Risk For Substance Use Disorders Research Articles

Impact of Treatment with Central Nervous System Stimulant and Risk of Substance Use Disorder in Adults with Attention-Deficit/Hyperactivity Disorder

Impact of Treatment with Central Nervous System Stimulant and Risk of Substance Use Disorder in Adults with Attention-Deficit/Hyperactivity Disorder

Age-varying association between discrimination, childhood family support, and substance use disorders among Latin American immigrants in the United States.

The cultural stress theory posits that immigrants experience a constellation of cultural stressors such as discrimination that could exacerbate alcohol- and other substance-related problems. Drawing on cultural stress theory, this study investigated the age-varying association between past-year discrimination and substance use disorders (SUDs) among Latin American immigrants aged 18-60 and whether childhood family support moderated the above association. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) among adults aged 18-60 who identified as a Latin American immigrant (N = 3,049; 48% female). Time-varying effect models (TVEMs) revealed that experiencing past-year discrimination was associated with greater odds of having a SUD during young and middle adulthood for Latin American immigrants. Furthermore, for immigrants with lower childhood family support, discrimination was associated with SUD risk in young and middle adulthood. The present study documents that past-year discrimination was linked to greater SUD risk during young and middle adulthood. Childhood family support may serve as a protective factor in the association between discrimination and risk for SUD among Latin American immigrants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Excess mortality among people in homelessness with substance use disorders: a Swedish cohort study

BackgroundPeople in homelessness have an increased risk of substance use disorders (SUDs) and poor health outcomes. This cohort study aimed to investigate the association between homelessness and mortality in people...

Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus): A Novel Interprofessional Training for Rehabilitation Science Professional Students.

With the increasing amount of substance use-related health conditions in the United States, it is important for rehabilitation science professionals to receive screening and prevention training. To describe and examine the preliminary effectiveness of a novel educational program, Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus), that combines traditional SBIRT training with new modules for cannabis, stimulant, and opioid use. Prospective, cohort design. Academic institution. One hundred eighty-one rehabilitation science graduate students. SBIRT-Plus curriculum. Outcomes included satisfaction with training, perception of interprofessional training, attitudes, knowledge, and stigma, as assessed with the Readiness for Interprofessional Learning Scale, Alcohol and Alcohol Problems Perception Questionnaire, Drug and Drug Problems Perception Questionnaire, Knowledge Screening Scale, and two stigma instruments. Most students (>80%) expressed satisfaction with their training, would recommend the training to a colleague, and believed that the training would influence and change the way they practiced with patients at risk for substance use disorders. Students' attitudes and knowledge increased from pre- to post-training, and stigma perceptions were significantly reduced. SBIRT-Plus is an evidence-based interprofessional training that is feasible to implement in graduate-level education programs. Integrating SBIRT-Plus into professional graduate programs may be an optimal and low-cost model for training rehabilitation health care professionals. Plain-Language Summary: Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus) is an evidence-based interprofessional training that can be easily adopted in curricula to train professional students about the importance of screening for substance use disorders.

Substance Addiction in Adolescents: Influence of Parenting and Personality Traits.

Substance use in adolescents has been separately related to personality traits and parental socialization styles; in this study, our objective was to study these variables in an integrated way. A cross-sectional observational study was conducted in five institutes in a final sample of 331 students, excluding those with gaming disorder. The sample was stratified into three subgroups: 'no addiction', 'low risk', and 'high risk' of Substance Use Disorders (SUD). 12.9% of the adolescents presented a low risk of SUD, while 18.3% showed a high risk, with both being older (F = 9.16; p < 0.001) than the no addiction group. Adolescents with high risk scored lower in control and structure variables and higher in maternal and paternal indifference factors. Non-addicted subjects presented higher scores in conscientiousness, extraversion, and agreeableness and lower scores in neuroticism. The probability of SUD increased with age (OR = 2.187; p = 0.022), sensation seeking (OR = 1.084; p < 0.001), and neuroticism (OR = 1.049; p = 0.042), while conscientiousness was a protective factor (OR = 0.930; p = 0.008). These results reflect that personality traits are directly related to the development of substance abuse in adolescents.

Impulsivity mediates the association between narcissism and substance-related problems beyond the degree of substance use: a longitudinal observational study

BackgroundNarcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association.MethodsNarcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators.ResultsGrandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂M = 0.30) and antagonistic narcissism (P̂M = 0.26) with substance-related problems.DiscussionWe demonstrate that grandiose narcissism– particularly antagonistic but also agentic narcissism– is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.

Mental Health of Adolescents Exposed to the War in Ukraine

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented. To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure. This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war. Self-reported exposure to war. A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated. A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25). The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

The Potential and Challenges of Genomics Informed Precision Care for Substance Use Disorders.

