Substance Abuse Group Research Articles

Co-abuse of amphetamine and alcohol harms kidney and liver.

The prevalence of alcohol use disorder was found 75% higher among amphetamine dependent patients. Alcohol and amphetamine alone have nephrotoxicity and hepatoxicity. But, the degree of risk with coabuse of alcohol and amphetamine is unknown. The objective of this study was to assess toxic effects of amphetamine-alcohol co-abuse on the liver and kidney. he present study was a cross-sectional study conducted et al. Amal Hospital for Mental Health, Qassim region, KSA and include one hundred participants. Seventy-five participants were patients hospitalized for the treatment of abuse, and twenty-five participants, were healthy voluntaries, have no history of abuse. An experienced psychiatrist conducted patient interviews and assessed the patients using the DSM-5 criteria. The data from healthy participants were considered as a control. The abuse group was paired with the control group by age and lifestyle. Participants were split into: Group I: Control group (n = 25); Group II: Amphetamine (AMP) abuser group (n = 25); Group III: Alcohol abuser group (n = 25) and Group IV: Combined drug abuser group (AMP and alcohol) (n = 25). The socio-demographic data was collected. Complete medical examination, Body Mass Index and samples of blood and urine were collected from all participants for analytical tests; determination of alcohol and AMP levels, kidney functions and liver functions. The mean BMI values in groups II, III, and IV showed no significant change from the control group. The serum level of albumin and alkaline phosphatase showed significant decrease in all abuser groups. While, alanine transaminase (ALT), Aspartate transaminase (AST) and osteopontin levels showed significant increase in all abuser groups. Fasting blood sugar values showed significant increase in alcohol abusers. On the other hand, it revealed no significant change in AMP and combined groups. The mean values of urea showed no significant change in AMP and alcohol abusers and significant increase in combined drug abuser group. The serum creatinine and all abuser groups showed significant increase in Cystatin C. The alteration in the most of studied biochemical parameters were more than two folds in combined group compared with that of AMP or alcohol groups. Study reveals synergistic liver and kidney toxicity. Amphetamine-alcohol co-abuse significantly heightens kidney and liver toxicity.

Amelioration of Cytogenotoxic Damage in Drug Abusers Supplemented with Folic Acid.

Cytogenotoxic damage caused by the consumption of legal and illegal drugs in drug abusers has been demonstrated, primarily due to alterations in their antioxidant capacity, cellular repair mechanisms, and increased production of free radicals. Folic acid shows antioxidant activity by acting as a reducing agent, neutralizing present free radicals, and reducing genomic damage. The intervention involved administering 15 mg of folic acid, divided into three doses per day, to a group of 44 drug abusers. The frequency of nuclear abnormalities (NAs) was determined; micronuclei (MNs), nuclear buds (NBUDs), binucleated cells (BNs), abnormally condensed chromatin (CC), karyorrhexis (KX), pyknotic nuclei (PNs), and karyolysis (KL) were determined at different pre-treatment (baseline) and post-treatment time points at 15 and 30 days. Additionally, a group of 44 healthy individuals was used as the control group. We observed a statistically significant decrease in the frequency of NAs in the drug abuser group (28.45 ± 17.74 before supplementation vs. 11.18 ± 7.42 at 15 days and 9.11 ± 10.9 at 30 days of supplementation). Specifically, it decreased the frequency of NBUDs, BNs, CC, KX, and PNs (p < 0.05). Our study demonstrates a clear improvement in cytogenotoxic damage in drug abusers supplemented with folic acid.

The Relationship between the Brain-Derived Neurotrophic Factor Gene Polymorphism (Val66Met) and Substance Use Disorder and Relapse.

