Problematic Substance Use Research Articles

Providing holistic end-of-life care for people with a history of problem substance use: a mixed methods cohort study of interdisciplinary service provision and integrated care

Harmful use of illicit drugs and/or alcohol is linked to life-limiting illness and complex health and social care needs, but people who use substances and have complex needs do not receive timely palliative care and fail to achieve quality standards for a good death. They and their families often require support from multiple health and social care services which are shown to be poorly integrated and fail to deliver interdisciplinary care. This study aimed to identify the existing barriers and facilitators within and between services in providing this population with a good death. Using a mixed methods approach of survey, focus groups and semi-structured interviews, we explored the perspectives of practitioner and management staff across a range of health and social disciplines and organisations in one combined authority in a large city in the north west of England. Our findings indicate that practitioners want to provide better care for this client group, but face structural, organisational and professional boundary barriers to delivering integrated and shared care. Differences in philosophy of care, piecemeal commissioning and funding of services, and regulatory frameworks for different services, lead to poor and inequitable access to health and social care services. Ways forward for improving care are suggested as bespoke hostel-based accommodation for palliative care for this client group, and specialist link workers who can transcend professional and organisational boundaries to support co-ordination of services and support. We conclude that it is no longer adequate to call for more training, better communication and improved joint working. Complex care at the end of life requires creative and cohesive systemic responses that enable multi-disciplinary practitioners to provide the care they wish to give and enables individuals using substances to get the respect and quality service they deserve.

Psychiatric comorbidities among patients hospitalized in the addictology department of Ar Razi hospital in Morocco

IntroductionComorbidity between psychiatric disorders and disorders linked to psychoactive substance use is common and represent a real public health problem.The association of a psychiatric disorder can, in certain cases, modify the treatment methods and also the evolution of the addictive behavior.ObjectivesDetermining the prevalence of psychiatric comorbidities in patients with substance use disorder Identify the sociodemographic and clinical characteristics of patients hospitalized in the addictology department.MethodsWe conducted a cross-sectional study with descriptive and analytical aims, in order to study psychiatric comorbidities in 150 patients with substance use disorder hospitalized in the addictology department of Ar Razi hospital in Salé over a period from June 1, 2022 to August 30, 2023.Data collection was done using a questionnaire including clinical and socio-demographic characteristics, the prevalence of problematic use of psychoactive substances and the comorbidity of psychiatric disorders (diagnoses assessed by DSM 5 criteria).ResultsA male predominance was noted (80%). The main substances consumed in the last 12 months were tobacco (98%), cannabis (74%), alcohol and benzodiazepines.The majority of patients presented at least one psychiatric comorbidity (80%), with a predominance of depressive disorder and anxiety disorders.Personal history of suicide attempts was found in 30% of the sample Substance dependency that prompted initially the consultation was higher in patients with psychiatric comorbidity (p < 0.05)Post-traumatic stress disorder was significantly associated with the presence of problematic cocaine and alcohol use. Social phobia is associated with the absence of a criminal record.ConclusionsAddictive behaviors are often associated with psychiatric disorders. The most common psychiatric comorbidities are depression, anxiety and personality disorders, hence the need for simultaneous treatment of psychiatric pathologies and addictive behaviorDisclosure of InterestNone Declared

Epidemiological, clinical, and forensic approach to a series of defendants examined in criminal psychiatric expertise

