Substance Use-related Problems Research Articles

Family dynamics and alcohol and marijuana use among adolescents: The mediating role of negative emotional symptoms and sensation seeking

The literature indicates a close relationship between family dynamics and psychoactive substance use among adolescents, and multi-causality among substance use-related problems, including personal adolescent characteristics as potential influential aspects in this relationship. The purpose of this study is to investigate the role of emotional symptoms and sensation seeking as mediators in the relationship between family dynamics and alcohol and marijuana use among adolescents. The sample consisted of 571 high school students with a mean age of 14.63, who completed the Communities That Care Youth Survey in its Spanish version. We propose and test a mediation-in-serial model to identify the relationships between the study variables. The results of the mediation models indicate that, in most cases, the relationship between family dynamics and the substance use variables is meaningfully carried through the proposed mediators, first through negative emotional symptoms, and then through sensation seeking. The meaning of the mediation varies as a function of the facet of family dynamics (conflict or attachment) and the use aspect (age of onset, frequency of use, and use intention). We discuss the implications of these findings for intervention and prevention strategies.

Adolescents Admitted to In-Patient Treatment with Alcohol Intoxication: Risk and Resilience Factors Associated with Problematic Alcohol Use

Background and Objectives: Although the number of adolescents admitted to in-patient treatment with alcohol intoxication (AIA) has strongly risen in many countries, knowledge about this patient population with respect to risk and resilience factors is lacking. The objectives of this study were (1) to explore whether the prevalence of substance use and use-related problems in a sample of AIA is elevated compared to adolescents from the general population and (2) to investigate which biopsychosocial factors are associated with prior problematic alcohol use in AIA. Methods: In a cross-sectional naturalistic study 65 AIA (M and SD age 15.2 ± 1.6 yr) completed questionnaires and were interviewed the morning after admission in two pediatric hospitals in the City of Dresden, Germany. Assessment included substance use, alcohol use disorders, and risk and resilience factors for problematic alcohol use. Results: Elevated prevalence rates were found for alcohol abuse, alcohol dependence, binge drinking, smoking, and illicit substance use. Exploratory analyses revealed that deviant peer affiliations, a positive family history of alcoholism, an elevated alcohol tolerance, and a parenting style characterized by less supervision and strictness were associated with problematic alcohol use. Conclusions: The investigated risk and resilience factors for problematic alcohol use should be included in the clinical decision regarding psychosocial interventions following hospitalization.

Substance Use and Depressive Symptoms Among Adolescents Treated in a Pediatric Emergency Department

ABSTRACTThe current study examined associations between substance use and depressed mood by gender and type of substance used (no use, alcohol, marijuana, or both alcohol and marijuana) in a sample of 713 adolescents (Mage = 15.3) recruited from a Pediatric Emergency Department (PED). Adolescents who reported any marijuana use had higher overall depressed mood scores compared to all other adolescents. When examined by gender, females with both alcohol and marijuana use reported the highest overall depressed mood symptoms. These results suggest the usefulness of screening and identification of depressive symptoms among adolescents presenting to a PED for substance use-related problems.

Peripheral Biomarker Candidates of Posttraumatic Stress Disorder.

There is high variability in the manifestation of physical and mental health problems following exposure to trauma and disaster. Although most people may show a range of acute symptoms in the aftermath of traumatic events, chronic and persistent mental disorders may not be developed in all individuals who were exposed to traumatic events. The most common long-term pathological consequence after trauma exposure is posttraumatic stress disorder (PTSD). However, comorbid conditions including depression, anxiety disorder, substance use-related problems, and a variety of other symptoms may frequently be observed in individuals with trauma exposure. Post-traumatic syndrome (PTS) is defined collectively as vast psychosocial problems that could be experienced in response to traumatic events. It is important to predict who will continue to suffer from physical and mental health problems and who will recover following trauma exposure. However, given the heterogeneity and variability in symptom manifestations, it is difficult to find identify biomarkers which predict the development of PTSD. In this review, we will summarize the results of recent studies with regard to putative biomarkers of PTSD and suggest future research directions for biomarker discovery for PTSD.