Substance addiction is a neuropsychiatric disorder characterized by a recurring desire to continue using a substance despite harmful consequences. Brain-derived neurotrophic factor (BDNF) is a protein that plays a role in the activity-dependent remodeling of neural function in adult nervous systems. This study analyzed the association of the rs6265 polymorphism of the BDNF gene in a group of patients addicted to psychoactive substances who were participating in addiction treatment for the first time, in a group of post-relapse psychoactive substance abusers and in a control group. The study also assessed personality and anxiety in all study groups. Statistically significant differences in the frequency of genotypes and alleles were found between all study groups. Compared to the control, both study groups had statistically significantly higher scores for trait and state anxiety. Addicted patients in both groups also had higher scores on the Neuroticism and Openness scales and lower scores on the Extraversion and Agreeableness scales. The results of this study provide further evidence that personality traits, anxiety and the rs6265 polymorphism of the BDNF gene may be risk factors for susceptibility to addiction to psychoactive substances. In addition, they can be a predictor of addiction relapse, but further extensive studies are required to confirm these findings.

Drug addiction and marital conflicts: Exploring the experiences of drug‐addicted wives in Abuja, Nigeria

AbstractRecent studies have shown that women now abuse drugs as much as men. Women even abuse certain kinds of drugs more than men. There is strong evidence that some married women also engage in drug abuse. However, few studies have explored the experiences of drug addicted wives in Nigeria in relation to marital conflicts. In this study, the experiences of drug addicted wives were explored in relation to marital conflicts in Nigeria using a phenomenological research design. A total of 18 married women participated in the study. They were purposively selected from a socially disadvantaged neighborhood of Batcher Estate, Gwarinpa, Abuja, Nigeria. In‐depth interviews (IDI) were used to collect data from the participants. Data were analyzed using content analysis. Two major conclusions were drawn from the study. Drug addiction may cause marital conflicts and vice versa. However, wives abusing drugs without the consent of partners or husbands were more likely to report marital conflicts than those abusing drugs with their partners' consent. Two groups of drug abusers were also discovered: those who were initiated into drug abuse/addiction prior to marriage and those who started taking drugs after marriage. Factors influencing drug abuse/addiction were complex and comprised a combination of psycho‐social and environmental issues. Access to substance‐use disorder (SUD) treatment was, however, impeded by poor knowledge, stigma and shame. Improved access to treatment is an important asset in minimizing drug abuse among married women and its impact on marital conflicts.

INVESTIGATING THE ROLE OF DOPAMINE SIGNALING GENE POLYMORPHISMS AND PREVALENCE OF HUMAN ANELLOVIRUSES INFECTION IN SUBSTANCE ABUSE

The dopaminergic system plays a major role in consolidating the effects and dependence of abused substances. Unlike monogenic diseases, psychiatric disorders – including substance abuse and addiction – are multifactorial disorders in which genetic factors, with varying contributions to the phenotype, and environmental factors are involved. This study aimed to investigate the association between polymorphisms in genes involved in the dopaminergic signaling pathway and substance abuse, as well as to assess the prevalence of human anelloviruses. Individuals hospitalized for substance abuse (n = 15) and healthy subjects (n = 15) were recruited for the study. Blood samples were collected and used for isolating DNA and genotyping two polymorphisms in dopamine signaling genes (i.e., DRD2 TaqI A, DAT1 VNTR) using PCR-RFLP. Anelloviral DNA was detected using hemi-nested PCR. The distribution of polymorphisms did not differ from Hardy-Weinberg equilibrium in the investigated groups. A slightly higher frequency of the A1 allele of DRD2 TaqI A polymorphism was found in the substance abuse group, consistent with literature. The DAT1 VNTR 12R allele associated with lower expression of DAT1 and slower dopamine reuptake at the synapse level, appears to be protective against this type of behavior. Additionally, anelloviral DNA was present in all study participants, in line with previous reports. DAT1 VNTR genotypes might be associated with substance abuse. However, replication of results in larger groups, study of other genes, environmental factors, and their interactions are important to obtain a broader understanding of this behavior.

