Coping style and substance use intention and behavior patterns in a cohort of BC adolescents

Adolescence is a developmental period during which young teenagers are particularly susceptible to shifting from well-defined behavioral intentions to abstain from substance use to intentions that include experimentation with substance use and in many cases engagement substance use. Coping mechanisms are often an important determinant of adolescent well-being, and the style of coping adopted by the individual can influence positive or negative health behavior. The goal of this study was to examine how the levels of positive coping style (i.e., engagement) and negative coping style (i.e., disengagement) associated with increased risk for tobacco and marijuana use, and intentions to use among those who have never tried. Higher levels of engagement coping were associated with lower odds of tobacco and marijuana use (AOR = 0.96 (95% CI: 0.94–0.98), p < 0.001 and AOR = 0.95 (95% CI: 0.93–0.97) p < 0.001, respectively). Higher levels of disengagement coping were associated with greater odds of tobacco and marijuana use (AOR = 1.03 (95% CI: 1.01–1.05), p < 0.001 and AOR = 1.05 (95% CI: 1.03–1.07), p < 0.001, respectively). Engagement coping was also protective against the intention to use tobacco (AOR = 0.97 (95% CI: 0.96–0.99), p < 0.001) or marijuana (AOR = 0.98 (95% CI: 0.96–0.99), p < 0.01). These findings suggest that psychoeducational programs supporting the development of engagement oriented coping strategies may contribute not only to reductions in adolescents' use of tobacco and marijuana, but also to reductions in adolescents' intentions to use in the future.     

Intentions to quit smoking among youth in substance abuse treatment

Introduction

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths’ intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.

Methods

Participants were 178 adolescents who were in inpatient (n = 90) or outpatient (n = 88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD = 1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).

Results

SUD youth intention to quit smoking averaged 4.9 out of 10 (SD = 3.2), comparable to intention to quit drinking (M = 5.3, SD = 3.6), but lower than their intention to quit using drugs (M = 6.0, SD = 3.4). Teens’ intentions to quit smoking were associated with nicotine dependence (r = −.30, p < .01) and smoking cessation related self-efficacy (r = .36, p < .01), but not with pretreatment substance use severity (r = −.15). Controlling for nicotine dependence, teens’ intentions to quit smoking were positively related to smoking cessation self-efficacy (pr = .26, p < .01) and intention to quit using illicit drugs (pr = .15, p < .05), but unrelated to intention to quit drinking.

Discussion

Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.     

A tale of two stimulants: Mentholated cigarettes may play a role in cocaine,but not methamphetamine,dependence

Background

Research suggests that mentholated cigarettes may play a role in cocaine dependence. The purpose of the present study was to expand upon the research on mentholated cigarettes and cocaine dependence and to evaluate the role of mentholated cigarettes in methamphetamine dependence.

Methods

Secondary analysis of a multisite, randomized trial evaluating the impact of smoking-cessation treatment in stimulant-dependent outpatients (N = 538). Participants’ reasons for concurrent use of cigarettes and illicit stimulants were assessed via self-report. Stimulant-abstinence was measured by self-report and urine drug screens. Smoking cessation was assessed via self-report and carbon monoxide levels.

Results

Of the 301 cocaine-dependent participants, 201 (67%) were menthol and 100 (33%) were non-menthol cigarette smokers. Cocaine-dependent participants who smoked menthol, compared to non-menthol, cigarettes were significantly more likely to report that cigarettes prolong their cocaine high (X²(1) = 16.3, p < .0001, OR = 3.58 [95% CI: 1.88–6.79]) and were less likely to be stimulant abstinent during active treatment (W = 3.6, p < 0.001, d = .39 [95% CI: 0.16–0.62]), at 3-month follow-up (X²(1) = 14.4, p < 0.001, OR = .32 [95% CI: 0.17–0.58]), and at 6-month follow-up (X²(1) = 4.6, p = 0.03, OR = .53 [95% CI: 0.29–0.95]). No parallel differences were found between menthol and non-menthol methamphetamine-dependent smokers. The prevalence of Caucasian menthol smokers was significantly greater in the cocaine-dependent participants (37.2%) than in the methamphetamine-dependent participants (17.61%), (X²(1) = 14.4, p < .001, OR = 2.77 [95% CI:1.62–4.73]). Smoking cessation was not significantly associated with cigarette type for either cocaine- or methamphetamine-dependent participants.

Conclusions

The present results suggest that mentholated cigarettes play a role in cocaine, but not methamphetamine, dependence.     