Rates of Substance Use of American Indian Students in 8th, 10th, and 12th Grades Living on or near Reservations: Update, 2009–2012

Understanding the similarities and differences between substance use rates for American Indian (AI) young people and young people nationally can better inform prevention and treatment efforts. We compared substance use rates for a large sample of AI students living on or near reservations for the years 2009-2012 with national prevalence rates from Monitoring the Future (MTF). We identified and sampled schools on or near AI reservations by region; 1,399 students in sampled schools were administered the American Drug and Alcohol Survey. We computed lifetime, annual, and last-month prevalence measures by grade and compared them with MTF results for the same time period. Prevalence rates for AI students were significantly higher than national rates for nearly all substances, especially for 8th graders. Rates of marijuana use were very high, with lifetime use higher than 50% for all grade groups. Other findings of interest included higher binge drinking rates and OxyContin(®) use for AI students. The results from this study demonstrate that adolescent substance use is still a major problem among reservation-based AI adolescent students, especially 8th graders, where prevalence rates were sometimes dramatically higher than MTF rates. Given the high rates of substance use-related problems on reservations, such as academic failure, delinquency, violent criminal behavior, suicidality, and alcohol-related mortality, the costs to members of this population and to society will continue to be much too high until a comprehensive understanding of the root causes of substance use are established.

Cost-effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a 4-year randomized trial

This study performs the first cost-effectiveness analysis (CEA) of Recovery Management Checkups (RMC) for adults with chronic substance use disorders. Cost-effectiveness analysis of a randomized clinical trial of RMC. Participants were assigned randomly to a control condition of outcome monitoring (OM-only) or the experimental condition OM-plus-RMC, with quarterly follow-up for 4 years. Participants were recruited from the largest central intake unit for substance abuse treatment in Chicago, Illinois, USA. A total of 446 participants who were 38 years old on average, 54% male, and predominantly African American (85%). Data on the quarterly cost per participant come from a previous study of OM and RMC intervention costs. Effectiveness is measured as the number of days of abstinence and number of substance use-related problems. Over the 4-year trial, OM-plus-RMC cost on average $2184 more than OM-only (P < 0.01). Participants in OM-plus-RMC averaged 1026 days abstinent and had 89 substance use-related problems. OM-only averaged 932 days abstinent and reported 126 substance use-related problems. Mean differences for both effectiveness measures were statistically significant (P < 0.01). The incremental cost-effectiveness ratio for OM-plus-RMC was $23.38 per day abstinent and $59.51 per reduced substance-related problem. When additional costs to society were factored into the analysis, OM-plus-RMC was less costly and more effective than OM-only. Recovery Management Checkups are a cost-effective and potentially cost-saving strategy for promoting abstinence and reducing substance use-related problems among chronic substance users.

Chapter 2. General Theoretical Perspectives of Narrative Analysis of Substance Use-Related Dependency

This chapter provides a short introduction to, and an overview for, using narrative analysis in the understanding of the use and misuse of alcohol and drugs. Important theoretical and methodological dimensions are discussed. Some tentative conclusions, limitations, and unresolved critical issues concerning the use of narrative research methods in the analysis of substance use-related dependency problems are also presented.

Chapter 3. A Multidimensional Model for Narrative Analysis of Substance Use-Related Dependency

This chapter examines the possibilities and limitations of using a narrative method as a framework within a multidimensional model for exploring and analyzing the use and misuse of alcohol and drugs. It is posited that a multidimensional model, based on narrative reasoning, can give a more detailed and specific understanding of substance users, who represent a heterogeneous population of people, and of substance use-related dependency problems. Such a model describes and analyses the drug-use related problems in a manner that provides holistic and important information and knowledge about the person by contextual and situation interaction processes which are involved in the use/misuse of alcohol and drugs. Tentative conclusions and unresolved critical issues are considered.

Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults

BackgroundDeficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations. MethodsYoung adults aged 16–25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N=560). ResultsFour latent classes/groups were identified: (1) suppressors, (2) others-reliant copers, (3) self-reliant copers and (4) active copers. Distinct patterns of prescription and illicit drug misuse were found among different coping/emotion regulation profiles, including differences in age of initiation of opiates, tranquilizers, and illicit drugs, recent injection drug use, substance use-related problems, and past 90-day use of tranquilizers, heroin, and cocaine. Specifically, suppressors and others-reliant copers evidenced more problematic patterns of substance use compared to active copers. ConclusionThis is among the first studies to show how coping and emotion regulation profiles predict distinct patterns of substance use. Results provide the groundwork for additional investigations that could have significant prevention and clinical implications for substance-using high-risk young adults.

