Severe Substance Research Articles

Cost-Effectiveness of Temporary Financial Assistance for Veterans Experiencing Housing Instability

The US Department of Veterans Affairs (VA) partners with community organizations (grantees) across the US to provide temporary financial assistance (TFA) to vulnerable veterans through the Supportive Services for Veteran Families (SSVF) program. The goal of TFA for housing-related expenses is to prevent homelessness or to quickly house those who have become homeless. To assess the cost-effectiveness of the SSVF program with TFA vs without TFA as an intervention for veterans who are experiencing housing insecurity. This study used a Markov simulation model to compare cost and housing outcomes in a hypothetical cohort of veterans enrolled in the SSVF program. Enrollees who are homeless receive rapid rehousing services, while those who are at risk of becoming homeless receive homelessness prevention services. The SSVF program with TFA for veterans who are experiencing housing insecurity. The effectiveness measure was the incremental cost-effectiveness ratio (ICER) with quality-adjusted life-years (QALYs). The model was parameterized using a combination of inputs taken from published literature and internal VA data. The model had a 2-year time horizon and a 1-day cycle length. In addition, probabilistic sensitivity analyses were conducted using 10 000 Monte Carlo simulations. The base case analyses found that the SSVF program with TFA was more costly ($35 814 vs $32 562) and yielded more QALYs (1.541 vs 1.398) than the SSVF program without TFA. The resulting ICER was $22 676 per QALY, indicating that TFA is the preferred strategy at a willingness-to-pay threshold of $150 000 per QALY. This ICER was $19 114 per QALY for veterans in the rapid rehousing component of the SSVF program and $29 751 per QALY for those in the homelessness prevention component of the SSVF program. At a willingness-to-pay threshold of $150 000 per QALY, probabilistic sensitivity analyses showed that TFA was cost-effective in 8972 of the 10 000 Monte Carlo simulations (89.7%) for rapid rehousing and in 8796 of the 10 000 Monte Carlo simulations (88.0%) for homelessness prevention only. This economic evaluation suggests that TFA is a cost-effective approach (ie, yields improved health benefits at a reasonable cost) for addressing housing insecurity for veterans enrolling in the SSVF program. Future research could examine the cost effectiveness of large, nationwide housing interventions such as this one among subpopulations of veterans such as those with certain comorbidities including severe mental illness or substance use disorders, those with chronic diseases, or those experiencing long-term housing instability vs acute loss of housing.

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Oral and Long-acting Injectable Aripiprazole in Severe Mental Illness and Substance Use Disorder Comorbidity: An Updated Systematic Review.

Co-occurrence of substance use disorders is frequent in patients with mental health disorders is a condition known as "dual diagnosis". The use of substances worsens the prognosis and lowers the quality of life of psychiatric patients. It also increases the risk of hospitalization and suicide rate. To assess the effects of aripiprazole therapy on substance use and other psychiatric outcomes in dually diagnosed patients. We performed a systematic review conducted on 3 databases PUBMED, SCOPUS, and Web of Science, selecting original studies and analyzing the impact of aripiprazole therapy on dually diagnosed patients. Six hundred and fifty-five articles were founded and, after removing duplicates (n = 274) and applying the exclusion criteria, 12 articles were included in our systematic review. 12 studies were included, among which 6 were Randomized Controlled Trials. The Most frequent psychiatric diagnosis were schizoaffective disorders, schizophrenia, and bipolar disorders. Alcohol and cocaine use disorders were the most used substances. Eleven studies showed a clinical improvement after aripiprazole treatment. 8 studies evaluated craving and found a significant reduction after treatment with aripiprazole. No definitive conclusions can be drawn on substance usage and maintenance of abstinence. The present findings suggest aripiprazole may be associated with reducing substance craving and improving depression, psychosis, and schizoaffective disorders in dually diagnosed patients.

