Severe Substance Use Disorders Research Articles

Mind it! A mindfulness-based group psychotherapy for substance use disorders in adolescent inpatients.

Cannabis use disorder (CUD) is the most frequent reason for psychiatric inpatient substance use disorder (SUD) treatment among 15-19-year-olds in Germany. Despite effective treatment programs, relapse rates remain high. Thus, existing multi-component programs (TAU) need to be enhanced with SUD-specific elements. Mindfulness-based interventions (MBI) seem promising as they can positively influence SUD-related behaviors (e. g. craving). Given limited research in adolescents, this randomized controlled trial investigated the extent to which MBI-based group therapy (Mind it!) as an add-on treatment to TAU led to fewer cannabis use days after 6months in 84 adolescent inpatients with CUD. Additionally, craving, severity of CUD, and changes in mindfulness were monitored (pre-, post-, and follow-up (FU) assessments). The results revealed a significant reduction in cannabis use days in both groups at 6-month FU (d = -0.72 and = -0.75). Although minor additional benefits of Mind it! were evident post-treatment, specifically reduction of craving and SUD severity, by the 6-month mark, TAU exhibited a more substantial decrease in SUD severity (d = 0.78), and reward craving (d = 0.28) compared to Mind it!. Regarding self-regulation skills (mindfulness), Mind it! demonstrated superiority over TAU after 6-month FU (d = 0.27). Therapists judged the MBI as feasible. (Serious) adverse events were unrelated to Mind it!. There was a systematic dropout among Mind it! participants. Primarily, the results emphasize the effectiveness of TAU in reducing cannabis use. MBI also seem feasible for youth, but results remain inconsistent and unstable over time. Importantly, enhanced adherence to reduce dropouts is needed.Trial registration: German Clinical Trials Register, DRKS00014041. Registered on 17 April 2018.

Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis

Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333–0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5–83.0%) than paternal (19.5–56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.

Pharmacist-implemented intervention to surmount COVID-19 vaccination hesitancy in adults with substance use disorders.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Substance use disorders (SUDs) increase the risk and severity of infectious diseases, including coronavirus disease 2019 (COVID-19). Adults with a co-occurring SUD and psychiatric disorder were studied to elucidate the association between SUD severity and (1) COVID-19 vaccination status, (2) receptivity to a one-session intervention with a pharmacist advocating the benefits of vaccination, and (3) acceptance of referral for vaccination following the intervention. COVID-19 vaccination status was recorded in 460 adults with SUD (324 males and 136 females) upon entry into inpatient treatment. A 2-parameter item response theory (IRT) model quantified SUD severity. Pharmacist-delivered intervention, modeled after the screening, brief intervention, and referral to treatment (SBIRT) protocol, was offered to unvaccinated participants. Higher SUD severity was associated with a lower vaccination rate. Nicotine, opioid, and sedative use disorders were most frequently associated with unvaccinated status. SUD severity was not associated with receptivity to intervention advocating vaccination or subsequent acceptance of a referral for vaccination. The portion of the sample that received the intervention was over 7 times more likely to accept a referral for vaccination when compared to participants who rejected the intervention (20.8% vs 2.8%). Pharmacist-administered intervention produced motivation for vaccination in a number of recipients; however, receptivity to the intervention was not related to SUD severity.

Clarifying Relations Between Core Features of Psychopathy and Substance (Mis)use: A Replication and Extension in Two Large Independent Samples.

Two studies examined the consistency of associations between specific components of psychopathy and two indices of drug use: (a) abstinence and (b) severity (i.e., counts) of lifetime substance use disorder (SUD) symptoms. Participants were 418 male county jail inmates in Illinois (Study One) and 354 male state prison inmates in New Mexico (Study Two). Across samples, lifestyle and antisocial trait ratings were associated with a reduced likelihood of abstinence from most substances. Lifestyle traits were also uniquely associated with severity of substance dependence ratings. Consistent with prior research, interpersonal traits were uniquely related to cocaine indices in both samples. Furthermore, analyses revealed negative associations between the affective features of psychopathy and alcohol dependence in one sample (Study Two), and illicit substance use across samples. These findings demonstrate the robustness of the associations between the interpersonal and affective features of psychopathy and specific aspects of substance (mis)use.

