Severe Substance Use Disorders Research Articles

Socio-contextual factors and adverse childhood experiences as determinants of substance use disorder among individuals between ages 18-40 years in Kano, Nigeria

ABSTRACT Background There is a paucity of literature on the connection between Adverse Childhood Experiences (ACEs), certain socio-contextual factors, and substance use disorder (SUD). Therefore, this study aimed at investigating the socio-contextual factors (gender, age range, educational levels, and types of settlement) and ACEs as determinants of SUD among individuals between the ages of 18-40 years in Kano, Nigeria. Methods This study used a pack questionnaire containing socio-contextual information, a 10-item Revised Inventory of Adverse Childhood Experiences, and Drug Abuse Screening Test-20 to collect data from 599-participant. Results Findings showed a high (55.3%) severe SUD (addiction problem) among the participants. Individuals with a history of ACEs (parental neglect, sexual abuse, physical abuse, and emotional abuse) scored more on SUD compared with their other counterparts. Moreover, male respondents scored higher on SUD than their female counterparts. Participants with a low level of education scored higher on SUD compared with secondary and tertiary certificate holders. However, types of settlement were not related to SUD. Conclusions Gender, age-range, educational levels, and ACEs are determinants of SUD among participants. Policymakers should organize programs that could ameliorate ACEs and low education. Also, emerging adults and males should be psycho-educated and trained to reduce substance use problems.

Teens with most severe SUDs do not ‘age out’ of symptoms: NIDA

Contrary to popular belief, not all adolescents with substance use disorders (SUDs) grow out of them. Those with mild SUDs may, but those with severe SUDs are likely to continue to have them and other problems in adulthood, according to a recent study.

Homelessness and Gender: Differences in Characteristics and Comorbidity of Substance Use Disorders at Admission to Services

Background: Substance use disorders and homelessness are two closely related behavioral health issues. This study examines associations between homelessness and severity of substance use disorder (SUD) characteristics (inclusive of alcohol and other legal and illegal drugs) and presence of mental health comorbidity among individuals entering treatment for SUD. We also examine differences in SUD and mental health comorbidity by gender within a sample of clients experiencing homelessness upon admission to treatment. Methods: Using the 2017 Treatment Episodes Data Set, we used logistic regression models to examine the association between homelessness and indicators of severity (e.g., frequency of use, route of transmission) and the presence of mental health conditions, and to examine the association between gender and these dependent variables among only individuals experiencing homelessness at treatment admission. Results: After controlling for covariates, homelessness is significantly associated with increased odds of cocaine and methamphetamine use compared to all other substances, higher frequency of use, younger age of first use, use of more substances, injection drug use, and co-occurring mental health conditions. Female gender is inversely associated with younger age at first use and highly associated with co-occurring mental health conditions among those experiencing homelessness at admission to treatment. Conclusions: Individuals experiencing homelessness enter substance use services with different characteristics of substance use disorders, different patterns of use, and with higher rates of mental health comorbidity. Within homeless admissions, women have significant differences in substance use and higher likelihood of mental health comorbidity than men. Future research should focus on the specific treatment needs of individuals experiencing homelessness, and how the combination of homelessness and gender affects barriers and challenges to treatment.

Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders

Background: The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)—behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)—and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.

Cognitive Processing Therapy Versus Medication for the Treatment of Comorbid Substance Use Disorder and Post-Traumatic Stress Disorder in Egyptian patients (Randomized Clinical Trial)

"Earlier research has established that posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently coexist. Aims: Cognitive Processing Therapy was compared to Sertraline and a placebo in an RCT for treating patients with comorbid SUD and PTSD. Methods: 150 patients with SUD and PTSD were interviewed by clinicians and asked to fill out the Clinician-Administered PTSD Scale (CAPS-5), Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI-II), Timeline Follow Back Interview (TLFB), and Brief Addiction Monitor (BAM). Patients were randomly assigned to the following conditions: CPT (n=50), Sertraline (n=50), or Placebo (n=50). Pretreatment, posttreatment, six and, twelve-month follow-up assessments were conducted. Results: When compared to the sertraline group, CPT resulted in much higher reductions in CAPS scores at posttreatment assessment (d=0.93, p < .000). When compared to the control group, CPT considerably reduced PTSD symptoms (the effect size, d=1.9, p < .000). Sertraline resulted in many significant decreases in CAPS when compared to control groups (the effect size , d=1.11, p<.000). At posttreatment, SUD and depression severity were significantly reduced in both CPT and Sertraline groups. After six and twelve months of follow-up, these differences persisted. Conclusion: Comparatively to the control group, CPT and Sertraline significantly decreased PTSD, SUD, and depression."

