Licit and illicit drug use and social change among Bedouin Arabs in southern Israel

This study examines the levels of licit and illicit drug use among the urbanized and non-urbanized Negev Bedouin Arabs in Israel. In addition, issues of social relationships, environment and change, and socio-cultural values toward substance use were explored. The sample included 312 respondents, 150 from the urbanized settlements and 162 from the non-urbanized settlements. The results revealed that 64% of Bedouin reported using cigarettes, 90% of whom reported smoking daily. Cigarette use was significantly higher among non-urbanized (74%) than urbanized (55%) Bedouin. Thirty-one per cent of urbanized Bedouin and 30% of non-urbanized Bedouin reported ever using alcohol. Fifteen per cent of urban and non-urban Bedouin reported ever using illegal drugs, mainly cannabis. The majority of Bedouin substance users were under the age of 35. This strongly suggests that substance use, and in particular alcohol and drug use, represents a new phenomenon in this society. The Bedouin are in a transitional phase, which exposes them extensively to new and conflicting sets of social values, norms and behavioural patterns.     

Trajectories of drug use among French young people: Prototypical stages of involvement in illicit drug use

Aims: This study investigated patterns and trajectories of substance use, with a special focus on illicit drugs other than cannabis. It examined both patterns and trajectories of use among a general population-based sample. Methods: We used data from the 2011 French ESCAPAD survey of French 17-year-olds to assess exposure and age of initiation of 14 licit and illicit drugs (N=23,882). Latent class analysis (LCA) and survival analyses were performed. Results: The results of the LCA showed that patterns of illicit drug use clearly distinguished between two groups of other illicit drugs: 1) amphetamines/speed, cocaine, ecstasy/MDMA, magic mushrooms, poppers, and solvents; 2) crack/freebase, GHB/GBL, heroine, LSD, and ketamine. Survival analyses highlighted that trajectories involved the first group before the second one. Conclusions: Prototypical drug use patterns and trajectories should include a distinction between two groups of illicit drugs. Preventive actions should focus on young people in their early teens, since very young users are more likely to progress to illicit drug use, and further studies should include this distinction instead of aggregating other illicit drugs into a single category.     

Risk of suicide: its occurrence and related variables among bereaved substance users

Background: Drug-dependent people are one of the most vulnerable populations to death by suicide. This study aims to explore the occurrence and related factors for risk of suicide in a sample of 196 bereaved substance-dependent patients.

Methods: Sociodemographic characteristics, bereavement and drug-related variables and symptoms of complicated grief (CG) were examined in a sample of 196 bereaved drug-dependent patients abstemious at least during the last month. A multiple linear regression analysis was adjusted to identify predictors of risk of suicide.

Results: 61.2% of patients reported risk of suicide. Those participants with risk of suicide were separated or widowed, without work, reported family antecedents of suicide attempts as well as personal suicide attempts and symptoms of CG.

Conclusion: Results indicate that the occurrence of the risk of suicide among drug-dependent people is very high and some risk factors are identified. Clinicians should pay particular attention to the bereaved drug-dependent patients with risk factors in order to identify people more vulnerable to present suicide risk.     

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Opioid use disorder (OUD) is a pediatric and adolescent problem as most young adults (aged <25 years) in treatment programs report initiating use before 25 years of age, and there are lifelong impacts from early substance use necessitating early screening for opioid use and subsequent treatment. Medication-assisted treatment (MAT) is a highly effective intervention for OUD, and there is strong evidence for its use with adolescents; however, most adolescents with OUD are unable to access MAT or remain in MAT long term to achieve substantial recovery. Using case examples drawn from a pediatric and adolescent physician's experiences proving MAT to adolescents and young adults (ages 16–24 years), this article explores the personal and socioeconomic determinants in MAT of OUD in adolescents and young adults and provides suggestions for advocacy areas and resources to improve MAT with this population.     

Aberrant behaviors with prescription opioids and problem drug use history in a community-based cohort of HIV-infected individuals

Context

The treatment of pain in patients with substance use disorders creates tensions for clinicians between undertreating pain and enabling opioid analgesic misuse.