La thérapie des schémas est-elle pertinente pour une population adulte souffrant de TSPT et de TSPT-complexe ? Une revue de littérature systématique qualitative

ContextSchema therapy (ST) involves two core concepts: early maladaptive schemas and modes. Early maladaptive schemas play a key role in the development and maintenance of post-traumatic stress disorder (PTSD), while observed modes reflect the internalized relationships of the traumatized individual. Given this context, how might ST be an interesting psychotherapeutic approach for a population suffering from PTSD or complex post-traumatic stress disorder (CPTSD)? ObjectivesConsidering the impact of trauma and/or adversity on the subject's psychological development, ST could be relevant for a population suffering from PTSD or CPTSD. This study aims to explore the effectiveness of ST in treating an adult population suffering from PTSD or CPTSD, through a review of qualitative literature. MethodsFollowing the PRISMA guidelines, articles were searched from December 2023 to May 2024 on PubMed, Google Scholar, PsycInfo, and the Cochrane Library, with specific eligibility criteria: studies on ST, adult population with PTSD or CPTSD, with no publication year limit. Data extraction considered the studied pathology (PTSD or CPTSD), research methodology, therapeutic setting (group/individual), measurement tools, and therapy effects. ResultsNumerous studies explore the early maladaptive schemas of traumatized individuals, while others observe the effectiveness of ST in various clinical populations. However, few studies focus specifically on PTSD or CPTSD. The research process, summarized in a flow diagram, identified 989 articles, of which twelve were selected and analyzed, involving for 302 participants. Given the predominantly qualitative nature of the studies, a qualitative synthesis was deemed appropriate. Researchers’ chosen diagnoses varied according to the nosographic reference (DSM-5 for PTSD, ICD-11 for CPTSD). ST was found to reduce post-traumatic symptoms but also impacts overall psychiatric symptoms, anxiety, depression, suicidal thoughts, and the severity of substance and/or alcohol addiction. Improvements were observed in overall functioning, emotional regulation, interpersonal relationships, socio-professional life, quality of life, and self-esteem. ST is found to be relevant when exposure therapy was ineffective for trauma treatment. Research methodologies varyQuantitative studies demonstrated ST's effectiveness, while case studies explore the process of change at work in therapy and ST's efficacy. Some biases were noted, particularly in session transcription practices, the small number of comparison groups, and the absence of independent evaluations. Psychotherapeutic interventions included individual and/or group-based approaches, utilizing cognitive, behavioral, and experiential tools, including imagery rescripting or chair work. Only one study adapted its group therapy content to the three-phase approach recommended in psychotraumatology. As an integrative approach, some researchers innovatively combined ST with Eye Movement Desensitization and Reprocessing (EMDR) to address traumatic and addiction memories or with psychoanalysis to work on dreams through imagery rescripting. DiscussionSeveral discussion points were explored. Contemporary psychotraumatology and its theoretical foundations, particularly the concepts of dissociation and integration, could enrich ST work for the studied population. Studying common factors, particularly the therapeutic alliance, would further illuminate the psychotherapeutic process, given ST's emphasis on the therapeutic relationship and attachment. Group therapy seems to reawaken previous family issues, with emotional regulation strategies implemented within the group. Examining group cohesion quality would clarify individual and group psychotherapeutic progress. Finally, contextual ST, integrating acceptance and commitment therapy principles, remains an unexplored avenue with this population. ConclusionTo bridge the gap between research and practice, action research in ST, combining individual and group therapy for CPTSD patients, would enhance understanding of the mechanisms of change within this therapeutic model.

Insights from California on Involuntary Commitment for Substance Use.

Involuntary commitment (IC) for the treatment of substance use disorders is a highly controversial and poorly understood practice, with California offering a striking example. The state's involuntary commitment laws, known collectively as Lanterman-Petris-Short, authorized IC for grave disability related to chronic alcoholism. These provisions remain shrouded in obscurity, and data on their usage are lacking. Amid the ongoing debate over the utility of IC as a tool to treat severe substance use disorders and legislation expanding IC for substance use disorders (SUDs) in California and other states, this article highlights the need to better study the use and effectiveness of existing legislation as well as to consider upstream interventions, such as expansion of community-based treatment models.

