Additional Substance Use Research Articles

Heterogeneity in the Relationship of Substance Use to Risky Sexual Behavior Among Justice-Involved Youth: A Regression Mixture Modeling Approach.

Justice-involved adolescents engage in high levels of risky sexual behavior and substance use, and understanding potential relationships among these constructs is important for effective HIV/STI prevention. A regression mixture modeling approach was used to determine whether subgroups could be identified based on the regression of two indicators of sexual risk (condom use and frequency of intercourse) on three measures of substance use (alcohol, marijuana and hard drugs). Three classes were observed among n=596 adolescents on probation: none of the substances predicted outcomes for approximately 18% of the sample; alcohol and marijuana use were predictive for approximately 59% of the sample, and marijuana use and hard drug use were predictive in approximately 23% of the sample. Demographic, individual difference, and additional sexual and substance use risk variables were examined in relation to class membership. Findings are discussed in terms of understanding profiles of risk behavior among at-risk youth.

Rates of Fetal Polydrug Exposures in Methadone-Maintained Pregnancies from a High-Risk Population

Methadone maintenance treatment (MMT) is the standard of care during pregnancy for opioid-dependency, showing efficacy in improving prenatal care and reducing risk of relapse. By design, however, MMT is only intended to prevent withdrawal thus facilitating cognitive behavioural interventions. In order to maximize the benefits of MMT, it is essential that methadone is both properly prescribed and that additional addiction treatment is concurrently administered. This study aims to determine the effectiveness of MMT engagement in high-risk pregnant women in reducing polydrug use by objective laboratory examination of neonatal meconium. Patients and MethodsOver a 29-month period, the Motherisk Laboratory at the Hospital for Sick Children in Toronto analyzed meconium samples as per request by social services and hospitals for drugs of abuse.ResultsOf the 904 meconium samples received, 273 were tested for methadone with 164 positive and 109 negative for methadone. Almost half of the methadone positive samples (46.34%) were also positive for at least one other opioid compound, which did not differ statistically from the methadone-negative control samples (46.79%; Chi square test, p=0.94). No differences were found between the methadone positive and negative groups in rates of concurrent amphetamines, cocaine, cannabis, and alcohol use indicating a similar risk of polydrug use between pregnant women taking or not taking methadone in this population. DiscussionThe high rates of additional opioid and other drug use in the MMT group, suggest that MMT is failing this population of patients. It is possible that methadone doses during pregnancy are not appropriately adjusted for changes in pharmacokinetic parameters (e.g. blood volume, renal function) during the second and third trimesters. This may result in sub-therapeutic dosing creating withdrawal symptoms leading to additional substance use. Alternatively, these results may be demonstrating a substantial lack in delivery of addiction support services in this vulnerable population.

Opioids and Traffic Safety – Focus on Buprenorphine

Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. The effects of opioids such as buprenorphine on cognitive functioning and driving ability are a matter of debate. A comprehensive review of studies of the effects of buprenorphine on traffic safety is presented. A number of recent epidemiological and road surveys indicate that opioids have a moderate risk for causing accidents compared to other drugs of abuse, such as alcohol. A number of neuropsychological studies, a few of which were prospective and used a randomized control group, have used standardized test batteries to measure domains relevant for psychomotor functioning and driving ability. Single doses of buprenorphine have been shown to induce some impairment in healthy volunteers, but less than found in chronic users. Some non-randomized studies indicate somewhat better cognitive performance of patients on buprenorphine than of those on methadone but this finding has not been demonstrated in randomized controlled trials. Opioids as a class of drugs induce some impairment of driving ability, but less than other psychotropic agents or drugs of abuse. Personality features such as impulsivity, sensation seeking, low risk perception and antisocial behaviour, comorbid psychiatric and neurological disorders and additional substance use of opioid users are of relevance for traffic safety. Buprenorphine does not cause more cognitive impairment than methadone or may even cause less. Caution is required when initiating treatment with buprenorphine. The risk for driving ability impairment is probably less under steady state conditions. Finally, higher doses of buprenorphine are probably not associated with more impairment.