Comparative effectiveness of trauma-focused and non-trauma-focused psychotherapy for PTSD among veterans with comorbid substance use disorders: Protocol & rationale for a randomized clinical trial

BackgroundCo-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is common and concurrent treatment is recommended. Relatively little is known about which evidence-based psychotherapies for PTSD are most effective for patients with varying substance use profiles. We aim to examine the comparative effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) among Veterans with PTSD and SUD. TFT has been found to be effective among those with PTSD/SUD, though effects are smaller and rates of treatment non-completion are higher than in those without SUD. NTFTs suggested for the treatment of PTSD, such as Present Centered Therapy, (PCT) have not been examined among those with co-occurring SUD, despite lower rates of treatment dropout. We will also examine the comparative effectiveness of TFT and NTFT for patients with varying SUD severity, type of substances used, and patient treatment preference. Method420 Veterans with PTSD and SUD will be randomized in a prospective, pragmatic comparative effectiveness trial at 14 Veterans Health Administration facilities. Participants will receive either TFT (Prolonged Exposure or Cognitive Processing Therapy) or NTFT (PCT) after enrolling in concurrent SUD treatment-as-usual. Assessments will occur at baseline, posttreatment, 3- and 6 -months posttreatment. Main outcomes are PTSD symptom severity and PTSD treatment dropout. Clinician, patient, and leadership stakeholder panels advise study activities, and a process evaluation will identify strategies to enhance the implementation of evidence-based PTSD treatments in SUD care settings. ConclusionsResults will provide critical information to guide clinicians when recommending PTSD treatments to patients with comorbid SUD.ClinicalTrials.gov Identifier: NCT04581434.

Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype?

Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG. This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood. The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes. Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.

Teens with most severe SUDs do not ‘age out’ of symptoms: NIDA

Contrary to popular belief, not all adolescents with substance use disorders (SUDs) grow out of them. Those with mild SUDs may, but those with severe SUDs are likely to continue to have them and other problems in adulthood, according to a recent study.

The impact of psychiatric disorders of parents on the severity of substance use disorder in their offspring

Introduction There is a lack of evidence in the literature about the impact of offspring addiction and their parents’ mental health. Objective is to explore psychiatric disorders in parents of patients with substance dependence and their effect on the severity of their addiction.ObjectivesTo evaluate psychiatric disorders in parents of patients with substance dependence and their effect on the severity of their addiction.MethodsThis is a cross sectional study contained group (A) 150 patients diagnosed with substance dependence according to DSM-IV. Patients were recruited form Psychiatry and Addiction Hospital of Cairo University. Group (B) included one or both parents of the patients group. The Addiction Severity Index (ASI) was used for the patients.ResultsIn the patients group, mean age was 24.89 (±4.52). 96% of them were males 4% were females. In the parent group, mean age was 51.59 (±5.48). 84% of them were mothers 16 % were females. Patients group was associated with moderate degree of education (46.7%), 73.3% were single and 64% were unemployed. Anxiety disorders (80%) and depressive disorders (69.3%) were the most prevalent among parents group. ASI score was statistically significant in predicting the incidence of parents psychotic and schizoid disorders (100% sensitivity, 86.3% specificity, AUC=0.887, P value <0.0001).Besides we found a significant correlation between patients ASI scores and parents psychiatric disorder.ConclusionsThis result emphasizes the relation between patient substance use disorder and psychiatric disorder of their parents. Patients ASI score may be a possible measure for parents mental disorder. Further research is needed to validate our findings.DisclosureNo significant relationships.