Abstract WMP69: Recreational Drug Use And Ischemic Stroke: Demographics, Stroke Mechanism, And Outcomes

Introduction: Various recreational drugs have been linked to cerebrovascular events, especially in young adults, however, few studies have examined relationships between substance abuse (SA) and acute ischemic stroke (AIS) in detail. The objective of this study was to determine prevalence and stroke mechanism in a cohort of AIS patients with SA and the impact of SA on outcomes and recovery. Methods: A retrospective case-control study comparing adults hospitalized with AIS with positive urine drug screen (UDS, excluding cannabis and its related products) from January 2015 to December 2019 compared with matched AIS controls from Greater Chicago area. Logistic regression was used to compare demographics, mechanism of stroke, discharge outcomes as measured by modified Rankin Scale (mRS), and disposition outcomes. Results: Out of 3229 AIS patients, 141 (6.5%) has positive UDS (SA group) and were compared to 282 controls. Illicit drugs used were cocaine (69%), opiates (21%), and the rest were amphetamines, phencyclidine, ecstasy, or multiple substances. Demographically, there were no significant differences in age [56.0±10.0 years vs 55.9±10.5], or sex [men 63.1% vs 60.3%]. Controls had higher rates of traditional stroke risk factors [diabetes (DM), p=0.0001 and hyperlipidemia (HLD), p=0.004], and a higher incidence of large artery atherosclerosis as suspected stroke mechanism than the SU group (p = 0.001). SA group at discharge had higher levels of disability [median mRS 2 vs 3 (p = 0.001)] and worse discharge disposition, i.e. subacute rehab/long term care facility/hospice/death vs home or acute rehabilitation (OR 0.49, p =0.009, CI 0.29-0.84), even after correcting for age, sex, HTN, DM, coronary artery disease, and HLD in a multiple logistic regression (OR 0.43, p= 0.004, CI 0.24-0.76). Conclusion: In our cohort, patients with AIS and SA were more likely to have a stroke mechanism of large artery atherosclerosis and poorer outcomes with higher levels of disability and worse discharge disposition.

The Effect of Drug Abuse on Clinical Outcomes of Adult Burn Patients Admitted to a Burn Center in the North of Iran.

Burn trauma is a life-threatening incident that may be accompanied by several risk factors that increase morbidity and mortality. Drug abuse is one of the lifestyle dangers on the rise globally and can have an impact on the outcomes of burn injuries. This study aimed to evaluate the effect of drug abuse on the clinical outcomes of adult burn patients who were admitted to a burn center in the North of Iran. This retrospective cross-sectional study included adult burn patients who were referred to Velayat Hospital, between March 1, 2021, and March 20, 2022. The hospital information system (HIS) was used to select patients with a history of drug use and then were compared with burn victims who had never used drugs before. In both groups, demographic information, the cause of the burn, the comorbid diseases, total body surface area, length of stay, and outcomes were collected and recorded for both groups. This study included 114 inpatients, 90 of whom (78.95%) were men. The mean age of the patients was 43±15 years. The mean length of hospitalization in the drug-user group was significantly higher than in the non-drug abuse group (p=0.004). The drug abuse group had significantly higher rates of comorbid diseases (p=0.021), inhalation injury (p<0.001), mortality (p=0.002), and pneumonia (p<0.001). However, there were no statistically significant differences in the Infection and Sir's rates (p=0.583) between the groups. Drug abuse is a risk factor in adult burn patients, which can affect the length of stay and burn-related morbidities.

Investigation of the Subtypes of Nonsuicidal Self-Injury Based on the Forms of Self-Harm Behavior: Examining Validity and Utility via Latent Class Analysis and Ecological Momentary Assessment.