Psychiatric distress,risk behavior,and treatment enrollment among syringe exchange participants

The present study evaluated psychiatric distress as a predictor of treatment enrollment in out-of-treatment injection opioid users newly registered at the Baltimore Needle Exchange Program (BNEP). Study participants (n = 281) completed the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), and the Symptom Checklist-90 (SCL-90-R), and were randomly assigned to one of three different conditions for 4 months that evaluated referral strategies designed to promote treatment interest and enrollment. The Global Severity Index (GSI) of the SCL-90 was used as a measure of psychiatric distress. A logistic regression showed that higher GSI scores predicted more treatment enrollment (Adjusted OR = 2.15, CI = 1.10–4.23, p < 0.05), after controlling for study condition, demographic variables, syringe exchange site, and severity of drug use. The results suggest that the data from the assessment of psychiatric distress in syringe exchange settings can be used to support motivational strategies for encouraging syringe exchangers to seek substance abuse treatment.     

Alcohol and drug use and related consequences among gay,lesbian and bisexual college students: Role of experiencing violence,feeling safe on campus,and perceived stress

Objective

To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns.

Methods

A random representative sample of university students (n = 988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences.

Results

Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR = 2.0; 95% CI: 1.1–3.9), more frequent negative AOD consequences (β = 5.5, SE = 1.4, p < 0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR = 6.6; 95% CI: 3.0–14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students.

Conclusions

Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students.     

Criminal justice referral and incentives in outpatient substance abuse treatment

A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from a large (N = 415) multi-site trial of a prize-based abstinence incentive intervention ( Petry et al., 2005) examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n = 138) were more likely than those not CJ referred (n = 277) to provide stimulant negative urine samples whether missing samples were counted as positive (50 versus 41%, p = .016) or as missing (96 versus 91%, p < .001). A significant interaction term was found only for percentage of treatment completers (p = .027). However, on that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. The study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can be considered for use with CJ-referred stimulant users based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program.     

Time to initiation of treatment for neonatal abstinence syndrome in neonates exposed in utero to buprenorphine or methadone

Background

The recommended standard of care calls for treating opioid-dependent pregnant women with methadone and observing neonates exposed in utero for five to seven postnatal days to see if treatment for neonatal abstinence syndrome (NAS) is needed. Data from a large multi-site randomized clinical trial comparing buprenorphine vs. methadone for the treatment of opioid dependence during pregnancy suggest buprenorphine-exposed neonates had less severe NAS, but may require pharmacologic treatment for NAS later than methadone-exposed neonates. The present study examined whether time to pharmacologic treatment initiation differed in a relatively large non-blinded clinical sample of buprenorphine- vs. methadone-exposed neonates treated for NAS.

Methods

Medical records for 75 neonates exposed to buprenorphine (n = 47) or methadone (n = 28) in utero who required treatment for NAS were examined. Time elapsed between birth and initiation of pharmacologic treatment was calculated for each neonate and time to treatment initiation compared between groups.

Results

Median time to treatment initiation (hours:minutes, IQR) was significantly later in buprenorphine- vs. methadone-exposed neonates (71:02, 44:21–96:27 vs. 34:12, 21:00–55:41, respectively, p < .001). Estimates of mean time to treatment initiation from parametric analyses that adjusted for maternal and neonatal characteristics were very similar (73:10 (95% CI: 61:00–87:18) vs. 42:36 (95% CI: 33:06–53:30), respectively, p = .0005). This difference was not dependent on maternal age or neonatal sex, gestational age, or birth weight.

Conclusions

These findings confirm results from randomized clinical trials, adding generality to the observation that buprenorphine-exposed neonates require treatment significantly later than methadone-exposed neonates.     

Self-perceived problem with alcohol use among opioid substitution treatment clients

Background and aim

Excessive alcohol use increases mortality and morbidity among opioid substitution therapy (OST) clients. Regular attendance for OST dosing presents key opportunities for screening and treatment. However, individuals' perception of their alcohol consumption as problematic or otherwise may impact their willingness to change. This study examines patterns of alcohol consumption among OST clients, perceptions of their own use and correlates of excess consumption.

Methods

Confidential, structured interviews were conducted with 264 clients of two Sydney OST clinics. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT); and illicit drug dependence with the Severity of Dependence Scale.

Results

Forty-one percent of the participants scored ≥ 8 on the AUDIT (‘AUDIT-positive’), indicating excessive alcohol use. The higher a participant's AUDIT score, the more likely they were to demonstrate insight into the potential problems associated with their drinking (linear trend, p < 0.01). However, only half of AUDIT-positive participants believed they drank too much and/or had a problem with alcohol. One-third had discussed their drinking with OST staff, and a similar proportion reported a history of alcohol treatment. AUDIT-positive participants were more likely than others to be classified as dependent on an illicit drug in the last six months (AOR = 1.76, 95% CI:1.00–3.09), report a history of alcohol treatment (AOR = 5.70, 95% CI:2.83–11.48) and believe it is safe to drink 4 + standard drinks in one session (AOR = 5.30, 95% CI:2.79–10.06).