Photocrosslinked poly(ester‐anhydride) microspheres with macroporous structure

In this work, the new method of preparation biodegradable microspheres with macroporous structure is presented. Typical methods used for generation of porous structures in microspheres obtained from preformed polymers require the use of additional substances acting as porogens. In this study, the porosity was achieved as the effect of photocrosslinking, without porogens. Microspheres were prepared using emulsion solvent evaporation technique from functional poly(ester‐anhydride)s with different amount of allyl groups in the side chains. The crosslinking was carried out by UV irradiation during the solvent evaporation (photoinitiator was introduced to polymer solution). The size of microspheres obtained was in the range of 1.7 – 4 µm (small microspheres) or 31 – 50 µm (large ones) and depended on the conditions used in emulsion formulation process. Effectiveness of the crosslinking was characterized by the content of insoluble part of samples, and it was in the range of 42–89%. The content of insoluble part of sample of microspheres and their porosity were dependent on functionality of poly(ester‐anhydride)s, the amount of photoinitiator used, and also on size of microparticles. The small particles were always more crosslinked than the large ones, but the latter were more porous than the small ones. Crosslinked microparticles indicated higher loading efficiency of model compound and appeared to degrade faster than uncrosslinked ones, probably due to their high porosity. The high porosity of microspheres obtained would enable their eventual use in pulmonary drug delivery systems or in construction of porous scaffolds for tissue engineering. Copyright © 2013 John Wiley & Sons, Ltd.

Cannabis use and cannabis use disorders among individuals with mental illness

BackgroundNational epidemiological surveys have reported increased rates of cannabis use and cannabis use disorders (CUDs) among individuals with mental illness. However, this subject has not been sufficiently investigated, particularly given limitations in diagnostic tools used and lack of data pertaining to frequency of cannabis used. ObjectivesTo examine the prevalence of cannabis use and CUDs among individuals with a wide range of mental illness. MethodWe analyzed data on 43,070 respondents age 18 and above from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey conducted from 2001 to 2002. Main outcome measures included rates of cannabis use by frequency (at least weekly and less than weekly use) and DSM-IV CUDs according to the number and type of axis I and axis II psychiatric diagnoses, assessed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule-IV. We estimated the proportion of cannabis used by individuals with mental illness using reported daily dose and frequency of cannabis used by individuals with and without mental illness. ResultsRates of weekly cannabis use, less than weekly cannabis use and CUDs among individuals with 12-month mental illness were 4.4%, 5.4% and 4.0%, respectively, compared to 0.6%, 1.1% and 0.4%, respectively, among individuals without any 12-month mental illness (P<0.0001 for all comparisons). The odds ratio for cannabis use among individuals with 12-month mental illness vs. respondents without any mental illness was 2.5, and the odds of having a CUD among individuals with 12-month mental illness were 3.2, after adjusting for sociodemographic variables and additional substance use disorders. Cannabis use and CUDs were particularly associated with bipolar disorder, substance use disorders and specific (anti-social, dependant and histrionic) personality disorders. Persons with a mental illness in the past 12months represented 72% of all cannabis users and we estimated they consumed 83% of all cannabis consumed by this nationally representative sample. ConclusionsThe current study provides further evidence of the strong association between cannabis use and a broad range of primary mental illness. This emphasizes the importance of proper screening for frequent cannabis use and CUDs among individuals with primary mental illness and focusing prevention and treatment efforts on this population.

Patterns of Symptom Reporting During Pregnancy Comparing Opioid Maintained and Control Women

To characterize the range of symptoms experienced by pregnant methadone-maintained (MM) and buprenorphine-maintained (BM) women to determine whether these differ from those experienced by a control group of nonopioid exposed pregnant women. Opioid-maintained (OM) patients report high rates of symptoms related to direct opioid effects and withdrawal. Pregnancy is associated with a range of symptoms, some overlapping with opioid effects and withdrawal. Prospective, nonrandomized, open-label comparison study undertaken in a large teaching maternity hospital in South Australia. Pregnant BM (n = 25), MM (n = 25) and nonopioid exposed controls (n = 25) were recruited and matched for age, parity, gravidity, alcohol consumption, and smoking status. Symptom report patterns, maternal withdrawal, and additional substance use were assessed. MM women reported 10 and BM women reported 2 symptoms throughout pregnancy at rates greater than controls. Methadone-maintained women reported significantly (P < 0.05) more symptoms than BM women compared to controls throughout pregnancy. Methadone-maintained women reported 8 and BM women reported 3 symptoms in the third trimester at rates greater than controls. Methadone-maintained women reported greater opioid withdrawal than controls; this did not occur in BM women. Additional substance use was comparable between BM and MM women but greater than controls. Patterns of symptom reports may have clinical implications for maternal and fetal health during pregnancy for OM women including optimization of opioid dosing regimens, education regarding maternal nutritional intake and preventing postnatal depression, thereby ensuring maternal health and fetal development during pregnancy and enhancing mother-infant bonding and healthy child development postnatally.

Does accumulating exposure to illicit drugs bring forward the age at onset in schizophrenia?