This study aimed to empirically derive and validate subtypes of nonsuicidal self-injury (NSSI) based on the forms of self-harm behavior. Sixty young adults who exhibited repetitive NSSI completed a clinical interview and baseline measures, followed by a two-week ecological momentary assessment (EMA). A latent class analysis was administered to identify NSSI subtypes based on the forms of self-harm behavior. The subtypes were then compared to baseline clinical and EMA variables, including emotions and urges to self-harm. The best-fitting model supported two subtypes: 1) substance abuse and suicide attempt subtype and 2) cutting and scratching subtype. The substance abuse and suicide attempt subtype reported a higher rate of engaging in lifetime suicide plans and suicide attempts and a higher number of lifetime suicide attempts. They also showed significantly higher severity of self-harm behavior, borderline personality traits, anger, posttraumatic symptoms, and difficulties in emotion regulation when compared to the cutting and scratching subtype. However, there was no inter-subtype difference in self-esteem. In the EMA data, anger toward others, feeling of rejection, loneliness, and helplessness were significantly high in the substance abuse and suicide attempt subtype. The variability of anger toward others was also higher in this subtype compared to the cutting and scratching subtype. Finally, in the two-week research period, the substance abuse and suicide attempt group showed a higher rate of reported urges to self-harm with or without suicidal intent. Findings support the validity of the subtypes based on the forms of self-harm behavior, suggesting the clinical utility of addressing heterogeneity within individuals exhibiting self-harm for assessment and treatment.

Substance abuse and inpatient outcomes in inflammatory bowel disease hospitalizations in the United States: a propensity matched analysis.

Inflammatory bowel disease (IBD) is a chronic intestinal inflammation resulting in a genetically susceptible population. The present study aimed to look at the effect of substance abuse on IBD hospitalizations in the United States. We identified primary IBD hospitalizations with substance abuse using the National Inpatient Sample database (2016-2019). A matched comparison cohort of IBD hospitalizations without substance abuse was identified by 1:N propensity score matching using the nearest-neighbor method, based on demographics, hospital-level factors, and comorbidities. We matched 4437 IBD hospitalizations with a diagnosis of substance abuse to 4528 hospitalizations without abuse. The median age was higher in the substance abuse group than no abuse (44 vs. 38 years, P<0.001). There was a higher prevalence of discharge to care facilities (2.9% vs. 2.2%) and against medical advice (4.9% vs. 1.8%) in the substance abuse group compared to the no abuse (P<0.001). The median length of hospital stays (LOS) (P=0.74) and hospitalization charge did not differ significantly (P=0.57). There was no significant difference in 30-day inpatient mortality among cohorts (adjusted hazard ratio 0.74, 95% confidence interval 0.32-1.81; P=0.54). There was a higher prevalence of psychoses (2.5% vs. 1.3%) and depression (18.8% vs. 15.7%) in IBD hospitalizations with substance abuse compared to those without abuse (P<0.001). This study reports no difference in median LOS, hospitalization charge, or mortality risk in IBD hospitalizations based on substance abuse. There is a higher prevalence of psychoses and depression in IBD patients, requiring screening for substance abuse to improve overall outcomes.

Psychometric evaluation of the Substance Abuse Subtle Screening Inventory-3 with Northern Plains American Indians.

The efficacy of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) was assessed among northern plains American Indians (AIs). The current study examined the efficacy of the SASSI-3 for identification of substance abuse in AIs. Northern plains AIs from 7 reservations participated in the study. The participants were either a clinical sample receiving substance abuse (SA) or mental health diagnoses from behavioral health clinicians and receiving outpatient treatment services or a community sample that had no substance abuse or mental health diagnoses and were not currently in treatment (no diagnosis). The internal consistency for Face Valid Alcohol (FVA), Face Valid Other Drugs, and Symptoms (SYM) subscales were excellent, and the consistency for the other subscales was moderate, ranging from .21 to 73. The results of the study suggest that the SASSI-3 has good positive predictive power (PPP) and negative predictive power (NPP), particularly when the criterion group substance abuse is larger in the sample. Additionally, the PPP and NPP varied depending on the decision rules. For the analysis that included individuals with just SA, the clinical group scored significantly higher than the no diagnosis group on all measures of the SASSI-3, except for Defensiveness. When the SA group included all individuals with the diagnosis (regardless of the comorbid diagnosis), the clinical group scored significantly higher than the no diagnosis group for all the SASSI-3 subscales. A discriminant examination of the standardized function coefficients indicated that the FVA and SYM subtests contributed the most to the function. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Left Ventricular Assist Device in Patients with History of Alcohol Abuse or Substance Abuse: An INTERMACS Analysis

