History Of Substance Use Problems Research Articles

A - 55 Exploring the Impact of Parental Substance Use Problems and Behavior on Pre-Adolescent Cognitive Performance

Abstract Objective Adults with a parental history of substance use problems (PH+) exhibit deficits in verbal, language, visuomotor, visuospatial, and executive functioning skills. However, findings on whether PH+ affects cognition developmentally is limited. This study explored how PH+ relates to preadolescents’ cognitive performance while controlling for environmental parental factors. Methods We sampled 11,633 participants aged 8–11 (47.74% female) from the Adolescent Brain Cognitive Development Study at baseline. The Family History Assessment evaluated PH+ of alcohol and other drug use problems, with scores ranging from 0–2 parents with problematic use (PH-, PH + 1, PH + 2). PH+ of alcohol (PHA+) and other drugs (PHD+) were assessed separately. The neurocognitive battery included the NIH Toolbox, RAVLT, and Matrix Reasoning. Parental factors assessed included prenatal substance exposure, family conflict, parental warmth, parental monitoring, and parental mental health history. Hierarchical linear mixed-effects models analyzed relationships between PHA+, PHD+, other parental variables of interest, and cognitive outcomes while controlling for demographics. Results PHA+ significantly predicted inhibitory control performance, with PHA + 1 youth performing better than PHA- youth (β = 0.71, p = 0.04), above and beyond other parental behaviors. Conversely, PHD + 1 youth scored lower on immediate (β = −0.3107, p = 0.02) and delayed (β = −3.58, p = 0.01) verbal memory recall, as well as visuospatial memory (β = −1.50, p = 0.003) compared to PHD- youth. Parental factors broadly predicted performance, with parental monitoring and prenatal exposure emerging as the most consistent predictors. Conclusion These findings underscore the complex relationship between PH+, environmental parental factors, and cognition among preadolescents. Future work should explore mechanisms linking parental behaviors to adolescent cognition, given these modifiable factors offer potential for intervention.

Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment.

Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants' behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no "gold standard" for EMA study design to promote compliance. The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs. Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1-number of questions per EMA survey (15 vs 25); factor 2-number of EMAs per day (2 vs 4); factor 3-EMA prompting schedule (random vs fixed times); factor 4-payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5-EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined. Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance. Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies. ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228.

Longitudinal associations between adult-supervised drinking during adolescence and alcohol misuse from ages 25–31 years: A comparison of Australia and the United States

Prior studies suggest that adult supervised drinking in adolescence predicts greater adolescent alcohol misuse. Long-term follow up data examining how adult supervised drinking during adolescence relates to alcohol misuse in adulthood are lacking. Longitudinal data from the International Youth Development Study tested associations between adult supervised drinking during adolescence (ages 13–16; 2002–2004) and adult alcohol misuse (ages 25–31; 2014, 2018, 2020). Cross-nationally matched samples were compared in Washington State, USA (n = 961) and Victoria, Australia (n = 1,957; total N = 2,918, 55 % female, 83 % White), where adult-supervised adolescent alcohol use was more common. Multilevel analyses adjusted for state, sex, adolescent drinking, parent education, family management, family history of substance use problems, and parent alcohol-related norms. Adult supervised drinking in adolescence (at dinner or parties, on holidays) predicted more adult alcohol misuse (mean Alcohol Use Disorders Identification Test score; b[SE] 0.07[0.03]; p = 0.004) and higher rates of alcohol-impaired driving (Odds Ratio [OR] 1.501, p = 0.034) and riding with an alcohol-impaired driver (OR 1.669, p = 0.005), but not the use of strategies to moderate alcohol intake (e.g., counting drinks). Better family management (monitoring, clear rules) in adolescence predicted less adult alcohol misuse. Associations were similar in the two states. Reducing the frequency of adult supervised drinking and improving family management practices in adolescence may help to decrease alcohol misuse well into adulthood. Findings support the widespread implementation of substance use prevention and family management training programs.

Rates, characteristics and toxicology of cocaine-related deaths in Australia, 2000-2021.