Outcome Evaluation of an Integrated, Combined-care Perinatal Addiction Medicine- Primary Care Obstetrics Model for Urban, Inner-city Pregnant Patients With Severe Substance Use Disorders

ABSTRACT Objective: Programs for pregnant individuals with severe substance use disorders that combine addiction, obstetrical, and psychosocial care contribute to better neonatal and maternal outcomes. This research aims to describe patient demographics, retention in care, and maternal and neonatal outcomes associated with an integrated perinatal addiction program. Methods: Retrospective chart review of patients who received care in the Substance Use in Pregnancy (SUP) program at St Michael’s Hospital, Toronto, ON, Canada, between July 1, 2013, and December 31, 2019. Demographic information, as well as outcome measures, were collected for each mother-infant dyad. Descriptive statistics were used to describe study participants and maternal and neonatal outcomes. Results: A total of 121 pregnancies were included in the study. Most of the cohort was unemployed, single, and with unstable housing. Pregnant patients attended, on average, 10 prenatal visits (SD=7.8), and 77% of the cohort had a visit after delivery. Ninety-seven percent of the pregnant individuals completed prenatal screening. Sixty-one percent of infants required admission to the neonatal intensive care unit with an average length of stay of 14 days (SD=14.9). Nicotine (71%) and cannabis (50%) were the most used drugs at program enrolment, followed by opioids (41%), cocaine (34%) and alcohol (32%). The proportion of pregnant patients using substances was lower at delivery, compared with the first visit, except for fentanyl users. Conclusions: The SUP program yields positive maternal and neonatal outcomes associated with high rates of prenatal appointment attendance. Participation in this integrated, combined care program is associated with sustained retention in care for a highly marginalized patient population. Objectif: Les programmes destinés aux personnes enceintes souffrant de troubles sévères liés à l’utilisation de substances psychoactives qui combinent les soins en toxicomanie, obstétricaux et psychosociaux contribuent à de meilleurs résultats néonataux et maternels. Cette recherche vise à décrire les caractéristiques démographiques des patients la rétention dans les soins et les résultats maternels et néonataux associés à un programme intégré en toxicomanie périnatale. Méthodes: Examen rétrospectif des dossiers des patientes ayant reçu des soins dans le cadre du programme Substance Use in Pregnancy (SUP) à l’hôpital St Michael, Toronto, ON, Canada entre le 1er juillet 2013 et le 31 décembre 2019. Des données démographiques ainsi que des mesures de résultats ont été collectées pour chaque dyade mère-enfant. Des statistiques descriptives ont été utilisées pour décrire les participants à l'étude et les résultats maternels et néonataux. Résultats: Au total, 121 grossesses ont été incluses dans l'étude. La plupart des membres de la cohorte étaient sans emploi, célibataires et avaient un logement instable. Les patientes enceintes ont assisté en moyenne à 10 visites prénatales (écart-type=7,8) et 77% de la cohorte ont eu une visite après l’accouchement. 97% des femmes enceintes ont effectué un dépistage prénatal. 61% des nourrissons ont dû être admis dans une unité de soins intensifs néonataux, avec une durée moyenne de séjour de 14 jours (écart-type=14,9). La nicotine (71%) et le cannabis (50%) étaient les drogues les plus consommées au moment de l’inscription au programme, suivies des opioïdes (41%), de la cocaïne (34%) et de l’alcool (32%). La proportion de patientes enceintes consommant des substances était plus faible à l’accouchement qu'à la première visite, sauf pour les consommatrices de fentanyl. Conclusions: Le programme SUP produit des résultats maternels et néonataux positifs associés à des taux élevés d’assiduité aux rendez-vous prénataux. La participation à ce programme de soins intégrés et combinés est associée à une rétention durable des soins pour une population de patients très marginalisés.

Interventions targeting patients with co-occuring severe mental illness and substance use (dual diagnosis) in general practice settings – a scoping review of the literature

BackgroundPeople with dual diagnosis die prematurely compared to the general population, and general practice might serve as a setting in the healthcare system to mend this gap in health inequity. However, little is known about which interventions that have been tested in this setting.AimTo scope the literature on interventions targeting patients with dual diagnosis in a general practice setting, the outcomes used, and the findings.Design and settingA scoping review of patients with dual diagnosis in general practice.MethodsFrom a predeveloped search string, we used PubMed (Medline), PsychInfo, and Embase to identify scientific articles on interventions. Studies were excluded if they did not evaluate an intervention, if patients were under 18 years of age, and if not published in English. Duplicates were removed and all articles were initially screened by title and abstract and subsequent fulltext were read by two authors. Conflicts were discussed within the author group. A summative synthesis of the findings was performed to present the results.ResultsSeven articles were included in the analysis. Most studies investigated integrated care models between behavioural treatment and primary care, and a single study investigated the delivery of Cognitive Behavioral treatment (CBT). Outcomes were changes in mental illness scores and substance or alcohol use, treatment utilization, and implementation of the intervention in question. No studies revealed significant outcomes for patients with dual diagnosis.ConclusionFew intervention studies targeting patients with dual diagnosis exist in general practice. This calls for further investigation of the possibilities of implementing interventions targeting this patient group in general practice.

