Severity Of Substance Use Research Articles

The Relationship of Lifetime Polysubstance Dependence to Trauma Exposure, Symptomatology, and Psychosocial Functioning in Incarcerated Women with Comorbid PTSD and Substance Use Disorder

SUMMARY There is a dearth of literature examining the relationship between trauma-related experiences, PTSD, and lifetime polysubstance dependence among incarcerated women. A sample of 69 treatment-seeking incarcerated women with current PTSD and comorbid substance use disorder (PTSD-SUD) were recruited from a northeastern state medium-security prison. Women with lifetime polysubstance dependence (PTSD-SUD/LPD; n = 33) were compared to women with no lifetime polysubstance dependence (PTSD-SUD only; n = 36) across a range of features: trauma characteristics (e.g., number of traumas, type of trauma), associated symptoms (e.g., dissociation, anxiety), severity of substance use and psychosocial functioning. Women with PTSD and lifetime polysubstance dependence reported greater severity of drug and alcohol use, increased exposure to traumatic events (i.e., general disasters, crime-related events), and increased prevalence of PTSD-related symptoms (i.e., derealization, survivor guilt). Trends also suggest that PTSD-SUD/LPD women are more likely to experience dissociation, anxiety, and sexual problems than PTSD-SUD respondents. Treatment-related implications are discussed.

Different Components of Opioid-Substitution Treatment Predict Outcomes of Patients With and Without a Parent With Substance-Use Problems*

The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems. This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined. Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use. The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.

Substance Use Criminality, and Social Support: An Exploratory Analysis with Incarcerated Women

This exploratory study examined the extent to which substance use and criminality influence perceptions of social support. A stratified random sample of 100 incarcerated women in one Kentucky prison participated in face-to-face interviews. Overall, findings indicate that perceptions of social support significantly and negatively correlated with women's severity of substance use and criminal involvement. In addition, the breadth of a respondent's social network was negatively related to the age of first incarceration and to the severity of alcohol and drug use. Findings from this study suggest there is a relationship between severity of substance use, criminality, and perceptions of social support. Implications for substance use research and practice are discussed.

Modified Therapeutic Community Treatment for Offenders with MICA Disorders

Treatment outcomes 1 year after release from prison were compared for two subgroups of male inmates with co-occurring serious mental illness and chemical abuse (MICA) disorders, those with a diagnosis for Antisocial Personality Disorder (APD), and those without a diagnosis of APD. The foundation study had randomly assigned inmates to either Modified Therapeutic Community (MTC) or Mental Health (MH) treatment programs. Results presented in this paper support earlier findings of the overall effectiveness of MTC treatment in correctional settings, and extend these findings to encompass the subgroup of offenders whose co-occurring disorders include APD. An intent-to-treat analysis (all study entrants) and a matched group analysis (Medium propensity stratum) found significantly greater improvement on measures of criminal activity and substance use for those in the MTC group (as compared with the MH group) regardless of APD diagnosis, and showed that negative treatment effects were not linked to APD. Differences between the treatment groups were consistent and significant, and persisted after an examination of various threats to validity (e.g., initial motivation, exposure to treatment, severity of substance use, severity of APD symptomatology). These findings are encouraging and consonant with other studies of the effectiveness of TC approaches for APD populations receiving substance abuse treatment in correctional settings. Given the available evidence and the demand for effective programming for offenders with co-occurring disorders, criminal justice program and policy makers should strongly consider developing modified TC programs across a full array of mental disorders, including APD.

Predictors of Outcome for Patients With Substance-Use Disorders Five Years After Treatment Dropout

Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes. Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified. In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label "drug addict" than "alcoholic." Lower severity of SUD, lower self-efficacy, fewer positive substance- use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts. In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out.

Gender Differences in Substance-Abuse Treatment Clients With Co-occurring Psychiatric and Substance-Use Disorders

The study examined gender differences in a sample of 213 substance-abuse treatment clients with co-occurring severe and nonsevere psychiatric disorders. Results indicated that women had higher rates of posttraumatic stress disorder. Males displayed greater severity on psychiatric measures and received a greater array of ancillary services during treatment yet reported less social and psychological problem days at admission. Conversely, females presented relatively greater substance-use severity but reported higher levels of psychosocial distress and less problem days related to substance use. These findings suggest gender differences in problem recognition may exist, with males more readily admitting to problems related to substance use and females more open to acknowledging the effects of social and psychiatric problems. The current results have clinical implications for both the assessment process and the treatment programming. [Brief Treatment and Crisis Intervention 6:255–267 (2006)]

Drug Use, Drug Severity, and Help-Seeking Behaviors of Lesbian and Bisexual Women

Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related helpseeking behaviors in an urban/metropolitan community sample of sexual minority women in California. Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors. Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help. The women in this study reported elevated rates of illicit drug use that was frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems. Future studies that examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems are needed.