Teens with most severe SUDs do not “age out” of symptoms: NIDA

Contrary to popular belief, not all adolescents with substance use disorders (SUDs) grow out of them. Those with mild SUDs may, but those with severe SUDs are likely to continue to have them and other problems in adulthood, according to a study published in JAMA Network Open this month.

Folate Status as a Nutritional Indicator among People with Substance Use Disorder; A Prospective Cohort Study in Norway.

Substance use disorder (SUD) is associated with poor nutrition. Vitamin B9, or folate, is an important micronutrient for health. The aim of this prospective longitudinal cohort study was to assess serum folate levels among people with SUD and to investigate the impact of factors related to substance use severity on folate status. Participants were recruited from outpatient clinics for opioid agonist therapy (OAT) and municipal health-care clinics for SUD in Western Norway. They were assessed annually, including blood sampling for determination of micronutrient status. Overall, 663 participants with a total of 2236 serum folate measurements were included. A linear mixed model was applied, and measures are presented as β-coefficients with 95% confidence interval (CI). Forty-eight percent (CI: 44–51) of the population had low serum folate levels (s-folate < 10 nmol/L), and 23% (CI: 20–26) were deficient (s-folate < 6.8 nmol/L) at baseline. Sixty percent (CI: 53–65) sustained their poor folate status in at least one subsequent assessment. Except for weekly use of cannabis (mean difference in serum folate [nmol/L]: −1.8, CI: −3.3, −0.25) and alcohol (1.9, CI: 0.15, 3.6), weekly use of no other substance class was associated with baseline differences in serum folate when compared to less frequent or no use. Injecting substances was associated with a reduction in serum folate over time (−1.2, CI: −2.3, −0.14), as was higher dosages of OAT medication (−1.1, CI: −2.2, −0.024). Our findings emphasize the need of addressing nutrition among people with severe SUD.

Vitamin B12 Levels, Substance Use Patterns and Clinical Characteristics among People with Severe Substance Use Disorders: A Cohort Study from Western Norway.

People with severe substance use disorder (SUD) have a higher burden of micronutrient deficiency compared with the general population. The aim of this study was to investigate vitamin B12 status and risk factors of deficiency related to substance use, opioid agonist therapy (OAT), as well as hepatitis C infection and liver fibrosis. In this prospective cohort study, participants were recruited from outpatient OAT and SUD clinics in western Norway, and assessed annually with a clinical interview and exam, including venous blood sampling. Data were collected between March 2016 and June 2020, and a total of 2451 serum vitamin B12 measurements from 672 participants were included. The median serum vitamin B12 concentration was 396 (standard deviation 198) pmol/L at baseline, 22% of the population had suboptimal levels (<300 pmol/L) and 1.2% were deficient at baseline (<175 pmol/L). No clear associations were seen with substance use patterns, but liver disease and younger age were associated with higher vitamin B12 levels. Although the majority of participants had satisfactory vitamin B12 levels, about a fifth had suboptimal levels that might or might not be adequate for metabolic needs. Future studies could investigate potential gains in interventions among patients with suboptimal but non-deficient levels.

The early onset of nicotine dependence, severity of substance use disorder, and relapse: an inpatient study

ABSTRACT Objective To assess the association of early onset of smoking and use of other addictive substances with nicotine dependence, the extent of substance use, and the probability of relapse in drug treatment and rehabilitation centers. Methods Self-reported data were collected from July to September 2019 from 632 inpatients at five drug treatment facilities in the Philippines. The Addiction Severity Index (5th edition) and the Fagerström Test for Nicotine Dependence were used to assess the inpatients’ drug and alcohol use and nicotine dependence severity, respectively. Results Of a group of smokers who started smoking before the age of 10 years old, 54.3% were nicotine dependent current smokers and 9.89% were low to moderate nicotine dependent smokers. There were 82.61% male responders and 76% of the females started using drugs and alcohol before the age of 14. Other drug use eventually increased, yielding odds ratio of 26.5 and 28.9 in the past 30 days and lifetime, respectively, with 95% confidence interval of 10.8–64.9 and 11.5–72.9, indicating significant (p < .05) differences. Conclusions This study advises policymakers to focus more on educating and disseminating information about the early onset of nicotine, which paves the way to nicotine dependence and other drug use problems eventually. This present study suggests a follow-up intervention and an aftercare therapy solely for nicotine dependents with substance use disorder in the prevention of relapse after treatment.