The Impact of Yoga on Athletes' Mental Well-Being: An Experimental Study.

Background Athletes have a variety of obstacles that might shrink their chances of getting adequate rest, including competing and training times, travel, stress, academic responsibilities, and overtraining. Furthermore, athletes have been reported to have poor self-reports of their sleep length and quality. The study aims to assess the impact of yoga practice on sleep quality, stress, anxiety, psychological rigidity, and experience avoidance. Methods A pre- and post-testrandomized design was applied for the research. Forty-four recreational athletes (age 18-45 years)were selected per the inclusion criteria from the athletes studying at Banaras Hindu University. Exclusion criteria are a likely severe psychiatric disorder, chronic illness, substance abuse, disability, endocrine or metabolic disorders, and history of using psychotropic drugsand smoking. The Yogic intervention contains the Pranayama and meditation, which was practiced for six weeks in the intervention group. Outcome variables were stress, sleep, anxiety, mindfulness, psychological rigidity, and experience avoidance. The Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI),Sport Competition Anxiety Test, Mindful Attention AwarenessScale (MAAS), and Acceptance and Action Questionnaire-II (AAQ-II) were applied to measure the outcomes. Results The majority of the participants(30 (68%)) were male, and 44 (100%) had more than two years of sports experience. Of the participants, 18 (40.90%) had a habit of 3-5 hours of internet surfing. We noticed that there was a significant mean difference from pre- to post-intervention in terms of stress, sleep, anxiety, mindfulness, psychological rigidity, and experience avoidance (p < 0.0001). Conclusion The results concluded positive effects of yoga on athletes' stress, sleep, anxiety, mindfulness, psychological rigidity, and experience avoidance in athletes.Stress alleviationand reduced anxiety are the strongest predictors of improving psychological flexibility skills in athletes' daily lives. Improving mindfulness and supporting good sleep patternscould be good indicators of improving psychological rigidity and experience avoidance.

Early vs. Later Experiences of Violence and Polysubstance Use Among Adults Who Inject Drugs

Background People who inject drugs (PWID) experience high rates of violence, especially in early childhood, increasing their likelihood of engaging in risky substance use behavior in adulthood. Additionally, complex trauma has been reported among PWID due to witnessing and experiencing an overdose, further highlighting the need to examine the role of multiple experiences of trauma on their vulnerability to substance misuse. Methods Our study of 350 PWID from rural Kentucky examined differences in polysubstance use between participants who experienced violence earlier (≤15 years old) versus later (≥16 years old) in their childhood. Results Findings highlighted a direct association between experiences of early childhood violence and polysubstance use in adulthood. Additionally, our sample of PWID who experienced violence early in their childhood reported higher rates of severe substance use disorder and mental health distress. Conclusions Tailored approaches that incorporate trauma-informed care may help to address the disproportionate rates of substance use and related adverse effects among PWID.

Psychometric properties of the modified Drug Abuse Screening Test Sinhala version (DAST-SL): evaluation of reliability and validity in Sri Lanka

