Types Of Substance Use Disorders Research Articles

Could Treatments for SUD Help Patients With Behavioral Addictions?

Back to table of contents Previous article Next article ProfessionalFull AccessCould Treatments for SUD Help Patients With Behavioral Addictions?Nick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:12 Aug 2019https://doi.org/10.1176/appi.pn.2019.7b7AbstractThere are key similarities and differences between patients with substance use disorder (SUD) and behavioral addictions including sex, gaming, eating, shopping, and internet addiction.Gambling disorder is the first non-substance-related addictive disorder to be included in DSM, but many practicing psychiatrists recognize that gambling is far from the only behavior that can become compulsive.At APA’s 2019 Annual Meeting in May, a panel of psychiatrists who specialize in addictions discussed four other potentially addictive behaviors: internet use, sex, shopping, and videogaming. None is listed in DSM-5, though the condition of “internet gaming disorder” is in the appendix under “conditions for further study.” (Gaming disorder was added in the International Classification of Diseases, 11th Revision.)Addiction specialist Timothy Fong, M.D., explains that while behavioral addictions share features of various psychiatric problems, neurobiological and pharmacological data point to their connection with substance use disorders.David HathcoxThe goal of the session was to help nonspecialists understand the biology of these problem behaviors, said session chair Timothy Fong, M.D., a professor of psychiatry at the University of California, Los Angeles (UCLA), and co-director of the UCLA Gambling Studies Program. This understanding can in turn lead to more effective diagnosis and treatment.A key question about behavioral addictions is whether they are a type of substance use disorder or whether they fit better in another DSM category. For example, addictive shopping is similar in appearance to hoarding disorder—a type of obsessive-compulsive disorder, while an eating addiction bears striking similarity to binge-eating disorder. In the case of sex disorder, Shram Shulka, M.D., a psychiatrist at Walter Reed National Military Medical Center in Bethesda, Md., noted that many patients with sex-control problems had attachment problems in childhood. This has led to a theory that sex disorder might be a type of attachment disorder.However, imaging studies indicate that people with sex and other behavioral addictions tend to have cue-related activity increases in regions of the brain known to be involved with motivation and reward, Shulka said. These activity changes are similar to what happens when someone with alcohol use disorder sees photos of drinks, supporting the idea that these behavioral addictions fit into the substance use disorder category.Fong also highlighted the importance of reward in driving addictive shopping behavior. “This compulsive need to buy and collect could be confused with hoarding disorder, but there is a key difference,” he said. “People with hoarding disorder know they have a bad compulsion, whereas people with shopping disorder have this urge or thrill to buy stuff.”Likewise, people who engage in addictive eating show more control over the foods they compulsively eat than do people who binge eat, said Robert Rymowicz, D.O., a psychiatry resident at the Rutgers New Jersey Medical School. For example, people with an eating addiction crave specific hedonic foods high in sugar and fat, whereas people who binge eat may be less discerning, he said. “This tendency to focus on foods like chocolate suggests that eating addiction might be better termed as ‘food addiction,’ ” Rymowicz added.While much of the session noted the similarities between these five behavioral addictions and traditional substance use disorders, the panelists did offer one important difference: the goals of treatment.“Unlike alcohol or drug treatment, abstinence is not a realistic goal,” said Meghan Quinn, M.D., a resident at the Uniformed Services University of the Health Sciences in Bethesda, Md. Therapists can’t ask someone to give up the internet, as an example. “We do need these behaviors in life,” she said. Rather, the panelists suggested that treatments focus on patient recovery and treating comorbidities (depression, insomnia, and other substance use are common) while promoting better self-awareness and self-care.As with substance use disorders, psychotherapy such as cognitive-behavioral therapy or acceptance commitment therapy is an important component of behavioral addiction treatment, and peer support groups can be useful as well.Medications are also an option. Fong cautioned that currently there is no consensus on pharmacotherapy for behavioral addictions, but there is some evidence for certain medications. Notably, naltrexone and bupropion—commonly used to treat alcohol use disorder, cigarette smoking, and obesity—are also effective for many of these behavioral addictions (further validating these disorders as substance use problems).Other panelists noted data suggesting that selective serotonin reuptake inhibitors (SSRIs) might work in some cases (especially for sex disorder since SSRIs have libido-lowering effects), as may mood stabilizers or stimulants. ■ ISSUES NewArchived