Whilst cannabis has been associated with an earlier age at onset in schizophrenia, the impact of amphetamine and/or cocaine plus cannabis consumption on age at onset remains unclear. The present study was designed to test the hypothesis that consumption of amphetamine and/or cocaine in addition to cannabis would lead to an earlier age at onset of schizophrenia than that seen for cannabis consumption alone. A secondary objective was to determine what kind of effect additional substance use exerted (e.g. additive, multiplicative). Patients with a diagnosis of schizophrenia were recruited from consecutive admissions to the inpatient and outpatient services of a large psychiatric hospital in Perth, Australia and 167 participants were assessed using the Diagnostic Interview for Psychosis, which included detailed inquiry into illicit drug use in the 12 months prior to the onset of psychiatric symptoms. Participants were categorized into four groups: no illicit substance use (n = 65), cannabis use (n = 68), cannabis plus amphetamine use (n = 25), and cocaine plus cannabis/cocaine plus cannabis plus amphetamine use (n = 9). Analysis of variance was performed to detect trends, and linear regression used to analyze the consumption of each additional substance as a predictor of age at onset. We observed a linear trend for mean age at onset: 23.34 (SD = 6.91) years for no illicit substance use, 22.51 (SD = 5.27) years for cannabis use, 20.84 (SD = 3.48) years for cannabis plus amphetamine use, and 19.56 (SD = 3.54) years for cocaine plus cannabis/cocaine plus cannabis plus amphetamine use; the variation in the means between groups was statistically significant: F(1,163) = 5.66, p = 0.008, Cohen's d = 0.38. For the consumption of each additional substance, age at onset was earlier by 1.2 years: R (2) = 0.034, F(1,165) = 5.72, p = 0.018. Whilst preliminary, these findings suggest that additional consumption of each substance predicted an earlier age at onset by approximately 1 additional year.

Alcohol as a Gateway Drug: A Study of US 12th Graders

The Gateway Drug Theory suggests that licit drugs, such as tobacco and alcohol, serve as a "gateway" toward the use of other, illicit drugs. However, there remains some discrepancy regarding which drug-alcohol, tobacco, or even marijuana-serves as the initial "gateway" drug subsequently leading to the use of illicit drugs such as cocaine and heroin. The purpose of this investigation was to determine which drug (alcohol, tobacco, or marijuana) was the actual "gateway" drug leading to additional substance use among a nationally representative sample of high school seniors. This investigation conducted a secondary analysis of the 2008 Monitoring the Future 12th-grade data. Initiation into alcohol, tobacco, and other drug use was analyzed using a Guttman scale. Coefficients of reliability and scalability were calculated to evaluate scale fit. Subsequent cross tabulations and chi-square test for independence were conducted to better understand the relationship between the identified gateway drug and other substances' use. Results from the Guttman scale indicated that alcohol represented the "gateway" drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs. The findings from this investigation support that alcohol should receive primary attention in school-based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use. Therefore, it seems prudent for school and public health officials to focus prevention efforts, policies, and monies, on addressing adolescent alcohol use.

Impulsivity-related brain volume deficits in schizophrenia-addiction comorbidity

Despite a high prevalence of schizophrenia patients with comorbid substance abuse, little is known about possible impacts on the brain. Hence, our goal was to determine whether addicted and non-addicted schizophrenic patients suffer from different brain deficits. We were especially interested to determine if grey matter volumes were affected by impulsivity. We hypothesized that (comorbid) substance abuse would be associated with enhanced impulsivity and that this enhanced impulsivity would be related to grey matter volume deficits in prefrontal areas. We employed a voxel-based morphometry approach as well as neuropsychological assessment of executive functions and trait impulsivity in 51 participants (age range 23-55). The schizophrenia group comprised 24 patients (12 patients with paranoid schizophrenia and 12 with additional comorbid substance use disorders). The comparison group comprised 27 non-schizophrenic individuals, matched by age and education (14 healthy individuals and 13 patients with substance use disorders). Total grey matter volume deficits were found in all patient groups as compared with healthy controls but were largest (~8%) in both addicted groups. While grey matter volume losses in lateral orbitofrontal and temporal regions were affected by schizophrenia, volume decreases of the medial orbitofrontal, anterior cingulate and frontopolar cortex were associated with addiction. Compared with non-addicted schizophrenics, comorbid patients showed significant volume decreases in anterior cingulate, frontopolar and superior parietal regions. Additionally, they showed an increased non-planning impulsivity that was negatively related to grey matter volumes in the same regions, except for parietal ones. The present study indicates severe grey matter volume and functional executive deficits in schizophrenia, which were only partially exacerbated by comorbid addiction. However, the relationship between non-planning impulsivity and anterior cingulate and frontopolar grey matter volumes points to a specific structure-function relationship that seems to be impaired in schizophrenia-addiction comorbidity.

