Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans

Objective

Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members.

Methods

The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined.

Results

Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care.

Conclusions

Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions.     

Prevalence and characteristics of substance abuse treatment utilization by U.S. adolescents: national data from 1987 to 2008

Objective

Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services.

Method

Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N = 25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization.

Results

The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services.

Conclusion

Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.     

Use of licit and illicit substances among adolescents in Brazil--a national survey

Objective

We estimate the prevalence of alcohol, tobacco and illegal substance use in a national representative sample of adolescents. We also estimate how socio demographic characteristics, household environment and mental health are associated with substance misuse.

Method

This is a cross-sectional study using data from the first Brazilian National Alcohol Survey, which gathered information on the use of psychoactive substances in 761 participants aged 14 to 19 years old. Weighted logistic regression was used to calculate adjusted odds ratios.

Results

More than half of the adolescents interviewed were regular alcohol users and one out of ten were abusers and/or dependents. Older male adolescents living in urban areas were more likely to present alcohol related disorders and to smoke. Age had an inverse association with illegal substance use. Smokers and those using illegal substances were more likely to report domestic violence while those with alcohol abuse/dependence were more likely to have depression.

Conclusions

The high prevalence of alcohol, tobacco and illicit substance consumption among Brazilian adolescents is staggering. Young males with mood disorders from urban areas are more at risk of developing alcohol disorders while illegal drug use is highly associated to household dysfunction in early life. Brazilian growing economy will possibly lead to increased levels of substance use among adolescents if new prevention measures are not implemented. The intensification of law enforcement strategies to reduce psychotropic substances access is required.     

Naltrexone treatment for opioid dependence: Does its effectiveness depend on testing the blockade?

Background

FDA approval of long-acting injectable naltrexone (Vivitrol) for opioid dependence highlights the relevance of understanding mechanisms of antagonist treatment. Principles of learning suggest an antagonist works through extinguishing drug-seeking behavior, as episodes of drug use (“testing the blockade”) fail to produce reinforcement.We hypothesized that opiate use would moderate the effect of naltrexone, specifically, that opiate-positive urines precede dropout in the placebo group, but not in the active-medication groups.

Methods

An 8-week, double-blind, placebo-controlled trial (N = 57), compared the efficacy of low (192 mg) and high (384 mg) doses of a long-acting injectable naltrexone (Depotrex) with placebo ( Comer et al., 2006). A Cox proportional hazard model was fit, modeling time-to-dropout as a function of treatment assignment and urine toxicology during treatment.

Results

Interaction of opiate urines with treatment group was significant. Opiate-positive urines predicted dropout on placebo and low-dose, but less so on high-dose naltrexone, where positive urines were more likely followed by sustained abstinence. Among patients with no opiate-positive urines, retention was higher in both low- and high-dose naltrexone conditions, compared to placebo.

Conclusions

Findings confirm that injection naltrexone produces extinction of drug-seeking behavior after episodes of opiate use. Adequate dosage appears important, as low-dose naltrexone resembled the placebo group; opiate positive urines were likely to be followed by dropout from treatment. The observation of high treatment retention among naltrexone-treated patients who do not test the blockade, suggests naltrexone may also exert direct effects on opiate-taking behavior that do not depend on extinction, perhaps by attenuating craving or normalizing dysregulated hedonic or neuroendocrine systems.     

Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA

Rationale

A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear.

Methods

This study analyzed a subset of multicross-sectional data (2006–2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA (N = 12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients.

Results

Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members.

Conclusion

These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.     

Patterns of methamphetamine use and symptoms of depression among young adults in northern Thailand

Introduction

Depression often co-occurs with amphetamine type stimulant use and can negatively impact drug treatment outcomes. Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options.

Methods

Methamphetamine users aged 18–25 years were enrolled in a 12-month randomized behavioral trial in Thailand. Questionnaires were administered every 3 months and included information on substance use and depressive symptoms. Pattern of methamphetamine use during follow-up was characterized into four groups: early cessation, late cessation, relapse and persistent use. Multinomial logistic regression was used to determine the impact of baseline depressive symptoms (CES-D score and % ≥22) on patterns of methamphetamine use during follow-up. Linear and logistic regression was used to determine the impact of patterns of methamphetamine use on depressive symptoms at the end of the trial.

Results

No association was found between baseline depressive symptoms and subsequent patterns of methamphetamine use. A significant relationship was found between patterns of methamphetamine use and ensuing depressive symptoms, with those achieving cessation experiencing lower levels of depressive symptoms.

Discussion

Many symptoms of depression may resolve with cessation or reduction in methamphetamine use. Clinical and community-based efforts that facilitate drug users’ attempts to stop using drugs should be supported as they may contribute to positive cessation outcomes and help to improve overall mental health.     

Reasons for substance use among people with mental disorders

Background

Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders.

Methods

Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression.

Results

Participants had a mean age of 38 (SD = 12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons.

Conclusions

It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.     

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.     

A comparison of Cambodian-American adolescent substance use behavior to national and local norms

Introduction

This study was designed to compare rates of alcohol, marijuana, and cigarette use in Cambodian-American adolescents with norms from nationally- and regionally-representative peers.

Methods

Substance use data from 439 10th grade Cambodian-American adolescents in Long Beach, California were compared to grade- and gender-matched nationally representative data from the Monitoring the Future study and data from the California Healthy Kids Survey of students within the same school district.