Family Aggregation of Substance Use Disorders: Substance Specific, Nonspecific, and Intrafamilial Sources of Risk

The primary aim of this investigation was to evaluate substance-specific and nonspecific associations between parental and sibling histories of alcohol, cannabis, amphetamine, and hallucinogen use disorders with proband risk for these conditions. A second aim was to evaluate whether the specificity of substance use disorder (SUD) risk to probands varied by family member (i.e., father, mother, and any sibling). Lifetime SUD diagnostic data for this family-based investigation were derived from semistructured interviews of community residents. Participants were an age-based cohort (probands), selected at random during adolescence and followed longitudinally until age 30, and their first-degree family members (n = 803 probands and families). Findings generally supported substance-specific and nonspecific forms of familial risk related to a particular type of SUD in probands. Family-based alcohol use disorder (AUD) demonstrated the greatest degree of risk specificity of any substance category, in that no other family SUD category predicted proband AUD. Family-based AUD, however, was also the most consistent nonspecific predictor of nonalcohol forms of SUD among probands. Among family members, the most consistent unique effects associated with a substance-specific risk to probands were observed for siblings. Findings support both the generality and specificity of risk associated with the abuse of or dependence on specific substances within families and highlight the impact of siblings on SUD risk to other siblings. Study findings underscore the need for a better understanding of malleable family-based factors that promote and reduce SUD risk among members.

Insomnia severity during early abstinence is related to substance use treatment completion in adults enrolled in an intensive outpatient program

BackgroundInsomnia and other types of sleep disturbance are highly prevalent during withdrawal across many different types of substance use disorders (SUDs). It is largely unknown how sleep impacts SUD treatment outcomes, including treatment completion. MethodsA retrospective chart review was conducted to obtain information about sleep disturbance and treatment completion in individuals beginning an intensive outpatient (IOP) SUD treatment program. Demographic data were collected along with number of sessions completed, treatment completion, comorbid psychiatric diagnosis, pertinent lab results, and scores on three self-reported measures of sleep: the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). ResultsPertinent information was available for 110 individuals. The majority had clinically significant scores on the ISI and PSQI but not the ESS. ISI, but not PSQI or ESS, was associated with treatment completion, such that those with more insomnia were less likely to complete treatment. ConclusionThe high prevalence of insomnia symptoms and poor sleep quality coupled with the relationship between insomnia severity and treatment completion may indicate that more severe symptoms of insomnia are a risk factor for treatment completion and subsequent relapse across many substance types. Applying evidence-based insomnia interventions in SUD treatment programs may have meaningful implications for outcomes.

Mental Health and Substance Use Disorders in Patients Diagnosed With Cancer: An Integrative Review of Healthcare Utilization.

The impact of mental health disorders (MHDs) and substance use disorders (SUDs) on healthcare utilization (HCU) in patients with cancer is an understudied phenomenon. A literature search of studies published prior to January 2018 that examined HCU in patients with preexisting MHDs or SUDs diagnosed with cancer was conducted. The research team evaluated 22 studies for scientific rigor and examined significant trends in HCU, as well as types of the MHD, SUD, and cancer studied. The heterogeneity of HCU outcome measures, MHD, SUD, sample sizes, and study settings contributed to inconsistent study findings. However, study trends indicated higher rates of HCU by patients with depression and lower rates of HCU by patients with schizophrenia. In addition, the concept of HCU measures is evolving, addressing not only volume of health services, but also quality and efficacy. Oncology nurses are essential to improving HCU in patients with MHDs and SUDs because of their close connections with patients throughout the stages of cancer care. Additional prospective studies are needed to examine specific MHDs and different types of SUDs beyond alcohol use, improving cancer care and the effectiveness of HCU in this vulnerable population.