Conclusions

OST clients with AUDIT scores ≥ 8 appear to underestimate the risks associated with their alcohol consumption. Regular assessments of alcohol use and targeted brief alcohol interventions may improve health outcomes among OST clients.     

Tuberculosis screening in a novel substance abuse treatment center in Malaysia: Implications for a comprehensive approach for integrated care

People who use drugs (PWUD) represent a key high risk group for tuberculosis (TB). The prevalence of both latent TB infection (LTBI) and active disease in drug treatment centers in Malaysia is unknown. A cross-sectional convenience survey was conducted to assess the prevalence and correlates of LTBI among attendees at a recently created voluntary drug treatment center using a standardized questionnaire and tuberculin skin testing (TST). Participants (N = 196) were mostly men (95%), under 40 (median age = 36 years) and reported heroin use immediately before treatment entry (75%). Positive TST prevalence was 86.7%. Nine (4.6%) participants were HIV-infected. Previous arrest/incarcerations (AOR = 1.1 for every entry, p < 0.05) and not being HIV-infected (AOR = 6.04, p = 0.03) were significantly associated with TST positivity. There is an urgent need to establish TB screening and treatment programs in substance abuse treatment centers and to tailor service delivery to the complex treatment needs of patients with multiple medical and psychiatric co-morbidities.     

A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.     

Antisocial personality disorder predicts methamphetamine treatment outcomes in homeless,substance-dependent men who have sex with men

One-hundred-thirty-one homeless, substance-dependent MSM were enrolled in a randomized controlled trial to assess the efficacy of a contingency management (CM) intervention for reducing substance use and increasing healthy behavior. Participants were randomized into conditions that either provided additional rewards for substance abstinence and/or health-promoting/prosocial behaviors (“CM-full”; n = 64) or for study compliance and attendance only (“CM-lite”; n = 67). The purpose of this secondary analysis was to determine the affect of ASPD status on two primary study outcomes: methamphetamine abstinence, and engagement in prosocial/health-promoting behavior. Analyses revealed that individuals with ASPD provided more methamphetamine-negative urine samples (37.5%) than participants without ASPD (30.6%). When controlling for participant sociodemographics and condition assignment, the magnitude of this predicted difference increases to 10% and reached statistical significance (p < .05). On average, participants with ASPD earned fewer vouchers for health-promoting/prosocial behaviors than participants without ASPD ($10.21 [SD = $7.02] versus $18.38 [SD = $13.60]; p < .01). Participants with ASPD displayed superior methamphetamine abstinence outcomes regardless of CM schedule; even with potentially unlimited positive reinforcement, individuals with ASPD displayed suboptimal outcomes in achieving health-promoting/prosocial behaviors.     

Effectiveness of drug tests in outpatients starting opioid substitution therapy

We aimed to assess the effectiveness of drug tests for treatment retention in outpatients starting opioid substitution therapy. A retrospective cohort was created from the data of the French health insurance system database for the Midi-Pyrenees region. Patients starting opioid substitution treatment (OST) were included and followed for 18 to 30 months. Two groups of patients were defined: the drug test group (at least one drug test reimbursement) and a control group (no drug test reimbursement). The cohort included 1507 patients. During follow-up, 39 subjects (2.6%) had at least one drug test reimbursement. Mean treatment retention was 207 days in the control group and 411 days in the drug test group (p < 0.001). With a multivariate Cox model, drug tests were associated with treatment retention: hazard ratio 0.55 (95% CI: 0.38–0.80). Use of a drug test in follow-up of opioid substitution treatment, although rarely prescribed, significantly improved treatment retention.     

Rewarding early abstinence in Veterans Health Administration addiction clinics

This study investigates the addition of a contingency management (CM) intervention to Veterans Health Administration substance use disorders treatment on during- and post-treatment outcomes for Veterans diagnosed with alcohol dependence only (n = 191) or stimulant dependence (n = 139). Participants were randomly assigned to 8 weeks of usual care or usual care plus CM. Follow-up assessments occurred at 2, 6 and 12 months. In the alcohol dependent subgroup, CM participants submitted significantly more negative samples (13 versus 11 samples, Cohen's d = 0.54), were retained significantly longer (7 versus 6 weeks, d = 0.47), achieved significantly longer median durations of abstinence (16 versus 9 consecutive visits; median difference = 7, 95% CI = 4–8), and submitted significantly more negative samples at follow-ups (unstandardized effect size = 0.669, se = 0.2483) compared to usual care participants. Intervention effects were non-significant for the stimulant dependent subgroup. The study provides support for the effectiveness of CM interventions for alcohol dependent patients.     