The association of cognitive functioning and substance use disorders with adaptive impairments of inpatients in forensic addiction treatment

ABSTRACT Background Addiction medicine still largely neglects the topic of mild and borderline intellectual disabilities (MBID), although patients with MBID are considered a risk group for substance-related problems and offending behaviour. This study aimed to explore the cognitive and adaptive impairments of inpatients in forensic addiction mental health care. Method Participants included a total of 50 consecutive referrals who had a substance use disorder. Results 74% of the patients had a total IQ-score lower than 85, and 78% had an adaptive impairment in one or more domains of functioning. Only 10% had no cognitive or adaptive impairments. The total IQ-score significantly predicted the total number of impaired domains of adaptive functioning and the severity of substance use disorder did not predict adaptive functioning at all. Conclusions It can be concluded that in forensic addiction care the prevalence of cognitive and adaptive impairments is high, with 62% having cognitive as well as adaptive impairments.

Not Two Sides of the Same Coin: A Qualitative Comparative Analysis of Post-Treatment Abstinence and Relapse.

Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse. In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interplay of multiple conditions, was applied to discern which factors were necessary or sufficient for the occurrence of either abstinence or relapse. We found two solutions predicting abstinence, and five for relapse. Post-treatment conditions (support and engagement in activities) were important for retaining abstinence. For relapse, individual baseline characteristics (intellectual disability, social disintegration, psychiatric comorbidity) combined with (post-)treatment factors (post-treatment support, activities) were important. Although abstinence and relapse represent opposing outcomes, they each exhibit distinct dynamics. To gain a comprehensive understanding of these dynamics, it is advisable to examine them as separate outcomes. For clinical practice, it can be worthwhile to recognize that fostering the conditions conducive to abstinence may differ from preventing the factors that trigger relapse.

Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation

BackgroundPrior reviews of substance use disorder (SUD) treatment have found mixed support for residential level of care but are limited by methodology problems and the ethical concerns of randomizing patients with severe SUD to lower levels of care. MethodsThe present study is the first to use a large archival SUD residential sample with a matched comparison group and one-year follow-up period to examine the benefits of residential treatment provided to adults clinically assessed as warranting SUD residential care. We used propensity score matching in our sample (N = 6177) of veterans with a SUD who were screened and accepted for Veterans Affairs (VA) SUD residential treatment between January 1st, 2019 and June 30th, 2019. ResultsWe found evidence that VA SUD residential treatment saves veteran lives with an average 66% all-cause mortality risk reduction during the study period (b = −1.09, exp(b) = 0.34, p <0.001). Medium-to-large residential pre- to post-treatment self-reported mental health and SUD symptom improvements (|SMDrobust| = 0.54–0.93) were sustained by one-year post-screening. These residential treatment improvements were significantly larger than estimated counterfactual outcomes across self-reported SUD and stress disorder symptoms at one-year post-screening (ps <0.001). We found mixed behavioral, service utilization, and other self-reported mental health outcomes. ConclusionsWe conclude that VA SUD residential treatment is an effective level of care for veterans warranting residential care particularly for SUD symptom improvements and reductions in mortality risk.

MISSION IMPOSSIBLE? Integrated services for people with SMI and SUD - The importance of good leadership and management.