Early life adversity and increased delay discounting: Findings from the Family Health Patterns project.

Increased discounting (devaluing) of delayed rewards is associated with nearly all types of substance use disorders (SUDs) and is also present in individuals with family histories of SUDs. Early life adversity (ELA) likely contributes to these findings as it is common in both individuals with SUDs and their children and is linked to increased delay discounting and other neurocognitive impairments in human and animal studies. Here we examined data from 1192 healthy young adults (average age 23.6 years old) with (SUDs+) and without (SUDs-) histories of SUDs and with (FH+) and without (FH-) family histories of SUDs. A 2-way ANOVA was conducted to examine the effects of SUDs (SUDs-, SUDs+) and FH (FH-, FH+) on delay discounting followed by an examination of the effects of adding ELA to the model. First, we replicated findings that SUDs+ and FH+ participants had increased rates of delay discounting. After taking ELA into account, the effect of SUDs and FH on delay discounting were both reduced but still significant. The association of ELA and delay discounting was similar in magnitude among both SUDs+ and SUDs- participants and FH+ and FH- participants; those with higher levels of ELA had increased delay discounting. Collectively, these findings indicate that increased ELA is closely associated with the increased delay discounting seen in SUDs+ and FH+ individuals and suggests ELA may be contributing to the increased delay discounting seen in these populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

FDA Clears App to Help Retain Patients in Treatment for OUD

Experts in addiction and in digital technology say the app for opioid use disorder is an exciting development, but it remains to be seen if the technology will be widely used.

Motor Timing Outcome Differences between Patients with Alcohol- and/or Cocaine Use Disorder in a Rehabilitation Program

Substance Use Disorders (SUD) lead to brain structural and functional deficits associated with cognitive and social functioning in affected individuals and can impact on treatment outcomes. The lack of behavioural autonomy is underpinned by direct reward, high impulsivity and difficulties in planning behaviour. The motor cortex — as part of a neural mechanism accounting for action and intention — plays a fundamental role in complex cognition, motor performance and coordination. The study sample consisted of 74 abstinent patients, aged 18–60 years, diagnosed with alcohol and/or cocaine dependence who were all inpatients at a private treatment programme for drug/alcohol dependence in South Africa. The main questions addressed were whether motor timing abilities would improve over time (as a function of recovery) in patients admitted to a rehabilitation programme for SUD, and if there were between-group differences. Timing abilities in SUD improved with prolonged abstinence. Timing in decision making (cognitive control) did not improve over time, nor did movement coordination. Rhythmic abilities and synchronisation with external events, as well as spatial abilities, improved with prolonged abstinence. The recovery of rhythmic and synchronisation abilities differed between the groups. This study shows for the first time that motor timing abilities can recover significantly with prolonged abstinence with differences in recovery between SUD populations. Improvements in interval timing only (both in time and in space) were observed. Not all motor timing abilities, and not every type of SUD, recovered equally, thereby suggesting that different substances may affect the brain differently with regard to timing abilities. These findings suggest that motor timing should further be investigated in different clinical settings.

Co-Occurring Substance Use Disorders, Mental Health Conditions and Offending Patterns among Local Jail Detainees