<h3>Purpose</h3> In order to understand the impact of history of alcohol and illicit substance abuse on outcomes after left ventricular assist device (LVAD) implantation, we analyzed the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry. <h3>Methods</h3> All patients entered into the INTERMACS registry who received a continuous-flow LVAD (CF-LVAD) from June 2006 to December 2017 were included. Patients who had a temporary LVAD, pulsatile-flow LVAD, right ventricular assist device (RVAD), total artificial hearts, or biventricular assist devices were excluded. The Median follow-up duration was 13.3 months (IQR 5.3-28.3). Multivariable Cox proportional hazards model was performed to compare survival in patients with history of alcohol or substance abuse with the rest of the population (control). <h3>Results</h3> There were a total of 15069 patients in the final study group with 1184 patients with history of alcohol abuse and 1139 patients with history of substance abuse. The mean age in alcohol abuse and substance abuse group were 53.3 ± 12.4 (years), and 47.6 ± 12.5 (years), while the mean age in control group was 57.8 ± 12.8 (years). The overall mortality rate during the follow-up in alcohol abuse and substance abuse group were 24.8%, and 21.0%, respectively, compared with 28.7% in control. There was no significant difference in adjusted mortality between the history of alcohol abuse group and control (HR, 0.97, 95% CI, 0.86-1.10, p = 0.62). Similarly, there was no difference between the history of substance abuse group and control (HR, 0.95, 95% CI, 0.83-1.10, p = 0.51) (Figure). <h3>Conclusion</h3> Our findings suggest that patients with history of alcohol abuse or substance abuse have similar mortality rates as control.

Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives.

Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.

Serotonin transporter protein in autopsied brain of chronic users of cocaine.

The long-held speculation that the brain serotonin system mediates some behavioral effects of the psychostimulant cocaine is supported in part by the high affinity of cocaine for the serotonin transporter (SERT) and by reports that the serotonin transporter (SERT), estimated by SERT binding, is increased in brain of human chronic cocaine users. Excessive SERT activity and consequent synaptic serotonin deficiency might cause a behavioral (e.g., mood) abnormality in chronic users of the drug. Previous studies focused on changes in SERT binding, which might not necessarily reflect changes in SERT protein. Therefore, we compared levels of SERT protein, using a quantitative Western blot procedure, in autopsied brain (striatum, cerebral cortices) of chronic human cocaine users (n = 9), who all tested positive for the drug/metabolite in brain, to those in control subjects (n = 15) and, as a separate drug of abuse group, in chronic heroin users (n = 11). We found no significant difference in protein levels of SERT or the serotonin synthesizing enzyme tryptophan hydroxylase-2 among the control and drug abuse groups. In the cocaine users, no significant correlations were observed between SERT and brain levels of cocaine plus metabolites, or with levels of serotonin or its metabolite 5-hydroxyindoleacetic acid. Our postmortem data suggest that a robust increase in striatal/cerebral cortical SERT protein is not a common characteristic of chronic, human cocaine users.

Attending Substance Abuse Groups and Identifying as Spiritual but not Religious

In recent years, the number of people who identify as “spiritual but not religious” has grown. At the same time, many addiction recovery programs such as Alcoholics Anonymous promote spiritual beliefs to help those suffering from alcohol use disorders. In this paper, we hypothesize and test to see whether individuals who have attended substance abuse groups such as Alcoholics Anonymous are more likely to identify as spiritual but not religious (SBNR). Using longitudinal data from the Midlife Development in the United States study ( N = 1711), we find that those who have attended substance abuse groups are more likely to identify as SBNR. Further, frequency of attendance in these groups is positively and significantly associated with being SBNR when compared to being both religious and spiritual. Implications for understanding the connections among religion, spirituality, and substance abuse recovery programs are discussed.

Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness

Although there is extensive literature on the processes and outcomes of drug and alcohol dependence treatments, little is known about specific predictors of treatment effectiveness. The present study aims to identify the predictors of abstinence in outpatient drug and alcohol dependence treatments, as well as the predictors of treatment effectiveness, according to a biopsychosocial approach. The study followed a cross-sectional research design. Participants (n = 290) were recruited from an outpatient treatment of the Intervention Division in Addictive Behaviors and Dependencies (DICAD), in the northern region of Portugal. A convenience sample was used. Data was collected using questionnaires administered at the facilities of the DICAD, in a private, quiet room. Results indicate that predictors of abstinence were involvement in treatment, psychopathology symptoms, and treatment program (i.e., outpatient drug vs alcohol dependence treatments). The full model of logistic regression analysis was significantly reliable (χ2(3) = 33.93, p < 0.001), with 72.5% successfully predicted for the non-substance abuse group and a 53.1% accurate prediction rate for the substance abuse group. The predictors of treatment effectiveness, according to a biopsychosocial approach, were social support and the treatment program. The full model was significantly reliable (χ2(2) = 68.28, p < 0.001), with 33.0% successfully predicted for the treatment effectiveness group and a 91.1% accurate prediction rate for the non-treatment effectiveness group. Results suggest that interventions need to focus not only on reducing substance abuse, but also on decreasing psychopathology and promoting therapeutic involvement, acting as predictors of abstinence. Furthermore, interventions must focus on promoting social support and the treatment program, acting as predictors of treatment effectiveness, according to a biopsychosocial approach.

Chapter 26 - Addiction among women and sexual minority groups

Gender-related alcohol and drug abuse problems are related not only to biologic differences but also to social and environment factors, all of which can influence the clinical presentation, consequences of use, and treatment approaches. The number of women becoming addicted to alcohol or drugs of abuse has significantly increased with women becoming the fastest-growing group of substance abusers in the United States. Given that women experience a more rapid progression of their addiction than men, it is important that we understand and address the differences to help develop prevention and treatment programs that are tailored for women, incorporating trauma assessment and management, comorbidities, financial independence, pregnancy, and child care.

Gonadal and Cortisol Hormone Profile among Male Chronic Khat, Marijuana, and Heroin Abuses.

Background Drugs of abuse could interfere with the hypothalamic-pituitary-gonadal axis, causing impaired functions of the gland and associated functions of target organs. Drugs of abuse tend to cause changes in the endocrine system, and these changes could be physiological, molecular, biochemical, genetic, and cellular. Method A case-control study design was conducted from a total of 171 male consented study participants (148 drug abusers and 23 controls). The serum gonadal and cortisol hormone levels were assayed using the electrochemiluminescence immunoassay method. Socio-demographic variables were collected using a semi-structured questionnaire by the interview method. Nonparametric statistical tools (Mann–Whitney test and median) were used to compare the groups. In all cases, P < 0.05 was considered statistically significant. Result The median age for drug abusers and control groups was 27, and the age difference between drug abusers and control group was not statistically important. The median estradiol levels among chronic khat chewers (39.4 pg/ml), marijuana (44 pg/mL), and users of heroin (40.2 pg/mL) were significantly higher than control groups (23 pg/mL), P < 0.003. However, the median luteinizing hormone levels among chronic khat chewers (5 IU/L), marijuana users (5 IU/L), and heroin users (5.6 IU/L) were significantly lower than those of control groups (6.2 IU/L), P < 0.02. The median testosterone levels among chronic khat chewers (6.1 ng/mL), marijuana users (6.3 ng/mL), and heroin users (6.6 ng/mL) were significantly lower than control groups (8.0 ng/mL), P < 0.003. However, cortisol and follicle stimulating hormone did not show statistically significant difference between users of khat, marijuana, and heroin compared with the control group. Conclusion The drug abuser group had significantly lower testosterone and luteinizing hormone levels compared with control groups. Drug abuse has been shown to affect gonadal hormones in an unusual physiological phenomenon. These findings reveal the need for intervention programs to solve these problems.