Teens with most severe SUDs do not ‘age out’ of symptoms: NIDA

Contrary to popular belief, not all adolescents with substance use disorders (SUDs) grow out of them. Those with mild SUDs may, but those with severe SUDs are likely to continue to have them and other problems in adulthood, according to a study published in JAMA Network Open this month.

Association of Severity of Adolescent Substance Use Disorders and Long-term Outcomes

Sean Esteban McCabe, PhD; John E. Schulenberg, PhD; Ty S. Schepis, PhD; Vita V. McCabe, MD; Philip T. Veliz, PhD

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood

Although more than 1 in every 3 US individuals will develop a substance use disorder (SUD) in their lifetime, relatively little is known about the long-term sequelae of SUD symptoms from adolescence through adulthood. To evaluate the longitudinal associations between adolescents' SUD symptom severity with later medical use of prescription drugs (ie, opioids, sedatives, and tranquilizers), prescription drug misuse (PDM), and SUD symptoms at ages 35 to 50 years. Eleven cohorts of US 12th grade students were followed longitudinally from age 18 years (1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study. Baseline surveys were self-administered in classrooms, and follow-ups were conducted by mail. Data were analyzed from June 2021 to February 2022. Response to MTF study between 1976 and 2018. Sociodemographic variables were measured at baseline. All bivariate and multivariate analyses use attrition weights to adjust for attrition by age 50 years within the sample. SUD symptoms, prescription drug use, and PDM were measured at baseline and every follow-up. The sample of 5317 individuals was 51.2% female (2685 participants; 95% CI, 49.6%-52.6%) and 77.9% White (4222 participants; 95% CI, 77.6%-79.1%). Participants were surveyed beginning at age 18 years and ending at age 50 years. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. Most adolescents with most severe SUD symptoms at age 18 years had 2 or more SUD symptoms in adulthood (316 participants [61.6%]; 95% CI, 55.7%-66.9%), and this association held for baseline alcohol, cannabis, and other drug use disorder symptoms. Adolescents with the highest SUD symptom severity at age 18 years had the highest adjusted odds of prescription drug use and PDM in adulthood (4-5 symptoms, adjusted odds ratio, 1.56; 95% CI, 1.06-2.32; ≥6 symptoms, adjusted odds ratio, 1.55; 95% CI, 1.11-2.16). The majority of adults using prescribed opioids, sedatives, or tranquilizers (568 participants [52.2%]; 95% CI, 48.4%-55.9%) in the past year had multiple SUD symptoms at age 18 years. These findings suggest that most adolescents with severe SUD symptoms do not transition out of symptomatic substance use, and the long-term sequelae for adolescents with more severe SUD symptoms are more deleterious than those for adolescents with no or low severity. Prescribers should be aware that many adults prescribed opioids, sedatives, or tranquilizers had multiple SUD symptoms during adolescence and require careful assessment and monitoring.

The acceptability of non-abstinent treatment goals among clinical social workers in the United States

ABSTRACT Research on acceptability of non-abstinence goals has focused primarily on addiction counsellors and lacks representation of clinical social workers (SWs). We examined whether acceptability of non-abstinence varied as a function of a client’s severity of substance use disorder (SUD) diagnosis (severe vs. moderate), finality of an outcome goal (intermediate vs. final), and type of substance (e.g. alcohol, cannabis) among clinical SWs in the US (United States). We surveyed a geographically representative sample of 309 SWs (Mean age = 48.9; Female = 76%; Mean years practicing = 14.6). For tobacco, alcohol and cannabis use, most SWs (51%–84%) rated non-abstinence as an acceptable goal regardless of finality of the outcome goal for clients with a moderate SUD; but smaller proportions rated non-abstinence acceptable for clients with severe SUD regardless of drug type or finality of the goal. Higher ratings of acceptability of non-abstinence were significantly associated with younger age and lower drug use stigma. Supporting clients who pursue non-abstinence is consistent with the values of the Social Work (SW) profession (e.g. self-determination, social justice, dignity/self-worth, importance/centrality of human relationships). Thus, SW education and training programmes should bolster understanding SUD recovery can take multiple pathways, should be self-directed and empowering, and may be defined in terms of improved health and wellness.

