Prior substance abuse and related treatment history reported by recent victims of sexual assault

To inform intervention approaches, the current study examined prevalence and comorbidity of recent use and history of abuse of alcohol, marijuana, and other illicit drugs as well as history of substance treatment among a sample of female victims of sexual assault seeking post-assault medical care. Demographic variables and prior history of assault were also examined to further identify factors relevant to treatment or prevention approaches. Participants were 255 women and adolescent girls seeking post sexual assault medical services who completed an initial follow-up assessment on average within 3 months post-assault. The majority (72.9%) reported recent substance use prior to assault, approximately 40% reported prior substance abuse history, and 12.2% reported prior substance treatment history. Prior history of assault was associated with recent drug use and history of drug abuse as well as substance treatment. Among those with prior histories of substance abuse and assault, assault preceded substance abuse onset in the majority of cases. Almost all those with prior treatment history reported recent drug or alcohol use. A portion of sexual assault survivors seen for acute medical services may benefit from facilitated referral for substance abuse treatment in addition to counseling at the time of screening. Assessment and intervention approaches should target alcohol, marijuana, and other illicit drug use and abuse. Substance use and associated impairment may serve as a rape tactic by perpetrators of assault. Substance use at the time of assault does not imply blame on the part of assault victims. Previous findings indicate that rape poses high risk of PTSD particularly among women with prior history of assault. Screening and intervention related to substance abuse should be done with recognition of the increased vulnerability it may pose with regard to assault and the high risk of PTSD within this population.     

Factors associated with lifetime history of drug treatment among substance dependent women

There is extensive research on factors related to substance use treatment retention and completion but less is known about factors related to treatment initiation, particularly for women. This paper examines factors associated with a lifetime history of substance abuse treatment among women with drug abuse or dependence. Baseline interview data, using the Addiction Severity Index (ASI) that obtained during a randomized clinical trial was analyzed comparing women with no history of drug treatment with women with a history at least one drug treatment episode. Of the 153 women, 47.4% had a lifetime history of drug treatment compared to 52.6% who have never enrolled in drug treatment. After multiple logistic regression, craving drugs at least 15 days in the past month, using cocaine at least 15 days in the past month, ASI alcohol composite score, perceived seriousness of legal problems, history of at least 3 pregnancies, and history of physical abuse by a known person, were independently associated with drug treatment.     

Drug-Using and Nonusing Women: Potential for Child Abuse,Child-Rearing Attitudes,Social Support,and Affection for Expected Baby

Eighty pregnant women (25 substance using, 55 nonusing) from an American prenatal clinic serving lower-income to working-class women responded to questionnaire measures of child-rearing attitudes. The drug users’ primary substance of misuse was cocaine (68%), alcohol (16%), amphetamines (12%), or sedatives (4%); polydrug use was documented for 80% of the women. The two (user and nonuser) groups were not different on demographic (age, race, marital status, education, SES, source of income) or obstetrical factors (number of pregnancies, number of children). Drug-using women scored significantly higher on a measure of child abuse potential; more than half scored in the range of clinical criterion for extreme risk. As their babies were not yet born, no actual physical abuse was documented, only a higher potential for abuse. The subgroup who were both drug users and had lower social support scored higher on child abuse potential than all other subgroups. The drug users also had lower self-esteem scores than the nonusers. The two groups did not differ on measures of overall social support, authoritarian/democratic child-rearing beliefs, or affection for the expected baby.     

A comparison of alcohol and drug use patterns of homosexual and heterosexual men: the San Francisco Men's Health Study

Very high prevalence rates for problem drinking and/or alcoholism have been estimated for homosexual male populations. Populations characterized by high prevalence rates for problematic drug or alcohol use are of special interest since study of such groups may help to provide insights regarding the processes associated with problematic substance use. However, prevalence estimates for problematic substance use within gay male populations have most typically relied on convenience samples and generally contain an over-representation of bar patrons. This study reports data from a large scale random household sample of homosexual and heterosexual men who live in an urban district of San Francisco, California. Few differences were noted in the drinking patterns of these men, although important differences were found in the prevalence of drug use over a 6-month period. Differences in the prevalence of at least weekly drug use were comparatively minor, however. Health policy implications of these findings are discussed.     