Co-Occurring Substance Use Disorders, Mental Health Conditions and Offending Patterns among Local Jail Detainees Albert M. Kopak, Ph.D; Alyssa L. Raggio, M.A; Norman G. Hoffmann, Ph.D. Abstract Basic prevalence data have documented the high rates of behavioral health needs among adults in jail, but much of this work is ambiguous, often glossing over specific conditions such as personality disorders and certain types of substance use disorders (SUD) (e.g. alcohol use disorder, opiate use disorder, etc.). The work in this area has also asserted multiple conditions are “the rule, not the exception” (Scott, Lewis, & McDermott, 2006), but there is still a limited amount of information available regarding the relationship between specific combinations of mental health conditions, SUDs, and offending patterns among jail detainees. The current study drew on data collected with the Comprehensive Addictions and Psychological Evaluation – 5 (CAAPE–5) over the course of a year from a random sample of adults detained in a local jail. The sample consisted of 258 adults with nearly three quarters (74%) of the sample meeting criteria for a mental health condition in combination with a minimum of one SUD. Additionally, nearly one third (31%) met criteria for multiple severe SUDs. Bivariate results indicated detainees with a combination of mental health and SUD were more likely to be booked into the jail for felony (χ2 (2) = 6.35, p = .042) offenses and property (χ2 (2) = 6.56, p = .038) offenses relative to detainees who did not meet similar criteria. A series of multivariate logistic regression analyses demonstrated detainees who met criteria for specific mental health conditions (i.e. PTSD, depression, antisocial personality disorder (ASPD), or obsessive compulsive personality disorder (OCPD)) in conjunction with multiple SUDs were significantly more likely to be charged with a felony offense. Detainees with PTSD and multiple SUDs were also more likely to be booked into the jail on multiple prior occasions. These results demonstrate the need for systematic comprehensive behavioral health assessments in local detention facilities in the effort to reduce repeat jail admissions. Full Text: PDF DOI: 10.15640/jlcj.v7n1a1

Joint versus separate inpatient rehabilitation treatment for patients with alcohol use disorder or drug use disorder: an observational study.

BackgroundIn many national treatment systems, patients with alcohol use disorders (AUD) and those with drug use disorders (DUD) are treated separately, while other systems provide joint treatment for both kinds of substance use disorders (SUDs). Regarding long-term rehabilitation treatment of DUD and AUD patients, there is however a lack of empirical studies on the comparison between a separate versus joint treatment modality.MethodsData were gathered from 2 rehabilitation units located in small towns from the same German region. One unit provided treatment to a mixed group of AUD and DUD patients, while the other unit treated the 2 groups separately. Staffing, funding, and treatment programs were otherwise similar between facilities. Data were gathered from standardized routine documentation and standardized interviews. In order to understand correlates of premature treatment termination, a logistic regression analysis was performed, with treatment modality and type of SUD as main predictors, and a range of patient characteristics as covariates.ResultsPatients (N=319) were diagnosed with AUD (48%), DUD (34%), or AUD plus DUD (18%). Patients in joint treatment showed a higher prevalence of lapses during treatment than those in separate treatment (26% versus 12%; p=0.009), but there was no significant difference in the prevalence of premature terminations (38% versus 44%, p=0.26). Treatment modality and interaction between modality and type of SUD was not significantly associated with premature termination. Joint treatment completers showed higher satisfaction with treatment than separate treatment completers (p<0.001).ConclusionWe found no evidence here for a difference between treatment modalities in terms of premature termination rate. Satisfaction level was higher in those who completed joint treatment compared to separate treatment.

The impact of substance use disorders on clinical outcomes in older-adult psychiatric inpatients.

To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non-psychiatric medical comorbidity (MEDCO) in older-adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes. A cross-sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI≥age 50, obtained from a 274-bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/-), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/-) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non-SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO. The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non-SUD) psychiatric diagnoses were significantly associated with longer LOS (both P<0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P<0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P<0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P<0.01). The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long-term consequences.

PTSD symptom presentation among people with alcohol and drug use disorders: Comparisons by substance of abuse

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) commonly co-occur, and there is some evidence to suggest that PTSD symptom clusters are differentially related to various substances of abuse. However, few studies to date have compared PTSD symptom patterns across people with different types of SUDs, and fewer still have accounted for the presence of comorbidity across types of SUDs in understanding symptom patterns. Thus, in the current study, we use a treatment-seeking sample of people with elevated symptoms of PTSD and problem alcohol use to explore differential associations between past-year SUDs with active use and PTSD symptoms, while accounting for the presence of multiple SUDs. When comparing alcohol and drug use disorders, avoidance symptoms were elevated in those with alcohol use disorder, and hyperarousal symptoms were elevated in those who had a drug use disorder. In the subsample with alcohol use disorder, hyperarousal symptoms were elevated in people with co-occurring cocaine use disorders and numbing symptoms were elevated in people with co-occurring sedative/hypnotic/anxiolytic use disorder. These findings provide evidence for different symptom cluster patterns between PTSD and various types of SUDs and highlight the importance of examining the functional relationship between specific substances of abuse when understanding the interplay between PTSD and SUDs.