Physician Views Regarding Substance Use‐Related Participation in a State Physician Health Program

Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for substance use-related problems completed an anonymous online survey regarding their experiences in the program. Results indicated that 78.1% of program completers had a 5-year contract, with 100% including random drug screening. In addition, 84.8% continued participation in 12-step fellowships after the required monitoring period. Participants were generally satisfied with the program, and 92.5% indicated that they would recommend it to others. They provided suggestions to increase the acceptability and efficacy of PHPs for physicians.

EDITORIAL: Addiction medicine: a new medical specialty in a new age of medicine

EDITORIAL: Addiction medicine: a new medical specialty in a new age of medicine

Three Potential Mediators of the Effects of Child Abuse and Neglect on Adulthood Substance Use Among Women

This study examined mechanisms that might account for the association between early childhood abuse and neglect, and substance use and related problems in adulthood for women. Women with documented cases of early childhood abuse and/or neglect and matched controls were interviewed in young adulthood (mean age=29 years) and again in middle adulthood (mean age=40) (n=582). We examined the mediating effects of posttraumatic stress disorder (PTSD) symptoms, stressful life events, and delinquent and criminal behavior measured in young adulthood on substance use-related problems and illicit drug use measured in middle adulthood. We found that all three potential mediators mediated the effects of abuse and neglect on substance-use problems and illicit drug use. When all three mediators were considered simultaneously, only stressful life events mediated the effects of child abuse and neglect for substance use-related problems and PTSD mediated for illicit drug use. These relationships were not moderated by race/ethnicity, although the effects of abuse and neglect on the mediators differed for white and non-white women. These findings suggest that interventions are needed with maltreated girls to recognize and attend to their PTSD symptoms and to assist them in developing coping strategies to deal with stressful life events in an attempt to reduce risk of subsequent substance use and related problems.

Nonmedical use of prescription opioids: motive and ubiquity issues.

Two issues relating to prescription opioid nonmedical use that to our knowledge have not been comprehensively addressed in the peer-reviewed literature are discussed: Motives for nonmedical use and the extent of nonmedical use of prescription opioids in other countries. The United States' national annual survey on illicit drug use in the general population (National Survey on Drug Use and Health) asks respondents whether they have used prescription opioids for nonmedical purposes but does not assess motives for such use. By not assessing motives, nonmedical users who use only for pain relief and nonmedical users who have other motives for use are grouped together, but 2 recent epidemiological studies suggest that these 2 groups may differ in a propensity to have substance use-related problems. We suggest that the survey add a question that assesses motives for nonmedical use. Regarding whether countries besides the United States have problems associated with nonmedical use of prescription opioids, after searching for epidemiological surveys and other materials potentially relevant to this issue, we were unable to determine the extent of nonmedical use of prescription opioids in other countries or draw cross-national comparisons. We suggest that more countries include specific questions about nonmedical use of prescription opioids in their national epidemiological surveys. We believe that critical information surrounding the nonmedical use of prescription opioids is not being gathered. Such information would allow for a better understanding of the problem. We invite discussion and commentaries regarding the issues we raise to more effectively address this public health issue.

Self‐injury in Japanese junior and senior high‐school students: Prevalence and association with substance use

The present study examined the prevalence of self-injury and its association with substance abuse in 2974 junior and senior high-school students, by self-reporting questionnaires. Consequently, 9.9% of students (boys, 7.5%; girls, 12.1%) reported an experience of self-injury at least once. Significant differences were found in substance use-related problems including alcohol abuse, smoking, and illicit drug use (P < 0.001) between students with and without an experience of self-injury. The results also suggest that self-injuring students may more easily gain access to illicit drugs even if they had not yet experienced the use of illicit drugs. Self-injury in adolescence may be associated with substance use and is considered to be a risk factor predicting future illicit drug use.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

The Relationship Between Substance User Treatment and 12-Step Fellowships: Current Knowledge and Research Questions

