Risk Of Substance Misuse Research Articles

Screening for illicit drug use in psychiatric hospitals: whose job is it?

This review focuses on screening and assessment in general psychiatric settings, where drug use is unlikely to be known to service providers. It builds on the recurrent finding that psychiatric patients are at high risk of substance misuse. The application of self-report questionnaires and rating scales and more in-depth assessment instruments is outlined, as are biological screening techniques. The use of brief self-completion questionnaires probably offers the most practical approach to routine screening by non-specialist staff in general hospital settings. The importance of implementing such tools lies in reaching an accurate diagnosis, choosing treatments more appropriately and monitoring the management of patients' psychiatric disorders.

Cross-cultural research on the development of adolescent substance misuse

Large epidemiological studies have shown that the prevalence of substance misuse (e. g., early initiation, binge drinking, illegal drug use) varies considerably among adolescents from different countries or regions (Currie et al., 2004). However, the underlying reasons for these differences are not necessarily known. The developmental sciences have attempted to explain the progression of adolescent problem behaviours, such as misuse of psychoactive substances (Silbereisen & Weichold, in press). For example, an imbalance between risk and protective factors is believed to engender behavioural problems, and certain national or cultural differences may help explain this relationship. A variety of personal risk factors that increase the probability of adolescent substance misuse have been identified in prior research. It is believed that such risk factors typically work proximally (e. g., positive consumption expectations) or distally (e. g., negative emotions) to influence substance use. In addition, characteristics of the broader cultural, socio-institutional, and immediate developmental contexts in which children and adolescents grow up (e. g., low social control or easy access to substances) can increase the risk for substance misuse (Petraitis et al., 1998). Moreover, protective factors that decrease the likelihood for adolescent substance misuse have been a focus of research (Silbereisen & Weichold, in press). Among such factors are positive relationships to parents or other adult role-models, external support systems (e. g., school), and positive attitudes towards school and learning (Jessor et al., 1998). The extent to which the potential influence of these factors can be generalized across different national, cultural or ethnic groups is not yet fully understood. Identifying differences in the balance of risk and protective factors among different groups may explain why adolescents from different countries differ in their substance-use behaviours. This article will summarise some such explanations. Adolescents are exposed to cultural traditions, social practices, and cultural norms which transact with developmental contexts. Across different cultures, pertinent influences on substance use vary, including patterns and methods of use, social acceptance, or policies on advertisement (Unger et al., 2004). For example, there may be cultural differences in the level or type of developmental resources provided or in the ease of access adolescents have to substances (e. g., laws against alcohol and tobacco advertisement, low consumption rate for general population, fines for smoking and drinking in public places). Another example relates to differences in access to organized and structured after-school activities, which are known to provide protection through positive role-modelling and social norms. Thus, some risk and protective factors may be culturally specific in their nature or importance. The investigation of differences in the role of risk and protective factors on adolescent substance misuse is of concern for health professionals aiming for theory-based development, implementation, and dissemination of effective prevention strategies. If risk and protective factors are similarly important for explaining substance use in different contexts, universal program components are appropriate for adolescents of different national or cultural groups (WHO, 1997). In the case of context-specific effects of risk and protective factors on substance use, culturally specific prevention components may be more adequate in meeting the target groups’ needs (Springer et al., 2004). Thus, cross-national research aiming at the comparison of the risks and protective factors related to substance misuse is necessary for recommending effective prevention strategies and social policies.

P.2.110 A case of schizophrenia-like psychosis in a patient with temporal arachnoid cyst

There is significant overlap in the pharmacological management of pain and psychological disorders. Appropriate treatment of patients' comorbid psychological disorders, including sleep disturbances often leads to an improvement in reported pain intensity. The three first line agents for neuropathic pain include tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors which are medications originally developed as antidepressants. The other first line medication for chronic neuropathic pain are anticonvulsant medications initially brought to the market-place for the treatment of epilepsy and are also now being used for the treatment of anxiety disorders and substance withdrawal symptoms. The efficacy of opioids for chronic pain is contentious, but it is agreed that the patients at highest risk for opioid misuse and addiction are patients with underlying psychological disorders who use opioids for their euphoric effects. Similarly, benzodiazepines may present a problem in patients with chronic pain, as up to one third of patients with pain are concomitantly prescribed benzodiazepines, and when combined with other sedating analgesic medications they put patients at increased risk for adverse events and polysubstance misuse. Finally, there is growing evidence for the efficacy of cannabis for treating neuropathic pain, but the consumption of cannabis has been associated with increased risk of psychosis in adolescents, and may be associated with an increased risk for developing bipolar disorder and anxiety disorders. The use of cannabis is associated with an increased risk of substance misuse in both adolescents and adults. In this narrative review, we examine the evidence for the use of several medications used for the treatment of both pain and psychological disorders, and their proposed mechanisms of action, in addition to special concerns for patients with comorbid pain and psychological disorders.

Substance misuse by doctors, nurses and other healthcare workers

Substance misuse by healthcare professionals raises many concerns, including the threat to patient care. This review summarizes the recent literature concerning misuse by doctors (physicians), nurses, dentists, undergraduates and other healthcare workers. Self-medication is common among doctors. Specific specialities are noted to be at higher risk, including emergency medicine, psychiatry, anaesthetics, and nurses in high stress specialities. Most studies are descriptive cross-sectional prevalence studies of self-reported substance use. Dedicated treatment programmes are reviewed, including specific treatment services for addicted professionals created at national, regional and local levels. A recognition of the risk of substance misuse should be explicitly included early in the training of healthcare workers. Specialist treatment programmes should be holistic in approach, and should not concentrate solely on substance misuse issues but include the treatment of depression, anxiety, sexual disorders and adjustment disorders.

