Patients In Substance Abuse Treatment Research Articles

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

Adolescent patients in substance abuse treatment: Examining callous-unemotional traits

Adolescent patients in substance abuse treatment: Examining callous-unemotional traits

Correlates of Having Never Been HIV Tested among Entrants to Substance Abuse Treatment Clinics: Empiric Findings from Real-World New England Settings

Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07–3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11–0.88) and medical problems (AOR = 0.40, 95% CI = 0.17–0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.

Substance abuse treatment patients with early onset cocaine use respond as well to contingency management interventions as those with later onset cocaine use

Early onset drug use is associated with increased risk of developing substance use disorders, but relatively little is known about the correlates of early drug use among adults receiving treatment. A retrospective analysis of a randomized study of contingency management treatment compared cocaine-dependent patients who reported initial cocaine use at age 14 or younger (n=41) to those who began using after age 14 (n=387). Patients with early onset cocaine use had more legal and psychiatric problems than those who initiated cocaine use later. Patients with early-onset cocaine use also dropped out of treatment sooner and achieved less sustained abstinence than those who began using at older ages, but the interaction between age of first use and treatment condition was not significant. Early-onset cocaine use is associated with persistent psychosocial problems and an overall poor response to treatment. However, contingency management is efficacious in improving outcomes in early onset cocaine users.

Prediction of intimate partner violence by type of substance use disorder

The present study investigated whether (combinations of) specific substance use disorders predicted any and severe perpetration and victimization in males and females entering substance abuse treatment. All patients (N=1799) were screened for IPV perpetration and victimization; almost one third of the sample committed or experienced any IPV in the past year. For males, an alcohol use disorder in combination with a cannabis and/or cocaine use disorder significantly predicted any IPV (perpetration and/or victimization) as well as severe IPV perpetration. For females, alcohol and cocaine abuse/dependence predicted both any IPV (perpetration and/or victimization) and severe IPV perpetration. Results from the present study emphasize the importance of routinely assessing IPV in patients in substance abuse treatment and demonstrate that clinicians should be particularly alert for IPV in patients with specific substance use disorder combinations.

Emergence of New Onset substance use disorders among post‐weight loss surgery patients

Elevated rates of substance use disorders (SUDs), particularly (but not only) alcohol use, are observed among post-weight loss surgery (WLS) patients. The development of SUDs among post-WLS patients typically occurs 1-2 years post-surgery. Post-WLS patients are developing SUD at a much later time of life than is typical of SUDs in the general population, suggesting they constitute a distinct SUD phenotype that is directly related to having undergone WLS. Overall, findings suggest that post-WLS patients are overrepresented in substance abuse treatment programmes, and the majority of them report no history of SUD before WLS. Relative to non-WLS patients in SUD treatment, post-WLS patients in substance abuse treatment are disproportionally diagnosed with alcohol dependence, including alcohol withdrawal. Post-WLS patients may be at elevated risk for development of New Onset SUD in the absence of a prior SUD history; this group is phenotypically different from those with a history of substance abuse prior to surgery, and such patients may have unique treatment needs. A comprehensive substance abuse treatment facility began observing increased admissions who reported histories of weight loss surgery (WLS). Emerging evidence suggests that roughly half of post-WLS patients in substance abuse treatment developed their substance use disorder (SUD) after surgery. The present study examined differences between SUD patients who developed New Onset SUD after surgery and those with a reported SUD onset before WLS (SUD Hx+ group). Participants completed a questionnaire and participated in a semi-structured interview. Data were also obtained from participants' electronic medical records. Of the total treatment sample (n = 4658), 2.8% reported a history of WLS. Post-WLS patients were significantly more likely to be diagnosed with alcohol use disorders (AUDs). Among post-WLS patients who were interviewed (n = 56), 60% were classified as New Onset SUD, while only 40% were SUD Hx+. SUD Hx+ cases reported using significantly more types of substances than New Onset cases and were more likely to report pre-surgical binge eating disorder (BED). Post-WLS patients are overrepresented in substance abuse treatment and are disproportionally diagnosed AUDs. Post-WLS patients may be at elevated risk for development of New Onset SUD at a time in life (middle age) when SUD onset is relatively uncommon.

Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities

The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.

