Rates Of Substance Use Problems Research Articles

Religiosity, impulsivity, and compulsivity in university students.

Prior research suggests that religiosity may be associated with healthier levels of mental health in certain domains (eg, higher self-esteem and lower rates of substance use problems). However, very little is known about religiosity and impulsive plus compulsive tendencies. This study examined associations between religiosity and impulsive and compulsive behaviors and traits among university students. Nine thousand, four hundred and forty-nine students received a 156-item anonymous online survey which assessed religiosity, alcohol and drug use, mental health issues, and impulsive and compulsive traits. Two groups of interest were defined: those with high religiosity, and those with low religiosity, based on z-scores. The two groups were compared on the measures of interest. Three thousand, five hundred and seventy-two university students (57.1% female) responded to the survey. Those with high levels of organizational religious activity, as well as those with high levels of intrinsic or subjective religiosity, differed from their fellow students in having better self-esteem, being less likely to have alcohol or drug problems, and generally being less impulsive in terms of attention and planning. Compulsivity did not differ between groups. Associations were of small effect size except for the link between religiosity and lower impulsivity, which was of medium effect size. This study shows a link between higher religiosity and lower impulsivity, as well as higher levels of mental health across several domains. Whether these associations are causal-and if so, the direction of such causality-requires rigorous longitudinal research.

Implementing risk stratification to the treatment of adolescent substance use among youth involved in the juvenile justice system: protocol of a hybrid type I trial

BackgroundYouth involved in the juvenile justice system (YIJJ) have high rates of substance use problems; however, rates of YIJJ engagement in substance use services is low. Barriers to service engagement include lack of appropriate screening and connection to services by the juvenile justice system, as well as lack of resources for delivering evidence-based treatment in community-based settings. To address these barriers, this paper describes a protocol for a type 1 hybrid design to (1) implement universal substance use screening for YIJJ; (2) implement and evaluate the feasibility and effectiveness of a brief, three-session substance use interventions based in motivational interviewing for youth with mild/moderate substance use: Teen Intervene (an individual-based intervention); (3) implement ENCOMPASS, an evidence-based substance use intervention based in motivational enhancement and cognitive behavioral therapy for youth with severe substance use; and (4) evaluate facilitators and barriers to implementing these interventions for mild to severe substance use among YIJJ in community mental health centers (CMHC).Methods/designUsing a hybrid type 1 clinical effectiveness-implementation design, we will collaborate with CMHCs and juvenile justice in two rural Indiana counties. Guided by the EPIS (exploration, preparation, implementation, sustainability) framework, we will measure factors that affect implementation of substance use screening in juvenile justice and implementation of substance use interventions in CMHCs utilizing self-reports and qualitative interviews with juvenile justice and CMHC staff pre- and post-implementation. YIJJ with mild/moderate substance use will receive a brief interventions and YIJJ with severe substance use will receive ENCOMPASS. We will measure the effectiveness of a brief and comprehensive intervention by assessing changes in substance use across treatment. We anticipate recruiting 160 YIJJ and their caregivers into the study. We will assess intervention outcomes utilizing baseline, 3-, and 6-month assessments.DiscussionFindings have the potential to improve screening and intervention services for YIJJ.

Syndemic Risk Classes and Substance Use Problems among Adults in High-Risk Urban Areas: A Latent Class Analysis.

Substance use problems tend to co-occur with risk factors that are especially prevalent in urban communities with high rates of poverty. The present study draws on Syndemics Theory to understand profiles of risk and resilience and their associations with substance use problems in a population at risk for adverse outcomes. African-American/Black and Hispanic heterosexual adults (N = 2,853) were recruited by respondent-driven sampling from an urban area with elevated poverty rates, and completed a structured assessment battery covering sociodemographics, syndemic factors (that is, multiple, co-occurring risk factors), and substance use. More than one-third of participants (36%) met criteria for either an alcohol or a drug problem in the past year. Latent class analysis identified profiles of risk and resilience, separately for women and men, which were associated with the probability of a substance use problem. Almost a third of women (27%) and 38% of men had lower risk profiles—patterns of resilience not apparent in other types of analyses. Profiles with more risk and fewer resilience factors were associated with an increased probability of substance use problems, but profiles with fewer risk and more resilience factors had rates of substance use problems that were very similar to the general adult population. Relative to the lowest risk profile, profiles with the most risk and fewest resilience factors were associated with increased odds of a substance use problem for both women [adjusted odds ratio (aOR) = 8.50; 95% CI: 3.85–18.74] and men (aOR = 11.68; 95% CI: 6.91–19.74). Addressing syndemic factors in substance use treatment and prevention may yield improved outcomes.

