Prior Substance Research Articles

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.

Predictors of incarcerated women’s postrelease PTSD, depression, and substance-use problems

ABSTRACTThis longitudinal project assessed predictors of women’s mental health postrelease from prison. Women (59) completed mental health and trauma exposure assessments while incarcerated and then postrelease. Women’s mental health did not change postrelease. Lifetime exposure to interpersonal violence and maladaptive coping were significantly associated with increased postrelease PTSD. In addition, adaptive and maladaptive coping were significantly associated with postrelease depression. Ethnicity, prior substance dependence, postrelease PTSD and depression, interpersonal violence since release, and coping were all significantly associated with postrelease substance use and problems. The findings of this study contribute to identification of potential points of intervention for women postrelease.

Abstract WMP49: White Matter Hyperintensities in a High Risk Population Living in Marginal Housing (HOTEL study)

Background: White Matter Hyperintensities (WMH) are features of cerebral small vessel disease (cSVD) along with lacunes, cerebral microbleeds and perivascular spaces. Vascular risk factors account for only a small proportion of the variability of the presence of WMH, and the role of additional risk factors including drug use/dependence or infections is not well defined. Objective: Examine prevalence and risk factors associated with WMH of presumed vascular origin within the HOTEL cohort, a population living in marginal housing with a high prevalence of prior homelessness, substance dependence, head trauma, mental illness and infectious diseases. Methods: Baseline imaging on 3T MRI included T1, T2-FLAIR and SWI sequences. WMH not consistent with vascular origins were excluded. Two raters assessed WMH using the Fazekas scale. Participants were divided into those with or without moderate-severe WMH (periventricular Fazekas score &gt;2 or deep score &gt;1). Potential cSVD risk factors which were significant on univariate analysis were entered into a multivariable stepwise binomial logistic regression to identify independent risk factors for moderate-severe WMH. Results: Intraclass coefficient for inter-rater reliability was 0.948 (95% CI, 0.924 to 0.965) for periventricular WMH and 0.848 (95% CI, 0.782 to 0.895) for deep WMH. Baseline prevalence of moderate-severe WMH (mean age 43.6 ± 9.5 years, 78% male) was 24.5%, much higher than in other, older healthy aging cohorts (Table). Age (OR 1.085, 95%CI 1.042-1.130), systolic blood pressure (OR 1.033, 95%CI 1.008-1.058) and regular injection drug use (OR 3.655, 95%CI 1.284-10.403) together explained 23.5% of variance in the presence of moderate-severe WMH within this population, with injection drug use having the largest effect. Conclusions: This young cohort appears to have an accelerated burden of cSVD, with injected drug use as a major risk factor. Further research is needed to elucidate potential mechanisms.

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.

Neurobehavioral Characteristics of Older Veterans With Remote Traumatic Brain Injury.

While traumatic brain injury (TBI) is common across the life span, the detailed neurobehavioral characteristics of older adults with prior TBI remain unclear. Our goal was to compare the clinical profile of older independently living veterans with and without prior TBI. Two veterans' retirement communities. Seventy-five participants with TBI and 71 without (mean age = 78 years). Cross-sectional. TBI history was determined by the Ohio State University TBI Questionnaire. We assessed psychiatric and medical history via interviews and chart review and conducted measures assessing functional/lifestyle, psychiatric, and cognitive outcomes. Regression analyses (adjusted for demographics, diabetes, prior depression, substance abuse, and site) were performed to compare between TBI and non-TBI participants. Compared with veterans without TBI, those with TBI had greater functional impairment (adjusted P = .05), endorsed more current depressive (adjusted P = .04) and posttraumatic stress disorder symptoms (adjusted P = .01), and had higher rates of prior depression and substance abuse (both adjusted Ps < .01). While composite memory and language scores did not differ between groups, participants with TBI performed worse on tests of executive functioning/processing speed (adjusted P = .01). Our results suggest that TBI may have adverse long-term neurobehavioral consequences and that TBI-exposed adults may require careful screening and follow-up.

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.

