Lifetime Substance Abuse Research Articles

Treatment adherence across different psychiatric disorders: findings from a large patient cohort

IntroductionMedication adherence was defined by the WHO as “the extent to which a person’s behavior coincides with the medical advice given” (WHO, 2003). Existing literature indicates that approximately 49% of patients with major psychiatric disorders do not fully adhere to their prescribed psychopharmacological therapy (Colom et al, 2002). Non-adherence can lead to partial therapeutic responses or treatment resistance, increased risk of relapse, re-hospitalization, elevated suicide risk, and overall poorer functioning, thereby compromising the patient-doctor therapeutic relationship (Garcìa et al, 2016).ObjectivesThe aim of the present study was to assess potential differences in terms of clinical features related to adherence to treatment in a large cohort of psychiatric patients of an Italian psychiatric department.MethodsThe study included 307 psychiatric patients, of any gender or age, diagnosed with unipolar depression (UD), bipolar depression (BD), anxiety disorders (AD), schizophrenic spectrum disorders (SS) or a primary diagnosis of personality disorders (PD), based on DSM-5 criteria. Patients were consecutively recruited from the Department of Psychiatry at Luigi Sacco University Hospital, in Milan. The patient’s adherence to treatment was evaluated using the Clinician Rating Scale (CRS), with a cut-off of ≥ 5 defining adherence subgroups (A+: score ≥ 5; A-: score < 5). Comparative and predictive analysis were performed for the whole sample and the two adherence subgroups.ResultsOverall, nearly one-third of the whole sample reported suboptimal medication adherence. Specifically, rates were approximately 35.3% and 32.7% for BD and SS, respectively, followed by 30.8% for PD, 28% for AD and, 20.3% for UD (see Figure 1). Patients with A- showed significantly higher current substance abuse (17.8% vs 4.5%, p<.001), along with a higher rate of lifetime substance abuse, although with a trend towards significance (31.5% vs 20.5%; p=.057). Moreover, the A- group had a significantly higher number of lifetime hospitalizations (1.35 ± 1.8 vs 0.73 ± 1.11; p<.001) and higher rate of previous psychotropic treatment dropouts compared to the A+ group (90% vs. 36.2%; p<.001, see Figure 2).Image:Image 2:ConclusionsApproximately one-third of the whole sample reported a suboptimal medication adherence, with varying rates across different diagnoses. Current and lifetime substance abuse appears to be an unfavorable transdiagnostic factor. Additionally, severe outcomes such as increased hospitalizations and a more acute disease presentation are linked to poorer adherence. Recognizing the characteristics of adherence patterns within specific diagnostic categories is crucial for designing precise interventions to enhance patient outcomes and optimize the overall effectiveness of treatment.Disclosure of InterestN. Girone: None Declared, B. Benatti Speakers bureau of: Angelini, Lundbeck, Janssen, Rovi., M. Cocchi: None Declared, F. Achilli: None Declared, C. Viganò: None Declared, M. Vismara: None Declared, B. Dell’Osso Grant / Research support from: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova, Speakers bureau of: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova

Lifetime history of childhood adversity and substance abuse in patients with treatment resistant depression

Both adverse childhood experiences (ACEs) and substance abuse have shown individual associations with treatment-resistant depression (TRD). Yet, limited research has explored the joint association of ACEs and substance abuse in TRD patients. This study aimed to evaluate how the amount and type of ACE exposure increase the risk of lifetime substance abuse in a clinical sample of 725 outpatients diagnosed with major depressive disorder (MDD) or persistent depressive disorder.Logistic regression analyses were used to assess whether heightened ACE exposure increased the risk of substance abuse, and to examine the relationship between five ACE subtypes (e.g., sexual abuse (CSA), physical violence, injury/illness, childhood grief, and parental upheaval) and history of substance abuse.Greater ACE exposure increased risk of substance abuse. CSA independently predicted a history of substance abuse. This provides further evidence for the additive effects of ACEs and that CSA may have a unique link to substance abuse.

Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project

ObjectiveSex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. MethodsThis Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. ResultsRegarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. ConclusionOur findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.