Screening for adult attention deficit/hyperactivity disorder in high-dose benzodiazepine dependent patients.

Adult attention-deficit/hyperactivity disorder (ADHD) is frequent in patients with substance use disorders (SUD), but information on its prevalence in high-dose benzodiazepine (BZD) dependence is lacking. We estimated the prevalence of adult ADHD in a group of treatment-seeking high-dose BZD dependent patients according to a valid screening tool, and explored the demographic and clinical characteristics of patients that screened positive for ADHD (ADHD+) in comparison to those that screened negative (ADHD-). We prospectively recruited 167 consecutive patients with high-dose BZD dependence and screened them for adult ADHD with the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS-v1.1) Symptom Checklist Part A. We compared demographic and clinical characteristics in ADHD+ and ADHD- groups. Fifty-three patients (31.7% of the sample) were positive to adult ADHD screening. ADHD+ patients showed a significantly larger prevalence of poly-drug abuse than ADHD- ones. BZD formulation and active principle significantly differed between the two groups. The other clinical variables, including psychiatric comorbidity, as well as the demographic ones, did not differ in ADHD+ versus ADHD- comparison. Adult ADHD may be common in treatment-seeking high-dose BZD dependent patients according to ASRS-v1.1 Symptom Checklist Part A. Screening for ADHD in this type of SUD with this questionnaire is quick and may offer useful information for prognosis and treatment. (Am J Addict 2017;26:610-614).

Obesity and obstetric complications are associated with rapid-cycling in Italian patients with bipolar disorder

IntroductionRapid cycling (RC) worsens the course of bipolar disorder (BD) being associated with poor response to pharmacotherapy. Previous results about clinical variables potentially associated with RCBD were discordant or unreplicated.ObjectivesAn early diagnosis should be the goal to properly treat RCBD patients.AimsTo compare clinical variables between RC and non-RC bipolar patients and to identify related risk factors.MethodsA sample of 238 bipolar patients was enrolled from three different community mental health centers. Descriptive analyses were performed on total sample and patients were compared in terms of sociodemographic and clinical variables according to the presence of RC by multivariate analyses of variance (MANOVAs, continuous variables) or χ2 tests (qualitative variables). Binary logistic regression was performed to calculate odds ratios.ResultsOverall, 28 patients (11.8%) had RC. The two groups were not different in terms of age, age at onset, gender distribution, type of family history, type of substance use disorder, history of antidepressant therapy, main antidepressant, psychotic symptoms, comorbid anxiety disorders, suicide attempts, thyroid diseases, diabetes, type of BD, duration of untreated illness, illness duration, duration of antidepressant treatment and GAF scores. In contrast, RC patients had more often a history of obstetric complications (P &lt; 0.05), obesity (P &lt; 0.05) and a trend to hypercholesterolemia (P = 0.08). In addition, RC bipolar patients presented more frequently lifetime MDMA misuse (P &lt; 0.05) than patients without RC.ConclusionsObesity and obstetric complications are risk factors for the development of RC in BD. Lifetime MDMA misuse may be more frequent in RC bipolar patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders.