Age of Crime/Substance Onset and Crime/Drug Versatility as Dimensions of the “Worst of Both Worlds” Effect

The purpose of this study was to ascertain whether age of crime and substance use onset and prior crime and substance versatility (variety of crimes committed or drugs used) could help define the “worst of both worlds” effect. Analyses were conducted on 2,539 children and young adults from a nationally representative sample of private households in England and Wales. As predicted, the early onset crime/substance group achieved the worst future crime and substance outcomes, the late onset crime/substance group achieved the second worst outcomes, the crime or substance alone group achieved the third worst outcomes, and the no crime and substance group achieved the best outcomes. Likewise, the high crime/drug versatility group achieved the worst outcomes, the low crime/drug versatility group achieved the second worst outcomes, the crime or drug alone group achieved the third worst outcomes, and the no crime and drug group achieved the best outcomes.

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.

Characteristics of cases submitted to a statewide system of child abuse experts

BackgroundThe Texas Department of Family and Protective Services (DFPS) created a statewide network of child abuse pediatricians working at 6 academic centers in 2006. MethodsCase data for the period 9/1/2012–8/31/2014 were reviewed for child demographics, risk factors, physician determinations, injury descriptors, and information made available to the physician. Results8061 of 410,315 DFPS cases (2%) were referred during the period. Network utilization rates ranged from 7.5% in counties served by San Antonio to 1.4% in Austin-served counties. Cases from outlying counties were less likely to involve older children. African American children were over-represented in referrals, and Caucasian and Asian children were underrepresented. Prevalent risk factors included prior DFPS history, single parent-household, mental illness, substance abuse, and domestic violence. Network providers found no or only nonspecific evidence for maltreatment in 45% of cases. Determinations were hindered by poor quality photographs in 188 cases and inadequate skeletal surveys in 121. Insufficient information precluded case completion for 65 cases of children <2years. ConclusionsOur data indicate that child abuse centers in Texas are underutilized, and there are practice differences with respect to medical referrals across different regions. Our findings concerning ethnic differences and risk factors are consistent with national trends. The problems of inadequate photographs and case information may improve with better training of workers; the issue of poor quality skeletal surveys requires further study. Standard DFPS criteria for referrals to child abuse pediatricians should mitigate some of the problems identified by this study.

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.

McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.

Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis. We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes. At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients. Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.

Assessment and Treatment of a Person at Risk for Psychosis in a Culturally Complex Case

A14-year-old Asian American girl presented to the emergency room with suicide ideation and a plan to overdose on medication. She reported the following symptoms of depression: chronic feelings of sadness, negative future outlook, anhedonia, agitation, indecision, and sleep disturbance. The symptoms had been present for 1 year. She went from being an honor roll student to struggling to pass several of her classes. Upon further investigation, she disclosed experiencing auditory and visual hallucinations. She was admitted for inpatient evaluation and treatment. She denied any prior or current substance use, and did not have any previous mental health treat-

Trajectories of Adolescent Alcohol Use in the Year Following a Brief Alcohol Intervention.

Brief interventions have become increasingly popular for youth who engage in problematic drinking behavior. The purpose of this study was to examine the alcohol use trajectories of adolescents over a 12-month period following the receipt of a brief intervention. The current sample came from two independent studies and consisted of 206 adolescents (ages 13-19; 52% male) recruited through an emergency department or community institution (e.g., courts, schools). Timeline followback methods were used at four points over 1 year to obtain daily estimates of alcohol use behaviors, with daily data then aggregated at the monthly level to examine trajectories of total drinks consumed and maximum drinks on one occasion. Using latent growth curve analysis, we expected a general pattern of increasing use over time, with lower use during the month immediately following completion of the intervention. Models with random intercepts, random linear slopes, and fixed quadratic trends provided good fit to the data for both total drinks and maximum drinks. For each outcome, there was an immediate decrease and then a gradual increase up to the 3- and 6-month assessments, with decreases seen in the months following assessments. Older age, White race, non-Hispanic ethnicity, and greater prior substance use were associated with greater initial levels of use and growth over time. Interindividual differences were observed in alcohol use trajectories over time for high-risk adolescents following an alcohol use intervention. Subsequent research may demonstrate more uniform and permanent modification of trajectories by incorporating intervention-related materials into follow-up contacts.