Introduction: Better services for people with mental illness and substance use disorder (SUD) can be looked at as a Mission Oriented Innovation (MOI). People with severe mental illness (SMI) and SUD are often in the need of a range of different services, and different service models for coordinating such services have been introduced through the years.&#x0D; Aim: This study explores what inhibits and promotes integrated services for people with SMI and SUD in the service model FACT – Flexible Assertive Community Treatment.&#x0D; Methods: This is a qualitative explorative multiple-case study with the use of focus group interviews and reflexive thematic analysis (RTA) of team members in three different FACT-teams in Norway.&#x0D; Results: In team A the themes ‘Poor and lacking communication’, ‘Culture &amp; Attitude’ and ‘Some resources are missing’ inhibits integrated services. And ‘A holistic and open work environment’, ‘Systemic assertive’ and ‘Focus on social recovery’ promotes. In team B ‘Lack of resources’, ‘Incorrect focus or problem focused practice’ inhibits, and ‘Function recovery advocacy &amp; practice – Function FACT’ and ‘Good triple Management’ promotes. In team C ‘Administration &amp; Management matters’, ‘Segregation &amp; Prioritizing’ and ‘External interaction’ inhibits, and ‘Skilled, creative &amp; dedicated team members’, ‘The FACT service model’ and ‘Internal &amp; external cooperation’ promotes.&#x0D; Conclusion: Will be presented at the conference.&#x0D; The study also has PPI - Personal and Public Involvement with the engagement of three peer co-researchers contributing to the research project INNOFACT from start to end. The next step is to summarize and conclude regarding the importance of good leadership and management that will be presented at the conference. Later on the peer co-researchers will interview the patients about the same research questions.&#x0D; There are to our knowledge no studies about what inhibits and promotes integrated services for people with dual (and multiple) diagnosis in the service model FACT. &#x0D;

Interpersonal Trauma and Substance Use Severity: The Serial Mediation of Emotional Intolerance and Emotional Dysregulation

ABSTRACT Substance use is highly prevalent in those with trauma histories, especially in women, which may be in part explained by high rates of interpersonal trauma in this population. Research examining the potential mechanisms underlying the relationship between co-occurring interpersonal trauma histories and substance use disorders (SUDs) is in its infancy. The current study examined whether the relationship between interpersonal trauma and SUD severity could be understood via the sequential ordering of two transdiagnostic emotional vulnerability factors: 1) emotional intolerance (anxiety sensitivity, distress intolerance), and 2) emotional dysregulation (negative urgency, lack of clarity, nonacceptance, limited strategies, difficulties with goal-directed behavior). A sample of 130 adult community-based women self-identifying as experiencing substance use problems completed the online survey. Mediation analyses suggest that as women’s lifetime interpersonal trauma increases, so does their SUD severity by way of emotional intolerance and subsequent difficulties regulating their emotions. The findings suggests that transdiagnostic interventions targeting tolerance of aversive emotions may facilitate the ability to learn and employ healthy emotion regulation strategies among women with interpersonal trauma histories and SUDs.

Baseline Characteristics and Postdischarge Outcomes by Medication for Opioid Use Disorder Status Among Women with Polysubstance Use in Residential Treatment.

Within residential treatment, medication for opioid use disorder (MOUD) is rarely offered, so little is known about group differences by MOUD status. This study characterizes samples of women receiving and not receiving MOUD and explores postdischarge outcomes. This is a secondary exploratory analysis of a residential clinical trial comparing women receiving treatment as usual (TAU) with those who also received computer-based training for cognitive behavioral therapy (CBT4CBT). Participants were N = 41 adult women with substance use disorder (SUD) who self-reported lifetime polysubstance use. Because 59.0% were prescribed MOUD (MOUD n = 24, no MOUD n = 17), baseline variables were compared by MOUD status; outcomes at 12 weeks postdischarge were compared by MOUD status and treatment condition using chi square and Mann-Whitney U tests. Participants were middle-aged (41.7 ± 11.6 years) and non-Latinx Black (80.4%). Most used substances in the No MOUD group were alcohol, cocaine, and cannabis, and in the MOUD group, most used substances were opioids, cannabis, and cocaine. Women in the MOUD group tended to have more severe SUD. Postdischarge substance use recurrence rates were twice as high in the MOUD group than in the No MOUD group. Among the women in the No MOUD group, those in the CBT4CBT condition increased the number of coping strategies twice as much as those receiving TAU. Postdischarge substance use recurrence differed by MOUD status. CBT4CBT may be a helpful adjunct to personalized residential SUD treatment. The parent study is registered at [www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03678051)].

