Negative Consequences Of Substance Use Research Articles

The Effectiveness of a School-Based Intervention for Adolescents in Reducing Disparities in the Negative Consequences of Substance Use Among Ethnic Groups.

Ethnic minority youth are disproportionately affected by substance use-related consequences, which may be best understood through a social ecological lens. Differences in psychosocial consequences between ethnic majority and minority groups are likely due to underlying social and environmental factors. The current longitudinal study examined the outcomes of a school-based motivational enhancement treatment intervention in reducing disparities in substance use consequences experienced by some ethnic minority groups with both between and within-subjects differences. Students were referred to the intervention through school personnel and participated in a four-session intervention targeting alcohol and drug use. Participants included 122 youth aged 13-19years. Participants were grouped by ethnicity and likelihood of disparate negative consequences of substance use. African American/Hispanic/Multiethnic youth formed one group, and youth identifying as White or Asian formed a second group. We hypothesized that (1) there would be significant disparities in psychosocial, serious problem behavior, and school-based consequences of substance use between White/Asian students compared to African American/Hispanic/Multiethnic students at baseline; (2) physical dependence consequences would not be disparate at baseline; and (3) overall disparities would be reduced at post-treatment follow-up. Results indicated that African American/Hispanic/Multiethnic adolescents demonstrated statistically significant disparate consequences at baseline, except for physical dependency consequences. Lastly, significant reductions in disparities were evidenced between groups over time. Our findings highlight the efficacy of utilizing school-based substance use interventions in decreasing ethnic health disparities in substance use consequences.

Parental Support, Mental Health, and Alcohol and Marijuana Use in National and High-Risk African-American Adolescent Samples.

African-American adolescents experience disproportionate rates of negative consequences of substance use despite using substances at average or below-average rates. Due to underrepresentation of African-American adolescents in etiological literature, risk and protective processes associated with their substance use require further study. This study examines the role of parental support in adolescents’ conduct problems (CPs), depressive symptoms (DSs), and alcohol and marijuana use in a national sample and a high-risk sample of African-American adolescents. In both samples, parental support was inversely related to adolescent CPs, DSs, and alcohol and marijuana use. CPs, but not DSs, partially mediated the relation of parental support to substance use. Results were consistent across the national and high-risk samples, suggesting that the protective effect of parental support applies to African-American adolescents from a range of demographic backgrounds.

Characteristics of a Treatment-Seeking Population in Outpatient Addiction Treatment Centers in Mexico

Background: Baseline patients’ characteristics are critical for treatment planning, as these can be moderators of treatment effects. In Mexico, information on treatment seekers with substance use disorders is scarce and limited to demographic characteristics. Objective: This paper presents and analyses demographic characteristics, substance use related problems, clinical features, and addiction severity in a sample of treatment seekers from the first multi-site randomized clinical trial implemented in the Mexican Clinical Trials Network on Addiction and Mental Health. Methods: A total of 120 participants were assessed prior randomization. Chi square or F-tests were used to compare sites across variables. Spearman correlation was used to associate negative consequences of substance use and motivation to change. Results: The majority of participants were men, and the most prevalent substances reported were alcohol, marijuana, and cocaine. Participants were predominantly on the contemplation or action stage of change, and this was correlated with the perception of the negative consequences associated with substance use. Participants reported a high prevalence of substance use related problems. Conclusions: Substance use related problems, clinical features, and addiction severity reported by treatment seekers are important characteristics to take into account when planning treatment as they facilitate tailoring treatment to meet patients’ needs.

Using mindfulness in a harm reduction approach to substance abuse treatment: A literature review.

Harm reduction, a modern post-2000 form of treatment for substance use behaviors, provided a public health and disease model for the reduction of the spread of the human immunodeficiency virus in the early 1980s. Different from the traditional choice of treatment, abstinence, harm reduction is designed to meet people “where they are at”. The traditional 12-step treatment for substance use disorders does not allow the individual to relapse, lest it is considered the treatment has failed. Harm reduction focuses on the reduction of negative consequences of substance use and allows the substance user to accept moderate and safer use, thereby, reducing the harmful effects of the disorder. The inclusion of mindfulness with harm reduction places the individual in the present state of awareness, the here and now, making them aware of cues that trigger the desire to use substances. This article will compare the use of harm reduction treatments combined with mindfulness techniques as an alternative treatment for substance abuse when the 12-step substance abuse program does not work for everyone.

Buffering Effect of Parental Monitoring Knowledge and Parent-Adolescent Relationships on Consequences of Adolescent Substance Use

When adolescents begin using substances, negative consequences are not always directly proportional to the amount used; heavy users may have few consequences whereas light users may have numerous consequences. This study examined how parental monitoring knowledge and parent-child relationship quality may serve as buffers against negative consequences when adolescents use substances. Self-report questionnaires were administered to a community sample of 200 healthy adolescents and their parents at two time points, one year apart. Results suggest that both parental monitoring knowledge and parent-child relationship quality serve as buffers against negative consequences of substance use - but only when adolescents report high levels of monitoring knowledge or strong parent-child relationship quality. Results suggests adolescent perceived parental monitoring knowledge and parent-child relationship quality each act independently to buffer adolescents against negative consequences of substance use over a one-year period.