To (i) assess the population mortality rates of cocaine-related deaths in Australia, 2000 to 2021; (ii) determine the circumstances of death and case characteristics; and (iii) determine their toxicological profile. Retrospective study of cocaine-related deaths in Australia, 2000 to 2021, retrieved from the National Coronial Information System. Australia-wide. A total of 884 cases, mean age = 33.8 (SD, 10.0) years and 86.5% (n = 765) male. Information was collected on characteristics, manner of death and toxicology. Only cases in which the presence of blood cocaine and/or metabolites were included. Population rates did not significantly increase during 2001-2011 (annual percentage change [APC] = 1.5; CI, -3.2, 6.5), but from 2012, there was a marked acceleration (APC = 20.0, 95% CI, 15.5, 25.3). Circumstances of death were unintentional drug toxicity (70.7%, n = 625), intentional self-harm (17.8%, n = 157), traumatic accident (11.5%, n = 102). The proportion of cases constituted by unintentional toxicity declined across the study period (APC = -2.6; CI, -3.1, -2.1). There was a substantial decline in the proportion of cases with a history of injecting drug use (APC = -5.7; CI, -6.5, -4.9) and with a history of substance use problems (APC = -3.2; CI, -3.9, -2.5). Both cocaine (0.100 vs 0.050 mg/L, P < 0.001) and benzoylecgonine (0.590 vs 0.240 mg/L, P < 0.001) concentrations were higher amongst toxicity cases than in cases of death from traumatic injury. Cocaethylene was present in 26.4% (n = 233), levamisole in 18.6% (n = 164) and lignocaine in 11.5% (n = 102). Psychoactive drugs in addition to cocaine were present in 92.9% (n = 821), most commonly opioids (50.5%, n = 446), alcohol (47.1%, n = 416), hypnosedatives (43.2%, n = 382) and psychostimulants (30.3%, n = 268). There was a steady decline in the proportion of opioid positive cases (APC = -5.4; CI, -6.3, -4.5). There was a large increase in cocaine-related deaths across Australia from 2000 to 2021. This was accompanied by changes in case profiles, with histories of injecting drug use and substance use problems, as well as recent opioid use, becoming less prominent.

Utilization of mental health and substance use disorder services by social workers in 13 U.S. states

ABSTRACT Over 5800 licensed social workers in 13 U.S. states responded to questions in an online survey regarding their use of mental health and substance use disorder (SUD) services during different periods of their lives. As many as 69% of respondents reported ever having accessed mental health treatment, with only 6% having utilized SUD treatment. Among participants reporting a history of mental health problems, 89% utilized mental health treatment. However, only 35% of respondents who indicated a history of substance use problems reported using SUD services, with a much larger proportion of this cohort (84%) reporting use of mental health services.

Characteristics of fatal ‘novel’ synthetic opioid toxicity in Australia

BackgroundAims: To determine 1. The characteristics of all recorded cases of fatal drug poisoning involving novel synthetic opioids (NSOs) in Australia; 2. The toxicology of cases; and 3. The major autopsy findings. MethodsReview of all fatal poisonings related to NSOs in Australia 2000–2021 identified in the National Coronial Information System. ResultsThirty-one cases were identified, 96.8% due to unintentional drug toxicity. The mean age was 31.9 years and 87.1% were male. Only six were aged over forty. A history of substance use problems was documented in 80.6% and 58.1% had a history of injecting drug use. In 32.3% the final route of administration of a NSO was by non-injecting routes of administration. Ten NSOs were identified. Fentanyl analogues were present in 67.2%, most commonly furanylfenatyl (19.4%). Other NSO types were present in 39.7%, most commonly U-47700 (35.5%). Substances other than NSOs were present in 90.3%, most commonly benzodiazepines (67.7%) and other opioids (51.6%). A CNS depressant in addition to NSOs was present in 90.3%, and a new psychoactive substance other than a NSO in 25.8%. Pulmonary oedema was diagnosed in 82.6%, aspiration of vomitus in 30.4%, and acute bronchopneumonia in 17.4%. ConclusionsTen NSOs were identified. Case characteristics suggest a younger cohort whose profile is more typical of use of other NPS than of the established opioids. A large proportion used NSOs by non-injecting routes of administration.