Objectives

To characterize prevalence and factors associated with aberrant opioid analgesic behaviors in a cohort of HIV-infected individuals who are at high risk for opioid analgesic misuse.

Methods

We assessed pain and substance use disorders in a cross-sectional study that enrolled 296 participants from the Research on Access to Care in the Homeless cohort, a community-based sample of indigent HIV-infected adults. We measured aberrant opioid behaviors, defined as major or minor depending on level of risk of harm to patients, using Audio Computer-Assisted Self-Interview technology.

Results

Most participants (91.2%) reported pain in the week before interview, with the majority of these experiencing severe pain (53.7%). More than two-thirds (69.2%) of the participants met criteria for a lifetime history of cocaine, amphetamine, or heroin/opioid use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). More than one-third of the sample (37.4%) had a history of aberrant opioid behavior within 90 days of interview. One-fifth (18.5%) had a history of “major” aberrant behaviors.

Conclusion

In this high-risk population, severe pain is common and aberrant opioid behaviors are prevalent but not universal. As recommended by American Pain Society and American Academy of Pain Medicine guidelines, when prescribing opioid analgesics, clinicians must consider variation in the severity of aberrant behaviors, particularly aberrant behaviors that may represent undertreatment of pain.     

The effect of personal use and family history on the attitudes of medical students toward alcohol and drug users

Objective: To investigate the effects of the personal exposure/usage of alcohol and drugs in medical students on their attitudes toward alcohol and drug users. Negative attitudes in health care practitioners about alcohol and drug users may lead to poor patient care. Personal experience on alcohol and drug use can influence the attitudes of health care professionals.

Method: This study used a quantitative cross-sectional methodology, utilizing a self-report survey on the personal use of alcohol and drug use, and the family history of alcohol and tobacco use. The “Substance Abuse Attitude Survey” (Chappel J. N., Veach, T. L., & Krug, R. S. (1985). The Substance Abuse Attitude Survey: An instrument for measuring attitudes. Journal of Studies on Alcohol, 46, 48–52.) measured attitudes (n = 417).

Results: The attitudes of medical students towards alcohol and drug users were weakly linked to their own personal use, and family history of alcohol and drug use. Increased use of alcohol was positively correlated with non-stereotyping. Length of time in medical school, number of years drinking alcohol, and high frequency of binge drinking were negatively correlated with non-moralism.

Conclusions: This study demonstrated that the attitudes of future medical professionals are fairly neutral toward alcohol and drug users. Given that alcohol and drug abuse are now considered medical illnesses health professionals themselves may attach fewer stigmas and stereotypes to the use and abuse of alcohol.     

Prevalence of psychoactive substance use among male adolescents in Southwest Nigeria

Introduction: Substance use in the adolescent period is recognized as a growing problem in Nigeria. The problem is even more significant among male adolescents in southwest Nigeria with consequent legal and academic problems.

Objectives: The study aimed to describe the pattern of substance use among male secondary-school adolescents and identify sociodemographic correlates of substance use.

Methods:. A total sampling of male students in senior classes of secondary schools selected randomly from urban and semi-urban areas of Ibadan a city in Nigeria were approached for the study.

Results: The mean age of the respondents was 16.49 years (SD ±1.31). Lifetime use of any psychoactive substance was 54%. The most common substance ever used by respondents were non-amphetamine stimulants (39%) followed by alcohol (31%) while hallucinogens (1.0%) and cocaine (1.0%) were the least ever used. None of the respondents had never used an amphetamine-type stimulant. Seven of the respondents (2.9%) reported ever using a psychoactive substance though injection in the last 3 months.

Conclusion: This study reports a high prevalence of psychoactive substance use among male secondary-school adolescents in Ibadan southwest Nigeria. It showed that being in a higher class and engaging in paid work after school were factors significantly associated with substance use. The findings of this study have implications for adolescent mental health intervention in the field of addiction.     

The mediating role of early maladaptive schemas on relations between post-traumatic stress disorder symptom severity and illicit substance use disorder

Background: This study examines the role of Early Maladaptive Schemas (EMS) on relations between Post-traumatic stress disorder (PTSD) symptoms and illicit substance use.