Factors Associated With Motivation to Change HIV Risk and Substance Use Behaviors Among Homeless Youth

This study sought to identify and compare variables associated with motivation to change alcohol, drug use, and HIV risk behaviors among a sample of homeless youths. More frequent alcohol use, older age, and childhood sexual abuse were associated with greater motivation to change alcohol use; higher reported negative consequences of substance use were associated with higher motivation to reduce illicit drug use. Shorter periods of current homelessness predicted higher motivation to change HIV risk behaviors. Findings suggest these areas might be fruitful targets for intervention efforts to enhance motivation to reduce alcohol and illicit drug use and HIV risk behaviors.

Development and validation of a scale for assessing reasons for substance use in schizophrenia: The ReSUS scale

This paper reports on the development of a questionnaire to assess self reported reasons for substance use in schizophrenia: the ‘reasons for substance use in schizophrenia’ (ReSUS) scale and explores the relationship between reasons for use, psychiatric symptoms and substance use in a sample of 230 people with psychosis. Principal components analysis revealed three subscales: “coping with distressing emotions and symptoms', “social enhancement and intoxication” and “individual enhancement”. Predicted associations were partially supported. ‘Coping’ reasons for use were related to positive symptoms, general symptoms, global functioning, depression and suicide behaviour as well as substance use (quantity of use and problems related to use). ‘Individual enhancement’ reasons were related to positive symptoms, to global functioning and to negative consequences of substance use. ‘Social enhancement and intoxication’ reasons were related to negative consequences of use but not to psychopathology. The findings suggest that the ReSUS is a reliable and valid instrument which can be used to explore self reported reasons for substance use and their relationship to psychotic symptoms in people with schizophrenia and other psychotic disorders.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Measurement of negative consequences of substance use in street youth: An expanded use of the Rutgers Alcohol Problem Index

The Rutgers Alcohol Problem Index (RAPI) was used to assess negative consequences due to both alcohol and drug use. Data were collected from 173 substance using homeless adolescents (13–19 years of age, 58% male) who were grouped based on the substances rated: alcohol only, alcohol and drugs, or drugs only. The RAPI retained good internal consistency across substance categories, exhibited strong measurement construct congruence, and good convergent validity based upon correlations with assessed DSM diagnostic criteria (both dependence and abuse). Discussion focuses on the RAPI as a reliable instrument for the measurement of negative consequences for alcohol and drug use.

The Impact of Publicly Funded Managed Care on Adolescent Substance Abuse Treatment Outcomes

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.

Should harm minimization as an approach to adolescent substance use be embraced by junior and senior high schools?: Empirical evidence from An integrated school- and community-based demonstration intervention addressing drug use among adolescents

The objective of this demonstration project was to determine if school-based harm minimization drug education was potentially acceptable and effective for junior and senior high school students in Nova Scotia. We conducted a four-year quasi-experimental intervention using mixed quantitative and qualitative methodologies. The intervention was a co-operative participatory research project with various activities determined by the participants. The project involved a partnership of four schools, two school boards, two regional addiction services, the provincial department of health, and a university. The outcomes evaluation was based on a sample of 1117 and 849 students in the intervention schools, compared with 3755 and 4247 students in the rest of the province, in 1998 and 2002, respectively. The evaluation of acceptability was based on an analysis of 491 documents generated from 1998 to 2002. The outcomes of effectiveness were specific risks and harmful consequences associated with substance use. We found that harm minimization was an acceptable approach to drug education targeting the senior high school population, and there was also some evidence of effectiveness in that age group in that the prevalence of several risks and negative consequences of substance use decreased significantly in the intervention schools relative to the rest of the province. In junior high school, harm minimization was found to not be an acceptable approach to drug education. This demonstration project provides evidence that school-based harm minimization may be acceptable and effective in senior high schools but may not be acceptable in junior high schools.

Measuring Negative Consequences of College Student Substance Use: A Psychometric Evaluation of the Core Alcohol and Drug Survey

A commonly used instrument to assess negative consequences of substance use among college students is the Core Alcohol and Drug Survey (CADS; C A Presley, P. W. Mailman, & J S. Leichliter, 1998; C. A. Presley. P W. Meilman. & R. Lyerla, 1993). Results from 2 studies suggest that a subset of CADS negative consequences items can be explained by 2 factors, which the authors named “Personal Consequences” and “Consequences With Others.”