This article reviews and synthesizes information about the relationship between two distinct approaches to helping substance users, formal “addiction treatment” and 12-step mutual aid. The following issues are addressed: Extent of formal treatment and 12-step fellowship participation for persons with substance use-related problems; overlap between treatment and 12-step participation; early attempts to “integrate” treatment and 12-step mutual aid; differences and similarities between the 12-step program and treatment; issues of spirituality in the 12-step program; effectiveness of 12-step participation as treatment aftercare; and whether help-seekers can be “matched” to 12-step. The article poses pertinent questions that could answered by additional research, including life cycle patterns of usage of treatment and 12-step, outcomes of such episodes, reasons for using different interventions at different times, feasibility of 12-step participation as a primary intervention, the relative contributions of striving for spiritual values vs. social support factors to the effectiveness of 12-step, and the comparative effectiveness of secular vs. 12-step mutual aid. The article concludes with a proposed reconceptualization of the relationship between formal treatment and 12-step mutual aid that may help in structuring future research.In the rarer sort … inexorable sorrow takes the form of fellowship and makes the imagination tender. George Eliot (1876)

Substance Abuse and Employment Among Welfare Mothers: From Welfare to Work and Back Again?

We have very little research on how substance use impacts employment among welfare mothers. But welfare reform's emphasis on moving aid recipients into the workforce has brought this issue to the fore. Using Cox proportional hazard and logistic regression in a longitudinal study of California welfare mothers in 2001–2003, we examine how substance use impacts the ability to move from welfare to work and to remain economically independent after welfare. While education, work history, and family size consistently predict transitions from welfare to work and back again, substance use-related problems consistently do not. However, the jobs obtained by welfare mothers are short-term and poorly paid regardless of whether they misuse alcohol or use drugs. We argue that, if all that is open to welfare mothers are short-lived work assignments, substance use may have little time to impact job retention. Limitations of the study are noted. This IRB-approved study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.

The Case for High-Dose Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) is a brief therapy for treating substance use-related problems that draws upon the stages of the change model of Prochaska et al. () and the clinical techniques of Motivational Interviewing (MI) Miller et al. (). Studies have shown that MET is effective in improving motivation for change and decreasing substance use. However, comparison of MET with more intensive treatment is limited and no studies have compared the standard low dose of MET with higher doses of MET. This article makes the case for a higher dose model. The rationale for the more intensive dose draws upon several sources: 1) Descriptive studies documenting that length of treatment is a predictor of outcome, 2) Well-controlled, randomized psychotherapy trials for other disorders, such as depression, that show a dose-response relationship, and 3) Conceptual considerations about the nature and process of psychotherapy.

MOTIVATIONAL INTERVENTION AS APPLIED TO SYSTEMS CHANGE: THE CASE OF DUAL DIAGNOSIS

The concept of motivational interviewing is based on helping individual clients build and sustain a commitment to reach and carry out a decision to change. In this paper, the motivational interviewing model is applied to systems change. Different stages of involvement and readiness to change are identified within systems which closely resemble those found in individuals. When applied to a system, we call this process “Motivational Intervention.” In this paper, the motivational intervention model is applied to a psychiatric system of health care delivery where large numbers of psychiatric patients are found to also have substance use-related problems. Several Italian health districts invited the authors to present a series of lectures and workshops in order to facilitate the incorporation of substance user treatment into existing psychiatric services. Using the motivational intervention model to determine where the system was in the process of change, we then identified the tasks necessary to facilitate further change.

Introduction to the Special Issue on "Anxiety Sensitivity and Addictive Behaviors".

Anxiety sensitivity (AS) is a cognitive, individual difference variable characterized by a fear of arousal-related bodily sensations due to beliefs that such sensations are signs of impending catastrophic physical, psychological, or social outcomes. AS has been linked to increased risk for the development and maintenance of panic attacks and anxiety disorders, and more recently has been related to risk for other psychopathological conditions including those related to substance misuse. This article introduces a special issue of Addictive Behaviors focusing on cutting edge findings on the relations of AS to substance use and abuse. We set the stage for the following series of eight novel empirical papers by providing a review of background on the ways in which AS has been hypothetically linked to increased risk for the development of substance abuse and addiction. We also consider whether AS might be differentially related to risk for abuse of specific classes of drugs with different pharmacological effects (e.g., depressants vs. stimulants). Finally, we consider how AS might be related to substance use disorder maintenance or relapse risk through its putative effects in increasing drug withdrawal severity and in lowering tolerance for withdrawal symptoms. Our overriding goal in writing this Introduction was to provide an organizational template for integrating the featured studies and to recommend promising directions for future work into the association of AS and substance use-related problems.