To examine gender differences in the associations between childhood adversity and different types of substance use disorders and whether gender moderates these relationships. We analyzed data from 19,209 women and 13,898 men as provided by Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender moderates the associations between childhood adversity and DSM-IV defined lifetime occurrence of alcohol, drug, and polysubstance-related disorders. We used multinomial logistic regression, weighted to be representative of the US adult civilian, noninstitutionalized population, and we calculated predicted probabilities by gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pair-wise comparisons corrected for multiple comparisons using Bonferroni's method. For each type of substance use disorder, risk was increased by more exposure to childhood adversity, and women had a lower risk than men. However, moderation effects revealed that with more experiences of childhood adversity, the gender gap in predicted probability for a disorder narrowed in relation to alcohol, it converged in relation to drugs such that risk among women surpassed that among men, and it widened in relation to polysubstances. Knowledge regarding substance-specific gender differences associated with childhood adversity exposure can inform evidence-based treatments. It may also be useful for shaping other types of gender-sensitive public health initiatives to ameliorate or prevent different types of substance use disorders.

Association Between Substance Use Diagnoses and Psychiatric Disorders in an Adolescent and Young Adult Clinic-Based Population

PurposeAdolescents with substance use disorders are more likely to have a current psychiatric disorder. However, when compared with the adult literature, there is relatively limited information regarding the specific co-occurrence of certain mental health diagnoses and substance use disorders in adolescents. The objectives of this study were to build on the previous literature regarding mental health diagnoses and different types of substance use disorders in adolescents, as well as explore the differences, if any, between groupings of mental health diagnosis and type of substance used. MethodsData were extracted from the clinical records of 483 individuals aged 11–24 years referred for an evaluation at the Adolescent Substance Abuse Program at Boston Children's Hospital. According to DSM-IV-Text Revision criteria, individuals received diagnoses of substance abuse or dependence and any additional psychiatric disorders. Problematic use was included within the sample for greater power analysis. A multivariable logistic regression model estimated the association between psychiatric diagnosis and substance use while adjusting for covariates including age and gender. ResultsMultiple significant associations were found, including having any anxiety-related diagnosis and opioid use (odds ratio [OR] = 2.23, p < .001), generalized anxiety disorder and opioids (OR = 3.42, p = .008), cocaine and post-traumatic stress disorder (OR = 3.61, p = .01), and marijuana and externalizing behavior disorders (OR = 2.10, p = .024). ConclusionsOur study found multiple significant associations between specific substances and certain co-occurring psychiatric disorders. The use of office screening systems to efficiently identify these youths should be a part of routine medical and psychiatric care.

Drug-related celebrity deaths: A cross-sectional study.

BackgroundCelebrities are at risk for premature mortality as well as drug-related death. Despite being a vulnerable patient group, celebrities influence people’s health behaviours through biological, psychological and social processes. Therefore, celebrity endorsement of the topic could be one way to challenge the current “opioid endemic”. Our aim was to better understand the factors surrounding drug-related celebrity deaths by investigating the incidence as well as substances used between 1970 and 2015 using a cross-sectional study design.MethodWe searched public databases for drug-related celebrity deaths between 1970 and 2015. They were categorized for sex, profession, age at death, year of death and substances involved. The main outcome measures are descriptive values including number of drug deaths per year and substances involved. Secondary outcome measures are analytical questions to examine whether and which factors influence age at death and year of death (e.g. type of substance use disorder).ResultsWe identified 220 celebrities who died a drug-related death with a clear indication of involved substances between 1970 and 2015. The average age at death was 38.6 years; 75% were male. Most celebrities died between the age of 25 and 40. The number of drug-related deaths increased in the 21st century, with a significant increase in the use of prescription opioids. Deaths involving prescription opioids and heroin were associated with a significantly lower mean age at death compared to deaths where these substances were not involved.ConclusionsCompared to the 20th century, the total number of celebrities who died from a drug-related death in the 21st century increased, possibly due to an increased involvement of prescription opioids. Negative effects on individual health decisions of celebrity’s followers could be the result.