The Effectiveness of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence

Telephone-based disease management protocols have shown promise in improving outcomes in a number of medical and psychiatric disorders, but this approach to continuing care has received little study in alcohol- and drug-dependent individuals. To compare telephone-based continuing care with 2 more intensive face-to-face continuing care interventions. A randomized 3-group clinical trial with a 2-year follow-up. Two outpatient substance abuse treatment programs, one community-based and the other at a Veterans Affairs medical center facility. Alcohol- and/or cocaine-dependent patients (N = 359) who had completed 4-week intensive outpatient programs. Three 12-week continuing care treatments: weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks (TEL), twice-weekly cognitive-behavioral relapse prevention (RP), and twice-weekly standard group counseling (STND). Percentage of days abstinent from alcohol and cocaine, total abstinence from alcohol and cocaine, negative consequences of substance use, cocaine urine toxicological results, and gamma-glutamyltransferase. Participants in TEL had higher rates of total abstinence over the follow-up than those in STND (P<.05). In alcohol-dependent participants, 24-month gamma-glutamyltransferase levels were lower in TEL than in RP (P = .005). In cocaine-dependent participants, there was a significant group x time interaction (P = .03) in which the rate of cocaine-positive urine samples increased more rapidly in RP as compared with TEL. On percentage of days abstinent or negative consequences of substance use, TEL did not differ from RP or STND. Participants with high scores on a composite risk indicator, based on co-occurring alcohol and cocaine dependence and poor progress toward achieving intensive outpatient program goals, had better total abstinence outcomes up to 21 months if they received STND rather than TEL, whereas those with lower scores had higher abstinence rates in TEL than in STND (P = .04). Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions. However, high-risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs.

Factors that predict adolescent motivation for substance abuse treatment

Many adolescent substance abusers enter treatment because of external pressures and thus lack motivation to change their behavior and engage in treatment. Because an understanding of adolescent motivation may contribute to improved treatment, an investigation of factors that predict motivation was undertaken with youth admitted to an adolescent outpatient substance abuse treatment program ( N = 196). At admission, these subjects received a comprehensive biopsychosocial assessment. Using multiple regression analysis, factors considered to potentially predict motivation were assessed. Of the factors examined, those that involved experiencing various negative consequences of substance use emerged as important predictors of motivation, whereas severity of substance use did not. Diminished awareness of negative consequences of use was consonant with lower motivation, suggesting the importance of interventions to help youth recognize negative consequences of their substance use. Interventions to enhance motivation are likely to become more important as the juvenile justice system increasingly refers troubled youth to treatment.

Pathways to Long-Term Recovery: A Preliminary Investigation

Recovery from addiction is a lifelong process. While there is a large body of empirical data on the short-term effectiveness (one to two years) of various treatment modalities, very little is known about the processes of recovery over time. This is particularly unfortunate as treatment gains are often short-lived and even multiple treatment episodes do not always succeed in breaking the addiction cycle. Further, treatment represents only one of the paths to recovery. This article reports on a study of individuals in long-term recovery from substance abuse (median = 12 years) and examines the factors they cite as important in establishing and maintaining their recovery status. Key factors reported were social and community support, affiliation with 12-Step organizations and negative consequences of substance use. Implications for clinical practice and future research directions are discussed.

Adolescents' substance-related risk perceptions: antecedents, mediators and consequences

The current study examined the hypothesis that adolescents' absolute and comparative perceptions of vulnerability to potential negative consequences of substance use mediate the relation between traditional predictors of use, and actual substance use. The data support the hypothesis in that absolute risk perceptions mediate the relations between parental communication about substances, peer substance use and risk-taking tendency, and subsequent adolescent use. Comparative risk perceptions, however, are only weakly related to these three predictors, and do not predict subsequent use. The data also replicate earlier findings that behavioral willingness mediates the relation between risk perceptions and behavior. Methodological and applied implications are discussed.

Regret, substance abuse, and readiness to change in a dually diagnosed sample

The transtheoretical stages of change model posits that increased readiness to change is associated with greater awareness of the negative consequences of substance use. Experiencing regrets implies a greater awareness of these consequences. Eighty dually diagnosed patients completed a 22-item Measure of Substance-Related Regret (MSR) that assessed the intensity, type, idiographic importance of, and emotions associated with regrets related to substance use and the Brief Readiness to Change Questionnaire. The MSR yielded a global measure of regret that accounted for statistically significant amounts of variance in total readiness-to-change scores ( R 2 = .30). Global scores also predicted precontemplation and contemplation stage scores, whereas total fear scores associated with regrets predicted action scores. Regret seems to play a complex yet important role in the decision to change substance abuse.

Integrating substance abuse treatment for the seriously mentally ill into inpatient psychiatric treatment.

This paper offers guidelines for the assessment and treatment of substance abuse problems in seriously mentally ill persons who are admitted into inpatient psychiatric treatment. This approach has been used successfully by the authors and may be most useful in settings where a specialized dual-diagnosis treatment program is not feasible. The first step consists of identifying potential substance abusers using several sources of information including the patient's record, a brief patient interview, and an interview with the patient's family and caseworker. Patients who have a confirmed or suspected substance abuse problem undergo a substance abuse assessment designed to evaluate consumption patterns, the negative consequences of substance use, and high-risk situations for alcohol and drug use. Patients are then presented with individualized feedback in a non-coercive manner, which is intended to increase their motivation to change their substance-use behavior. Treatment consists of a structured coping skills group which covers nine specific topics. The topics covered in the group treatment include both general social skills and specific drug and alcohol coping skills intended to assist individuals in coping effectively with high-risk situations. The content of each group session is described along with guidelines for conducting coping skills group treatment with the seriously mentally ill.