Introduction The transgression of the law can be a deliberate act by a lucid adult, but it can also be the result of a deficiency in judgment and discernment due to lack of age or insanity. Psychiatric expertises are more and more solicited in the penal field with the objective of identifying the causal link between mental illness and the criminal act.ObjectivesThe objective of this work was to give an overview of the subjects expertised, the offences and the pathologies encountered through the report of a psychiatric expertise activity in criminal law.MethodsIt is a retrospective descriptive study carried out on the criminal psychiatric expertises made for a forensic act in the psychiatric department of Mahdia during the period from January 1, 2003 to March 30, 2022.Results In total, we collected 101 defendants. The average age of our study population was 35±12.07 years. The majority of our study sample was male (98%), from an urban area (50%). 46.6% had primary education and only 11.2% had higher education. The defendants were single in 57.8% of the cases, and almost half (45.7%) had no occupation. Two-thirds of the accused (61.2%) had experienced emotional deprivation at a young age. The problematic use of psychoactive substances was found in 10.3%, as well as alcohol consumption in 46.6%. Moreover, 39.7% of the patients had a personal psychiatric history and 19% had been incarcerated at least once. The forensic acts were mostly against people (62.9%) dominated by physical aggression (33.6%) followed by homicide or its attempt in 19% of the cases. The majority of patients were not related to their victims (62.1%). The nosographic diagnosis found was a personality disorder in 32.75% of cases, followed by schizophrenic disorders in 22.4% of cases.ConclusionsPsychiatric expertise is a useful, complex and noble clinical act. Determining the predictive factors of a possible acting out allows to specify the objectives of interventions aiming at limiting the acts of violence, hospitalizations and incarcerations of patients suffering from mental disorders.Disclosure of InterestNone Declared

Stories of building friendships during long-term recovery from problematic substance use

Background Building friendship is crucial for attaining and upholding recovery from problematic substance use. However, how people who have used substances problematically develop friendships needs to be investigated more from a first-person perspective. Aim To provide insight into how people in long-term recovery find meaning in their experience of building friendships. Method In semi-structured interviews, 17 people in recovery drew network maps and reflected on how friendships had developed during the long-term process. We analysed the narratives by way of a thematic narrative approach. Results Participants presented the friendship-formation process through four distinct storylines: (1) ‘I don’t make friends easily’; (2) overcoming barriers to building friendships; (3) ‘birds of a feather flock together’; and (4) ‘having “regular” friends makes me feel like an “average” person’. Conclusion People in long-term recovery from problematic substance use felt haunted and hindered by past experiences when building friendships. These experiences created a social divide between those who had experienced problematic substance use and those who had not. The valuable insights that social workers can gain from this study can support friendship development for people in long-term recovery on multiple levels. By understanding someone’s self-perceptions and their perspectives on others, social workers can engage with barriers when people in recovery enter social environments such as work. We emphasise the significance of a long-term approach to overcoming barriers to building new friendships.

Substanzkonsum und Nutzung von sozialen Medien, Computerspielen und Glücksspielen unter Auszubildenden an beruflichen Schulen

ZusammenfassungHintergrundDas Ziel der vorliegenden Arbeit war die Erfassung der Verbreitung des (problematischen) Konsums von Alkohol, Tabak und Cannabis sowie der (problematischen) Nutzung sozialer Medien, von E‑Produkten, Computerspielen und Glücksspielen unter Auszubildenden.MethodeQuerschnittliche Befragung von 4591 Auszubildenden an 17 beruflichen Schulen in Bayern, Schleswig-Holstein und Hamburg. Die Datenerhebungen mittels Fragebogen erfolgten zwischen März 2021 und April 2022. Die primären Endpunkte waren die 30-Tages-Prävalenz und das problematische Konsum- und Nutzungsverhalten der genannten Substanzen/Verhaltensweisen auf Basis von Screening-Instrumenten.ErgebnisseSoziale Medien wurden mit einer 30-Tages-Prävalenz von 97,7 % am häufigsten von den Auszubildenden genutzt, gefolgt von Alkohol (64,3 %) und Computerspielen (55,8 %). Zigaretten wurden von 35,1 %, E‑Produkte von 17,9 % und Cannabis von 15,4 % konsumiert. Glücksspiele betrieben 12,2 % der Auszubildenden. Ein problematischer Konsum lag für Alkohol bei 47,4 %, für Tabak bei 18,0 %, für E‑Produkte bei 6,2 % und für Cannabis bei 1,6 % der Auszubildenden vor. Eine problematische Nutzung sozialer Medien wiesen 45,0 % der Auszubildenden auf, bei Glücksspiel waren 2,2 % und bei Computerspielen 0,7 % betroffen.DiskussionDie Ergebnisse weisen darauf hin, dass es sich bei Auszubildenden um eine Risikogruppe für Suchtprobleme handelt, die erhöhten Interventionsbedarf aufweist. Vor allem Angebote der Sekundärprävention in den Bereichen Alkohol und soziale Medien sollten aufgrund ihrer weiten Verbreitung im Setting Berufsschule beachtet werden.