Family History of Alcohol and Drug Abuse,Childhood Trauma,and Age of First Drug Injection

Background: Childhood maltreatment may lead to development of future substance use; however the contributions of a family history of substance use is unclear. Objectives: To better understand the relationship between childhood abuse, family history of alcohol and drug abuse, and injecting drug use initiation in a cohort of chronic opioid users. Methods: A cross-sectional survey of long-term and difficult to treat intravenous opiate users of the North American Opiate Medication Initiative (NAOMI) cohort was conducted in two Canadian cities (Vancouver and Montreal). For the analysis, we selected a subsample (n = 87) of the population reported experiencing childhood abuse and completed a 12-month follow up. The sample was 41.4% female and 14.9% First Nations, with a mean age of 38 years. This sample then completed the Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index (ASI) beside others. Results: Maternal alcohol and drug use was significantly associated with childhood sexual abuse, emotional abuse, and physical neglect. Paternal alcohol and drug use was significantly associated with childhood physical abuse. Increased severity of all types of childhood trauma was related to an earlier age of first injection. Conclusions/Importance: Family history of drug and alcohol use is strongly associated with childhood trauma, which may, in turn, lead to an earlier initiation to the dangerous routes of drug injection.     

Cultural investment: providing opportunities to reduce risky behavior among gay American Indian males

Many gay American Indian (GAI) men feel alienated from their tribal, ceremonial and social communities because of homophobia and heterosexism. As a result, they often turn to their local gay community for social participation and sex opportunities. It is no secret that a significant aspect of some gay communities is socializing in local bars and clubs. The gay bar scene makes healthy living difficult for Native American gay men. This is especially the case for those who are in alcohol or drug recovery. In response, gay Native men's support groups are attempting to make available a cultural alternative to the double bind of alienation from one's Native community and exposure to substance abuse by providing alcohol and substance free opportunities for ceremonial and social involvement. The hope is that the men will go to bars less frequently and instead turn to Native cultural activities in men's groups for social, spiritual and emotional support. The logic of this approach assumes that individuals who are culturally invested in a community will gain a level of self and social acceptance, making them less likely to abuse substances and put themselves at risk for HIV infection. The information presented in this article comes from over six years of ethnographic research among GAI men concerning self and social acceptance, HIV/AIDS and American Indian GLBT identity.     

Childhood abuse and harmful substance use among criminal offenders

Childhood abuse is a serious problem that has been linked to harmful alcohol and drug use in non-offender samples. In a sample of 219 criminal offenders, we examined the associations between childhood physical and sexual abuse and three indices of harmful substance use. Results indicate that physical abuse was associated with symptoms of alcohol use disorder and sexual abuse was associated with symptoms of drug use disorder among offenders. Both forms of childhood abuse were associated with substance use consequences, even after taking into account substance type and frequency of use. No gender by childhood abuse interactions were found. Symptoms of depression and generalized anxiety partially mediated relationships between childhood abuse and substance use consequences. Findings underscore the importance of assessing childhood abuse and treating anxiety and depression among offenders who exhibit harmful substance use.     

Substance Abuse in an Urban Aboriginal Population

Abstract

This work is the result of a research program developed from a research partnership between the Native Mental Health Research Team of McGill University and the Native Friendship Centre of Montreal, a Native-run urban community-based service organization. The aims of the study were to examine substance abuse as well as physical and mental health among an urban Aboriginal population. The nature and severity of drug or alcohol problems in this population were explored. Data was collected through structured interviews with urban Aboriginal people in the greater Montreal area (n = 202). Results indicate that the majority of the sample were single, unemployed, and had lived in the urban area for a long time (mean of 9.96 V .76 years). Approximately two thirds of the sample were current alcohol drinkers and cigarette smokers and one third of the sample reported having a current drug or alcohol problem. Results indicate that individuals who abused substances were more likely to live with someone who had a drug or alcohol problem. Substance abusers also had a greater history of legal problems with more convictions, time spent in jail, and were more likely to be on probation or parole. A large proportion of the sample reported having significant medical problems that required treatment, and substance abusers were less likely to have identification needed to access medical services. Results indicated high levels of psychological distress in the general sample (depression, anxiety, suicidal ideation, attempted suicide). These phenomena were augmented by substance abuse problems. In particular, substance abusers had a history of more suicide attempts, and were more likely to have been the victims of abuse.     