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Psychiatric Comorbidity Reduces Quality of Life in Chronic Methadone Maintained Patients

Despite the efficacy of methadone maintenance treatment (MMT), opioid dependence still involves severe impairment of functioning and low quality of life. This study examines the influence of the psychiatric comorbidity of MMT patients on their quality of life. A total of 193 middle-aged patients in long-term MMT were assessed for current and lifetime Axis I psychiatric disorders, substance use disorders, and personality disorders using the MINI, the CIDI-SAM, and the SIDP-IV. Quality of life (Qol) was assessed using the EQ-5D. Psychiatric comorbidity was documented in 78% of the patients. Mood disorders (60%) and anxiety disorders (46%) were the most common diagnoses. Additional substance use disorders were diagnosed in 70% of the MMT patients. While a probable personality disorder was documented for 65% of the patients, 66 of these patients actually showed an antisocial personality disorder. Qol was severely diminished to a level comparable to that for patients with chronic psychiatric and/or somatic disorders. Multivariate analyses showed the occurrence of comorbid psychiatric disorders to explain about 32% of the variance in Qol. The quality of life for MMT patients is generally low. The present results showed a high rate of psychiatric comorbidity for this patient group with mood disorders, additional substance use disorders, and personality disorders occurring in particular. Such comorbid psychopathology substantially affects quality of life. The negative influence of comorbid psychopathology on quality of life is an important reason to provide additional mental health services for MMT patients.

Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: Results from two national surveys

Objectives This study examined trends in prescription drug abuse and dependence (sedatives, tranquilizers, opioids, and stimulants), co-occurrence with other substance use disorders and substance abuse treatment utilization among those with diagnoses of prescription drug abuse and dependence in two large, nationally representative, independent samples of adults in the United States in 1991–1992 and 2001–2002. Methods Two nationally representative cross-sectional samples of civilian non-institutionalized adults 18 years or older in the United States, of which 52% were women. Data were collected from structured diagnostic interviews using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). National prevalence estimates were derived from the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey ( n = 42,862) and the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions ( n = 43,093). Results The past-year prevalence of prescription sedative abuse, sedative dependence, opioid abuse, and opioid dependence increased from 1991–1992 to 2001–2002. The majority of individuals with past-year sedative (56.8%), tranquilizer (89.0%), stimulant (67.9%) and opioid (74.2%) use disorders also met DSM-IV criteria for an additional past-year substance use disorder. The co-occurrence of several forms of prescription drug use disorders and other substance use disorders increased from 1991–1992 to 2001–2002. A minority of individuals with past-year prescription drug abuse and approximately one-half of those with past-year prescription drug dependence utilized substance abuse treatment. Conclusions The findings reinforce the importance of continued national monitoring based on the increases in prescription drug abuse and dependence, high co-occurrence with other substance use disorders, and underutilization of substance abuse treatment services.

Modified Therapeutic Community Treatment for Offenders with MICA Disorders: Substance Use Outcomes

Correctional systems nationwide have increasingly turned to therapeutic community (TC) programs for the treatment of addiction in prisons. TC treatment, with modifications, has shown considerable promise in treating offenders who have co-occurring mental and substance use disorders, a group that has a mounting prevalence in prison populations. This article reports data from a study that randomly assigned male inmates with mental illness and chemical abuse (MICA) disorders (n = 139) to either a Modified TC (MTC) or a comparison group. Analyses revealed that the MTC group had significantly greater declines in alcohol and drug use at 12-months post-prison release. Additional analysis related positive substance use outcomes to reduced contact with the justice system and self-reported criminal activity. Implications for treatment and policy are discussed.

Patterns of heroin, cocaine, and alcohol abuse during long-term methadone maintenance treatment

Individuals' use of heroin, cocaine, and alcohol during long-term methadone maintenance treatment (MMT) was studied. Prospectively collected data from 103 heroin-addicted individuals who were consecutively admitted for MMT and remained 2 years in treatment were evaluated. The patients were assessed every 6 months with a standardized interview. Three longitudinal patterns of drug abuse were identified. A proportion of patients abstained fully from their particular drug use (26% from heroin, 39% from cocaine, and 19% from alcohol); a proportion (39%, 32%, and 47%, respectively) switched between periods of abuse and nonuse of these drugs; and chronic drug users (34%, 28%, and 33%, respectively) continued use, including periods of daily abuse throughout MMT. Different therapeutic interventions may be needed in patients with different longitudinal patterns of additional substance use during MMT.