Integration of an Electronic Screening, Brief Intervention, and Referral to Treatment Program Into an HIV Testing Program to Reduce Substance Use and HIV Risk Behavior Among Men Who Have Sex With Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial.

Men who have sex with men (MSM) are disproportionally affected by HIV and drug and alcohol use; however, few effective HIV prevention interventions for MSM who use substances exist. Screening, Brief Intervention, and Referral to Treatment is an early intervention for non-treatment-seeking individuals with problematic substance use and for timely referral to treatment for those with substance use disorders. Electronic screening and brief interventions (e-SBIs) reduce implementation challenges. An e-SBI tailored for MSM at the time of HIV testing might be particularly opportune to strengthen their motivation to reduce substance use and HIV risk behavior. This study aims to develop a tailored e-SBI program to reduce substance use and HIV risk behavior among MSM seeking HIV testing at Nexo Asociación Civil, our community partners in Argentina (primary); assess the feasibility and acceptability of integrating the e-SBI into the Nexo HIV testing program (primary); assess the feasibility and acceptability of implementing an adapted Men's Health Project (MHP) at Nexo (secondary); and finally, explore preliminary findings on substance use and sexual risk reduction outcomes (exploratory). This mixed methods study has 2 stages. During stage 1 (development), we will use the User Centered Rapid App Design process consisting of focus groups (n=16), individual interviews (n=24), and a pilot deployment of the e-SBI (n=50) to iteratively develop the e-SBI. Quantitative and qualitative assessments at each step will inform the revision of the e-SBI. Furthermore, we will use the assessment, decision, administration, production, topic experts, integration, training, testing framework to adapt MHP. During stage 2 (pilot randomized controlled trial [RCT]), we will randomize 200 MSM coming to Nexo for HIV testing. They will complete a baseline assessment and then their assigned intervention (e-SBI vs screening only) and will be followed-up for 6 months. We will also conduct in-depth interviews with up to 45 participants: 15 participants from either study condition who entered or completed MHP or other substance abuse treatment and 15 from each arm who met the criteria for MHP but did not request it. The study began recruitment in October 2022, and the stage-1 pilot study is near completion. Preliminary findings from stage 1 show high e-SBI acceptability. Data analysis of the stage-1 pilot is now beginning. The stage-2 pilot RCT will be launched in March 2024, with all data collection completed by May 2025. This study will allow us to assess the acceptability and feasibility of e-SBI implementation during HIV testing encounters. We will also build the necessary research infrastructure for a subsequent RCT to assess the efficacy of e-SBIs in reducing substance use and HIV sexual risk behavior among MSM in this setting. ClinicalTrials.gov NCT05542914; https://tinyurl.com/yyjj64dm. DERR1-10.2196/56683.

The elephant in the room: Metaphors in women's accounts of life with a family member with problematic substance use.

Background: Research has shown that a family member's problematic substance use has significant deleterious mental and physical health impacts on other members of the family. Women are more often affected than men. These negative health effects persist as the person with problematic substance use ages, and they vary according to the relationship status. Aim: The aim of this study was to gain a deeper understanding of how women experience and are affected by their family member's substance use problems. Method: A metaphorical analysis of narrative interviews with 11 daughters and five wives of older adults (>65 years) with problematic substance use. Results: We identified four areas of signification in which metaphors were employed: (1) experiences (chaos and crash and walking on eggshells); (2) strategies (complicity and silencing); (3) dilemmas (deceit or a disease and open or closed dilemmas); and (4) consequences (obtaining or retaining an identity, health and different types of help). Conclusion: Family life with a parent or spouse with a substance use problem was described as chaotic, unsafe, uncertain and with no prospects of change. The study illustrates how metaphors are used to mediate experiences and worldviews pertaining to existential matters founded in deep negative emotions, deceit, shame and stigma. Metaphors make up a crucial material for communicating emotions and themes that are difficult to convey due to shame and stigma.