Imaginal exposure processing during Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) therapy: Examination of linguistic markers of cohesiveness.

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is an integrated, evidence-based treatment that results in significant reductions in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) severity. Emotional processing theory suggests that successful prolonged exposure-based treatments should result in more cohesive trauma narratives due to better integration and organization of trauma memory into cognitive conceptualizations of fear. Therefore, we hypothesized that language used by patients would become more cohesive over time and increased language cohesion would be related to larger reductions in PTSD and SUD outcomes. Broadly, language cohesion refers to several linguistic devices that help establish and cohere meaning throughout spoken and written discourse (e.g., increased use of transition words like "and," "then," and "but"). This was the first known study to examine changes in language related to both PTSD and SUD severity during COPE treatment. The sample included 28 military veterans with current comorbid PTSD/SUD enrolled in a larger COPE study. A text analysis program, Coh-Metrix, was used to analyze language cohesiveness. No language cohesion variables significantly changed over time. Narrativity levels significantly moderated change in PTSD outcomes, =0.11. Adversative connectives significantly moderated change in SUD outcomes, = 0.26. The findings illuminate potential processes underlying successful COPE treatment. Less use of language conveying a narrative and more use of contrast-indicative words (e.g., but, whereas) was associated with larger reductions in PTSD and SUD outcomes during treatment. These results contribute to the extant literature on associations between trauma exposure, language, and emotional processing.

Characterizing Clinical Heterogeneity in a Large Inpatient Addiction Treatment Sample: Confirmatory Latent Profile Analysis and Differential Levels of Craving and Impulsivity.

Individuals with substance use disorders (SUDs) have highly heterogeneous presentations and identifying more homogeneous subgroups may foster more personalized treatment. This study used SUD and other psychiatric indicators to characterize latent subgroups of patients in a large inpatient addiction treatment program. The resulting subgroups were then analyzed with respect to differences on clinically informative motivational mechanisms. Patients (n = 803) were assessed for severity of SUD (ie, alcohol use disorder, drug use disorder), post-traumatic stress disorder, anxiety disorders, and major depressive disorder. Confirmatory latent profile analysis (CLPA) was used to identify latent subgroups, hypothesizing 4 subgroups. Subgroups were then characterized with respect to multiple indicators of impulsivity (ie, delay discounting and impulsive personality traits via the UPPS-P) and craving. The CLPA confirmed the hypothesized 4-profile solution according to all indicators (eg, entropy = 0.90, all posterior probabilities ⩾.92). Profile 1 (n = 229 [32.2%], 24.9% female, median age in range of 45-49) reflected individuals with high alcohol severity and low psychiatric severity (HAlc/LPsy). Profile 2 (n = 193 [27.1%], 29.3% female, median age in range of 35-39) reflected individuals with high drug and psychiatric severity (HDrug/HPsy). Profile 3 (n = 160 [22.5%], 37.6% female, median age in range of 45-49) reflected individuals with high alcohol severity and psychiatric severity (HAlc/HPsy). Profile 4 (n = 130 [18.3%], 19.4% female, median age in range of 35-39) reflected individuals with high drug severity and low psychiatric severity (HDrug/LPsy). Both high comorbid psychiatric severity subgroups exhibited significantly higher craving and facets of impulsivity. The results provide further evidence of 4 latent subgroups among inpatients receiving addiction treatment, varying by alcohol versus other drugs and low versus high psychiatric comorbidity. Furthermore, they reveal the highest craving and impulsivity in the high psychiatric comorbidity groups, suggesting targets for more intensive clinical intervention in these patients.