Substance use disorders (SUDs) are complex brain disorders with heritability rooted in the interplay of multiple genetic factors, alongside significant environmental influences. Gaining insights into the genetic mechanisms that heighten SUD risk can guide precision care, specifically in the development of targeted tools for prevention, early intervention, and the discovery of therapeutic targets. Nurses are ideally placed to advance genomics-informed precision care for individuals with SUDs. To fulfill this role, they must be adequately prepared to assess the value and utility of current genomics knowledge, its limitations, and ways to incorporate this understanding into clinical practice, education, research, and health care policy. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 11-14.].

Pattern of Risks for Psychiatric and Substance Use Disorders in the Offspring of Parents With Alcohol Use Disorder.

The authors sought to clarify the components of the familial liability to alcohol use disorder (AUD) by examining parent-offspring transmission in a large Swedish population sample. To this end, 1,244,516 offspring in intact families with a mean age at follow-up of 37.7 years (SD=6.8) were examined. Hazard ratios for offspring of parents with AUD were calculated using Cox models for risk of five disorders assessed from Swedish medical and criminal registries: AUD, drug use disorders, attention deficit hyperactivity disorder, major depression, and anxiety disorders. The hazard ratio for the offspring was highest for AUD (hazard ratio=2.36), followed by drug use disorder (hazard ratio=2.04), attention deficit hyperactivity disorder (hazard ratio=1.82), major depression (hazard ratio=1.43), and anxiety disorder (hazard ratio=1.43). The risks for AUD were statistically indistinguishable between the children having mothers with AUD compared with those having fathers with AUD and between sons and daughters of a parent with AUD. All risks for offspring having two parents with AUD were higher than those having one parent with AUD, but the increase with two parents with AUD was greatest for AUD, followed by drug use disorder and attention deficit hyperactivity disorder. Age at AUD onset of the parents predicted risk among the offspring more strongly for AUD and drug use disorder, followed by attention deficit hyperactivity disorder, and then major depression and anxiety disorders. Number of recurrences of the parents with AUD predicted risks for all disorders equally. The risk pattern of disorders for the offspring of not-lived-with fathers with AUD was similar to that in the main analysis of intact families. No evidence was found for sex-specific transmission of AUD or a familial female protective effect. Familial and likely genetic liability to AUD has three components: a nonspecific risk of common internalizing and externalizing disorders, a moderately specific risk of externalizing disorders, and a highly specific risk of AUD.

It is not just about transcription: involvement of brain RNA splicing in substance use disorders.

Alternative splicing is a co-transcriptional process that significantly contributes to the molecular landscape of the cell. It plays a multifaceted role in shaping gene transcription, protein diversity, and functional adaptability in response to environmental cues. Recent studies demonstrate that drugs of abuse have a profound impact on alternative splicing patterns within different brain regions. Drugs like alcohol and cocaine modify the expression of genes responsible for encoding splicing factors, thereby influencing alternative splicing of crucial genes involved in neurotransmission, neurogenesis, and neuroinflammation. Notable examples of these alterations include alcohol-induced changes in splicing factors such as HSPA6 and PCBP1, as well as cocaine's impact on PTBP1 and SRSF11. Beyond the immediate effects of drug exposure, recent research has shed light on the role of alternative splicing in contributing to the risk of substance use disorders (SUDs). This is exemplified by exon skipping events in key genes like ELOVL7, which can elevate the risk of alcohol use disorder. Lastly, drugs of abuse can induce splicing alterations through epigenetic modifications. For example, cocaine exposure leads to alterations in levels of trimethylated lysine 36 of histone H3, which exhibits a robust association with alternative splicing and serves as a reliable predictor for exon exclusion. In summary, alternative splicing has emerged as a critical player in the complex interplay between drugs of abuse and the brain, offering insights into the molecular underpinnings of SUDs.

Assessing emotional intelligence domains and levels in substance use disorders

BackgroundMany individuals with substance use disorders face challenges in their social interactions and often have strained relationships with peers. Challenges related to problem-solving, stress management, and impulsivity often contribute to their substance use disorders. Emotional intelligence plays a pivotal role in assisting individuals with substance use disorders in coping with stress, enhancing peer connections, resolving problems, and preventing relapse. Consequently, our study aimed to assess emotional intelligence in individuals with substance use disorders and explore the factors influencing it. A cross-sectional study compared 50 individuals with substance use disorders and 50 healthy individuals. We assessed various factors, including clinical data, sociodemographic variables, family socioeconomic status, Addiction Severity Index (ASI) scores, and Emotional Intelligence (EI) scale scores.ResultsIndividuals with substance use disorders had significantly lower mean scores in total EI and its subscales compared to the healthy control group. Additionally, a higher percentage of individuals with substance use disorders exhibited low EI levels, while healthy individuals demonstrated better EI. Furthermore, there was a substantial association between higher ASI scores in individuals with substance use disorders and lower EI scores.ConclusionsLower EI scores are associated with an increased risk of substance use disorders. Also, can contribute to difficulties in impulse control, and challenges in managing relationships and stress. These findings underscore EI crucial role in preventing and treating substance use disorders.