Problematic substance use in depressed adolescents: Prevalence and clinical correlates

BackgroundSubstance use among adolescents is common and associated with significant consequences, including depression. Adolescents can experience myriad problems related to early onset substance use and depression, making further understanding of this comorbidity necessary. MethodParticipants were a subset from a large-scale performance improvement project and consisted of adolescents aged 12–18 who screened positive for depression during their routine medical or psychiatric appointment and who then completed the substance use assessment Car, Relax, Alone, Forget, Friends, Trouble Version 2.1 (CRAFFT). Participants with problematic substance use had a CRAFFT score ≥2. ResultsA total of 621 participants were included in this study, and 105 (16.9%) reported problematic substance use. Compared with participants without problematic substance use, those with problematic use were more likely to have moderate to severe depression and anxiety, as well as significantly higher irritability, impulsivity, suicidal propensity, and suicidal thoughts scores. Controlling for age at screening, sex, race, and ethnicity, problematic substance use remained a significant predictor of depression severity, impulsivity, suicidal propensity, and suicidal thoughts. LimitationsParticipants were from a large, metropolitan area of the Southwest United States who must have screened positive for depression, so results may not generalize. Because all participants were underage, they may have been wary in responding to the substance use assessment accurately. ConclusionsBy using a large, diverse sample in a real-world clinical setting, findings strengthen the association between problematic substance use and depression and depression-associated symptoms among adolescents, highlighting the need for early detection and universal depression screening.

Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia.

Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.

Structural instability and linear allocation control in generalized models of substance use disorder

Substance use disorder (SUD) is a complex disease involving nontrivial biological, psychological, environmental, and social factors. While many mathematical studies have proposed compartmental models for SUD, almost all of these exclusively model new cases as the result of an infectious process, neglecting any SUD that was primarily developed in social isolation. While these decisions were likely made to facilitate mathematical analysis, isolated SUD development is critical for the most common substances of abuse today, including opioid use disorder developed through prescription use and alcoholism developed primarily due to genetic factors or stress, depression, and other psychological factors. In this paper we will demonstrate that even a simple infectious disease model is structurally unstable with respect to a linear perturbation in the infection term — precisely the sort of term necessary to model SUD development in isolation. This implies that models of SUD which exclusively treat problematic substance use as an infectious disease will have misleading dynamics whenever a non-trivial rate of isolated SUD development exists in actuality. As we will show, linearly perturbed SUD models do not have a use disorder-free equilibrium. To investigate management strategies, we implement optimal control techniques with the goal of minimizing the number of SUD cases over time.

A mixed methods experience sampling study of a posttraumatic growth model for addiction recovery

Problematic substance use and addiction is a growing crisis in the United States. As a result, identifying factors that effectively promote addiction recovery is, currently, of particular societal importance. Informed by evidence that—while addiction can be perpetuated by stress-related impulsivity and decreased self-regulation—perceived social support is protective against addiction, we test a model for addiction recovery as a form of posttraumatic growth (PTG), focused specifically on close relationships and personal strength—two domains of PTG. In an initial study, we found that perceived social support and impulsivity predicted number of relapses in individuals in a substance use disorder recovery program. Using experience sampling, we then observed that experiencing a stressful event predicted impulsive behavior. However, experiencing closeness with others—a domain of PTG—was directly associated with perceived social support, and both predicted positive emotional states, which were, in turn, inversely associated with experiencing a stressful event. Further, when experiencing a stressful event, personal strength—also a domain of PTG—was inversely associated with impulsive behavior and was predicted by both perceived social support and positive emotional states. Finally, in a follow-up experiment, we found that an ecological momentary intervention targeting perceived social support decreased impulsivity and increased self-regulation—an aspect of personal strength—in a dose-dependent fashion. Taken together, our findings: (1) support a PTG model for recovery; (2) provide evidence for processes by which close supportive relationships are protective against addiction and relapse; and (3) indicate that self-regulation is responsive to a short in-the-moment perceived social support intervention. We suggest that these findings support the theory that addiction is a social disease in the sense that close personal interactions and supportive relationships: (a) buffer against stress-related impulsivity, thereby protecting against addiction and relapse; and (b) increase personal strength, thereby decreasing the probability of impulsive—including addictive—behavior and promoting recovery.