BackgroundPsychoactive drug use is an important public health issue in Sri Lanka as it causes substantial health, social and economic burden to the country. Screening for substance use disorders in people who use drugs is vital in preventive health care, as it can help to identify problematic use early. Screening can aid in referring those in need, for the most appropriate treatment and care. Thus, preventing them from developing severe substance use disorders with complications. The Drug Abuse Screening Test (DAST-10) is an evidence-based tool widely used to assess the severity of psychoactive drug use. This study aimed to culturally adapt and evaluate the validity and reliability of the Drug Abuse Screening Test (DAST-10) in Sri Lanka.MethodsThe DAST-10 was culturally adapted, and the nine-item Sinhala version (DAST-SL) was validated using exploratory and confirmatory factor analysis. The validation study was conducted in the Kandy district among people who use drugs, recruited using respondent-driven sampling. Criterion validity of the questionnaire was assessed by taking the diagnosis by a psychiatrist as the gold standard. Cut-off values for the modified questionnaire were developed by constructing Receiver Operating Characteristic (ROC) curves. The reliability of the DAST-SL was assessed by measuring its internal consistency and test re-test reliability.ResultsThe validated DAST-SL demonstrated a one-factor model. A cut-off value of ≥ 2 demonstrated the presence of substance use disorder and had a sensitivity of 98.7%, specificity of 91.7%, a positive predictive value of 98.8% and a negative predictive value of 91.3%. The area under the curve of the ROC curve was 0.98. A cut-off score of ≤ 1 was considered a low level of problems associated with drug use. The DAST-SL score of 2–3 demonstrated a moderate level of problem severity, a score of 4–6 demonstrated a substantial level of problems, and a score of ≥ 7 demonstrated a severe level of drug-related problems. The questionnaire demonstrated high reliability with an internal consistency of 0.80 determined by Kuder–Richardson Formula-20 and an inter-class correlation coefficient of 0.97 for test re-test reliability.ConclusionThe DAST-SL questionnaire is a valid and reliable tool to screen for drug use problem severity in people who use drugs in Sri Lanka.

Striatal brain volume linked to severity of substance use in high-risk incarcerated youth.

Substance use disorders among juveniles are a major public health concern and are often intertwined with other psychosocial risk factors including antisocial behavior. Identifying etiological risks and mechanisms promoting substance use disorders remains a high priority for informing more focused interventions in high-risk populations. The present study examined brain gray matter structure in relation to substance use severity among n = 152 high-risk, incarcerated boys (aged 14-20). Substance use severity was positively associated with gray matter volume across several frontal/striatal brain regions including amygdala, pallidum, putamen, insula, and orbitofrontal cortex. Effects were apparent when using voxel-based-morphometric analysis, as well as in whole-brain, data-driven, network-based approaches (source-based morphometry). These findings support the hypothesis that elevated gray matter volume in striatal reward circuits may be an endogenous marker for vulnerability to severe substance use behaviors among youth.

Understanding Barriers and Facilitators of Primary Care Use Among Assertive Community Treatment Teams Via Qualitative Analysis of Clients and Clinicians.

Individuals with severe mental illness and substance use disorders face complex barriers to achieving physical health. This study aims to explore the barriers and facilitators of primary care access among an Assertive Community Treatment (ACT) team. Semi-structured qualitative interviews were conducted with 14 clients and 7 clinicians from an ACT team at a community mental health center in Connecticut. Data analysis followed a grounded theory approach, with codes and themes emerging iteratively during the interview process. The study identified multifaceted barriers to accessing primary care, including economic challenges, homelessness, and the prioritization of mental health and substance use symptoms over healthcare. The conceptual framework consists of nine dominant themes: clients' attitudes, knowledge, mental health, andmotivations("Client-Level Barriers and Facilitators"); ACTteam-directed care coordination and relationship-building as well as primary care provider communication ("Provider-Level Barriers and Facilitators"); and clients'experiences with medical care andsocioeconomic status("Systemic-Level Barriers and Facilitators"). This research provides valuable insights into the various barriers faced by ACT clients in accessing primary care. Improving primary care access for individuals with severe mental illness and substance use disorders is crucial for reducing health disparities in this vulnerable population.

Service Learning as a tool for the development of pre-professional skills for students of Psychology of Social Intervention

Abstract Background: Based on our team's professional and teaching experience, we aim to enhance the academic training of Social Psychology and Master of Social Psychology students, bolstering their professional and personal skills with practical insights. Our project seeks to bridge the gap between academic learning and real-world practice, providing students with a direct connection to the realities of social intervention work they'll face post-graduation. The significance of cultivating these competencies is evident in the increasing demand for social intervention psychology professionals, currently the second-largest group within the field. Objectives: The aim of this article is to examine Service learning as a catalytic element in the transformation of self and society. Method: This project was done in a Research-Action model, especially with participative action of stakeholders. Results: When designing the initial project in the 2020-2021 academic year, we were aware of the urgent and significant demand for social intervention psychology across various domains. As the project progressed, it became evident that this need existed, not only within identified 'risk groups'—such as individuals facing exclusion, loneliness, minors with behavioral challenges, and those dealing with severe mental illnesses or substance abuse—but also within the broader population and specific subgroups within it. Conclusion: The project has brought about a transformation in how participants acquire capabilities, particularly in the development of competencies and skills. The emphasis on skill training and active involvement has been greatly appreciated by the students. Keywords: Service Learning, Psychology of the Social Intervention, Skills and competencies, Learning outcomes, Evaluation of programmes.