Attitude of Health Care Professionals Toward Patients With Substance Use Disorders

Objectives: Substance use disorder (SUD) is a chronic relapsing disease with multiple general health and behavior deterioration making it vulnerable to discrimination. As health care professionals play a crucial role in the identification and feasibility of access to treatment of such patients, negative attitudes can reduce the quality of the medical service provided. The purpose of our study is to measure and compare stigma variables toward SUDs among different professions of the health care staff. Patients and Methods: In all, 300 participants were enrolled in the study distributed equally into physicians from different specialties, nurses, clerical work employees, manual workers, and early career medical interns. A predesigned semistructured sheet was used to screen the occupation, previous contact SUD cases, family history of substance use problems; they also answered the general health questionnaire, and 4 scales concerning the attitude toward addicts including the level of familiarity, perceived dangerousness, and fear, social distance scales. Results: Women showed higher perceived dangerousness and desired social distance from polysubstance use disorder than men. Social distance was significantly more away from polysubstance in staff below the age of 30 years, and from alcohol in the group above 30 years. The level of familiarity with and a desired social distance away from polysubstance abuse among physicians were significant. There was a highly significant fear of benzodiazepine, tramadol, and polysubstance among physicians. Perceived dangerousness for polysubstance among physicians was significantly evident as well as for alcohol among manual workers, for benzodiazepine among house officers, and for heroin among clerical workers. Conclusion: Stigma of medical field professionals toward patients with SUDs is common and may contribute to underqualified health care service for these patients, which mandates dissemination of model educational programs starting from college medical curricula to postgraduate ones.

Externalizing Risk Pathways for Adolescent Substance Use and Its Developmental Onset: A Canadian Birth Cohort Study: Trajectoires de comportements extériorisés et le risque pour l'initiation et l'usage de substances des adolescents : Une étude de cohorte de naissance canadienne.

Objective:Only a minority of drug and alcohol users develops a substance use disorder. Previous studies suggest that this differential vulnerability commonly reflects a developmental trajectory characterized by diverse externalizing behaviors. In this study, we examined the relation between child and adolescent externalizing behaviors and adolescent substance use in a prospectively followed Canadian birth cohort, accounting for the temporal sequence of a wide variety of contributing factors.Methods:Two hundred and forty-two adolescents followed since birth (date range: 1996 to 2012) were assessed on externalizing behavior (age 17 months to 16 years), alcohol and cannabis use at age 16, age of alcohol use onset, family history of substance use problems, family functioning (age 11 to 15), sensation seeking (age 16), prenatal substance exposure, socioeconomic status (age 1 to 9), and sex.Results:Age of alcohol use onset was predicted by a family history of substance use problems, externalizing traits from ages 6 to 10 and 11 to 16, sensation seeking at age 16, prenatal alcohol and tobacco exposure and family functioning at ages 11 to 15. High frequencies of alcohol and cannabis use at age 16 were both predicted by externalizing traits from ages 11 to 16, a family history of substance use problems and sensation seeking after controlling for other individual, environmental and familial variables. The association between familial substance use problems and substance use during adolescence was partially mediated by externalizing traits from age 11 to 16.Conclusions:The present findings provide prospective evidence for a developmental risk pathway for adolescent substance use, potentially identifying those who could benefit from early interventions.

Pre- and Post-Immigration Correlates of Alcohol Misuse among Young Adult Recent Latino Immigrants: An Ecodevelopmental Approach.

Latinos in the United States experience numerous alcohol-related health disparities. There is accumulating evidence that pre-immigration factors are associated with post-immigration alcohol use, but the explanation for health disparities remains unclear. The present study is a secondary analysis of data from the Recent Latino Immigrant Study (RLIS), the first community-based cohort study to examine the pre- to post-immigration alcohol use trajectories of young adult Latino immigrants during their initial years in the United States. Exploratory analysis and hierarchical multiple logistic regression were performed to assess associations between various pre- and post-immigration factors and alcohol misuse among young adult Latino immigrants early in the immigration process. Using an ecodevelopmental approach, we examined potential social and environmental determinants across multiple levels of influence associated with post-immigration alcohol misuse in this population. The study sample consisted of 474 young adult Latino immigrants between the ages of 18–34. The sample was comprised of the following national/regional origins: Cuban (43%), South American (28.7%), and Central American (28.3%). Approximately half of the sample (49.6%) reported a family history of substance use problems (FHSUP+). Participants who reported FHSUP+ and who engaged in alcohol misuse prior to immigrating to the US were more likely to engage in post-immigration alcohol misuse. Results revealed various social and environmental factors associated with pre-immigration alcohol misuse in this population. Study findings can inform culturally tailored prevention interventions aimed at mitigating problem drinking behaviors among young adult recent Latino immigrants.

Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids

BackgroundAlthough much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids. MethodsAnalysis of opioid overdose deaths in Australia between 2000–2015, extracted from the National Coronial Information System (NCIS). The NCIS is an online database of deaths reportable to the coroner, and contains coroner’s findings, autopsy and toxicology reports. Deaths were categorized into mutually exclusive groups: 1) Heroin deaths; and 2) PO deaths (excluding heroin). PO deaths were examined by individual opioid. ResultsThere were 10,795 opioid overdose deaths over the study period. Relative to deaths occurring in major cities, deaths in regional/remote areas had 15.2 (95 % CI: 11.5–20.2) times the risk of being attributed to pharmaceutical fentanyl than heroin. Relative to deaths among people without a recorded history of chronic pain, deaths among people with a recorded history of chronic pain had a 1.9–10.7-fold increased risk of the death being attributed to POs than heroin. Deaths among people with a recorded history of substance use problems where the opioid was injected prior to death had 7.2 and 1.7 times the risk of being attributed to methadone and pharmaceutical fentanyl (respectively) than heroin. ConclusionsFindings suggest the need to: educate PO consumers about the risks of overdose at the time of prescribing; increase coverage and engagement in opioid dependence treatment (particularly in regional/remote areas); and increase uptake of take-home naloxone to reduce opioid overdose mortality.

Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes

Background: Factors associated with prescription opioid misuse in a chronic pain treatment population are limited, and increasing our understanding of associated factors could lead to improved targeting of prevention and intervention efforts. Objective: The aim of this study was to evaluate factors associated with problematic prescription opioid use in patients with chronic pain, and whether assessing emotional processes – alexithymia, ambivalence over emotional expression (AEQ), and emotional approach coping – improves understanding of problematic prescription opioid use beyond traditional risk factors. Methods: Participants were 100 patients with chronic pain (mean age = 47.57 years, SD = 11.57; 53% female; 81% African American) who were receiving a self-administered opioid medication through a local pain clinic. We assessed traditional risk factors (substance use history, pain, psychiatric distress, and pain catastrophizing), the three emotional processes, and problematic prescription opioid-related outcomes. Results: Zero-order correlations revealed that alexithymia was significantly, positively related to problematic prescription opioid use behaviors (PDUQ), and AEQ was significantly positively related to both prescription opioid misuse behaviors and opioid use disorder symptoms. Multiple regressions that included traditional risk factors and the three emotional processes indicated that AEQ was a unique correlate of problematic opioid use behaviors (β=.27, p=.04) and prescription opioid-related symptoms of abuse and dependence (β=.37, p=.01); history of substance use disorders was also associated. Conclusions: In addition to personal history of substance use problems, AEQ is a modifiable risk factor – and thus potential treatment target – for prescription opioid misuse and opioid use disorders.

DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults

BackgroundCannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults. MethodParticipants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N = 1527), the prevalence and demographic and clinical correlates of DSM-5 CWS were examined. ResultsIn frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p < 0.001), and with mood disorders (adjusted odds ratios [aOR] = 1.9–2.6), anxiety disorders (aOR = 2.4–2.5), personality disorders (aOR = 1.7–2.2) and family history of depression (aOR = 2.5) but not personal history of other substance use disorders or family history of substance use problems. ConclusionsCWS is highly comorbid and disabling. Its shared symptoms with depressive and anxiety disorders call for clinician awareness of CWS and the factors associated with it to promote more effective treatment among frequent cannabis users.

Paternal history of mental illness associated with posttraumatic stress disorder among veterans

This study examined the association between parent and family reported history of non-PTSD mental illness (MI), PTSD specifically, and substance use problems, and participant clinical diagnosis of PTSD. Participants were drawn from the US Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) study (n = 3191), an ongoing multi-site cohort study of US Afghanistan and Iraq conflict era veterans. Participants who recalled a father history of PTSD had a 26-percentage point higher likelihood of meeting criteria for PTSD; while participants reporting any family history of PTSD had a 15-percentage point higher probability of endorsing symptoms consistent with PTSD. Mother history of substance use problems was associated with Veteran current PTSD, but results were sensitive to model specification. Current PTSD was not associated with family/parent history of non-PTSD mental illness, mother history of PTSD, or family/father history of substance use problems. Family history of PTSD may increase PTSD risk among veterans exposed to trauma, particularly when a father history is reported. Knowledge of family history could improve clinical decision-making for trauma-exposed individuals and allow for more effective targeting of programs and clinical services.