The role of competence factors in reducing the future risk of drug use among young Swedish men.

To investigate the importance of individual competences and risk factors at the age of 18 for future risk of substance misuse. Both behavioural and home-background risk factors were studied. The study group consisted of 7577 18-year-old Swedish conscripts followed for substance misuse up to the age of 36. Information on competence and risk factors was obtained from a survey at conscription. Records of drug use were obtained from official registers; 158 (2%) people were identified as serious adult substance misusers. Good emotional control and cognitive and social capacity were significantly associated with reduced risk of adult drug use whereas early contact with the police or juvenile authorities and alcohol misuse were the most powerful predictors for increased risk of adult drug misuse in multivariate analyses. The proportion of registered adult drug misuse in conscripts with multiple behavioural risk factors was 13.3% in those with drug experiences in late adolescence, compared with 2.6% in those with no earlier drug-experiences. Subjects with multiple behavioural and home-background risk factors but more than one competence were less likely to develop future substance misuse than those with only one or no competence factor. When analysed in relation to behavioural risks, competence factors are most effective in reducing drug use among subjects belonging to the high-risk category, whereas when analysed in relation to home-background risks personal competences are effective in low, medium and high-risk groups. Competences can protect against the development of serious problematic drug use and thus must be considered in preventive efforts.

Core issues for female child abuse survivors in recovery from substance misuse.

Female survivors of childhood abuse have increased risk for substance misuse. Childhood abuse survivors describe current mental health and substance misuse services as not addressing central problems, the "heart of the matter." Negative core issues related to abuse events, contexts, substance use, and current problems were explored in open-ended interviews with 20 female abuse survivors. Most were marginalized because of cocaine use, poverty, and ethnic status. Narrative analysis involved within- and between-account comparisons through adequate paraphrasing of in vivo descriptions. Results include in-depth description of basic core beliefs, developmental core influences, and current core experiences. Implications for practice and policy include appreciation of the influence of negative core experiences on mental health, substance misuse recovery, and preparedness for adulthood demands.

The Substance Use System: Social and Neighborhood Environments Associated with Substance Use and Misuse

Substance use theory and practice have traditionally focused on individuals who misuse substances or who are at risk for substance misuse, but this emphasis is shifting. The present study views both substance use and misuse systematically, assessing the relationships between the physical and social environments and substance use and misuse in dynamic interplay. This substance use system was examined through a survey of approximately 10,000 persons, aged 22–44, from primarily inner-city neighborhoods in the United States. Individual indicators such as race, sex, age, socioeconomic status, education, and religious service attendance relate to both the physical and interpersonal environments, even when each is controlled for the others. Qualities of both environments are strongly associated with substance dependency, even after individual indicators are controlled. These findings suggest the difficulty of bringing about change in drug and alcohol use without hndamental change in the environments where use takes place.

Southeast Asians: Asian-Pacific Americans at Risk for Substance Misuse

Projections indicate that by the year 2000 over a million Cambodians, Laotians, and Vietnamese will be living in the United States. There is sparse information relative to the use of substances by these groups due to the absence of national prevalence data. The combined stressors that these refugee groups have faced puts them at high risk for substance misuse. Southeast Asians infrequently use substance misuse and mental health services, which has been perceived as a lack of need for services by these groups. In reality, there is a critical shortage of culturally-appropriate treatment and intervention programs as the prevalence of substance misuse increases in these populations. [Translations are provided in the International s Section of this issue.]

Substance use among Venezuelan medical and pharmacy students

The frequency of substance use disorders and non-pathological use of drugs was assessed in a cohort of undergraduate medical ( N = 1013) and pharmacy students ( N = 426) from the University of the Andes (Mérida, Venezuela). The survey was conducted using a self-administered Spanish version of the Diagnostic Interview Schedule (DIS-III-A). It was found that the lifetime frequency of substance use disorders was significantly higher in medical than in pharmacy students, but this difference disappeared when the sex was controlled. Substance use disorders were more common in single males and most cases were observed in subjects in their intermediate academic semesters. It was also found that the frequency of non-pathological use of drugs was higher in medical than in pharmacy students and in men than in women. The frequency of substance use disorders in our sample was smaller than that reported in American surveys of substance misuse among medical and pharmacy students. However, because of methodological differences these comparisons are questionable. Our results suggest that Venezuelan medical students are not at an unusually high risk of substance misuse when compared with pharmacy students whose reputedly low levels of substance use are often contrasted with those of the medical profession.

Social Pressure in the Family and School

Abstract: Most adolescents initially use drugs out of curiosity, or experimentally. Those who continue on to become problematic users need to be identified early so that preventive strategies can be used. At risk for substance misuse are those young people who are particularly vulnerable to adverse social pressures in their families and schools. They have poor coping skills to deal with demands and stresses and often have low self image and absence of a positive identity. Preventive strategies therefore need to be directed at both family and school level. Drug education involves the acquisition of communication and decision making skills, as well as the enhancement of young people's confidence and self esteem, thus leading to the development of a positive identity.