How effective is continuing care for substance use disorders? A meta-analytic review

Given the often chronic nature of substance use disorders, patients sometimes receive less intensive continuing care following an initial period of more intensive treatment. This meta-analysis estimated the effect of continuing care and formally tested several proposed moderators (intervention duration, intensity, modality, and setting) of that effect. A systematic search identified 33 controlled trials of continuing care; 19 included a no/minimal treatment condition and were analyzed to assess the overall effect of continuing care versus control. Continuing care had a small, but significant, positive effect size, both at the end of the continuing care interventions (g = 0.187, p < 0.001) and at follow-up (g = 0.271, p < 0.01). Limited by a small number of studies, analyses did not identify any significant moderators of overall effects. These results show that continuing care can provide at least modest benefit after initial treatment. We discuss study characteristics that may have reduced the magnitude of the overall continuing care effect estimate.     

Client incentives versus contracting and staff incentives: How care continuity interventions in substance abuse treatment can improve residential to outpatient transition

Interventions for improving transition from short-term residential to outpatient treatment were examined. Usual care (UC; n = 114) was referral to a preferred outpatient program with advance appointment optional. Client incentive (CI; n = 97) offered up to $100 in gift cards for intake and attendance during the first 30 days of treatment. Contracting with staff incentives (CSI; n = 49) consisted of meeting with an outpatient counselor prior to residential discharge, signing an attendance contract, receiving an appointment and payment to staff if clients attended. CSI significantly improved rates of successful transition (84%) and admission (74%) compared to UC (64% contact; 49% admitted). CI did not result in significantly improved outcomes (74%; 60%). CSI was likely mediated by the reliability (92 versus 52% in UC) and immediacy (1.0 versus 3.9 days) of appointment scheduling. This study supports use of CSI for improving rates of transition between residential and outpatient continuing care treatment.     

Cannabis and depression: An integrative data analysis of four Australasian cohorts

Background

This study presents an integrative data analysis of the association between frequency of cannabis use and severity of depressive symptoms using data from four Australasian cohort studies. The integrated data comprised observations on over 6900 individuals studied on up to seven occasions between adolescence and mature adulthood.

Methods

Repeated measures data on frequency of cannabis use (not used/<monthly/≥monthly/≥weekly) and concurrently assessed depression scores were pooled over the four cohorts. Regression models were fitted to estimate the strength of association between cannabis use and depression. Fixed effects regression methods were used to control for confounding by non-observed fixed factors.

Results

Increasing frequency of cannabis use was associated with increasing depressive symptoms (p < 0.001). In the pooled data weekly users of cannabis had depression scores that were 0.32 (95%CI 0.27–0.37) SD higher than non-users. The association was reduced but remained significant (p < 0.001) upon adjustment for confounding. After adjustment depression scores for weekly users were 0.24 (95%CI 0.18–0.30) SD higher than non-users. The adjusted associations were similar across cohorts. There was a weak age × cannabis use interaction (p < 0.05) suggesting that the association was strongest in adolescence. Attempts to further test the direction of causality using SEM methods proved equivocal.

Conclusions

More frequent cannabis use was associated with modest increases in rates of depressive symptoms. This association was stronger in adolescence and declined thereafter. However, it was not possible from the available data to draw a definitive conclusion as to the likely direction of causality between cannabis use and depression.     

Perceptions of behavioral health care among veterans with substance use disorders: Results from a national evaluation of mental health services in the Veterans Health Administration

Understanding patients' perceptions of care is essential for health care systems. We examined predictors of perceptions of behavioral health care (satisfaction with care, helpfulness of care, and perceived improvement) among veterans with substance use disorders (SUD; n = 1,581) who participated in a phone survey as part of a national evaluation of mental health services in the U.S. Veterans Health Administration. In multivariate analyses, SUD specialty care utilization and higher mental health functioning were associated positively with all perceptions of care, and comorbid schizophrenia, bipolar, and PTSD were associated positively with multiple perceptions of care. Perceived helpfulness of care was associated with receipt of SUD specialty care in the prior 12 months (adjusted OR = 1.77, p < .001). Controlling for patient characteristics, satisfaction with care exhibited strong associations with perceptions of staff as supportive and empathic, whereas perceived improvement was strongly linked to the perception that staff helped patients develop goals beyond symptom management. Survey responses that account for variation in SUD patients' perceptions of care could inform and guide quality improvement efforts with this population.     

The relation between interpersonal violence and substance use among a sample of university students: Examination of the role of victim and perpetrator substance use

Objective

To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.

Methods

A random sample of students (N = 1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.

Results

Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p's < 0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR's = 2.0–5.1). Among females, most forms of substance use were associated with sexual victimization (OR's = 2.4–4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.

Conclusions

Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.