TELEPSYCHIATRY VS IN-PERSON CONSULTATION DURING COVID-19 PANDEMIC: A COMPARISON ACROSS DIAGNOSIS.

Since the onset of COVID-19 pandemic, telepsychiatry is being used at a massive scale, but without assessing its edge over traditional in-person consultation. The aim of this study was to compare the sociodemographic and clinical profile of cases seeking online consultations with those seeking in-person consultations when the second wave of COVID-19 pandemic hit India. In this record based cross-sectional study, we compared age, gender and clinical profile 6048 patients seeking in-person consultation with 2446 patients seeking teleconsultation. Patients with severe mental disorders and substance use disorders were more in the in- person group while those with common mental disorders (Depression, anxiety, and sexual disorders) were more in the telepsychiatry group. However, these differences were statistically non-significant. A non-significant but slightly lesser average age was noted in the telepsychiatry group across both male (p=0.44) and female gender (p=0.32). No significant difference was noted across both genders between both groups. This suggests that teleservices could serve as an alternative and innovative approach to bridge the treatment gap in psychiatry. This study draws attention to the need of expanding and strengthening telepsychiatry further, even after the pandemic that can impart convenient, affordable, and accessible mental health services.

Examining Parental Alcohol Use and Peer Relationships as Predictors of Substance Use Severity

In the United States, issues with substance use among adolescents has grown in its prevalence, and past research has shown a continuity in substance use amongst children with substance involved parents. In adolescence, young men tend to report higher rates of alcohol use when compared to young women. As such, we were interested in examining gender as a moderating factor on the relationship between parental alcohol use and substance use severity. Amazon’s MTurk was used to recruit 185 participants with a history of substance use to complete a series of surveys. Participants reported parental alcohol use during childhood and involvement with pro-social peers. Results revealed gender did not moderate the relationship between parental substance use and respondents’ self-reported substance use. However, there were strong correlations among substance use severity, parental alcohol use, and involvement with pro-social peers. Specifically, respondents who were the child of a mother who experienced problems with alcohol were 3.12 times more likely to have a severe SUD. This effect was not observed when paternal alcohol use was examined as a predictor of substance use severity (p=0.651). Respondents involved with pro-social peers are less likely to have a severe substance use disorder (p less than 0.001). Together, children whose mothers struggled with alcohol use were more likely to develop a severe substance use disorder. In contrast, having a father who struggled with alcohol use did not affect respondents’ involvement with substance use. Furthermore, having a peer support system reduces subsequent substance use, regardless of parental alcohol use.

Trauma Exposure, Suicidality, and Symptom Severity Among Young Adults Seeking Counseling Who Report Childhood Emotional Abuse

There is limited research regarding childhood emotional abuse (CEA) and its influence on mental health across development, as most studies of childhood maltreatment to date have focused on childhood sexual and physical abuse. We conducted a cross-sectional study on 2,604 young adults seeking counseling services at a large post-secondary institution in the southwestern United States. Participants were screened for trauma exposure, mental health issues, and suicidality. Findings indicated that CEA was significantly associated with higher rates of exposure to other traumatic events, more severe depression, generalized anxiety, social anxiety, academic distress, eating concerns, family distress, hostility, and substance use. CEA exposure was also significantly associated with more frequent suicidal ideation, suicide attempt, and non-suicidal self-injury prior to seeking counseling services. As CEA was associated with elevated symptom presentation and more severe risk for suicide, recommendations for counseling practice and future research are discussed.