A Qualitative Study of Addiction Help-Seeking in People with Different Co-occurring Mental Disorders and Substance Use Problems

People with mental disorders (MD) have high rates of substance use problems (SUP) that are undertreated and understudied despite their adverse outcomes. The objective of this study is to examine barriers and facilitators that influence help-seeking to addiction treatment from the perspective of people with co-occurring MD and SUP. Forty-three individuals with MD and SUP were selected from the sample (n = 127) of a larger research project. This sub-group participated in semi-structured interviews and completed questionnaires. Interview contents were thematically analyzed using a trajectory approach. Based on participants’ addiction trajectories, two mental health experiences were identified: the “multiple disorders experience” and the “anxiety disorder experience.” The analysis highlighted how participants relate to barriers and facilitators to addiction help-seeking at the individual level (denial/minimization of problematic drug use, fear of being labeled an addict, influence of social networks, and knowledge of addiction services) and health system level (waiting time, costs, relationships with health providers, therapeutic approaches, and availability of psychological support). Interventions should be sensitive to the different experiences of people with MD and SUP. Integrated addiction services and a “no wrong door” approach are suggested.

Client and provider views on access to care for substance-using American Indians: perspectives from a Northern Plains urban clinic.

In addition to disparities in rates of substance use problems, American Indians (AIs) report multiple barriers to receiving treatment services. The present study utilized intake questionnaire data and focus groups to gain perspectives from 152 clients (65% male, 35% female; mean age 30 years) and 6 female providers on access to treatment for Northern Plains AIs in an urban, non-Native program. AI clients acknowledged the need for treatment more often than did substance users in general, but faced greater resource barriers. Both clients and providers offered specific recommendations for improving access to substance use treatment for AI populations in the Northern Plains.

Health Psychology Intervention in Key Social Environments to Promote Adolescent Health

Although important challenges remain, advances in psychological theory and practice have made significant contributions to preventing and reducing adolescent health problems in Australia and in other nations. This article reviews current approaches and advances within the field of health psychology, and their contribution to the prevention of high priority adolescent health problems and to adolescent health promotion. Advances in adolescent health in Australia are indicated by reductions in mortality, tobacco use, road trauma, early‐age alcohol use, illicit drug use, suicide, homicide, and HIV transmission. Within a strategic interdisciplinary public health model, psychologists have contributed to these advances through research identifying the psychological and behavioural processes that influence adolescent health risks, trialling and evaluating behavioural intervention strategies to reduce risk processes, and communicating evidence to advocate the dissemination of effective approaches. Current challenges in adolescent health include high rates of obesity and overweight related to increasing physical inactivity and overconsumption of high‐calorie and processed foods, high rates of substance use problems, and rising rates of youth violence and socioeconomic inequalities. Among potential solutions, this article describes the prevention science and positive youth development approaches to enhancing population rates of health and well‐being in the adolescent population.

Addressing Substance Use Disorders in VA Nursing Homes

Residents of Veterans Affairs nursing homes have high rates of substance use problems. To evaluate relevant treatment resources and practices available to them, we surveyed 48 nursing home units with high substance use disorder prevalence. We summarize survey findings and describe areas of strength and weakness in addressing the needs of residents with substance use disorders. Social workers can make important contributions in key areas identified in the survey, including fostering improved communication and coordination with medical center programs, educating care staff regarding substance use in older persons, and providing discharge planning that takes into account residents' substance use history.