Psychosocial and cultural factors in alcohol and drug abuse: an analysis of a homosexual community

Homosexual men and women may be at risk for alcohol and drug abuse due to psychosocial variables such as drinking styles, stress, or the cultural importance of bars. The study of psychosocial variables in homosexual culture may help us understand how they operate generally. This paper describes the findings of a large (n = 3400) survey of homosexual population. The core hypothesis was that stress and other psychosocial variables have their primary effects among people made vulnerable to substance abuse by individual expectancies and/or cultural values. Tension reduction expectancies of alcohol effects had substantial effects on alcohol and drug abuse, as did the use of bars as a social resource, a vulnerability variable more specific to urban homosexual culture. Further, stress affected alcohol-drug problems only among people who were "vulnerable" via expectancies and values, and both high risk styles of substance use and simple consumption levels had much stronger effects on problems among vulnerable respondents, thus supporting the stress-vulnerability perspective. Individual differences in social role status was related to alcohol and drug problems, and may explain differences between homosexual and general populations.     

Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) with substance abusers in outpatient and residential treatment

The psychometric properties of the Drug Use Disorders Identification Test (DUDIT), an 11-item self-report questionnaire developed to screen individuals for drug problems, are evaluated. The measure, developed in Sweden and evaluated there with individuals with severe drug problems, has not been evaluated with less severe substance abusers or with clinical populations in the United States. Participants included 35 drug abusers in an outpatient substance abuse treatment program, 79 drug abusers in a residential substance abuse treatment program, and 39 alcohol abusers from both treatment settings who did not report a drug abuse problem. The DUDIT was found to be a psychometrically sound drug abuse screening measure with high convergent validity (r = .85) when compared with the Drug Abuse Screening Test (DAST-10), and to have a Cronbach's alpha of .94. In addition, a single component accounted for 64.91% of total variance, and the DUDIT had sensitivity and specificity scores of .90 and .85, respectively, when using the optimal cut-off score of 8. Additionally, the DUDIT showed good discriminant validity as it significantly differentiated drug from alcohol abusers. These findings support the DUDIT as a reliable and valid drug abuse screening instrument that measures a unidimensional construct. Further research is warranted with additional clinical populations.     

Dual Diagnosis Patients in Clinical Trials of Antipsychotics

ABSTRACT

Objectives: Substance abuse and schizophrenia comorbidity are common, and substance abuse may negatively affect schizophrenia treatment effectiveness. This research was conducted to determine whether lifetime history of substance abuse diagnosis or concurrent substance use is associated with poor prognosis in schizophrenia as measured by the treatment outcome in controlled clinical trials of atypical antipsychotics.

Methods: A post hoc analysis of four randomized, double-blind, 24-to 28-week studies of schizophrenia treatment was performed to examine effect of historical substance abuse diagnosis on treatment outcome. Patients with a diagnosis of substance dependence within 1 or 3 months (specific to study) were excluded from the trials. Positive and Negative Syndrome Scale (PANSS) scores were compared between patients who had and did not have a history of substance abuse. PANSS scores were also compared between patients who reported different degrees of concurrent substance use for two of the trials.

Results: Patients with lifetime history of substance abuse had earlier onset of illness and tended to have lower PANSS scores at baseline compared with other patients. Male patients with lifetime history of substance abuse had less improvement in PANSS scores than those without a history. Patients who reported alcohol use during the trials also tended to have less improvement in PANSS scores and a higher rate of dropout than patients without reported alcohol use.

Conclusions: These results suggest that patients with a lifetime history of substance abuse disorders may have earlier disease onset and may respond poorly to treatment compared with other patients with schizophrenia.     

Temperament Style and Substance Abuse Characteristics

The relationship of temperament to different patterns and types of alcohol abuse has received much attention over the last decade in order to provide clues to matching patients optimally to treatment strategies. The purpose of this study was to examine the relationship of temperament with a number of relevant substance abuse characteristics in a substance abusing population. One hundred forty-five male veterans were interviewed on their lifetime use of substances and on their psychiatric symptoms, problems associated with use, context, and family history of substance abuse. Subjects filled out the TPQ and the MPQ, which were subjected to factor analysis and revealed four factors: (1) Negative Affectivity/Impulsivity, (2) Positive Affectivity/Sociability, (3) Persistence/Achievement, and (4) Constraint. There was partial support for the hypotheses. Impulsivity was negatively correlated with age of onset and positively correlated with substance-related problems and a family history of substance abuse. Subjects with a history of depression scored significantly lower on the Positive Affectivity/Sociability factor than those who had not experienced a significant depression. Individuals who used alone scored lower on this factor than those who used in social contexts. The temperament factors of Persistence/Achievement and Constraint were, for the most part, unrelated to substance abuse.     