Lithium treatment versus hospitalization in bipolar disorder and major depression patients

BackgroundPreventing hospitalization of major affective disorder patients is a fundamental clinical challenge for which lithium is expected to be helpful. MethodsWe compared hospitalization rates and morbidity of 260 patients with DSM-5 bipolar or major depressive disorder in the 12 months before starting lithium versus 12 months of its use. We evaluated duration of untreated illness, previous treatments, substance abuse, suicidal status, lithium dose, and use of other medicines for association with new episodes of illness or of symptomatic worsening as well as hospitalization, using bivariate and multivariate analyses. ResultsWithin 12 months before lithium, 40.4 % of patients were hospitalized versus 11.2 % during lithium treatment; other measures of morbidity also improved. Benefits were similar with bipolar and major depressive disorders. Independently associated with hospitalization during lithium treatment were: receiving an antipsychotic with lithium, suicide attempt during lithium treatment, lifetime substance abuse, and psychiatric hospitalization in the year before starting lithium, but not diagnosis. LimitationsParticipants and observation times were limited. The study was retrospective regarding clinical history, lacked strict control of treatments and was not blinded. ConclusionsThis naturalistic study adds support to the effectiveness of lithium treatment in preventing hospitalization in patients with episodic major mood disorders.

Criminal behaviors and substance abuse in psychiatric patients

IntroductionPeople with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.ObjectivesIn order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.MethodsThis is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.ResultsData were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.Table 1.Lifetime substance abusers (N=39)Non-lifetime substance abusers (N=37)Proportion DifferenceP-valueN%N%Depot administrationYes11(28,9%)0(0%)28,9%0,02HospitalizationsFour or more25(64,1%)5(33,3%)30,8%0,04Economic crimeYes15(40,5%)1(6,7%)33,8%0,02Previous crimesYes17(51,4%)2(13,3%)38,1%0,02ConclusionsData emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.Disclosure of InterestNone Declared

Lifetime substance abuse and adverse childhood experiences in psychosis: impact on clinical outcomes

Lifetime substance abuse and adverse childhood experiences in psychosis: impact on clinical outcomes

Prevalence and Correlates of Sexually Transmitted Infections in Transgender People: An Italian Multicentric Cross-Sectional Study.

The burden of sexually transmitted infections (STIs) in the transgender population remains an underestimated issue. The aims of the present study were to evaluate the prevalence of either self-reported and serological STIs and to describe socio-demographic and clinical characteristics of transgender individuals with STIs. A consecutive series of 705 transgender individuals (assigned-male at birth, AMAB n = 377; assigned-female at birth, AFAB n = 328) referring to six Italian gender clinics were included. Sociodemographic and clinical information was collected during the first visit. In a subsample of 126 individuals prevalence of STIs (human immunodeficiency virus, HIV; hepatitis C, HCV; hepatitis B, HBV; syphilis) were evaluated through serology tests. The self-reported prevalence of HIV, HBV, HCV and syphilis infection in the total sample were 3.4%, 1.6%, 2.6% and 2.0%, respectively. In the subsample who underwent serological tests, higher rates of serological prevalence were found (9.5%, 4.0%, 5.6% and 7.9% for HIV, HBV, HCV and syphilis, respectively). When comparing transgender people with or without self-reported STIs, unemployment, previous incarceration, justice problems and sex work resulted more frequent in the first group (p< 0.03 for all). Regarding health status, we observed higher rates of lifetime substance abuse and psychiatric morbidities in trans people with at least one reported STI (p < 0.05). The prevalence of STIs exceeded that reported in general population and STIs correlates underline the importance of stigma and discrimination as determinants of transgender health.

Epilepsy and Associated Factors Among Adults Hospitalized for Attempted Suicide.