Objectives: We assumed that EMS play a mediating role in the pathways from PTSD symptom severity to illicit substance use.

Method: We used the composite score from the Addiction Severity Index to assess illicit substance use severity, the PTSD Checklist Specific to determine PTSD symptom severity, and the Young Schema Questionnaire – Short Form, Second Edition to measure the number of hyperactivated EMS. The sample consisted of 35 patients receiving social and medical care for illicit substance use problems in three French drug centers.

Results: The results showed that the number of hyperactivated EMS is an intermediate variable playing a mediating role between PTSD symptom severity and illicit substance use. Results indicating full mediation. Conclusion. Future research perspectives on this question are discussed as well as the clinical repercussions of these results on the current models of management of illicit drug users.     

Substance use during and after pregnancy among a national cohort of pregnant women in opioid maintenance treatment and their partners

Background: Most individuals in opioid maintenance treatment (OMT) have had serious polydrug problems in addition to opiate addiction. Prospective studies on substance use among pregnant women in OMT and their male partners on a national level have been scarce and therefore deserve attention.

Methods: The European Addiction Severity Index was used to map substance use history among a Norwegian national cohort (2005–2006) of pregnant OMT women (n = 37) and their partners (n = 23), as well as substance use during the last month of pregnancy and 1 year later.

Results: Lifetime substance use indicated an average of 8 years of heroin abuse before entering OMT. During the last month of pregnancy one woman and two partners reported using illegal substances, while 1 year later, one women and one partner reported having used illegal substances. The use of legal substances among the partners was significantly reduced from pregnancy to 1 year later (38–20%, p < 0.01), while the use of legal substances among the women increased from 8% to 19%.

Conclusion: The results suggest that a majority of OMT mothers in Norway and their partners are able to abstain from most illegal substances 1 year after pregnancy, but the tendency of problem drinking among the women is a concern.     

The prevalences of and perceived risks from drug use among teenagers in 33 European countries

The study examines data from teenagers from 35 countries taking part in surveys conducted within the European School Survey Project on Alcohol and Other Drugs (ESPAD). The main hypothesis tested was that the higher the prevalence of use of a particular drug the fewer will be the respondents who perceive great harm in using it. The hypothesis was tested for cannabis, alcohol, ecstasy, and inhalants, and was strongly confirmed for the former two in the data from the 1999 and 2003 surveys. For cannabis, the perceived risk of harm changed in the expected direction as prevalence changed between 1999 and 2003. The results, although always in the expected direction, were inconclusive regarding ecstasy and inhalants.     

Opioid use and dependence among persons with migraine: results of the AMPP study

Objective.— To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health‐care resource utilization (HRU), comorbidities and probable dependence within a large, US population‐based sample of persons with migraine. Background.— Opioids are used in the acute treatment of migraine. However, their use is controversial. Methods.— Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no‐use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders–4th edition. All opioid‐use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire‐9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME‐MD], and cardiovascular events and risk factors), and headache‐related HRU. Results.— In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache‐related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache‐related HRU were higher for all opioid‐use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers. Conclusions.— Opioid use for migraine is associated with more severe headache‐related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined.     

Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France

Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15–44 years included in the ‘Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey’, an annual cross‐sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005–2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58–0.88]) and with lower medication misuse (0.66 [0.49–0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio‐economic environment.     

The relationship between self-efficacy,coping skill and substance use in adolescent: based on structural equation modeling

Background: This study was aimed to investigate interrelationships between the self-efficacy and coping skill in relation to substance use behavior in adolescent.

Method: A self-administered questionnaire was completed by 720 girls and boys, aged between 14 and 18, involved in the cross-sectional study in Iran. In the first step, first-order measurement models were examined to assess how well the observed measures could reflect the latent constructs and in the second step, the structural component consisting of relationships between the latent factors was examined to determine the theoretical factors of the coping and self-efficacy predicted substance use behavior, as hypothesized.

Result: The results of the first step revealed stable assessment of four confirmed factors in the first-order measurement model. In second step, the structural model of coping and self-efficacy showed an acceptable adequacy in predicting substance use behavior in the second-order model. Direct and indirect path analysis demonstrated that relationship between refusal self-efficacy and substance use would be mediated by the coping skill, and this relationship could significantly predict substance use behavior in our study.

