Prior Substance Use Research Articles

The Influence of Romantic Relationships on Substance Use in Emerging Adulthood

The current work built on prior research showing aspects of romantic relationships, including relationship quality and partner substance use, influence individual risk for substance use during emerging adulthood. Analyses were based on a sample of males from the Pathways to Desistance Project (PDP) data. Romantic relationships were quantified with an aggregate measure of relationship quality and specific measures of relationship satisfaction, monitoring, and partner antisocial behavior. With a focus on emerging adulthood, the current work was centered on Waves 8 and 9 of the PDP data. Regression models tested the association between the relationship measures and alcohol intoxication, marijuana use, and hard drug use in the past year. Models considered both contemporaneous and longitudinal effects. Across the aspects of romantic relationships, monitoring and partner antisocial behavior had the most consistent association with substance use. The association between monitoring and substance use was strongest when longitudinal effects were tested among those in a relationship at both Waves 8 and 9. Peer antisocial behavior and prior substance use were also associated with substance use. Results show that romantic relationships have an important influence on substance use within a criminal justice involved sample.

Predicting Suicide Attempts and Suicide Deaths Following Outpatient Visits Using Electronic Health Records.

The authors sought to develop and validate models using electronic health records to predict suicide attempt and suicide death following an outpatient visit. Across seven health systems, 2,960,929 patients age 13 or older (mean age, 46 years; 62% female) made 10,275,853 specialty mental health visits and 9,685,206 primary care visits with mental health diagnoses between Jan. 1, 2009, and June 30, 2015. Health system records and state death certificate data identified suicide attempts (N=24,133) and suicide deaths (N=1,240) over 90 days following each visit. Potential predictors included 313 demographic and clinical characteristics extracted from records for up to 5 years before each visit: prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency department care, and routinely administered depression questionnaires. Logistic regression models predicting suicide attempt and death were developed using penalized LASSO (least absolute shrinkage and selection operator) variable selection in a random sample of 65% of the visits and validated in the remaining 35%. Mental health specialty visits with risk scores in the top 5% accounted for 43% of subsequent suicide attempts and 48% of suicide deaths. Of patients scoring in the top 5%, 5.4% attempted suicide and 0.26% died by suicide within 90 days. C-statistics (equivalent to area under the curve) for prediction of suicide attempt and suicide death were 0.851 (95% CI=0.848, 0.853) and 0.861 (95% CI=0.848, 0.875), respectively. Primary care visits with scores in the top 5% accounted for 48% of subsequent suicide attempts and 43% of suicide deaths. C-statistics for prediction of suicide attempt and suicide death were 0.853 (95% CI=0.849, 0.857) and 0.833 (95% CI=0.813, 0.853), respectively. Prediction models incorporating both health record data and responses to self-report questionnaires substantially outperform existing suicide risk prediction tools.

Religious Involvement and Substance Use Among Urban Mothers

AbstractAlthough numerous cross‐sectional studies suggest that religious involvement is associated with lower rates of substance use, it is unclear whether these protective effects can be observed over time with more rigorous longitudinal designs. In this study, we use longitudinal data from the U.S. Fragile Families and Child Wellbeing Study (n = 3,176) to test whether indicators of religious involvement are protective against illicit drug use and prescription drug misuse among mothers who are primarily single and of low socioeconomic status. Our results show that religious involvement at baseline is unrelated to prescription drug misuse at follow‐up. We also find that religious attendance at baseline reduces the odds of illicit drug use at follow‐up. Respondents who increased their level of religious attendance over the study period also tended to exhibit a concurrent reduction in the odds of illicit drug use. Although prior substance use was unrelated to changes in religious attendance, prior illicit drug use and prescription drug misuse were associated with a reduction in religious salience over the study period.