The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: a randomized controlled trial

BackgroundResearch has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. A large proportion of IPV perpetrators is diagnosed with co-occurring substance use disorders and it has been demonstrated that successful treatment of alcohol dependence among alcohol dependent IPV perpetrators also led to less IPV. The current study investigated the relative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) to cognitive behavioral treatment addressing substance use disorders including only one session addressing partner violence (CBT-SUD+) among patients in substance abuse treatment who repeatedly committed IPV. Substance use and IPV perpetration were primary outcome measures.MethodPatients who entered substance abuse treatment were screened for IPV. Patients who disclosed at least 7 acts of physical IPV in the past year (N = 52) were randomly assigned to either I-StoP or CBT-SUD+. Patients in both conditions received 16 treatment sessions. Substance use and IPV perpetration were assessed at pretreatment, halfway treatment and posttreatment in blocks of 8 weeks. Both completers and intention-to-treat (ITT) analyses were performed.ResultsPatients (completers and ITT) in both conditions significantly improved regarding substance use and IPV perpetration at posttreatment compared with pretreatment. There were no differences in outcome between conditions. Completers in both conditions almost fully abstained from IPV in 8 weeks before the end of treatment.ConclusionsBoth I-StoP and CBT-SUD+ were effective in reducing substance use and IPV perpetration among patients in substance abuse treatment who repeatedly committed IPV and self-disclosed IPV perpetration. Since it is more cost and time-effective to implement CBT-SUD+ than I-StoP, it is suggested to treat IPV perpetrators in substance abuse treatment with CBT-SUD+.Trial registrationClinicalTrials.gov: NCT00847873

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.

Screening on Perpetration and Victimization of Intimate Partner Violence (IPV): Two Studies on the Validity of an IPV Screening Instrument in Patients in Substance Abuse Treatment

BackgroundAbout 50% of patients in substance abuse treatment with a partner perpetrated and/or experienced intimate partner violence in the past year. To date, there are no screeners to identify both perpetrators and victims of partner intimate violence in a substance abusing population. We developed a 4 item screening instrument for this purpose, the Jellinek Inventory for assessing Partner Violence (J-IPV). Important strengths of the J-IPV are that it takes only 2 minutes to administer and is easy to use and to score.MethodsTo investigate the validity of the J-IPV, two independent studies were conducted including 98 and 99 participants, respectively. Aim of the second study was to cross-validate findings from the first study. Psychometric properties of the J-IPV were determined by calculating sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio’s by comparing J-IPV outcomes to outcomes on the Revised Conflict Tactics Scales (‘gold standard’). Also, receiver operator characteristics (ROC)-curves were determined to weight sensitivity and specificity as a result of different J-IPV cutoffs, and the area under the curve (AUC) was calculated.ResultsResults of the first study demonstrated that the J-IPV possesses good psychometric properties to detect perpetrators and victims of any as well as severe intimate partner violence. Results from the second study replicated findings from the first study.ConclusionsWe recommend administering the J-IPV to patients entering substance abuse treatment. If perpetrators and victims of partner violence are identified, action can be taken to stop IPV perpetration and arrange help for victims, for example by offering perpetrators treatment or by providing safety planning or advocacy interventions to victims.

Body Practices Among Male Drug Abusers. Meanings of Workout and use of Doping Agents in a Drug Treatment Setting

The use and understanding of anabolic steroids and other doping agents have changed in recent years. Associations between illicit drug use and the use of doping agents have been highlighted, but less attention has been given to the relationship between drug abuse treatment and associated body practices. In this study we looked at different experiences with, and understandings of, physical exercise and the use of doping agents. The study draws on interviews with nine young men, 22 to 35 years old, who are patients in residential substance abuse treatment in Norway. The phenomenological analysis showed various meanings of doping agents, some of which have previously not been fully described–namely the use of doping agents for transforming an emaciated drug user’s body into a muscular body and the use of doping agents for getting high. The findings are discussed in relation to theories of gender and embodiment, as well as theories of affect regulation and mentalization.

Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients

BackgroundOpioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. MethodsUsing data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. ResultsBoth an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58–20.28). ConclusionsThese results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population.