Substance use and depression. Comparative course in adolescents

To examine the relation between depression and substance use in adolescents and the concomitant courses of both disorders. Four individual interviews were administered to 85 adolescent substance users aged 14-19 years (mean 17.1 years, SD 1.4) over a 3.5 year period using the Adolescent Drug Abuse Interview (ADAD) and the Beck Depression Inventory (BDI-13). No predictive effect was observed on one dimension over the other, but each dimension was predictive of its own course. A decrease in substance-use severity paralleled a decrease in depressive state. Similarly, stable substance-use rates, either at a low or a high level, tended to be associated with low or high levels of depression, respectively. However, an increase in substance use was not accompanied by an increase in depressive states. Moreover, depression varied greatly between adolescents, and according to gender and age. Depressive states and substance use in adolescents can vary considerably overtime, and are closely but rather synchronically related. Since most of the adolescents do not seek help for substance-related problems, substance use should be systematically assessed in adolescents presenting with a depressive state.

Gender Specific Associations Between Types of Childhood Maltreatment and the Onset, Escalation and Severity of Substance Use in Cocaine Dependent Adults

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.

Differential impact of severity of drug use on frontal behavioral symptoms

Increasing evidence indicates that substance abusers are impaired in cognitive–executive control tasks relying on different functional systems converging in the prefrontal cortex (PFC). Different PFC functional systems relevant to addiction have been described: the dorsolateral (DLC), orbitofrontal (OFC), and anterior cingulate (ACC) circuits. Each system is associated with different behavioral, cognitive, and emotional deficits, including apathy, disinhibition, and executive dysfunction. In this study, we examined the effects of severity of use of different drugs on apathy, disinhibition and executive dysfunction behavioral deficits as measured by the Frontal Systems Behavior Scale (FrSBe). The FrSBe, and a severity of substance use interview were administered to 32 poly-substance abusers. Multiple regression analyses showed that severity of cannabis use significantly predicted greater apathy and executive dysfunction behavior; and that severity of cocaine use significantly predicted greater disinhibition behavior. These results are consistent with previous studies using cognitive measures and support the notion that severity of substance use significantly affects behavioral symptoms associated with PFC systems functioning. These clinical symptoms should be specifically addressed during rehabilitation.

Treatment outcomes: First time versus treatment-experienced clients

A sample of treatment seeking clients was assessed at intake and 6, 12, 24 and 30 months later. Treatment-naïve and treatment-experienced clients were compared in terms of baseline characteristics, 6-month outcomes, and predictors of these outcomes. Long-term outcomes of clients achieving an initially successful outcome were compared for the two groups. Results revealed significant short-term improvement for both groups, although treatment-experienced clients reported more serious drug use. The most consistent significant predictors of substance use outcomes were baseline severity of substance use and self-help participation. Outcome predictors unique to each group were also identified. Long-term outcomes for clients with an initial successful outcome tended to be better for treatment-experienced than treatment-naïve clients. Both groups tended to have poorer outcomes as the follow-up duration increased. The results suggest that common and unique predictors of outcomes be considered in treating these two groups of clients. Additionally, treatment-naïve clients may be at increased risk for poor outcomes even when initial success is achieved.

Clinical Variations of Adolescent Substance Abuse: An Empirically Based Typology

ABSTRACT This study was designed to establish and validate a multidimensional empirically based typology of clinically referred adolescent substance abusers. A total of 141 adolescent substance abusers, most of whom were male, African-American, and juvenile justice involved, comprised the study sample. Youth and their parents completed comprehensive assessments at intake to treatment, discharge, and at 6 months and 12 months post-discharge from treatment. Adolescents were classified based on individual and family risk factors, associated problems, and severity of substance use. Variables included in the 2-stage cluster analysis included adolescents' substance use, psychiatric disorders, and legal involvement; peer substance use; family substance abuse; parental psychopathology; and family conflict. Three groups emerged: Juvenile Justice Involved Substance Abusers, with the lowest level of overall risk but highest juvenile justice involvement; Comorbid Substance Abusers, with the greatest family risk and individual psychopathology; and Heavy Substance Abusers, marked by serious substance abuse and peer substance use. Discriminant and predictive validity of the typology were established. This multidimensional typology of teenage substance abusers suggests that risk factors, associated problems, and substance use severity are all critical in assessing and treating this heterogeneous population. Different intervention strategies may be appropriate for these subgroups of adolescent substance abusers.

