conduct disorder may be a key to understanding some of the variance in the cooccurring disorders population. Consistent with earlier research, 2 his article suggests that conduct disorder and antisocial behaviors may be key vulnerability markers for substance-use disorder during the prepsychotic phase of schizophrenic illness. The next 2 articles, by Brunette and colleagues and by Petrakis and colleagues, describe pharmacologic research that may lead to clues regarding both the treatment and the neurobiology of co-occurring disorders. Brunette’s article shows that medications may be critical in the relapse prevention stage of substance-abuse treatment and that clozapine continues to demonstrate unique properties among antipsychotic medications as a treatment for schizophrenia and co-occurring substance-use disorder. Petrakis’ article, which describes one of the few randomized controlled trials to test medications for alcoholism, such as disulfiram and naltrexone, in patients with cooccurring disorders, suggests that these medications are probably effective for those with psychotic disorders. The final article by McHugo and colleagues reviews several methodological implications drawn from intervention research on co-occurrence over the past 20 years. McHugo’s suggestions may help the field begin to standardize research approaches and develop more robust clinical trials, ones that are feasible and applicable to the large population of patients with co-occurring disorders. Considering these articles in relation to the larger field of co-occurring disorders invokes several scientific trends. Because animal and human studies expand, theories of co-occurrence will likely become more refined. It is now clear that patients with schizophrenia have heightened vulnerability to substance abuse before and after they become psychotic. 3 Both the genetic profiles and the neurocognitive features of patients with schizophrenia may lead to enhanced sensitivity to substances of abuse and almost certainly predispose them to high rates of substance-use disorder. This could imply converging neurobiological vulnerabilities (to schizophrenia and to substance abuse), perhaps within the brain reward circuit, consistent with a common mechanism for the dual effects of clozapine. 4,5 Prepsychotic neurocognitive

The impact of substance use disorders on clinical outcome in 643 patients with first‐episode psychosis

Studies investigating the impact of comorbid substance use disorders (SUD) in psychosis have tended to focus on cross-sectional data, with few studies examining the effects of substance use course on clinical outcome. The main aim of the present study was to assess the impact of baseline SUD and course of SUD on remission of positive symptoms. The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis (FEP) patients between 1998 and 2000. Data on SUD and clinical outcome were collected from patients' medical records (MR) of 643 patients who met inclusion criteria. Lifetime prevalence of SUD was 74%, with 62% having a SUD at baseline. This reduced to 36% in those patients who completed 18 months of treatment at the EPPIC program. A Cox regression analysis indicated that a decrease or cessation of substance use significantly increased the probability of remission, whilst persistent SUD substantially reduced the likelihood. In addition, patients who reduced use appeared to have better outcomes at 18 months than those patients who had never used substances. Baseline SUD was not found to have any significant influence on symptom remission. Patients presenting with FEP have high rates of SUD. Effective management of psychosis within a specialized service is associated with reductions in SUD over the course of treatment, although persistent substance use is associated with non-compliance, treatment drop-out and poor remission rates. As such, young people with FEP and comorbid substance use should be offered integrated treatment that addresses both disorders.

Interpersonal processes and psychopathology among expectant and nonexpectant adolescent couples.

This study examined the interpersonal and psychological functioning of expectant and nonexpectant adolescent couples. Interpersonal processes were assessed using the Structural Analysis of Social Behavior (L. S. Benjamin, 1974) and psychological functioning was assessed using the Diagnostic Interview for Children and Adolescents--Revised (W. Reich, 1991). Compared with their nonexpectant peers, expectant couples exhibited higher rates of negative interpersonal processes, including demand-withdraw behaviors and lower rates of positive interpersonal processes. Expectant males reported higher rates of behavior disorders, substance use disorders, and internalizing disorders than nonexpectant males. Higher rates of substance-use disorders mediated the effect of expectancy status on demand-withdraw behavior. Results help clarify the links between the psychological risks associated with adolescent pregnancy and the interpersonal functioning of young expectant couples.