Bereaved siblings’ stories of drug-related death

Background Deaths caused by problematic substance use are an international concern. In bereavement, meaning-making is an essential activity embedded in social and cultural contexts. There is a lack of knowledge about how sociocultural perceptions and stigma associated with problematic substance use and drug-related deaths influence how bereaved siblings give meaning to the loss of their loved ones. Methods This article investigates bereaved siblings’ meaning-making stories about the drug-related death of their brother or sister. The study involves in-depth interviews with 14 bereaved siblings, analysed via a discursive psychologic perspective. Results Participants used four groups of sense-making stories about drug-related deaths: ‘death as the only outcome,’ ‘death caused by difficulties in the family,’ ‘death caused by lack of public help’, and ‘stories of uncertainty and doubt.’ Conclusion By identifying culturally constructed storylines used by participants about their siblings’ deaths, positionings of blame and responsibility are displayed, leading to social consequences that may affect how siblings bereaved by drug-related deaths cope with their loss and adapt to life without their brother or sister.

I was easier for him to control when I was drunk: women’s experiences of substance use and domestic abuse victimisation

Many women who are victims of domestic abuse also experience problematic substance use; yet there is a gap in knowledge concerning the interplay of both issues from the perspective of women. While some may use substances to cope with the impact of abuse, their use of substances can also be used against them by the perpetrator as a means of control. This narrative study seeks to reduce the gap in knowledge regarding women’s substance use and victimisation experiences by presenting findings from interviews with women who have experienced the co-occurring issues. Reflecting on the definition of coercive control, and exploring women’s narratives, this article demonstrates how perpetrators may use a woman’s substance use as justification to increase dependency, isolate them from sources of support, reduce their independence and regulate their everyday behaviour. This is an important finding, evidencing how substances are a tactic of coercive control. Conversely, the narratives also illustrate how women may use their substance use to be in control in an uncontrollable situation. Initial recommendations highlight the need to explore the nuance of experience among women with co-occurring substance use and domestic abuse, so that support is provided that is reflective of their lived experience.

Internet, App-Based, and Casino Gambling: Associations Between Modality, Problem Gambling, and Substance Use.

Technology-based gambling prevalence is not well understood since relevant questions are not included in health and disease surveillance studies. The current study sought to estimate the prevalence of internet-based and smartphone app-based gambling, along with casino gambling, in a sample of U.S. young adults and determine if gambling modality was associated with problem gambling symptoms or substance use. The 2022 Rhode Island Young Adult Survey included N = 1,022 students between the ages of 18 to 25 years old who had lived in Rhode Island, with n = 414 lifetime gamblers (40.5%) included in this study. Odds of gambling via a smartphone app and on the internet, respectively, were greater in heterosexual cis-males compared to heterosexual cis-females (OR[95%CI] = 3.14 [1.25,7.91]; OR[95%CI] = 6.30 [2.05,19.3]). Internet gambling amongst employed students was less common than among those who were not a student and not employed (OR[95%CI] = 0.25 [0.06,1.00]). Odds of problem gambling symptoms were higher among those who gambled via a smartphone app (OR[95%CI] = 3.23 [1.21,8.60]). All forms of gambling were associated with alcohol consumption, although the strength of the association was stronger in app and internet gamblers. Casino gamblers were more likely to be high risk marijuana and illicit drug users. The rising availability of app gambling coupled with its social, psychological, and cultural context may presents an alternative pathway to problem gambling. Bans on internet gambling and/or strict guidelines on the frequency of wagers and cash placed per wager, should be considered as viable methods to mitigate associated consequences.