Substance use disorders among Aboriginal and Torres Strait Islander people in custody: a public health opportunity

BackgroundTo describe the prevalence, type, and mental health correlates of substance use disorders in a large sample of incarcerated Indigenous Australians.MethodsAn epidemiological survey of the mental health of Indigenous people in custody in the state of Queensland, Australia was conducted using culturally informed methods. The prevalence, type and mental health correlates of substance use disorders were determined using a diagnostic interview and questionnaire.ResultsIn a sample of 396 Indigenous people (331 males, 65 females) the prevalence of any substance use disorder was 66%. Alcohol dependence (males 47%, females 55%) was the most common type of substance use disorder, followed by cannabis dependence (males 20%, females 26%). Mental illness (anxiety, depression and psychotic disorder), and lifetime suicide thoughts and attempts, were significantly more likely among those with a substance use disorder. The majority of the sample reported intoxication with alcohol (70%) and/or other drugs (51%) at the time of arrest. Most individuals (87%) had not accessed alcohol and other drug services in the 12 months prior to custody.ConclusionsSubstance dependence was common in this sample and was associated with other forms of mental health adversity, yet most individuals reported no access to health services prior to incarceration. Effectively responding to substance dependence for Indigenous Australians is a public health and criminal justice priority. Culturally capable alcohol and other drug treatment services in custody and in the community are critical, and should be co-located and coordinated with mental health services.

Beyond methamphetamine: Documenting the implementation of the Matrix model of substance use treatment for opioid users in a South African setting

IntroductionThe Matrix model of substance use treatment has been evaluated extensively in the United States as an effective treatment for methamphetamine use disorders. Since 2007, the Matrix model has been implemented in Cape Town, South Africa, where one in four treatment-seeking individuals are primarily opioid rather than stimulant users. Yet, there has been limited data on the application of the Matrix model for other types of substance use disorders in a resource-limited setting. MethodsWe compared primary opioid and primary methamphetamine users seeking treatment at the first certified Matrix model substance use treatment site in Cape Town, South Africa from 2009 to 2014 (n=1863) on engagement in treatment, an important early predictor of later substance use treatment outcomes, and urine-verified abstinence at treatment exit. ResultsCompared to primary opioid users, primary methamphetamine users had over 50% greater odds of initiating treatment (defined as attending at least one treatment session following intake; OR=1.55; 95%CI: 1.24–1.94), and 4.5 times greater odds of engaging in treatment (i.e., attending at least four treatment sessions; OR=4.48; 95%CI: 2.27–8.84). There were no significant differences in rates of urine-verified abstinence at treatment exit. ConclusionsResults suggest primary opioid users may experience additional barriers to treatment initiation and engagement in the Matrix model of substance use treatment, yet those who enter treatment are equally as likely to be abstinent at treatment exit compared to primary methamphetamine users. Findings highlight the need for additional strategies to optimize treatment initiation and engagement among primary opioid users in this setting, for instance by integrating medication-assisted treatment (e.g., methadone).

Annals for Educators - 15 November 2016

Annals for Educators - 15 November 2016

Prevalence of dual diagnosis among clinic attending patients in a de-addiction centre of a tertiary care hospital

Indian research on dual diagnosis is mostly on prevalence of co-morbidity in a particular type of substance use disorder or psychiatric disorder. They were not on overall prevalence of dual diagnosis in a clinical sample. The study aims to assess prevalence of dual diagnosis among first time visitors to a tertiary care deaddiction centre. The study participants were recruited using computer-generated random number table from 10th Apr 2013 to 28 June 2013 from a deaddiction centre in North India. Psychiatric diagnosis was done by qualified psychiatrist and confirmed by Mini International Neuropsychiatric Interview (M.I.N.I.). One seventy nine participants were recruited during the study period. The prevalence of dual diagnosis was 58 (32.4%). Affective disorder group 22 (12.3%) is the most common group followed by anxiety disorders group 20 (11.2%) and psychotic disorder group 9 (5.0%). Duration of use and dependence (in months) of alcohol, opioids, and nicotine was shorter and of cannabis and benzodiazepines was longer in dual diagnosis group compared to non dual diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The study reported that nearly one third of substance use disorder patients are cases of dual diagnosis. The prevalence reported in our study is lower than reported in some western hospital based and community based studies.