Sexual Abuse, Antisocial Behaviour and Substance Use: Gender Differences in Young Community Adolescents

Objective To investigate gender-specific relationships between self-reported sexual abuse, antisocial behaviour and substance use in a large community sample of adolescents. Method A cross-sectional study of students aged, on average, 13 (n = 2596), 14 (n = 2475) and 15 years (n = 2290), from 27 schools in South Australia with a questionnaire including sexual abuse, frequency and severity of substance use, depressive symptomatology (CES-D), family functioning (McMaster Family Assessment Device), and antisocial behaviour (an adapted 22-item Self-Report Delinquency Scale). Logistic regression analyses using HLM V5.05 with a population-average model were conducted. Results In the model considered, reported sexual abuse is significantly independently associated with antisocial behaviour, controlling for confounding factors of depressive symptomatology and family dysfunction, with increased risks of three- to eightfold for sexually abused boys, and two- to threefold for sexually abused girls, compared to nonabused. Increased risks of extreme substance use in sexually abused girls (age 13) and boys (ages 13–15) are more than fourfold, compared to nonabused. Age differences were not statistically significant. Conclusion Childhood sexual abuse is a risk factor for the development of antisocial behaviour and substance use in young adolescents. Clinicians should be aware of gender differences.

Sexual abuse, antisocial behaviour and substance use: gender differences in young community adolescents.

To investigate gender-specific relationships between self-reported sexual abuse, antisocial behaviour and substance use in a large community sample of adolescents. A cross-sectional study of students aged, on average, 13 (n = 2596), 14 (n = 2475) and 15 years (n = 2290), from 27 schools in South Australia with a questionnaire including sexual abuse, frequency and severity of substance use, depressive symptomatology (CES-D), family functioning (McMaster Family Assessment Device), and antisocial behaviour (an adapted 22-item Self-Report Delinquency Scale). Logistic regression analyses using HLM V5.05 with a population-average model were conducted. In the model considered, reported sexual abuse is significantly independently associated with antisocial behaviour, controlling for confounding factors of depressive symptomatology and family dysfunction, with increased risks of three- to eightfold for sexually abused boys, and two- to threefold for sexually abused girls, compared to nonabused. Increased risks of extreme substance use in sexually abused girls (age 13) and boys (ages 13-15) are more than fourfold, compared to nonabused. Age differences were not statistically significant. Childhood sexual abuse is a risk factor for the development of antisocial behaviour and substance use in young adolescents. Clinicians should be aware of gender differences.

Prevalence and correlates of past-year substance use, abuse, and dependence in a suburban community sample of high-school students

To assess the severity of substance use, abuse and dependence in a community sample of high school students, a cross-sectional survey was conducted in a suburban New Jersey community. Participants, a sample of 9th to 12th graders from six high schools ( N=1044), completed a self-administered questionnaire after obtaining active parental consent. The measure of substance use disorders was based on 27 specially designed questions that approximate the DSM-IV criteria for abuse and dependence. Equivalent multivariate logit models were used to estimate the significant correlates for both use and dependence/abuse. The prevalence of drug use in this sample was similar to the national average for all drugs except alcohol. A total of 16.4% of the surveyed students reported either abuse or dependence symptoms with alcohol in the past year. The rates of abuse/dependence for marijuana and other illicit drugs were 13.4% and 3.9%. The rate of nicotine dependence was 8.0%. The logit models designed to examine the correlates of substance use showed minimal predictive or correlative value in explaining substance abuse or dependence in adolescence. More research is needed to identify and understand the factors leading adolescents from drug use to abuse or dependence.

Demographic and clinical correlates of client motivation among substance abusers.

Understanding the role of motivation in substance abusers' acceptance of treatment is critically important to improving treatment outcomes. To examine this phenomenon a cohort of substance abuse treatment clients was recruited from two treatment programs whose services are funded by a state managed care system. Motivation at treatment entry was examined. Better motivation was consistently associated with severity of substance use. Neither the coercion that accompanies legal system involvement nor self-referral was significantly related to measured levels of motivation. Motivation was not related to alcohol and drug use severity six months later. The severity associated with motivation at treatment entry was, for the most part, not related to clients' success six months later. Implications for social work practice with substance abusers are discussed.