Utilization of communication technology by patients enrolled in substance abuse treatment

BackgroundTechnology-based applications represent a promising method for providing efficacious, widely available interventions to substance abuse treatment patients. However, limited access to communication technology (i.e., mobile phones, computers, internet, and e-mail) could significantly impact the feasibility of these efforts, and little is known regarding technology utilization in substance abusing populations. MethodsA survey was conducted to characterize utilization of communication technology in 266 urban, substance abuse treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy clinics. ResultsSurvey participants averaged 41 years of age and 57% had a yearly household income of less than $15,000. The vast majority reported access to a mobile phone (91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and yearly mobile contract was higher for White participants, and also for those with higher education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer use was much lower (39–45%), with younger age, higher education and income predicting greater use. No such differences existed for the use of mobile phones however. ConclusionsConcern regarding the digital divide for marginalized populations appears to be disappearing with respect to mobile phones, but still exists for computer, internet, and e-mail access and use. Results suggest that mobile phone and texting applications may be feasibly applied for use in program–client interactions in substance abuse treatment. Careful consideration should be given to frequent phone number changes, access to technology, and motivation to engage with communication technology for treatment purposes.

Major Depression and Risky Sexual Behavior Among Substance Dependent Patients: The Moderating Roles of Distress Tolerance and Gender

The goal of the present study was to examine the main and interactive effects of major depressive disorder (MDD), distress tolerance (DT), and gender on multiple indices of risky sexual behavior (RSB) within a sample of 185 substance dependent patients in residential substance abuse treatment. Participants were interviewed to establish current MDD (as well as other Axis I and II diagnoses) and completed a behavioral measure of DT, the Paced Auditory Serial Addition Task - Computerized Version. Results provided evidence of a MDD × DT interaction for number of different past year commercial and casual sexual partners with which penetrative sex occurred. Post-hoc analyses demonstrated that participants with current MDD and low DT reported the greatest number of commercial and casual sexual partners. Results highlight one psychological vulnerability (DT) that may improve our understanding of the complex relationship between depression and RSB. Treatment implications of findings are discussed.

The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients

BackgroundDespite elevated rates of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients, as well as the clinical relevance of this co-occurrence, few studies have examined psychological factors associated with a PTSD–SUD diagnosis. Two factors worth investigating are emotion dysregulation and impulsivity, both of which are associated with PTSD and SUDs. Therefore, this study examined associations between PTSD and facets of emotion dysregulation and impulsivity within a sample of trauma-exposed SUD inpatients. MethodsParticipants were an ethnically diverse sample of 205 SUD patients in residential substance abuse treatment. Patients were administered diagnostic interviews and completed a series of questionnaires. ResultsPatients with PTSD (n=58) reported significantly higher levels of negative urgency (i.e., the tendency to engage in impulsive behaviors when experiencing negative affect) and lower sensation seeking, as well as higher levels of emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall emotion dysregulation emerged as a significant predictor of PTSD status, accounting for unique variance in PTSD status above and beyond facets of impulsivity (as well as other relevant covariates). ConclusionsResults suggest that emotion dysregulation may contribute to the development, maintenance, and/or exacerbation of PTSD and highlight the potential clinical utility of targeting emotion dysregulation among SUD patients with PTSD.

“I Didn’t See This Coming.”: Why Are Postbariatric Patients in Substance Abuse Treatment? Patients’ Perceptions of Etiology and Future Recommendations

Recent evidence suggests that bariatric patients may be overrepresented in inpatient substance abuse treatment, but the reasons for this are unclear. Patients' perceptions of this problem may be of heuristic value. Using a qualitative approach, the present study evaluated bariatric patients' impressions of how their postsurgical substance use disorders emerged and their future recommendations for those working with bariatric patients. Semi-structured interviews were conducted with 24 bariatric patients in an inpatient substance abuse treatment program. Seven prominent themes emerged, four referring to etiology of substance use (unresolved psychological problems, addiction transfer/substitution, faster onset or stronger effects from substances, and increased availability of pain medications) and three pertaining to future recommendations (counseling pre- and/or postsurgery, increased knowledge of the associated risks of substance use postsurgery, and greater "honesty"). Blind coders rated the presence or absence of each theme in each interview. Of the four etiology themes, 75% of patients acknowledged unresolved psychological problems, 83.33% identified addiction transfer/substitution, 58.33% noticed faster onset or stronger effects from substances, and 45.83% identified increased availability of pain medications. For future recommendations, 41.67% suggested counseling pre- and/or postsurgery, 70.83% suggested increased education about the associated risks of substance use postsurgery, and 41.67% identified a need for greater "honesty." Patient perceptions suggest that several common themes may be related to risk for the development of postsurgical substance use disorders.