Attachment styles, emotion regulation difficulties and mindfulness in substance use disorder

ABSTRACT Objective This study aimed to evaluate attachment, emotion regulation, and mindfulness in patients with substance use disorder (SUD) in comparison to a control group (CG). Methods The study comprised 50 individuals with SUD and 50 healthy people. Addiction Profile Index (API) was applied to the patient group whereas a sociodemographic data form, Mindful Attention Awareness Scale (MAAS), Experiences in Close Relationships Scale (ECRS), Difficulty in Emotion Regulation Scale (DERS) and SCID-5 were applied to both groups. Results Age, education level, MAAS, ECRS, DERS scores showed statistically significant differences between the groups. Substance use and age, education level, ECRS (avoidant attachment) and DERS were shown to be significant in logistic regression analyses. Age, education level and MAAS demonstrated protective effects, while ECRS (avoidant attachment) and DERS showed weak predictors. MAAS was found to be negatively significant with a weak protective effect and determined that ECRS (anxious attachment) and DERS were positively significant and moderately predictive in the SUD severity. Conclusion It can be concluded that disordered attachment and emotion dysregulation may have a more pronounced effect on SUD and severity, while mindfulness may have a weaker efficacy with the evaluation of these variables, which may be important in terms of prevention and treatment.

A Comparative Study of Women With Substance Use Disorder With and Without Post-traumatic Stress Disorder: Complex Interaction Between Childhood Trauma, Empathy, Personality Traits, and Substance Use Severity.

Substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) significantly coexist; thus, identifying potential related factors of both illnesses is important for advancing the prevention strategies. The goals of this study were to compare women with SUD with and without PTSD in terms of potentially related variables and to investigate if those factors are associated with SUD severity. Ninety-five participants (women) with SUD who had been admitted to the outpatient treatment clinic in Turkey were assessed with borderline personality questionnaire, childhood trauma questionnaire, addiction profile index, Levenson self-report psychopathy questionnaire, and basic empathy scale. Participants with PTSD had significantly higher severity of addiction, childhood trauma, borderline personality traits, secondary psychopathy scores, and affective empathy scores than participants without PTSD (P = .013, P = .012, P = .008, P = .031, P = .040). Our study suggested that comorbid PTSD and SUD resulted in more complicated presentation. It seems to be crucial for practitioners to screen PTSD symptoms in women with severe SUD and complicated clinical presentations.

Type of Victimization Exposure, Perpetrator Type, and Timing of Victimization: The Impact on Behavioral Health Outcomes.

The effect of abuse victimization in correctional samples has been researched previously, particularly with an eye toward these experiences on justice-involved youth and prison samples' offending and recidivism behavior. The role of this type of victimization, including physical abuse, sexual abuse, and polyvictimization, is less studied in jail populations. The effect of abuse victimization is also less researched among other outcomes, including behavioral health disorders (BHDs) and substance use disorder (SUD). While the effect of abuse, generally, has been examined, less is known about how abuse perpetrator type and timing of abuse impact justice-involved individuals' outcomes. Using logistic regressions, we examined the influence of abuse perpetrator type (non-stranger or stranger) and timing (before childhood, after childhood, or before and after childhood) in a population of jailed adults from one state (n = 4,713). Outcomes studied included internalizing BHDs, externalizing BHDs, and severe SUD. Results indicated that abuse perpetrated by a non-stranger yielded a greater impact on mental illness compared to abuse perpetrated by a stranger. In contrast to abuse experienced as an adult, childhood abuse was more consistently associated with internalizing and externalizing disorders but was not related to severe SUD, with an exception of physical abuse. Further, BHDs and SUD were strongly associated with each other. Overall, polyvictimization had the strongest effect on the outcomes compared to either physical abuse or sexual abuse alone. Our findings suggest that screening for abuse experiences as a potential destabilizing factor in justice-involved populations could improve case management and interventions for people incarcerated in jails. Results also highlight the importance of distinguishing between the perpetrator type of abuse and timing of abuse.

Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders

Significant trauma histories and post-traumatic stress disorder (PTSD) are common in persons with substance use disorders (SUD) and often associate with increased SUD severity and poorer response to SUD treatment. As such, this sub-population has been associated with unique risk factors and treatment needs. Understanding the distinct etiological profile of persons with co-occurring SUD and PTSD is therefore crucial for advancing our knowledge of underlying mechanisms and the development of precision treatments. To this end, we employed supervised machine learning algorithms to interrogate the responses of 160 participants with SUD on the multidimensional NIDA Phenotyping Assessment Battery. Significant PTSD symptomatology was correctly predicted in 75% of participants (sensitivity: 80%; specificity: 72.22%) using a classification-based model based on anxiety and depressive symptoms, perseverative thinking styles, and interoceptive awareness. A regression-based machine learning model also utilized similar predictors, but failed to accurately predict severity of PTSD symptoms. These data indicate that even in a population already characterized by elevated negative affect (individuals with SUD), especially severe negative affect was predictive of PTSD symptomatology. In a follow-up analysis of a subset of 102 participants who also completed neurocognitive tasks, comorbidity status was correctly predicted in 86.67% of participants (sensitivity: 91.67%; specificity: 66.67%) based on depressive symptoms and fear-related attentional bias. However, a regression-based analysis did not identify fear-related attentional bias as a splitting factor, but instead split and categorized the sample based on indices of aggression, metacognition, distress tolerance, and interoceptive awareness. These data indicate that within a population of individuals with SUD, aberrations in tolerating and regulating aversive internal experiences may also characterize those with significant trauma histories, akin to findings in persons with anxiety without SUD. The results also highlight the need for further research on PTSD-SUD comorbidity that includes additional comparison groups (i.e., persons with only PTSD), captures additional comorbid diagnoses that may influence the PTSD-SUD relationship, examines additional types of SUDs (e.g., alcohol use disorder), and differentiates between subtypes of PTSD.

Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature.

Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10-24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed.

Feasibility of Virtual Reality-Delivered Transcending Self Therapy in Veterans Undergoing Residential Substance Use Treatment

Substance Use Disorder (SUD) is common among military veterans, where post-traumatic stress disorder and other comorbidities stemming from deployment or other military experiences increase the severity of SUD and incidence of relapse. It is thus critical to discover and evaluate potential advances in SUD treatment, such as methods for enhanced patient engagement in treatment.

Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study.

Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone's battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes.

Subjective effects as predictors of substance use disorders in a clinical sample: A longitudinal study

BackgroundThe literature on the association between subjective effects (SEs; i.e., how an individual perceives their physiological and psychological reactions to a drug) and substance use disorders (SUDs) is largely limited to community samples. The present study addressed the following aims in a clinical sample: whether SEs predict general versus substance-specific SUD in adolescence and adulthood after controlling for conduct disorder symptoms (CDsymp); whether SEs predict SUDs across drug classes; whether SEs predict change in SUD from adolescence to adulthood; and whether there are racial/ethnic differences in associations. MethodsLongitudinal analyses were conducted using data from a sample of 744 clinical probands recruited from residential and outpatient SUD treatment facilities in CO during adolescence (Mage = 16.26) and re-assessed twice in adulthood (Mages = 22.56 and 28.96), approximately seven and twelve years after first assessment. SEs and CDsymp were assessed in adolescence. SUD severity was assessed at adolescence and twice during adulthood. ResultsSEs assessed in adolescence robustly predicted general SUD for legal and illegal substances in adolescence and adulthood, whereas CDsymp predicted SUD primarily in adolescence. Higher positive and negative SEs in adolescence were associated with greater SUD severity after controlling for CDsymp, with similar magnitudes. Results indicated cross-substance effects of SEs on SUD. We found no evidence for racial/ethnic differences in associations. ConclusionsWe investigated the progression of SUD in a high-risk sample with greater odds of sustained SUD. In contrast to CDsymp, both positive and negative SEs consistently predicted general SUD across substances in adolescence and adulthood.

Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management

BackgroundMentalization is the ability to use internal mental states to manage and understand one’s own and others’ behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. MethodsUsing the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., ‘hypo-mentalization’ or ‘uncertainty’: concrete thinking with poor attribution of mental states; ‘hyper-mentalization’ or ‘certainty’: rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). ResultsThirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients’ mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. ConclusionsOA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.

Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental lifestages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilienceagainst developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.