Factors that predict adolescent motivation for substance abuse treatment

Many adolescent substance abusers enter treatment because of external pressures and thus lack motivation to change their behavior and engage in treatment. Because an understanding of adolescent motivation may contribute to improved treatment, an investigation of factors that predict motivation was undertaken with youth admitted to an adolescent outpatient substance abuse treatment program ( N = 196). At admission, these subjects received a comprehensive biopsychosocial assessment. Using multiple regression analysis, factors considered to potentially predict motivation were assessed. Of the factors examined, those that involved experiencing various negative consequences of substance use emerged as important predictors of motivation, whereas severity of substance use did not. Diminished awareness of negative consequences of use was consonant with lower motivation, suggesting the importance of interventions to help youth recognize negative consequences of their substance use. Interventions to enhance motivation are likely to become more important as the juvenile justice system increasingly refers troubled youth to treatment.

Outcomes of homeless adults with mental illness in a housing program and in case management only.

The effectiveness of two types of service programs in ameliorating homelessness among individuals with severe mental illness was compared. Homeless persons with severe mental illness were recruited into the study on their entry into one of two types of homeless service programs. The first was a comprehensive housing program, in which consumers received guaranteed access to housing, housing support services, and case management. The second was a program of case management only, in which consumers received specialized case management services. In a quasi-experimental or nonrandom-assignment design, participants responded to instruments measuring housing status, mental health symptoms, substance use, physical health, and quality of life at baseline (program entry) and at six months and 12 months after entry. The baseline interview was completed by 152 participants and at least one of the two follow-up interviews by 108 participants. High-, medium-, and low-impairment subgroups, based on psychiatric symptoms and degree of alcohol and illegal drug use, were formed by means of a propensity score subclassification. Persons with high psychiatric symptom severity and high substance use achieved better housing outcomes with the comprehensive housing program than with case management alone. However, persons with low and medium symptom severity and low levels of alcohol and drug use did just as well with case management alone. The results suggest that the effectiveness, and ultimately the cost, of homeless services can be improved by matching the type of service to the consumer's level of psychiatric impairment and substance use rather than by treating mentally ill homeless persons as a homogeneous group.

Smoking Among Psychiatric Outpatients: Relationship to Substance Use, Diagnosis, and Illness Severity.

To understand the elevated smoking rates among psychiatric patients, the authors investigated whether psychiatric diagnosis, illness severity, and other substance use predicted smoking status in a diverse sample (N=2774) of psychiatric outpatients. Results indicated that 61% smoked daily and that 18% smoked heavily. Smoking was related to psychiatric diagnosis and illness severity as well as caffeine consumption and substance abuse. Diagnoses of bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking status, an association that was most pronounced among persons treated at clinics serving more impaired patients. Thus, diagnosis and illness severity contribute to elevated smoking rates, even after controlling for other substance use. Cessation programs are needed to reduce tobacco use in this vulnerable population.

Serotonin transporter polymorphisms and measures of impulsivity, aggression, and sensation seeking among African-American cocaine-dependent individuals

Considerable evidence indicates that serotonergic mechanisms, particularly the serotonin transporter (5HTT), may mediate central effects of cocaine and may also be involved in impulsive and aggressive behavior. We investigated whether polymorphisms in the 5HTT gene were related to traits of impulsivity, sensation seeking, and aggression among cocaine abusers. Standardized measures of these personality traits were obtained in a sample of 105 severely affected cocaine-dependent African-American subjects and 44 African-American controls. Two polymorphisms of the 5HTT gene were examined involving the 5′ promoter (5HTTLPR) region and a 17 base pair variable-number-tandem-repeat (VNTR) marker among cocaine patients. No significant relationships were observed between polymorphic variants of the 5HTTLPR and VNTR regions and scores on any of the trait measures. Similarly, demographic variables and measures of severity of substance use and depression were unrelated to allele frequencies or genotype distributions of the variants among cocaine patients. As expected, cocaine patients scored significantly higher on total scores of impulsivity, aggression, and sensation seeking compared to controls. The findings do not seem to support an association between these polymorphisms in the 5HTT gene and impulsive-aggressive traits among cocaine-dependent African-American individuals.