Effects of Stimulant Treatment on Changes in Brain Activation During Reward Notifications in Drug Naïve Youth With ADHD

Background: Research examining the potential effects of stimulant exposure in childhood on subsequent development of substance use disorder (SUD) have focused on differences in the brain reward system as a function of risk. Methods: 18 drug naïve children ages 7 to 12 years (11 High Risk [ADHD + ODD/CD]; 7 Low Risk [ADHD only]), underwent fMRI scans before and after treatment with mixed amphetamine salts, extended release (MAS-XR). We examined correlations between clinical ratings and fMRI activation at baseline and following treatment as a function of risk status. Results: High Risk children had higher activation than Low Risk children at baseline during both the Reward and Surprising Non-Reward conditions. Treatment produced strong differential effects on brain activation pertinent to group and reward outcome. Conclusions: Findings support the hypothesized role of reward mechanisms in SUD risk, and suggest that stimulant treatment may have differential effects on reward processing in relation to SUD risk.

Perspectives on early insights: pediatric cancer caregiving amidst natural calamities - A call for future preparedness.

Natural disasters cause immense damage and disruption to the environment, human lives, and property, posing a threat to safety and well-being. These disasters annually affect individuals and communities, severely impacting mental health. Research indicates a significant link between catastrophic events and an increased risk of mental disorders, including anxiety, depression, substance use, and post-traumatic stress disorder (PTSD). Individuals with chronic conditions, like cancer patients, are particularly vulnerable post-disaster due to disrupted healthcare services. The recent earthquake in Morocco highlighted the urgent need for continued care, especially for vulnerable populations living in poverty. Soleterre Foundation's interventions focus on supporting young cancer patients and their families, emphasizing psychological support following the earthquake. Effective disaster response needs coordinated efforts, clear roles, communication, and standardized healthcare procedures, especially for vulnerable groups like cancer patients. Education programs for patients and clinicians are vital for disaster preparedness. Communication challenges and lack of medical history further emphasize the need for well-defined disaster preparedness plans and continued care guidelines for cancer patients.

Predictors of Substance Use Risk in Nurse Anesthetists.

Certified registered nurse anesthetists (CRNAs) are exposed daily to highly addictive substances and stressful work environments, placing them at risk for substance use disorders (SUDs). Previous research, which is scarce, indicated that drugs of choice were opioids and propofol. Therefore, the purpose of this study was to investigate predictors of SUD risk using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test. From June to July 2020, an online survey was sent via the American Association of Nurse Anesthesiology Research Survey Service to 3,000 CRNAs with a response of approximately 225 members. CRNAs were found to be at a moderate risk for SUDs in the following categories: 10.27% for tobacco, 23.56% for alcohol, and 6.28% for cannabis. Regression analysis by substance category includes robust, differing models in this homogeneous sample. Predictors for all three models include a collection of demographic variables, religiosity, anxiety, difficulties due to anxiety, depression, substance use history, contact with the American Association of Nurse Anesthesiology Peer Assistance Program, and organizational support. Over 10% of CRNAs are at risk for developing tobacco use disorder, and almost one quarter of those surveyed are at a moderate risk for developing alcohol use disorder. These data are of concern and may indicate a shift of preferred substances used by CRNAs from controlled substances to alcohol.

Challenging Disability Discrimination in the Clinical Use of PDMP Algorithms.

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm-generated information and risk scores motivates clinicians to refuse to treat-or to inappropriately treat-vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act.

Rural and urban differences in disparities in substance use and substance use disorders affecting sexual minority populations.

Sexual minority populations are at elevated risk for substance use (SU) and substance use disorders (SUD) compared to heterosexual populations. These disparities are theorized to be amplified for rural sexual minority populations due to their increased exposure to minority stress and reduced access to sexual minority communities. However, there is a lack of research examining differences in SU disparities affecting sexual minority populations by urbanicity, and little research has examined differences in SUD treatment utilization by sexual minority status or urbanicity. We utilized data from 2015 to 2019 National Survey on Drug Use and Health to examine disparities in SU, SUD, SUD treatment utilization, and unmet SUD treatment need between sexual minority and heterosexual populations and test whether such disparities vary by urbanicity. Results indicate that disparities in SU and SUD affecting sexual minority populations generalize across urbanicities. A subset of disparities differed by urbanicity, and the direction of these differences varied, with some disparities being stronger in urban than rural populations and vice versa. Despite elevated treatment utilization among some sexual minority groups, disparities in unmet SUD treatment need were prevalent across urbanicities and sexual identity groups. Study findings highlight the ubiquity of disparities in SU, SUD, and unmet SUD treatment need affecting rural and urban sexual minority populations, while also demonstrating nuanced differences in disparities by urbanicity. The persistence of disparities in unmet SUD treatment need emphasizes the need for future research to identify factors contributing to this disparity and for policies that alleviate these disparities.

Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA

Background: While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied. Objective: To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA. Methods: This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4. Results: Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2–6.8). Conclusion: Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.

Which substances pose the greatest risk of substance use disorder after controlling for polysubstance use?

Both physiological and epidemiological research suggest that certain psychoactive substances have a greater potential for abuse (e.g. heroin) than others (e.g. hallucinogens). The use of multiple substances is also associated with a higher risk of substance use disorder (SUD). The goal of the present study was to evaluate the association between the use of different substances and the risk of SUD while accounting for polysubstance use. Data from the 2021 National Survey on Drug Use and Health (n = 58,034, unweighted) were used. Eight different substances (i.e. Alcohol, Cannabis, Cocaine, Inhalants, Hallucinogens, Heroin, Methamphetamine, and Opiate Misuse) were compared with respect to their typical frequency of use; the prevalence of SUD among individuals using each substance; the odds of SUDs when controlling for polysubstance use; and the rate of other substance use among those with a substance-specific SUD. Notable differences were found regarding the frequency of use and the rate of SUD among individuals reporting past year use. Heroin and methamphetamine were associated with the highest risk of SUD across all analyses. In contrast, hallucinogens and inhalants were consistently identified as having the lowest risk. The present results confirm that certain substances appear to have an inherently greater association with SUD compared to other substances. While these findings are not fundamentally divergent from prior epidemiological studies or ranking systems, they provide a more solid empirical foundation for assumptions of differential risk.

1805. Tennessee’s Drug Diversion Investigation Team: A Collaborative Approach to a Growing Public Health Problem

Abstract Background Injection drug use using nonsterile equipment can lead to transmission of viral, bacterial, and fungal infections. Frontline healthcare workers (HCW) are at high risk for substance use disorder due to unprecedented job stress and access to injectable controlled substances. The Tennessee Department of Health (TDH) developed a collaborative investigative process to determine the risk of bloodborne pathogen (BBP) transmission from licensed HCWs engaging in drug diversion. This program recommends public health action and provides consultation to improve drug diversion programs. Methods In 2019 TDH formed a drug diversion investigation team (DDIT) consisting of pharmacists, epidemiologists and medical directors from the HAI and HIV/STI/Viral Hepatitis programs. The DDIT responds to notification by the Health-Related Boards (HRB) of a licensed HCW under investigation for diversion of injectable products. The DDIT interviews the investigator and meets the facility drug diversion program to review drug diversion policies and processes. Based on the suspected method(s) and, if known, the individual’s Hepatitis B/C and HIV status, recommendations are made regarding the need for patient notification and testing. Results From 2020–2022 the DDIT received notification of 49 licensed HCWs under investigation for diversion of injectable products. Patient notification and testing was recommended in seven facilities for CDC Category A infection control breaches; in two cases, later HCW testing negated the need for further action. Among the 34 facilities queried, only five (14.7%) had existing policies for for-cause BBP testing. Other recommendations to improve diversion programs include infection prevention participation and releasing “not eligible for rehire” status to other facilities. Conclusion The TDH DDIT facilitates communication with HRB on reported cases of injectable drug diversion. Joint investigations with facilities raise awareness of the risk of BBP transmission and improve facility diversion programs. Tennessee facilities are adding for-cause BBP testing to their investigation procedures. The TDH DDIT model receives mostly positive responses from facility and health system drug diversion teams and may be considered by other public health jurisdictions. Disclosures All Authors: No reported disclosures

Neuroimaging in Adolescents: Post-Traumatic Stress Disorder and Risk for Substance Use Disorders.

Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them, post-traumatic stress disorder (PTSD) during adolescence illustrates the connection between trauma and substance misuse, as adolescents may utilize substances to cope with PTSD. Drug misuse may in turn lead to neuroadaptations in learning processes that facilitate the consolidation of traumatic memories that perpetuate PTSD. This reflects, apart from common genetic and epigenetic modifications, overlapping neurocircuitry engagement triggered by stress and drug misuse that includes structural and functional changes in limbic brain regions and the salience, default-mode, and frontoparietal networks. Effective strategies to prevent PTSD are needed to limit the negative consequences associated with the later development of a substance use disorder (SUD). In this review, we will examine the link between PTSD and SUDs, along with the resulting effects on memory, focusing on the connection between the development of an SUD in individuals who struggled with PTSD in adolescence. Neuroimaging has emerged as a powerful tool to provide insight into the brain mechanisms underlying the connection of PTSD in adolescence and the development of SUDs.