Co-morbid health conditions at mid-life in the Iowa adoptees

Adverse health effects due to alcohol and illicit drug abuse and dependence have been well documented. This study examines the effect of substance misuse on five major groups of health conditions using a sample of well characterized adoptees. The sample consisted of 742 adoptees interviewed in the last wave of the Iowa Adoption Studies. Death rate analyses included an additional 34 participants who had died prior to the last follow-up. Substance use patterns and medical history were assessed using the SSAGA-II (Bucholz, K. K., Cadoret, R. J., Cloninger, C. R., Dinwiddie, S. H., Hesselbrock, V. M., Nurnberger, J. L., Jr., et al. (1994). A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. Journal of Studies on Alcohol, 55 (2), 149-158). Subjects were divided into three groups according to DSM-IV diagnostic criteria, controls, alcohol abuse or dependence only (alcohol only), and the Alcohol-Drug group (abuse or dependence diagnosis on at least one illicit substance with or without alcohol diagnosis). Incidence rates of various diseases were measured using logistic regression. Survival analyses were used to examine whether substance abusers developed cardiovascular or metabolic disease at an earlier age than control subjects. Diagnostic grouping made no difference in the incidence rates or age of onset of health conditions. The amount of alcohol consumed by males significantly predicted higher number of overall health complaints as well as higher incidence rates of cardiovascular disease. The amount of illicit drug exposure did not predict an earlier age of diagnosis for cardiovascular or metabolic disease. Individuals in the Alcohol-Drug group had an increased incidence of deaths than either the alconly or the control groups.     

Postgraduate Medical Education in Substance Abuse: An International Perspective on Dissemination of Treatment Research

The relationship of temperament to different patterns and types of alcohol abuse has received much attention over the last decade in order to provide clues to matching patients optimally to treatment strategies. The purpose of this study was to examine the relationship of temperament with a number of relevant substance abuse characteristics in a substance abusing population. One hundred forty‐five male veterans were interviewed on their lifetime use of substances and on their psychiatric symptoms, problems associated with use, context, and family history of substance abuse. Subjects filled out the TPQ and the MPQ, which were subjected to factor analysis and revealed four factors: (1) Negative Affectivity/Impulsivity, (2) Positive Affectivity/Sociability, (3) Persistence/Achievement, and (4) Constraint. There was partial support for the hypotheses. Impulsivity was negatively correlated with age of onset and positively correlated with substance‐related problems and a family history of substance abuse. Subjects with a history of depression scored significantly lower on the Positive Affectivity/ Sociability factor than those who had not experienced a significant depression. Individuals who used alone scored lower on this factor than those who used in social contexts. The temperament factors of Persistence/Achievement and Constraint were, for the most part, unrelated to substance abuse.     

Evaluation of a Grief Group for Women in Residential Substance Abuse Treatment

Most women in substance abuse treatment have experienced significant losses. This preliminary study examined the effectiveness of a therapy group addressing grief and loss among women enrolled in a gender-specific residential substance abuse treatment program. The intervention group consisted of 24 grief group participants and the comparison group consisted of 31 nonparticipants. Qualitative analysis revealed a pattern: participants identified traumatic loss, moved to emotional loss and abandonment by their own mothers, then focused on their own children. Data obtained at induction and at exit or follow-up were used for quantitative analysis. Length of stay, self-esteem, depression, mood, and parenting attitudes were assessed using standardized instruments. Women who participated in the grief group remained in treatment longer. While both groups were depressed and had low self-esteem at induction, the self-esteem of nonparticipants was significantly lower than that of participants. Both groups improved over time on mood, depression, and parenting. At exit or follow-up, participants had higher self-esteem. Based on these findings, we hypothesized that higher self-esteem at induction made it possible for women to participate in and benefit from the grief group, thus contributing to length of stay. To test this hypothesis we conducted regression analyses which found that, individually, group status (participation) and self-esteem explained 11% of the variance in length of stay. However, since the number of women with available data varied for group status and self-esteem, group status was a significant predictor of length of stay and self-esteem showed only a trend toward significance. These findings support our hypothesis. The women's pattern of disclosure and the hypotheses drawn from the results of this preliminary analysis will be examined further in an evaluation of a series of groups focused on loss and grief.     