Presence of Drug-Free Family and Friends in the Personal Social Networks of People Receiving Treatment for Opioid Use Disorder

The present study evaluated the presence of drug-free family and friends in the personal social networks of individuals seeking treatment for opioid use disorder, and the willingness of patients to bring these individuals to the treatment program to support recovery efforts. Patients at a community medication-assisted treatment program (n=355) completed a clinical survey to identify drug-free social network members. Results showed that almost all patients (98%) reported having at least one drug-free family or friend in their personal network (M=3.7), and that these network members often lived in relatively close proximity to the patient (M distance of closest member =1.8 miles). About a quarter of these individuals (26%) had a history of substance use problems, with 10% of the entire sample currently receiving treatment for a substance use problem. Rates of drug-free network members varied across several baseline characteristics. Most patients (89%) reported a willingness to invite at least one drug-free network member into treatment to support recovery efforts. Mobilizing drug-free network family and friends may provide a pathway to help individuals with substance use disorders access and benefit from community support.

Associations Between Family History of Substance Use, Childhood Trauma, and Age of First Drug Use in Persons With Methamphetamine Dependence.

The current study examined the association among family history of substance use problems, childhood maltreatment, and age of first drug use in a sample of men and women seeking treatment for methamphetamine dependence. Various forms of childhood maltreatment were considered as mediators of the association between family history of substance use problems and age of first drug use. Participants (N = 99, 40% women, mean age 33) who were under treatment for methamphetamine dependence completed a baseline interview that obtained demographic information, past substance use by participants, history of drug/alcohol problems in their family of origin, and age at first use of any drug (excluding alcohol and tobacco). The Early Trauma Inventory Self-Report-Short Form was used to assess child maltreatment experiences before the age of 18. Family history of substance use problems and childhood physical (but not emotional or sexual) trauma significantly predicted age of first drug use. Further, childhood physical trauma mediated the association between family history of substance use problems and age of first drug use. These findings suggest that the experience of childhood physical abuse may be an important mechanism through which family history of substance use is associated with an earlier age of first drug use.

Factors Associated with Community Corrections Involvement among Formerly Incarcerated People in Recovery.

The current study examined whether current community supervision status was associated with differences in demographic characteristics, lifetime substance use patterns, and criminal history among a sample of formerly incarcerated individuals with a history of substance use problems. Results of multivariate analyses revealed participants on community supervision were more likely to have graduated from high school or earned a GED (OR = 1.60; 95% CI [0.15, 17.24]) and were less likely to have a history of psychiatric hospitalization (OR = .88; 95% CI = [0.08, 9.35]). These characteristics may be proxies for social and emotional functioning that influence eligibility for community supervision. Despite these apparent advantages, the community supervision group did not significantly differ from the formerly incarcerated group without current justice involvement on lifetime substance use patterns or criminal history, suggesting formerly incarcerated individuals with substance use disorders may require more intensive interventions to promote existing strengths.

Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands

Experiences and expectations of discrimination (anticipated discrimination) may delay treatment seeking among people with substance use disorders. In addition, experienced and anticipated discrimination can be a barrier to successful recovery and rehabilitation. The aim of this study was to study the level of experienced and anticipated (the expectation to be rejected) discrimination among individuals in treatment for substance use disorders as well as the association between both concepts of discrimination. In addition, the association of experienced and anticipated discrimination with clinical and social characteristics was investigated. A cross-sectional survey among individuals in treatment for substance use disorders in the Netherlands was carried out in 2012. Individuals in treatment (N=186) completed a self-reported questionnaire about experienced and anticipated discrimination. Descriptive statistics and chi-squared analyses were performed to investigate the level of experienced and anticipated discrimination and the association between both concepts. Linear regression analyses were used to investigate the association with clinical and social characteristics, such as occupational status and type of treatment. Individuals in treatment for substance use disorders reported high levels of experienced and anticipated discrimination. Respondents experienced most discrimination in family ties, intimate relationships and friendships. Experienced and anticipated discrimination were both positively correlated. Having complex substance use problems and a longer history of substance use problems was related to higher levels of experienced discrimination. In conclusion, experienced and anticipated discrimination were highly prevalent among individuals in treatment for substance use disorders. Attention in addiction treatment for adequate coping with discrimination may be needed in order to achieve successful social participation and rehabilitation of these individuals.