Personality disorders and addiction A study of 54 patients

IntroductionPersonality disorders are very often comorbid with addictions and are known to have a negative impact on the development of substance use disorder.ObjectivesEvaluate the prevalence of personality disorder in patients with problematic use of psychoactive substances followed at Ar Razi hospital Determine the relationship between different personality disorders and the clinical aspects of psychoactive substance useMethodsThis is a descriptive and analytical cross-sectional study carried out among 54 patients followed at Ar-Razi hospital Salé in Morocco for problematic use of psychoactive substances from June 1 to September 15, 2023 (Diagnosis assessed by DSM 5) Data collection was done using a questionnaire including clinical and socio-demographic characteristics and data on addiction to psychoactive and behavioral substances. The psychometric scale used to assess personality disorder: Personality Disorder Questionnaire (PDQ-4+)ResultsWe recruited 54 patients with age ranges from 18 to 45 years, with a male predominance. The average age at the start of psychoactive substance use was 15 years. Tobacco is the most used substance followed by cannabis Antisocial, histrionic and borderline personality disorders were the most common in our population. There was a statistically significant difference between specific personality disorder and the presence of severe psychoactive substance use disorderConclusionsThe frequency of personality disorders is high among subjects with problematic use of psychoactive substances. It is necessary to take care of them simultaneously (integrated care) in order to improve the prognosisDisclosure of InterestNone Declared

Childhood abuse and craving in methamphetamine-dependent individuals: the mediating role of alexithymia.

Individuals with a history of childhood abuse (CA,including neglect and abuse by caregivers before the age of 18years) have more severe substance dependence problems than those without a history of childhood abuse. However, whether a history of CA exacerbates craving and the mechanism of this effect remain largely unknown. The aim of this study was to explore the role of alexithymia in the effects of CA on craving in a large sample of methamphetamine-dependent individuals based on latent vulnerability theory. A total of 324 methamphetamine-dependent individuals who met DSM-5 criteria for substance use disorder were recruited. CA, alexithymia, and craving data were collected from the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale-20, and the Obsessive Compulsive Drug Use Scale, respectively. t tests and ANCOVA were conducted to compare variables between the CA and non-CA groups, while partial correlation and mediation analyses were conducted to examine the potential mediating role of alexithymia in the relationship between CA and craving. Abused methamphetamine-dependent individuals reported higher levels of craving and higher levels of alexithymia than those of non-abused methamphetamine-dependent individuals. Alexithymia partially mediated the link between CA and craving, especially the effect of CA on craving frequency was fully mediated by alexithymia. Our findings reveal that a history of childhood abuse has a lasting effect on craving in stimulant-dependent individuals, and alexithymia contributes to some extent to the severity of substance abuse problems in abused methamphetamine-dependent individuals.

“There’s so much wrong with me. I’ve just gotten a little sick”: Syndemic cancer experiences among people struggling with homelessness and severe substance use

This article investigates the complex ways that social conditions and illness experiences interact with cancer in a marginalised population. Drawing on the theoretical framework of syndemics, we explore how people living in circumstances of homelessness and severe substance use in Denmark experience and manage their cancer illness. We draw upon qualitative, partly longitudinal, interviews with marginalised people with current or previous cancer illness. Participants suffered from a wide range of physical and mental conditions alongside their cancer illness and substance use. Adverse interactions between these conditions delayed, complicated, or hindered both the cancer diagnosis and the cancer treatment of participants. Surprisingly, for some, the cancer diagnosis also contributed to temporary periods of stability. Nevertheless, disadvantaged social conditions of chaotic, unwanted housing conditions, fragile social relations and social isolation worked to aggravate participants' cancer trajectories and general life situation. Participants' cancer experiences were cases of syndemic suffering that took on a distinct direction in which cancer created cyclical rounds of suffering due to the many late effects of the illness and treatment. The article demonstrates how marginalised people’s cancer experiences are inextricably linked to, and shaped by, the social and health inequities characterising their lives.

‘It can be difficult to help them’

Older marginalized citizens with severe substance use are presently a growing population in Denmark. They struggle with comprehensive and complex needs for care and treatment, which put high demands on health and care professionals working with them. Yet, the complexity of their needs for care and the care provided to them is highly understudied. We take our empirical point of departure in an anthropological pilot study of care work in private homes and retirement homes in two municipalities, where we followed care professionals on their shifts and interviewed them in order to identify challenging situations in daily care. Building on Mol’s concept of logic of care (Mol 2008), we examine how the care professionals in their everyday work with substance using older citizens faced dilemmas in the provision of care within the logics of on the one hand Danish standards for “correct” care and on the other respecting the autonomy of substance using citizens.