Social cognitive theory as a theoretical framework to predict sustained abstinence 6 months after substance use treatment

ABSTRACTBackgrounds: A wide variety of factors such as individualistic and social/environmental factors appear to determine whether or not individuals can successfully quit substance use. In this study, Social Cognitive Theory was used as a theoretical framework to predict substance use abstinence among a sample of Iranian substance users.Methods: Data from 269 male substance users undergoing residential treatment were analyzed using logistic regression to assess the effects of socio-cognitive factors (treatment motivation, perceived social support, drug avoidance self-efficacy, and drug quitting outcome expectations) and background characteristics measured at 5–7 days after admission on drug abstinence status measured at 6-month follow-up.Results: Abstinence rate after 6-month follow-up was 48.6%. Perceived social support, treatment motivation, prior substance use treatment, and age of onset of substance use were predictors of abstinence. However, substance use treatment outcome was not influenced by drug avoidance self-efficacy, drug quitting outcome expectations, and demographic variables.Conclusion: Our findings do not support the notion that pretreatment drug avoidance self-efficacy and drug quitting outcome expectancies are among the most consistent predictors of substance use treatment outcome. Accordingly, future research is recommended to explore post-treatment levels of these variables on treatment outcome.

A Randomized Clinical Trial Examining the Effect of Video-Based Prevention of Alcohol and Marijuana Use Among Recent Sexual Assault Victims.

This study examined whether a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims reduced alcohol and marijuana use at 3 points over the course of a 6-month follow-up compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Prior assault history, minority status, and pre-SA substance use also were examined as moderators of intervention efficacy. Women aged 15 and older (N=154) who participated in a post-SA medical forensic examination were randomly assigned to watch the PPRS video (n=54) or the PIRI video (n=48) or receive TAU (n=52) and completed at least 1 follow-up assessment targeted at 1.5 (T1), 3 (T2), or 6 (T3) months following the examination. Regression analyses revealed that, relative to TAU, PPRS was associated with less frequent alcohol use at 6months post-SA among women reporting pre-SA binge drinking and minority women. Relative to TAU, PPRS also was associated with fewer days of marijuana use at T1 among those who did not report pre-SA marijuana use and prior SA. Findings for pre-SA marijuana use were maintained at T3; however, findings for prior SA shifted such that PPRS was associated with fewer days of marijuana use at T3 for women with a prior SA. PPRS may be effective at reducing substance use for some recent SA victims,including those with a prior SA history, a prior substance use history, and minority women.

Trajectories of energy drink consumption and subsequent drug use during young adulthood

BackgroundHighly caffeinated energy drinks (EDs) are popular with adolescents and young adults, but longitudinal consumption patterns are poorly understood especially in relation to other substance use. MethodsED and other substance use were assessed annually (modal ages 21–25) among a sample (n=1099) who were originally recruited as first-year college students (modal age 18). Trajectory groups were derived based on probability of past-year use during ages 21–24, and compared for possible differences in substance use outcomes at age 25, holding constant demographics, sensation-seeking, other caffeine consumption, and age 21 substance use. ResultsFrom age 21–25, ED consumption declined in both annual prevalence [62.5%wt to 49.1%wt (wt=weighted)] and frequency of use among consumers (35.2–26.3 days/year). Yet individuals exhibiting a Persistent trajectory (51.4%) of consumption outnumbered those with Non-Use (20.6%), Intermediate (17.4%), or Desisting (10.6%) trajectories. Age 25 cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD) risk were significantly associated with trajectory group membership, with Persistent and Intermediate groups exhibiting the highest risk for such outcomes, even accounting for prior substance use and other risk factors. Neither marijuana nor tobacco use were associated with group membership. ConclusionsThe typical pattern of ED consumption among this sample was sustained use throughout young adulthood. Such individuals appear to be at high risk for adverse substance use outcomes, and results suggest possible specificity regarding cocaine use and NPS, and AUD risk. More research is needed to understand the mechanisms underlying the connection between ED and substance use.

Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

BackgroundHepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. ConclusionWhile only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine

IntroductionPatients with opioid use disorder often require multiple treatment attempts before achieving stable recovery. Rates of disengagement from buprenorphine are highest in the first month of treatment and termination of buprenorphine therapy results in return to use rates as high as 90%. To better characterize these at-risk patients, this study aims to describe: 1) the frequency and characteristics of patients with very early disengagement (≤1month) from Office Based Opioid Treatment (OBOT) with buprenorphine and 2) the frequency and characteristics of patients who re-engage in care at this same OBOT clinic within 2years, among the subset of very early disengagers. MethodsThis is a retrospective cohort study of adult patients enrolled in a large urban OBOT program. Descriptive statistics were used to characterize the sample and the proportion of patients with very early (≤1month) disengagement and their re-engagement. Multivariable logistic regression models were used to identify patient characteristics associated with the outcomes of very early disengagement and re-engagement. Potential predictors included: sex, age, race/ethnicity, education, employment, opioid use history, prior substance use treatments, urine drug testing, and psychiatric diagnoses. ResultsOverall, very early disengagement was unusual, with only 8.4% (104/1234) of patients disengaging within the first month. Among the subset of very early disengagers with 2years of follow-up, the proportion who re-engaged with this OBOT program in the subsequent 2years was 11.9% (10/84). Urine drug test positive for opiates within the first month (AOR: 2.01, 95% CI: 1.02–3.93) was associated with increased odds of very early disengagement. Transferring from another buprenorphine prescriber (AOR: 0.09, 95% CI: 0.01–0.70) was associated with decreased odds of very early disengagement. No characteristics were significantly associated with re-engagement. ConclusionsEarly disengagement is uncommon; however, continued opioid use appeared to be associated with higher odds of treatment disengagement and these patients may warrant additional support. Re-engagement was uncommon, suggesting the need for a more formal explicit system to encourage and facilitate re-engagement among patients who disengage.

Health Self Efficacy and African American Male Inmates Prior Substance Use Treatment History: Implications for STI Risk Reduction

Health Self Efficacy and African American Male Inmates Prior Substance Use Treatment History: Implications for STI Risk Reduction

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth

BackgroundYouth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. MethodsYouth ages 13–24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. ResultsRates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) ConclusionsThis study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

The Effect of Adverse Childhood Experience on Clinical Diagnosis of a Substance Use Disorder: Results of a Nationally Representative Study

ABSTRACTBackground: Substance abuse is one of the most common health outcomes associated with adverse childhood experience, and poses a significant public health threat. Objectives: The purpose of this study is to demonstrate a relationship between adverse childhood experience and a substance use disorder using nationally representative data as well as to test whether religion moderates this relationship. Methods: We conducted a secondary analysis using data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,279). Three types of adverse childhood experiences were considered; physical, emotional, and sexual abuse. Logistic regression was used to determine whether risk for developing an alcohol use, cannabis use, or other drug use disorder in adulthood increased as exposure to multiple types of adverse childhood experiences increased while controlling for prior substance use and other demographic variables that have shown associations with substance use. In addition, religiosity was investigated as a possible moderator of the relationship between adverse childhood experience and substance abuse. Results: The likelihood of developing a substance use disorder later in life increased as the score on the adverse childhood experience index increased. While religiosity did significantly reduce the likelihood of developing a substance use disorder, no moderating effects were observed. Conclusions/importance: This study underscores the long-term consequences of exposure to childhood adversity.

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

BackgroundRisk factors associated with developing opioid use disorders (OUD) are documented, but less is known about different pathways to initiation of opioids or opioid dependence, or how such pathways affect treatment engagement. MethodsWe recruited 283 adults with electronic medical record (EMR) evidence of opioid dependence diagnoses. Open-ended and structured interview items focused on prior opioid treatment experiences, barriers to and knowledge of treatment options. Interviews were audio-recorded, transcribed, and coded. In exploratory analyses, we used a modified grounded theory approach to organize emergent, patient-reported themes describing participants' perceived pathways to opioid dependence. Results121 participants described one or more pathways to OUD. Qualitative analyses revealed five pathway themes. Three pathways were related to pain control: inadequately controlled chronic pain, exposure to opioids during acute pain episodes, and chronic pain among individuals with prior substance use disorders. A fourth pathway included individuals for whom opioids provided relief from emotional distress; the fifth related to recreational or non-medically supervised opioid use. We identified pain-related barriers to reducing/stopping opioids and treatment engagement barriers among individuals who perceived themselves solely as pain patients. ConclusionPatients' perceptions of inadequately controlled pain, patients' previous substance use disorders, and the relief from emotional distress that some patients feel while using opioids are relevant when making clinical decisions about whether to initiate or sustain opioid therapy, and for how to monitor certain individuals. Among individuals with pain and OUD, treatment barriers include fear of uncontrolled pain, and stigmatization of being treated alongside people with non-medical opioid use.