Attachment and Substance Use Disorders-Theoretical Models, Empirical Evidence, and Implications for Treatment.

Introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). Based on attachment theory, substance abuse can be understood as “self-medication,” as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD and, on the other hand, a negative impact of substance abuse on attachment security. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups. Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results: All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment, results mainly point toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful–avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood. Discussion: The last decades have seen a substantial growth in studies on attachment and SUDs. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to the understanding and treatment of SUDs in a significant way. But to do so, a lot of open questions have to be answered. We will need more carefully designed longitudinal studies, more studies connecting psychological data with brain processes, and more clinical trials.

Health Care Utilization and Payments of Postoperative and Drug Abuse-Related Spinal Infections.

Retrospective analysis of data extracted from the MarketScan database (2000-2016) using International Classification of Diseases (ICD)-9, ICD-10, and Current Procedural Terminology-4 codes. Evaluate the economic costs and health care utilization associated with spine infections. Spinal infections (SI) are associated with significant morbidity and mortality. A recent spike in SI is attributed to the drug abuse epidemic. Management of SI represents a large burden on the health care system. We assessed payments and outcomes at the index hospitalization, 1-, 3-, 6-, and 12-month follow up. Outcomes assessed included length of stay, complications, operation rates, and health care utilization. Outcomes were compared between cohorts with spinal infections: (1) with prior surgery, (2) drug abuse, and (3) without previous exposure to surgery or drug abuse, denoted as control. We identified 43,972 patients; 15.6% (N = 6847) of patients underwent prior surgery, 3.8% (N = 1,668) were previously expose to drug abuse while 80.6% fell into the control group. Both the postsurgical and drug abuse groups longer hospital stay compared with the control cohort (5 d vs. 4 d, P < 0.0001). Exposure to IV drug abuse was associated with increased risk of complications compared with the control group (43% vs. 38%, P < 0.0001). Payments at 1-month follow-up were significantly (P < 0.0001) higher among the postsurgical group compared with both groups. However, at 12-months follow-up, payments were significantly (P < 0.0001) higher in the drug abuse group compared with both groups. Only postsurgical infections were associated with higher number of surgical interventions both at presentation and 1 year follow up. SI following surgery or IV drug abuse are associated with higher payments, complication rates, and longer hospital stays. Drug abuse related SI are associated with the highest complication rates, readmissions, and overall payments at 1 year of follow up despite the lower rate of surgical interventions. 3.

Psychosocial rehabilitation:a model by Rajah Rehabilitation Centre

‘Thanal’- Rajah Rehabilitation Centre (RRC) is a nonprofit voluntary organization established in 2001 dedicated to the people suffering from psychiatric illness. RRC adopts an interdisciplinary team approach for the upliftment of the disabled. RRC follows the recovery model of psychosocial rehabilitation. The psychiatric rehabilitation program is initiated with the assessment and trial stay under the supervision of the multidisciplinary treatment team. Rajah Rehabilitation Centre provides the following programs for the service recipients of sheltered workshop; individual consultations, activity scheduling, psychoeducation classes, living skill training, culinary skill training, social skill training, cognitive retraining, yoga training, recreation therapy, music training & therapy, dance training & therapy, work skill training, craft & artwork training, computer training program, on-job training, supported employment, supported housing etc. RRC also offers treatment for substance abuse, SS & Al-Anon groups and peer support groups for patients with mental illness, and crisis intervention program for elderly women with distress (Shanti Bavan) etc. Services at RRC facilitate individuals with psychiatric disability to increase their level of functioning and quality of life.