Delay and probability discounting in pathological gamblers with and without a history of substance use problems

Pathological gambling and substance use disorders are highly comorbid, possibly because they both stem from a similar process-impulsivity. Although much data exist regarding the association between delay discounting and these psychiatric disorders, relatively little research has examined probability discounting and its relationship with either substance use or gambling. The goal of the current study was to compare rates of probability and delay discounting in a large population of pathological gamblers with and without a history of substance use problems. Treatment-seeking pathological gamblers with (n = 117) and without (n = 119) a history of substance use problems completed questionnaires about discounting of hypothetical monetary outcomes and the Eysenck Impulsivity Questionnaire. The delay-discounting questionnaire involved choices between a smaller amount of money delivered immediately versus a larger amount delivered later, and the probability questionnaire was comprised of choices between a smaller certain versus a larger probabilistic monetary outcome. Hyperbolic functions estimated delay and probability discounting rates based on the indifference points obtained through the questionnaires. Results revealed significant effects of substance use problem status on delay but not on probability discounting, with no significant correlation noted between the two discounting processes. Only delay discounting correlated with Eysenck impulsivity scores. These data suggest that delay and probability discounting tap different dimensions, and delay discounting is more closely linked with substance use problem histories in pathological gamblers.

Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM)

To compare patients with and without a history of suicidal attempts in a large cohort of patients with bipolar disorder and to identify variables that are associated with suicidal behavior. European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) is a two-year, prospective, observational study that enrolled 3,684 adult patients with bipolar disorder and initiated or changed oral treatment for an acute manic/mixed episode. Of those, 2,416 patients were eligible for the two-year follow-up. Only baseline characteristics were studied in the present study, included sociodemographic data, psychiatric history and comorbidities, history of suicide attempts, history of substance use problems, compliance with treatment, inpatient admissions, and functional status. Symptom severity was assessed using the Clinical Global Impression-Bipolar Disorder (CGI-BP) scale, the Young Mania Rating Scale (YMRS), and the 5-item Hamilton Depression Rating Scale (HAMD-5). A logistic regression model identified baseline variables independently associated with a history of suicidal behavior. Of the 2,219 patients who provided data on their lifetime history of suicide attempts, 663 (29.9%) had a history of suicidal behavior (at least one attempt). Baseline factors associated with a history of suicidal behavior included female gender, a history of alcohol abuse, a history of substance abuse, young age at first treatment for a mood episode, longer disease duration, greater depressive symptom severity (HAMD-5 total score), current benzodiazepine use, higher overall symptom severity (CGI-BP: mania and overall score), and poor compliance. These factors may be considered as potential characteristics to identify subjects at risk for suicidal behavior throughout the course of bipolar disorder.

Spiritual Transformation, Psychological Well-Being, Health, and Survival in People with HIV

Although Spiritual Transformation (ST) occurs in a sizable proportion of people with HIV (about 39%), there is little research on the potential benefits of ST with respect to psychological well-being, health, and survival in this population. Our study attempts to fill this gap. Using a mixed method approach, we related interviews of 147 people with HIV (identifying the presence/absence of ST) to questionnaires measuring demographics, medical history, treatment adherence, physical symptoms, and psychological well-being (i.e., stress, coping, life attitude, and spirituality), and assessments of CD4-counts and viral load and survival 3 to 5 years later. At comparable times since HIV-diagnosis and antiretroviral medications prescribed, the presence of ST was significantly associated with better treatment success (undetectable viral loads, higher CD4 counts), better medication adherence, fewer symptoms, less distress, more positive coping, different life attitudes (i.e., existential transcendence, meaning/purpose in life, optimism, death acceptance), more spiritual practices, and increased spirituality. ST was also associated with substance-use recovery and with being African American. Survival up to 5 years was 5.35 times more likely among participants with ST (p(f) = .044). According to a Cox-regression adjusted for baseline CD4-counts, age, race-ethnicity, gender, education, years since HIV-diagnosis, and a history of substance-use problems, ST still reduced the risk of death (HR = 0.07, 95% CI = 0.01-0.53, p = .010). ST has associated benefits for psychological well-being, health, and survival.