A Within-Person Analysis of the Association between Borderline Personality Disorder and Alcohol Use in Adolescents.

Many studies examining the association between borderline personality disorder (BPD) and alcohol use during adolescence have focused on between-individual differences (rank order stability), comparing whether adolescents with elevated rates of alcohol use have higher BPD symptoms than those with lower rates of alcohol use. As such, the extent to which an individual's alcohol use is associated with concurrent and future BPD symptoms has been relatively unstudied. The current study assessed year-to-year fluctuations in alcohol use and BPD symptoms in a large urban sample of girls from age 14 to age 17 (N=2450). The primary aim was to examine whether increases in alcohol use were associated with increases in adolescent girls' BPD symptoms in the same year and in the following year. Results of fixed-effects (within-individual) models revealed that even while controlling for the time-varying impact of symptoms of both internalizing and externalizing disorders, prior and concurrent other substance use, and all time invariant, pre-existing differences between individuals, higher past-year alcohol use was associated with higher levels of BPD symptoms. Furthermore, this association did not vary by age, or by sociodemographic factors, including child race and socioeconomic status of the family. The results of this study indicate heightened risk for the exacerbation of BPD symptoms following increases in alcohol use frequency and highlight the potential utility of interventions targeting drinking behavior for preventing escalations in BPD symptoms.

Psychiatric disorders as predictors of long-term opioid therapy and the need for treating chronic pain correctly in patients with prior opioid substance use disorder: a commentary.

Psychiatric disorders as predictors of long-term opioid therapy and the need for treating chronic pain correctly in patients with prior opioid substance use disorder: a commentary.

More Than Friends and Family? Estimating the Direct and Indirect Effects of Religiosity on Substance Use in Emerging Adulthood

Religiosity tends to negatively influence substance use among emerging adults because religious communities can serve as pro-social reference groups and provide alternative resources for coping with stress and negative life events. The relationship may also be mediated, however, by differences in family attachments and drug- and alcohol-using peer associations. With data from a nationally representative panel study, I implemented longitudinal structural equation modeling to simultaneously assess both direct and indirect effects of religiosity on substance use. While a substantive portion of its effect is mediated by substance-using peers, it is mostly direct, and increasingly so as individuals transition from late adolescence to emerging adulthood. Furthermore, religion appears to be a particularly effective social institution, as religiosity decreases contemporary substance use but is not itself affected by prior substance use. Religiosity may thus be beneficial with regard to certain short- and long-term health outcomes related to substance use during emerging adulthood.

Trajectories of marijuana use from late childhood to late adolescence: Can Temperament × Experience interactions discriminate different trajectories of marijuana use?

Informed by developmental ecological and epigenetic theory, the current study examined three aims concerning adolescent marijuana use with a large community sample (N = 755; gender = 53% female) and six annual assessments that spanned 11-18 years of age. First, the natural history of adolescent marijuana use was modeled using a two-part latent growth curve analysis. Second, the validity of the mixtures was examined with a broad array of known correlates of adolescent marijuana use. Third, temperament (e.g., surgency, effortful control, and negative affect) was tested as individual differences that would enter into statistical interactions with peer substance use and prior alcohol and cigarette use to distinguish trajectories of marijuana use. The results suggested that escalations in marijuana use were observed for some youth who initiated marijuana use early in adolescence. Youth whose marijuana use did escalate substantially (10%) were distinguished on temperament, conduct disorder, peer delinquency, and pubertal development at baseline. Furthermore, hypothesized interactions between surgency and both peer substance use and prior substance use discriminated different patterns of marijuana use. The findings are discussed with respect to strategies for timing and content of preventive interventions.