Chronically Homeless Women Report High Rates of Substance Use Problems Equivalent to Chronically Homeless Men

Introduction The U.S. federal government recently committed itself to ending chronic homelessness within 5 years. Women constitute one out of four chronically homeless adults and represent a particularly vulnerable group, but have been little studied. To identify potentially unique needs in this group, we report characteristics and 2-year outcomes in a large sample of male and female chronically homeless adults participating in a multisite, supportive housing program. Methods Men and women participating in the outcome evaluation of the 11-site Collaborative Initiative on Chronic Homelessness ( n = 714) supportive housing program and who received at least one follow-up assessment were compared on baseline characteristics and up to 2-year follow-up outcomes. Mixed model multivariate regression adjusted outcome findings for baseline group differences. Results Few significant baseline differences existed between males and females, with both sexes self-reporting very high rates of lifetime mental health (83% women, 74% men) and substance use (68% women, 73% men) problems. Throughout the 2-year follow-up, both men and women dramatically increased the number of days housed, showed minimal changes in substance use patterns, and had modest improvements in mental health outcomes, without significant differences between genders. Conclusion Unlike other U.S. populations, chronically homeless adults do not demonstrate substantial gender differences on mental health or addiction problems. Policy and service delivery must address these remarkably high rates of substance use and mental illness.

College students rarely seek help despite serious substance use problems

The prevalence of substance use disorders (SUD) and aspects of the help-seeking process among a high-risk sample of 946 students at one large public university were assessed in personal interviews during the first 3 years of college. After statistically adjusting for purposive sampling, an estimated 46.8% wt of all third-year students met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUD involving alcohol and/or marijuana at least once. Of 548 SUD cases, 3.6% perceived a need for help with substance use problems; 16.4% were encouraged by someone else to seek help. Help-seeking was rare among SUD cases (8.8%) but significantly elevated among individuals who perceived a need (90.0%) or experienced social pressures from parents (32.5%), friends (34.2%), or another person (58.3%). Resources accessed for help included educational programs (37.8%), health professionals (27.0%), and 12-step programs (18.9%). College students have high rates of substance use problems but rarely recognize a need for treatment or seek help. Results highlight the opportunity for early intervention with college students with SUD.

Advances in Treating Chronic Nonmalignant Pain and Substance Use Disorders

Can J Psychiatry 2008;53(8):485^86 Substance use problems and chronic nonmalignant pain are 2 major causes of human suffering, health care use, and psychiatric and psychosocial dysfunction in the United States and around the world. Point prevalence estimates of chronic pain in the United States range from about 10% to 50% of the population, depending on the several definitions used,1 with similar rates reported elsewhere in the world.2 Even higher rates of chronic pain are reported in individuals with opioid and other substance use disorders,3 and rates of substance use problems both in the United States and in Canada are highly prevalent and growing.4-5 Substance use disorders and chronic pain produce an impressive and strikingly similar range and number of negative effects on humans and society, and cause notable concerns and dilemma in health care workers and across the entire health care treatment system. At a basic level, both problems are strong motivators of human behaviour, much of which is maladaptive. Substance use and chronic pain problems are commonly associated with high rates of health care use and hospitalization, and pain is the most common complaint given by individuals seeking health care in the United States.6 Substance use disorder also provokes a wide range of illegal and socially maladaptive behaviours to sustain access to drugs and to help disguise some of the negative effects of these substances on mood and behaviour.7 Another striking similarity between substance use and chronic pain problems is their blindness to social class and economics. These problems affect poor and wealthy alike, ignore educational background and accomplishments, and are oblivious to intelligence and talent. Equally important, each of these problems is related to marked deterioration in psychiatric and psychosocial functioning,7-8 including high rates of persistent unemployment.9-10 Other noteworthy similarities is their strong relation to increase risks of other health care problems, their ability to confound the diagnostic and treatment process of other psychiatric and medical disorders, and their capacity to create notably strained relations between patients and health care providers. Most of these problems are amplified in individuals unfortunate enough to have both substance use disorder and chronic pain. The articles in this In Review address these problems by focusing on 2 unique subgroups of patients that experience similar clinical courses and overall problem profiles. The article by Dr Michael Kidorf and Dr Van L King11 focus on a subset of injection drug users participating in a community-based syringe exchange program (SEP) to reduce the risk of human immunodeficiency virus and other blood-borne dis ease transmission. The report authored by Dr Michael R Clark, Dr Kenneth B Stoller, and me12 focuses on a subset of chronic pain patients enrolled in an outpatient treatment program for opioid and other substance dependence disorders. Both articles provide a clear and disturbing picture of the scope and severity of problems experienced by these individuals and the disturbingly low numbers of them receiving any specific treatment for their many problems. Despite the somewhat daunting scope of these problems, each article provides a rational and empirically based set of evaluation and treatment guidelines that have a good chance to improve access to treatment and overall quality of care. The article by Dr Kidorf and Dr King11 provides a comprehensive overview of the growth and benefits of community SEPs over the past decade, a compelling characterization of the scope and severity of drug use and other problems in injection drug users, and illustrates the large mismatch between these problems and the near absence of any treatment for them. A clear case and lucid strategy is presented for efforts to expand the benefits of community-based SEPs by using these settings to engage and motivate syringe exchangers to seek substance abuse treatment. …