Background: Suicidal behaviors are known to be increased in people with epilepsy compared to the general population. However, few studies have explored the frequency of epilepsy in a large sample of suicide attempters, and scarce data exist about differences and similarities between epileptic attempters (EA) and nonepileptic attempters (NEA). The aim of this study was to explore the frequency of epilepsy as well as psychopathological and somatic factors among suicide attempters.Methods: In this multicenter cross-sectional study, 1,229 adults hospitalized for attempted suicide were included during the period between July 2001 and December 2015. They were assessed with the Mini-International Neuropsychiatric Interview for DSM-IV Axis I mental disorders. Data concerning sociodemographic and somatic diseases, including epilepsy, were collected.Results: Sixty-five patients (5.3%) had epilepsy. EA had significantly fewer mean ± SD years of education compared with NEA (11.2 ± 3.2 vs 12.1 ± 2.9; P = .011) as well as increased rates of head trauma (29.2% for EA vs 16.2% for NEA; P = .007), antiepileptic use (35.4% for EA vs 23.8% for NEA; P = .036), and lifetime substance abuse and/or dependance (49.2% for EA vs 36.1% for NEA; P = .034). Multivariate analyses showed that years of education, head trauma, and panic disorder with agoraphobia predicted belonging to the EA group.Conclusions: These results suggest that epilepsy is overrepresented among suicide attempters. Few psychopathological differences as well as differences in somatic comorbidities except head trauma were observed between EA and NEA in this sample. These results contribute to draw a clinical profile of people with epilepsy in the population of suicide attempters.

Substance use in youth at-risk for serious mental illness.

The aim of this paper is to describe the substance use of participants who are at-risk for serious mental illness (SMI). The Canadian Psychiatric Risk and Outcome study (PROCAN) is a two-site study of 243 youth and young adults aged 13 to 25 years, categorized into four groups: healthy controls (n = 42), stage 0 (asymptomatic individuals with risk of SMI typically family high risk; n = 41), stage 1a (distress disorder or mild symptoms of anxiety or depression; n = 53) and stage 1b (attenuated syndromes, including bipolar disorder or psychosis; n = 107). Substance use measures were administered at baseline, 6- and 12-months. At baseline, the most commonly reported substance used in the past month was alcohol (43.6%), followed by cannabis (14.4%) and tobacco (12.4%). There were no significant group differences in use. 42.4% of all participants reported ever using cannabis in their lifetime, whereas 21.4% reported currently using cannabis. There were no group differences in ever having used cannabis. Regarding lifetime substance abuse disorders, cannabis use disorder (5.7%) and alcohol use disorder (4.5%) were the most common and more often reported in stage 1b participants relative to other groups. Furthermore, alcohol, cannabis and tobacco use remained relatively consistent at 6- and 12-month follow-ups when compared to baseline use. Alcohol was the most commonly used substance followed by cannabis and tobacco. Although substance use did not differ between those at different stages of risk, overall prevention strategies are still warranted for youth at-risk for SMI, especially those who are more symptomatic and potentially at greater risk of developing an SMI.

A positive shift in resting-state functional connectivity between the insula and default mode network regions reflects the duration of illness in gambling disorder patients without lifetime substance abuse

The insula is considered an important structure involved in addiction and in the context of dynamic activity switching between large-scale brain networks, such as the default mode network (DMN) and the central executive network. Although insular-DMN resting-state functional connectivity (rsFC), which could affect such switching, has been examined in substance addiction populations, the results have been inconsistent, partly because of the confounding neural effects of the abused substances. To investigate this subject, using MRI, we examined insular-DMN rsFC in gambling disorder (GD) patients without a history of substance use. We examined rsFC between insular seeds and DMN regions of interest during rest in 23 GD patients and 27 age-, sex-, handedness-, and high education rate-matched healthy control (HC) subjects. We found a positive shift in insular-DMN rsFC in GD patients compared with HC subjects. Furthermore, the connectivity strength between insular seed regions and DMN regions was positively correlated with illness duration in GD patients. This alteration might affect switching between large-scale brain networks, potentially leading to a preoccupation with gambling as well as various types of cognitive impairments. Our results could clarify the controversial findings regarding substance addiction and enhance the system-level understanding of addiction.

