Parental substance use as a modifier of adolescent substance use risk

Aims  A major question in national substance use prevention efforts is how much influence parents have on their children's substance use, answers to which could determine whether current school-based prevention programs that address peer pressure are sufficient or whether parents need to be involved. The present study examines whether parents act as gatekeepers by testing the moderator effects of parents' substance use on the relationships of friends' substance use to adolescent substance use (cigarettes, alcohol and marijuana).
Design  A longitudinal school-based trial for prevention of substance use in adolescents.
Setting  Indianapolis, Indiana, USA.
Participants  As part of a large substance use prevention trial, entering middle school students were surveyed prospectively at baseline, 6 months and 18 months ( n  = 1807 from 57 schools).
Measurements  A self-reported survey was used to measure behaviors, attitudes and social influences related to adolescent substance use.
Findings  Results of logistic regression analyses and multiple group structural equation modeling showed that increasing numbers of parents and friends using substances were associated with greater risk of adolescent substance use, as were more substance offers and lower levels of refusal self-efficacy. Additionally, refusal self-efficacy mediated the effects of baseline use and substance offers on subsequent use. However, non-using parents had a buffering effect on friends' influences to use substances, such that friends' use did not affect adolescent use when parents were non-users, and the effects of substance offers on refusal self-efficacy were weaker.
Conclusions  The findings suggest that parent substance use should be addressed in adolescent substance use prevention programs, and that continuing non-use by parents should be reinforced.     

The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review

Aims This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders. Methods A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods. Results Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self‐stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations. Conclusions A range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders. The limited evidence indicates that self‐stigma can be reduced through therapeutic interventions such as group‐based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact‐based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective.     

Co-occurrence of obsessive-compulsive disorder and substance use disorder in the general population

Aim Very little is known about the relationship between obsessive–compulsive disorder (OCD) and substance use disorder (SUD). The aim of this study is to compare the co‐occurrence of OCD with SUD to the co‐occurrence of SUD with other psychiatric disorders in a representative community sample. Design In order to examine the association of SUD and OCD, logistic regression analyses were used generating odds ratios and 95% confidence intervals for life‐time prevalence and 12‐month prevalence. Setting and participants Cross‐sectional data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the Dutch population (n = 7076). Measurements The Composite International Diagnostic Interview (CIDI) 1.1 was used to assess Diagnostic and Statistical Manual of Mental Disorders Axis I criteria for psychiatric disorders. Findings The life‐time and 12‐month odds of being diagnosed with SUD in subjects with OCD are significantly higher than the odds of SUD for people without a psychiatric disorder. In men, the co‐occurrence of substance dependence and OCD is significantly higher than the co‐occurrence of substance dependence and other psychiatric disorders, whereas in women this co‐occurrence does not differ significantly. Conclusions The co‐occurrence of substance dependence in obsessive–compulsive disorder is higher than the co‐occurrence of substance dependence in other non‐obsessive–compulsive disorder DSM disorders, especially in men.     

Implementation of smoking cessation treatment in substance use disorder treatment settings: a review

ABSTRACT

Background: The high prevalence of smoking among individuals receiving treatment for substance use disorder (SUD) has led to repeated calls for integrating smoking cessation treatment into these settings. Objectives: This review summarizes key findings from the research on the implementation of smoking cessation in SUD treatment. Methods: PubMed searches of articles published from 2000 to 2015 yielded 48 empirical studies that focused on the delivery of smoking cessation in the US specialty SUD treatment settings in which organizations and counselors were the unit of analysis. Most studies used observational designs to gather data from organizations and counselors. Organizational studies show that few SUD treatment programs offer cessation counseling or pharmacotherapy. Organizational barriers include limited training, inadequate resources, and cultural norms that do not recognize smoking cessation as part of the organization’s mission. Smoking cessation services are more likely to be available in medically oriented treatment settings, larger treatment programs, those offering a broader array of comprehensive services, and those that are more reliant on fee-for-service reimbursement (e.g., insurance, Medicaid). Surveys of counselors also show very low implementation. Counselors’ personal skills and attitudes, their perceptions of managerial and coworker support for smoking cessation, and the availability of resources and reimbursement to support these services are correlated with implementation. State policies requiring treatment programs to offer tobacco treatment increase both adoption and implementation, yet these services continue to reach only modest percentages of the patients. Conclusions: Few studies have tested specific implementation strategies. Such research is needed to determine how to accelerate the diffusion of these evidence-based practices to the SUD treatment field.     

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review

Aims To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. Methods A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. Conclusions There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid‐childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.