Eighteen-Month Follow-Up Data on a Treatment Program for Homeless Substance Abusing Mothers

In response to the dearth of data on substance abuse treatment among homeless mothers, this study breaks new ground in presenting 18-month follow-up data on 149 homeless mothers with young children enlisted in a substance abuse treatment program. The effects of residential compared to nonresidential services were evaluated over the follow-up period. Although dropout rates were high, predictors of dropout were identified, and the residential had a lower dropout rate compared to the nonresidential comparison group. Members of both residential and nonresidential groups evidenced improvement in alcohol and drug problems and in housing stability, regardless of the amount of time they spent in the program. This project demonstrated that homeless mothers can be more successfully engaged in substance abuse programs with provisions of residential placement in addition to participation in a therapeutic community. Future interventions can take advantage of this knowledge in designing more effective programs.     

Effects of illicit drug use in an inpatient psychiatric population

All 533 patients in the acute and subacute psychiatric wards of a VA psychiatric facility were evaluated by nursing staff for substance abuse history and for illicit drug use. Eighteen percent had a history of either drug or combined drug and alcohol problems, 40% had a history of alcohol abuse, and only 42% had no substance abuse problems. Fifty-six of the patients with a history of drug problems (58%) were illicitly using drugs in the hospital. They were compared with a group of 64 randomly chosen patients with no substance abuse history.Drug users were much younger and tended to be black; they had more re-admissions, even though their original hospital admission was much more recent. Eighty-three percent of both groups had a primary diagnosis of schizophrenia, but drug users were more likely to be diagnosed paranoid schizophrenic. The groups did not differ significantly in treatment status and progress, except that drug users were more likely to exhibit marked mood changes.Half of the drug users were taking drugs three or more times weekly. Marijuana use was by far the most common substance observed. Ten consequences of drug use occurred in at least one-third of the users on a regular basis, the most common effects being negative attitudes toward treatment, cliquishness, secretiveness, and a need for greater supervision. The treatment problems and effects of drug use were much more serious for about half of the drug users than for the others.     

The Impact of Abuse Trauma on Alcohol and Drug Use: a Study of High-Risk Incarcerated Girls

ABSTRACT

This study examines the impact of abuse trauma (physical and sexual) on alcohol and drug use of high-risk girls (12 to 18 years of age) who were surveyed within the first two weeks of their incarceration. One-way ANOVA analyses and Tukey post hoc tests indicate physical abuse with a weapon was associated with higher marijuana use and number of drugs used. Sexual abuse, especially within the past year, increased marijuana use, alcohol use, number of drugs used, and alcohol and other drug (AOD) problems. Policy implications reflect the need for treatment protocols within substance abuse programs to address abuse trauma, particularly forced sex which has occurred within the past year.     

A family history and direct interview study of the familial aggregation of substance abuse: the adolescent substance abuse study

The adolescent substance abuse (ASA) study collected information concerning drug use and psychopathology on male adolescent probands in treatment for substance abuse and also on matched control adolescents, as well as all available family members of both groups. Information was obtained through direct interview and the family history method of assessment. Both methods revealed greater alcohol and drug use, conduct disorder (CD) and antisocial personality disorder (ASP) in the relatives of treatment probands as compared with control relatives. These results suggest familial transmission, not only for alcohol abuse, but also for non-alcohol substance abuse. Familial transmission for CD and ASP is also evident for both male and female relatives, although the prevalence of these disorders is significantly greater in males than females.     

The Prevalence of Sexual Abuse and Its Impact on the Onset of Drug Use Among Adolescents in Therapeutic Community Drug Treatment

ABSTRACT

Assessing the prevalence of sexual abuse among adolescents is problematic because they are generally reluctant to disclose abusive experiences. Often the abuse is ongoing and may involve family members with whom the adolescent lives or with whom there may be strong emotional attachments. Statistics based on self-reports of childhood victimization suggest that issues of childhood abuse are critical factors in the initiation of drug use. The current study describes the prevalence of sexual abuse among a sample of 938 adolescents admitted to residential therapeutic communities for the treatment of substance abuse and related disorders. The data indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than boys (64% vs. 24%). A history of sexual abuse correlates with several social, behavioral, and psychological characteristics of clients at entry to treatment, including greater drug use, more severe psychopathology, family drug use and more deviant peer associations. Cox regression analyses show that a history of sexual abuse is related to earlier onset of alcohol and illicit drug use. One explanation of the findings is the self-medication hypothesis (Cavailo & Schiff, 1989) which states that drug use functions to ameliorate feelings of depression, and poor self-esteem which often accompany childhood abuse.