Rethinking Substance Use as Social History: Charting a Way Forward.

Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors' own experiences as generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as "life-style choices" rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use. The ongoing placement of the substance use history within the Social History may lead to a failure to diagnose and make appropriate management plans for clients with substance use disorders. These missed opportunities may include inadequate withdrawal management leading to discharge before medically advised, insufficient use of evidence-based pharmacotherapy and psychotherapy, polypharmacy, medical complications, and repeated admissions to hospital. We argue instead that the Substance Use History should be a stand-alone section within the consultation note. This new section would reduce the invisibility of substance use disorders within our medical systems and model that these chronic medical conditions are amenable to prevention, treatment and harm reduction through the application of evidence-based practices.

119. Problematic Screen Use, Mental Health, and Substance Use Among Early Adolescents: a Prospective Cohort Study

119. Problematic Screen Use, Mental Health, and Substance Use Among Early Adolescents: a Prospective Cohort Study

‘It's a sanity restorer’: Narcotics anonymous (NA) as recovery capital during COVID‐19 in Aotearoa New Zealand

AbstractNarcotics Anonymous has flourished globally across 143 countries as a key community response to problematic substance use, despite disruptions, including the COVID‐19 pandemic. This research sought to understand how the Aotearoa New Zealand Narcotics Anonymous (NA) community engaged with NA meetings online during the 2020–2021 COVID‐19 pandemic. During in‐depth, semi‐structured interviews, 11 NA members shared their stories of addiction, abstinence‐based recovery, experiences of NA and managing pandemic restrictions. A narrative analysis identified four tropes particularly relating to how community members managed during the pandemic: responding via technology; maintaining recovery connections; creating opportunities; and consistency. Each trope showcases how NA members were able to connect online and garner support for their abstinence‐based recoveries and, more generally, during unprecedented times. In addition, the NA members in this research narrated the opportunities the pandemic restrictions created for them, such as engaging with the NA programme in new ways and improving their quality of life. Members of NA were able to maintain their psychological, physical, spiritual and community wellbeing during the COVID‐19 pandemic primarily due to existing recovery capital—peer‐based support and the principles of the 12‐steps of NA. The implications are that access to peer‐based communities and salient recovery identities are pivotal during ordinary and extraordinary times. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Barns upplevelser av en intervention i familjer där vuxna har ett problematiskt bruk av alkohol och droger

Aim: To investigate children's experiences of the intervention Me and my Family. Me and my Family is an intervention, for families with parental substance use problems (SUP) provided by Swedish social services outpatient care, includes eight weekly sessions where family members communicate how the SUP affects the family. Method: Data consists of 17 qualitative interviews with children, 7 to 19 years old. The qualitative data were analysed using a thematic approach, initially inductively and then discussed by adding salutogenic perspective. Results: The results are presented in three themes. Regardless of the children's varying ages, the results indicate that participating in the intervention has helped the family break the taboo surrounding parental substance use and enabled the young participants to communicate with their family members differently. The intervention also contributed to stronger bonds between children and their parents.

Substance use outcomes from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS).

Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3-12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use). The sample was from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), a naturalistic follow-up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7-17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11-26 years) at the time of the first CAMELS follow-up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use). Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow-up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow-up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow-up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome. Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.

Exploring the Methodological Benefits and Challenges of Utilising a Photovoice Methodology With Individuals in Recovery From Problem Substance Use.

Photovoice is a type of visual research method which supports participants to reflect upon their experiences by capturing digital images. It is a methodology that is routinely used with groups that could be considered vulnerable, as a way of allowing participants to tell their stories for themselves. This article details the process of conducting a Photovoice study with individuals in recovery from problem substance use and reflects on the methodological benefits and challenges of utilising a visual research methodology with this population. Researchers wishing to conduct a Photovoice study with individuals in recovery should be mindful of striking a delicate balance between respecting an individual's autonomy and ensuring their wellbeing. Although ethically complex, Photovoice is an ideal method for research with this population as it allows participants to convey meaning and introduce narratives for themselves in an engaging way.