Lifetime prevalence and correlates of smoking behavior in Iranian adults\u2019 population; a cross-sectional study

AbstactBackgroundThere are few if any reports concerning the joint use of waterpipe, cigarette and exposure to second-hand smoking in Tehran, Iran. Here, we simultaneously investigated the prevalence and predictors of smoking habits in Iranian adults.MethodsIn this population-based cross-sectional study, we recruited 1057 Iranian adults between August 2013 and February 2015, in Tehran, a multi-ethnic city. Participants were selected using random digit dialing. Three separate logistic regression models were applied to estimate the adjusted odds ratios (95% CI).ResultsExposure to second-hand smoking was the most prevalent smoking type (37, 95% CI: 35–41%) followed by cigarette (23.9% (95% CI: 21–27%)) and water-pipe smoking (20.25% (95% CI: 18–23%)) in adults in Tehran. Almost 3.3 and 4.5% of adults reported three and two types of lifetime smoking behaviors, respectively. Age, sex, history of depression along with lifetime alcohol intake was the important predictors of all three types of smoking. Lifetime alcohol consumption was associated with increased prevalence of all three types of smoking (p for trend < 0.009). Lifetime drug abuse was also associated with increased prevalence of cigarette smoking (OR = 2.04, 95% CI: 1.61–2.59, p < 0.001).ConclusionsLifetime prevalence of waterpipe, cigarette and exposure to second-hand smoking is moderately high. Dual smoking behaviors are increasing in Iranian adults. An apparent age-related difference in pattern of waterpipe and cigarette smoking was observed. These findings highlight the need for further educational and preventive programs especially for dual smoking in Iranian young adults. This could provide practical information for evaluating and reforming the tobacco control programs and policies in Iran.

Patients participating to neurobiological research in early psychosis: A selected subgroup?

AimSelection bias could be an important limiting factor in psychiatric neurobiological research. The study aim was to compare, within an early psychosis program, patients who agreed to participate to neurobiological research with patients who refused. Methods284 patients with early psychosis were assessed at baseline on a large set of socio-demographic and clinical variables and were followed-up over 36 months. ResultsThere were no differences between groups, except regarding forensic/psychiatric history, lifetime substance abuse and social-occupational level during follow-up. ConclusionsWhile patients participating to neurobiological research seem representative of our clinical cohort, the few differences identified may deserve attention.

Lifestyle factors and multiple sclerosis: A population-based incident case-control study

ObjectiveAlthough low sun exposure, low vitamin D, and smoking are established risk factor of multiple sclerosis (MS), there is less evidence on the role of the other lifestyle factors. We examined the association of sun exposure, physical activity, drug abuse, and alcohol intake with MS. Materials and methodsThis was population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013–17/2/2015). Logistic regression was used to analyse the data. ResultsHigher sun exposure during adolescence was associated with a reduced risk of MS, both in summer (test for trend p < 0.001) and winter (P < 0.001), while physical activity was not associated with MS (test for trend p = 0.712). Lifetime drug abuse (OR for ever use 2.93 (1.83–4.70)), with a dose-response association (test for trend p < 0.001), and alcohol intake (OR for ever use 1.49 (1.05–2.12)) was significantly associated with an increased risk of MS. ConclusionIn a middle-eastern setting, we found that sun exposure during adolescence, drug abuse, and alcohol use were all associated with MS. Increasing sun exposure and reducing drug abuse and the use of alcohol through educational programs is likely to reduce the rate of MS.

A Longitudinal, Latent Class Growth Analysis of the Association of Aggression and Special Education in an Urban Sample

As special education provides the context for delivery of an individualized approach to administering evidence-based interventions, regardless of disability category, we were interested in whether the provision of special education impacts the developmental trajectory of aggression. A longitudinal latent class growth model was utilized to examine the aggressive trajectories of participants in middle through high school and further analyses explored the relationship of special education variables with important variables. Participants included 578 students (53.4% male, 86.3% African American, 69% receiving free and reduced lunch [FRL]). Covariates were measured in first grade, aggressive-disruptive behavior indicators were measured in sixth through twelfth grades, and distal outcomes were assessed through young adulthood (i.e., 22–23 years old). Results identified two latent class trajectories. The lower aggressive trajectory class was more likely female with a special education history. The higher aggressive trajectory class was more likely male, received FRL, demonstrated lifetime drug abuse and dependence disorders (DUD) and criminal histories, and was less likely to graduate from high school. Further, students who received special education in elementary school were more likely to have graduated on-time, and less likely to have a DUD, to have been incarcerated, or to have reported a lifetime suicide attempt. Interestingly, further exploration of special education variables revealed few statistically significant differences. As special education is typically viewed as a risk factor for students, these findings illuminate a potential protective function of special education and prompt the need for further investigation into the types of individualized education plans targeting aggressive behaviors.

Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study

ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.

Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study

ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.

Childhood Abuse, Religious Involvement, and Substance Abuse Among Latino-American Men in the United States.

Childhood abuse/victimization and subsequent substance abuse are significant behavioral health problems among developed countries. In the United States (U.S.), however, few studies have examined whether this early trauma exacerbates adulthood substance abuse, viewed as a negative coping strategy, among Latino-American men. Furthermore, little is known about how collectivist cultural factors (i.e., ethnic identity, social support, and religious involvement), indicating potentially positive coping resources, were related to substance abuse in this largest minority-male population. We investigated Latino-American men (N = 1127) in a nationally representative U.S. sample, using logistic regression analysis adjusting known demographic and acculturation correlates. The results identified considerably elevated rates of childhood physical abuse/victimization (35.7%) and lifetime substance abuse (17.3%). Childhood physical (not sexual) abuse/victimization was positively associated with lifetime substance abuse, alongside age, being U.S.-born, and perceived discrimination. Latino-American men with lifetime substance abuse reported more religious coping. Findings may contribute to the design of culturally competent behavioral care.

Lifetime abuse among male inmates in an italian prison: Psychiatric clinical correlates

Aim to evaluate the prevalence of lifetime abuse in inmates of the Spoleto prison (Umbria, Italy) as well as the association with psychiatric disorders, Axis I or II, lifetime drug abuse, self-harm in the inmates and the history of legal problems or lifetime drug abuse in their parents. Subjects and methods Five hundred and twenty-six convicted males incarcerated in the Spoleto Prison between October 2010 and September 2011 were evaluated by trained interviewers with the SCID-I, the SCID-II, the ASI-X and the DSHI. Chi 2 tests were performed to examine the relation between the history of lifetime abuse and the different clinical features. Results Ninety-seven (18.4%) inmates reported a lifetime history of abuse. Among them, 65 (67%) suffered from an Axis I diagnosis and 65 (67%) were given an Axis II diagnosis. Inmates that reported a lifetime history of abuse were more likely to have an Axis II diagnosis ( P =.002) but not an Axis I diagnosis ( P =0.086) or a lifetime drug abuse ( P =0.060) than those without abuse. Furthermore, there was a significant relationship between history of abuse and lifetime self-harm in inmates ( P P Conclusion Even though a lifetime history of abuse is not so frequently reported in our sample of inmates, the high rates of psychiatric disorders among those abused and the correlation with self-harm should be taken in consideration when needs of inmates are evaluated, mainly in those who require psychiatric treatments.

The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

Introduction It is unclear from prior research whether or not substance abuse co-morbid with psychosis is an added barrier to success in vocational rehabilitation. The aim of this study was to examine the relationships among three types of co-morbid substance abuse or dependence, by type of employment assistance received (disability employment services, mainstream unemployment services, other government programmes, and own resources), and by type of employment attained (competitive and non-competitive). Method Data were drawn from the Australian National Survey of High Impact Psychosis ( N = 1825). The survey was conducted in seven Australian catchment areas March to December 2010. Descriptive statistics and logistic regression methods were used. Results There were no added effects of lifetime substance abuse or dependence on any employment. However, there were some minor substance-specific effects. Past year cannabis use was negatively associated, while alcohol use was positively associated with being employed. All categories of lifetime substance abuse or dependence were associated with reduced utilisation of intensive forms of employment assistance. Conclusion At a population level, lifetime substance abuse or dependence had no added impact on current employment status. Those with psychosis co-morbid with lifetime substance abuse or dependence could benefit from greater utilisation of evidence-based supported employment.

Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use - a clinical study.

ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples.The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.