Conclusion: The results of our hypothesized model of coping self-efficacy (CSE) had an acceptable adequacy in predicting substance use behavior in adolescents.     

Potential risk and protective factors of substance use among school adolescents in Morocco: A cross-sectional study

Background: Substance use among adolescents is responsible, in long term, for several chronic diseases, including cancer. In this study, we sought to assess the prevalence and correlates of substance use among students’ adolescents in Taza city, focusing on risk and protective factors to develop a health promotion intervention.

Methods: A school-based cross-sectional survey was conducted in Taza during 2016. The sample consisted of 800 students from 14 to 19 years old from randomly stratified cluster sampling. Data were collected using a Global School Health Survey questionnaire.

Results: Of 800 total students, 764 responded to the survey (response rate of 95.5%), with slightly more than half (53.3%) being girls. The survey showed current tobacco use of 16.2%, lifetime alcoholic drink of 6.8%, and lifetime drug use of 9.2%. Results from multivariate logistic regression analyses showed that substance use was significantly associated with older age, being male, poor hand hygiene, suicidal ideations, peer substance use, and absenteeism. Parental bonding represented a protective factor for illicit drug use.

Conclusions: We found a high prevalence of substance use among adolescents in Taza city, similar to rates reported at the national level. These findings suggest an urgent need to develop national health promotion programs for adolescents.     

Pattern of alcohol use among problem alcohol users in a community-based setting in India: A cross-sectional study

Introduction: Impact of alcohol on various adverse consequences is also determined by the pattern of consumption. Pattern of drinking from developing countries is an under-researched area. The present study aims to assess the pattern of drinking among nontreatment-seeking problem alcohol users from an urban slum in a metropolitan city of North India.

Methodology: Using a cross-sectional study design and employing the snowball method, 75 adult males with problem alcohol use were recruited and interviewed using questionnaire and standard instruments.

Results: The median duration of alcohol consumption was 12 (7, 21) years, 90% were drinking daily, 64% were morning drinkers and 92% reported heavy episodic drinking (HED). Three-fourth participants were in the high-risk category of alcohol use as assessed by WHO-ASSIST. One-third were spending 25–50% of their family income on alcohol. The most preferred alcohol beverage was country-made liquor (CML; 54.3%). Most alcohol users preferred drinking at home (58%), alone (67%), in evening or at night (80%).

Conclusion: Although many alcohol users consume alcohol in amounts much above the recommended levels, with high rates of HED, they are not on treatment for alcohol-use disorder. Their pattern of alcohol consumption is likely to place them at risk for alcohol-related harmful consequences.     

Grey matter alterations associated with cannabis use: results of a VBM study in heavy cannabis users and healthy controls

Cannabis abuse is related to impairments in a broad range of cognitive functions. However, studies on cannabis abuse in relation to brain structure are sparse and results are inconsistent, probably due to differences in imaging methodology, severity of cannabis abuse, and use of other substances. The goal of the current MRI study was to investigate brain morphology related to current and lifetime severity of cannabis use and dependence in heavy cannabis users without intensive use of other illicit drugs. Voxel-based morphometry was used to assess differences in regional grey and white matter volume between 33 heavy cannabis users and 42 matched controls. Within heavy cannabis users, grey and white matter volume was correlated with measures of cannabis use and dependence. Analyses were focused a priori on the orbitofrontal cortex, anterior cingulate cortex, striatum, amygdala, hippocampus, and cerebellum, regions implicated in substance dependence and/or with high cannabinoid receptor-1 concentrations. Regional grey matter volume in the anterior cerebellum was larger in heavy cannabis users. Within the group of heavy cannabis users, grey matter volume in the amygdala and hippocampus correlated negatively with the amount of cannabis use or dependence. No associations were found between white matter volume and measures of cannabis use or dependence. These findings indicate that associations between heavy cannabis use and altered brain structure are complex. Differential patterns of structural changes for various cannabis use levels imply that alterations in brain structure are associated with specific characteristics of cannabis use and dependence.