Suicidal Ideation and Attempts Among Court-Involved, Nonincarcerated Youth

ABSTRACTOver the past decade, suicide remains one of the leading causes of death among adolescents and a public health priority. Court-involved non-incarcerated juvenile justice youth frequently present with risk factors for suicide. Among these court-involved youth, 14% (n = 50) endorsed a lifetime history of suicidal ideation and attempts. Three main factors were associated with increased risk: prior offense, substance use, and childhood sexual abuse histories. This study highlights the importance of understanding suicidal behavior among nondetained juvenile justice populations. Community-based court involvement provides a rare opportunity to coordinate screening and suicide prevention efforts for youth and their families.

Prior substance use, depression and gender as determinants of self-harm urges in prison inmates: A study of Uyo Prison

This study examined prior substance use, depression and gender as determinants of selfharm urges in prison inmates. It was a survey utilizing ex-post facto design. A total of 183 male and 29 female inmates from Uyo prison participated in the study. Their mean age was 34.4years. Multi-stage sampling method was used. The t-test results {t (210)=2.89, p<.01} showed that inmates who used psychoactive substances before imprisonment reported higher self-harm urges than those who did not use. Also, inmates with high depressive symptoms reported higher self-harm urges than those with low depressive symptoms {t (210)= 4.21, p<.01}. The interaction of prior substance use and depression was significant, Wilks Lambda = .72, F (1, 210) = 19.02, p = <.01, partial eta squared = .17. A post-hoc test was conducted using LSD to show multiple comparison effect. Furthermore, the t-test results {t (210)= 2.60, p<.01} showed that female inmates reported higher self-harm urges than their male counterparts. The findings of this study have implications on the involvement of psychologists and other mental experts in the management of the prison system. Keywords: Self-harm urges, prior substance use, depression, gender, prison inmates

The Relationships of Cigarette and Alcohol Use With the Initiation, Reinitiation, and Persistence of Cannabis Use

This study used a prospective survey to examine (a) the relationships of early onset and prior consumption of cannabis, cigarette, and alcohol use with later cannabis use initiation, reinitiation, and persistence; and (b) whether the quantity or frequency of alcohol or cigarette use was more predictive of cannabis use initiation, reinitiation, or persistence. This study used data from the National Epidemiologic Survey of Alcohol and Related Conditions, Wave 1 (2001-2002) and Wave 2 (2004-2005), including 27,741 nonusers, 5,623 prior users, and 1,279 current cannabis users at baseline who were at risk of cannabis use initiation, reinitiation, and persistence, respectively, between baseline and follow-up assessments. We employed logistic regression to examine the effects of prior substance use on cannabis use initiation, reinitiation, and persistence, controlling for sociodemographics. Frequency and early-onset status of cigarette use (≤14 years) and alcohol use (≤17 years) predicted cannabis use initiation and reinitiation but not persistence. While considering the potential effects of early onset and consumption levels of cannabis use, baseline alcohol and cigarette use quantity and frequency did not predict persistent cannabis use. Frequency, compared with quantity, of alcohol and cigarette use was more predictive of cannabis use initiation and reinitiation. Early onset and prior experience with cannabis, cigarettes, and alcohol could have effects on later cannabis use, varying among the three at-risk populations. Different strategies are needed for preventing cannabis use initiation, reinitiation, and persistence, based on targeting early use of alcohol and cigarettes.

Pain Symptoms Associated with Opioid Use among Vulnerable Persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention.

Current or former injection drug users with human immunodeficiency virus (HIV) are at high risk for pain, which adversely affects their quality of life and may increase their risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among injection-drug-using study participants with HIV who had histories of heroin use. Using generalized estimating equations and controlling for prior substance use, we found that pain in each six-month period was associated with the use of heroin and prescription opioids, but not the use of nonopioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed for persons with HIV and a history of injection drug use, particularly those with chronic pain, for whom there is increased risk for heroin use.