Medical Marijuana Use Among Adolescents in Substance Abuse Treatment

To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age = 16.09, SD = 1.12), in substance abuse treatment in the Denver metropolitan area. Bivariate and multivariate analyses were completed to determine factors related to adolescents' use of medical marijuana. Approximately 74% of the adolescents had used someone else's medical marijuana, and they reported using diverted medical marijuana a median of 50 times. After adjusting for gender and race/ethnicity, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms compared with those who did not use medical marijuana. Medical marijuana use among adolescent patients in substance abuse treatment is very common, implying substantial diversion from registered users. These results support the need for policy changes that protect against diversion of medical marijuana and reduce adolescent access to diverted medical marijuana. Future studies should examine patterns of medical marijuana diversion and use in general population adolescents.

The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment

The present study examined the unique contribution of emotion regulation difficulties to past-year risky sexual behavior (RSB) among substance use disorder (SUD) patients (above and beyond other known RSB risk factors). A sample of 177 SUD patients completed a series of questionnaires. At the zero-order level, emotion regulation difficulties, were significantly positively associated with the number of commercial sexual (i.e., the exchange of sex for drugs or money) partners with which penetrative sex occurred and significantly negatively associated with the likelihood of using a condom when having sex with a commercial partner under the influence of drugs. Emotion regulation difficulties also significantly predicted these RSB indices above and beyond other RSB risk factors, including demographics, depression, sensation seeking, traumatic exposure, and substance use severity. The specific emotion regulation difficulty of lack of emotional clarity emerged as a unique predictor of RSB. The implications of these findings for understanding motivations for RSB and developing targeted interventions for RSB among SUD patients are discussed.

Tobacco addiction and smoking status in heroin addicts under methadone vs. buprenorphine therapy.

Aims of the present investigation were: (i) to assess the prevalence of current smokers and relative smoking status among a large number of heroin addicts attending opioid-substitution therapy prevalence; (ii) to evaluate the relationship between the type (methadone, buprenorphine) and dosage of opioid substitution therapy and nicotine dependence. Three hundred and five (305) heroin addicts under opioid-substitution therapy were recruited at five Addiction Units. All participants completed a questionnaire assessing sociodemographic information, type and dose of opioid-substitution therapy, smoking history and status, Fagerström Test for Nicotine Dependence (FTND), and the Zung Self-Rating Depression scale (SDS). 298 subjects, out of 305 (97.2%) were smokers, with an average of 20.5 cigarette/day and a median FTND of 6. Our data confirmed the high prevalence of smokers among heroin addicts, the highest described in the literature to date among heroin addicts under substitution therapies, without any significant difference between methadone vs. buprenorphine therapy groups. There was no correlation between dose of methadone or buprenorphine and average number of cigarettes/day. Patients in substance abuse treatment very frequently smoke cigarettes and often die of tobacco-related diseases. Substance abuse treatment programs too often ignore tobacco use. We hope that these findings will help to incorporate smoking cessation in substance abuse treatments.

Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients

Recent investigations have demonstrated that posttraumatic stress disorder (PTSD) is associated with a range of impulsive behaviors (e.g., risky sexual behavior and antisocial behavior). The purpose of the present study was to extend extant research by exploring whether emotion dysregulation explains the association between PTSD and impulsive behaviors. Participants were an ethnically diverse sample of 206 substance use disorder (SUD) patients in residential substance abuse treatment. Results demonstrated an association between PTSD and impulsive behaviors, with SUD patients with PTSD reporting significantly more impulsive behaviors than SUD patients without PTSD (in general and when controlling for relevant covariates). Further, emotion dysregulation was found to fully mediate the relationship between PTSD and impulsive behaviors. Results highlight the relevance of emotion dysregulation to impulsive behaviors and suggest that treatments targeting emotion dysregulation may be useful in reducing impulsive behaviors among SUD patients with PTSD.