Do Users of Regularly Prescribed Opioids Have Higher Rates of Substance Use Problems Than Nonusers?

To determine whether individuals who use prescribed opioids for chronic noncancer pain have higher rates of any opioid misuse, any problem opioid misuse, nonopioid illicit drug use, nonopioid problem drug use, or any problem alcohol use, compared with those who do not use prescribed opioids. Respondents were from a nationally representative survey (N = 9,279), which contained measures of regular use of prescribed opioids, substance use problems, mental health disorders, physical health, pain, and sociodemographics. In unadjusted models, compared with nonusers of prescription opioids, users of prescription opioids had significantly higher rates of any opioid misuse (odds ratio [OR] = 5.48, P < 0.001), problem opioid misuse (OR = 14.76, P < 0.001), nonopioid illicit drug use (OR = 1.73, P < 0.01), nonopioid problem drug use (OR = 4.48, P < 0.001), and problem alcohol use (OR = 1.89, P = 0.04). In adjusted models, users of prescribed opioids had significantly higher rates of any opioid misuse (OR = 3.07, P < 0.001) and problem opioid misuse (OR = 6.11, P < 0.001) but did not have significantly higher rates of the other outcomes. Users of prescribed opioids had higher rates of opioid and nonopioid abuse problems compared with nonusers of prescribed opioids, but these higher rates appear to be partially mediated by depressive and anxiety disorders. It is not possible to assign causal priority based on our cross-sectional data, but our findings are more compatible with mental disorders leading to substance abuse among prescription opioid users than prescription opioids themselves prompting substance abuse iatrogenically. In patients receiving prescribed opioids, clinicians need to be alert to drug abuse problems and potentially mediating mental health disorders.

Pathological gambling and comorbid substance use.

The objective of this study was to determine the rates of substance use problems in a sample of diagnosed pathological gamblers seeking treatment in a university teaching hospital cognitive behavioural outpatient clinic. A semistructured interview schedule and the composite international diagnostic interview (CIDI-auto) were administered to assess substance dependence in a sample of 75 poker-machine gamblers meeting DSM-IV and South Oaks gambling screen (SOGS) criteria for pathological gambling. Both the self-reported rates and the proportion meeting criteria for a psychiatric disorder were determined. The rates for substance use disorder within a sample of treatment-seeking pathological gamblers is higher as compared to general population figures. Gender differences were found with more current alcohol-abuse problems reported among male than female participants. Non-alcohol-related substance abuse was relatively lower than rates reported by other studies in the literature. Substance abuse is a common comorbid condition of pathological gambling and therefore should be screened for in routine clinical assessments. Failure to identify and treat comorbid substance-use disorders in gamblers may lead to higher relapse rates.

Concomitance between childhood sexual and physical abuse and substance use problems: A review

This review focuses on the apparent connection between childhood sexual or physical abuse (CSA, CPA) and later substance use problems (SUPs) among adolescents and adults. The rates of CSA among females with SUPs were found to be, on average, nearly two times higher than those found in the general population, and the rates of SUPs among women with CSA histories were found to be similarly elevated. The rates of CSA were not found to be elevated among males with SUPs, but men with histories of CSA were found to be at greater risk for SUPs than men in the general population. Women, girls, and boys with SUPs were found to have elevated rates of CPA relative to the general population, while adult males with SUPs were not found to have elevated rates of CPA. Concomitance rates were not found to vary systematically with regard to either the methodological quality of the studies included nor the year of study publication. Additional descriptive examination of selected studies indicates that among women, childhood abuse is likely to be a factor in the development of SUPs, but that the relationship is mediated by other psychiatric conditions, such as anxiety and depressive disorders.