Multiple challenges in services for women experiencing domestic violence

This paper is based on a survey of service provision for women experiencing domestic violence and who have additional complex mental health or substance use needs. Postal questionnaires were sent to domestic violence organisations, community mental health teams, mental health NHS trusts and substance use services. The views of women survivors of domestic violence were also sought. The survey, undertaken by Women's Aid, identifies some shortcomings in existing provision and makes recommendations for future development of services. More refuge provision is needed which can accommodate women with mental health and substance use needs, and their children.Mental health professionals and those working in drug and alcohol services also need training in domestic violence, to enable them to respond more appropriately to the needs of abused women and to work effectively in partnership with refuge organisations.

A comparison of schizophrenic patients with or without coexisting substance use disorder.

Increasing numbers of research investigations have documented psychosocial, demographic, and treatment course differences between schizophrenic patients with and without additional substance use disorder. However, many of these studies have failed to control for additional psychiatric diagnoses. This study sought to elucidate differences between schizophrenic patients with versus without coexisting substance use disorder, while controlling for the possible confounding impact of additional Axis I or Axis II diagnoses. We explored the records of 308 psychiatric inpatients who were either solely diagnosed with schizophrenia or solely diagnosed with coexisting schizophrenia and substance use disorder. We compared these two groups on a variety of psychosocial, demographic, and clinical variables shown in prior research to differentiate these two types of patients. Findings revealed that substance use interacts with schizophrenia to increase psychiatric admissions and decrease lengths of stay upon admission. Findings also revealed that patients with coexisting substance use and schizophrenia have unique psychosocial and demographic presentations that reflect more challenging life circumstances. Differences were not revealed between groups in terms of legal and criminal involvement. Based on pure diagnostic groupings, findings indicate that an additional substance use disorder is associated with psychosocial, demographic, and treatment course differences among individuals with a schizophrenia diagnosis. When screening, developing treatment, and planning aftercare, it is crucial to not view individuals with schizophrenia diagnoses as a monolithic group, but rather to consider the presence of a substance abuse diagnosis; such consideration will increase the likelihood of appropriate treatment and successful outcomes.

Improvement of the designs of hydropower plants' water-intake and outlet facilities

1. The designs of water-intake and outlet facilities, like the designs of other elements of water-delivery and discharge paths, are constantly improving. Their development is due to many factors, the most important of which are: the action of objective patterns of development and the influence of scientific and technical progress; new requirements imposed on them in connection with environmental protection, raising the reliability and safety of operation, and consideration of the social factor; and the use of new materials, technologies, and other achievements. 2. Analysis of new developments revealed the following basic directions of improvement in water intakes and outlets: 1) the use of new geometric forms and configurations, and of more efficient geometric parameters; 2) increasing dynamism and mobility; 3) the use of self-controlling operation; 4) splitting up of design elements; 5) the use of additional extraneous substances introduced into the flow; 6) the use of fields (mechanical, centrifugal, thermal, gravitational, magnetic, and electric). 3. Realization of new design solutions in specific objects of hydrotechnical construction is hindered by objective, as well as subjective factors, including the absence of a procedure for substantiating the use of these developments in designing and reconstructing facilities that would take into account their action on the environment, the reliability and safety of operation, social efficiency, specific local conditions, etc.

Attrition from an Evening Alcohol Rehabilitation Program

In recent years many groups have become interested in the potential cost savings and efficacy of outpatient treatment for chemical dependency. This study was originally conceived to answer questions of both patients and staff concerning graduation and attrition rates in an evening outpatient alcohol treatment program. Of particular interest were gender effects, rates of attrition across two progressive program levels, and whether alcohol-only users and self-initiated clients fared better in treatment than did polysubstance users and patients who were referred by others. Medical records were available for 103 of the 107 treated patients, and of these, 27 remained in the program until graduation. Women were more likely to graduate and remain in the program longer than men. Alcohol users were more likely to graduate than subjects with additional substance use disorders. Graduation rates did not differ significantly between contact initiators and noninitiators; however, the former dropped out of treatment more quickly. The study is an example of the potential use of data obtained from an existing agency data base.

Patterns of substance abuse in psychiatric inpatients

257 of the initial 26 patients no longer satisfied the criteria for depression. Initial Beck Depression Inventory (BDI) scores were significantly elevated as compared to the two week follow up (pc.001). Although analysis of variance of initial BDI scores showed a trend toward increased depressive symptomatology among women and polysubstance abusers, the two week follow up suggested that persistence of depressive symptoms was greatest in women (p = .48) and those with additional substance use disorders (p = .025) with an interaction (p = 309). These results confirm the utility of a drug free period in the assessment of depression among hospitalized alcoholics.