Results

Overall, the Cambodian-American youth were less likely than nationally- and regionally-representative youth to use alcohol, marijuana, and cigarettes. Specifically, relative to estimates obtained for the general population and students attending school in the same school district, Cambodian-American youth were significantly less likely to use alcohol and marijuana. Cambodian-American youth were also less likely than youth in the general population to smoke cigarettes, but did not differ statistically from youth within their same school district.

Conclusions

As a group, Cambodian-American youth may not be at especially high risk for substance use. As is the case with virtually all populations, some individuals within the Cambodian-American group are likely to have more difficulty than others with substance use concerns. Thus, additional research is needed to identify factors that might help to identify high users with potential service needs.     

Testing different thresholds for risky episodic drinking—What's so special about five drinks?

Background

Studies of episodic drinking typically use a measure based on the frequency of drinking five or more standard drinks (a definition which itself varies based on the standard units being used). While this threshold clearly defines drinking behaviour with a range of risks and negative consequences, there has been limited research outside of US college-based studies to determine the appropriateness of this definition. This study examines fifteen different risky-drinking thresholds to assess which definitions of risky drinking best predict negative outcomes.

Methods

This paper presents an analysis of a national survey sample of 19,757 drinkers. The appropriateness of each threshold is assessed using basic risk-curves, specificity and sensitivity analyses and the performance of each threshold definition in multivariate logistic regression models. Risky drinking was defined in fifteen ways (based on frequency and volume) and tested against a series of self-reported negative outcomes and risky behaviours.

Results

The study finds that the most appropriate risky drinking threshold for these data varies based on the mode of analysis and on the type of outcome being considered. Across all approaches used, risky drinking thresholds of seven or fewer drinks performed better than higher thresholds.

Conclusions

While individual level risks peak at higher levels of consumption, these findings support the continuing use of relatively low thresholds for defining risky-drinking, as risk across the total population is highest at these levels.     

High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan

Background

This study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV.

Methods

Participants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates.

Results

The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection.

Conclusion

An extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.     

Prevalence of cannabis use in Brazil: Data from the I Brazilian National Alcohol Survey (BNAS)

Aims

To estimate the prevalence of cannabis use in the last 12 months in the Brazilian population and to examine its association with individual and geographic characteristics.

Design

Cross-sectional survey with a national probabilistic sample.

Participants

3006 individuals aged 14 to 65 years.

Measurements

Questionnaire based on well established instruments, adapted to the Brazilian population.

Findings

The 12-month prevalence of cannabis use was 2.1% (95%CI 1.3–2.9). Male gender, better educational level, unemployment and living in the regions South and Southeast were independently associated with higher 12-month prevalence of cannabis use.

Conclusion

While the prevalence of cannabis use in Brazil is lower than in many countries, the profile of those who are more likely to have used it is similar. Educational and prevention policies should be focused on specific population groups.     

Results of a transtheoretical model-based alcohol, tobacco and other drug intervention in middle schools

Background

Early use of alcohol, tobacco, and other drugs threatens the physical and mental well-being of students and continued use negatively affects many areas of development. An internet-based, tailored intervention based on the Transtheoretical Model of Behavior Change was delivered to middle school students to reduce alcohol, tobacco, and other drug use. This internet-based approach requires very little faculty and staff time, which is efficient given curricular demands.

Methods

Twenty-two middle schools in the United States were matched and randomly assigned to either the intervention or control conditions (N = 1590 students who had ever used substances). Participants received one pre-test assessment, three thirty-minute intervention sessions over three months, and two post-test assessments (3 and 14 months after pre-test, respectively).

Results

Random effects logistic models showed significant treatment effects for the intervention group when compared to the control group at the 3-month post-test.

Conclusions

This program has the potential to be applied as stand-alone practice or as part of more intensive interventions to promote substance use cessation.     

Buprenorphine sniffing as a response to inadequate care in substituted patients: results from the Subazur survey in south-eastern France

Background

Despite the safety profile of buprenorphine, which makes this treatment highly acceptable for many countries, the risk of its diversion raises several public health and drug policy concerns. Although buprenorphine injection has been investigated quite extensively, diversion by sniffing has been overlooked. The Subazur survey gave us the opportunity to identify factors associated with buprenorphine sniffing in patients receiving buprenorphine in primary care.

Methods

We studied a population of 111 stabilized patients receiving office-based buprenorphine in south-eastern France. The design of the study consisted of two longitudinal assessments by phone interviews (at enrolment and 6 months later) detailing patients' socio-demographic characteristics, addictive behaviors, treatment experience and general health status. We used a logistic regression based on generalized estimating equations (GEE) to identify factors associated with buprenorphine sniffing at any interview.

Results

Among the 111 interviewed subjects, 33 (30%) patients reported sniffing buprenorphine after having initiated treatment. After multivariate analysis, 4 variables remained significantly associated with buprenorphine sniffing: not living in a stable relationship, having had only one or no parents during childhood, a history of drug sniffing and dissatisfaction with buprenorphine treatment.

Conclusions

Our findings underline the need to address these patients to appropriate social and mental services as well as diversifying therapeutic options, in order to provide them with adequate care and minimize diversion. The issues highlighted in the study reflect the need for recommendations for physicians prescribing OST in primary care to consider buprenorphine diversion during treatment more as non-adherence behavior than an abuse.     

Latent class analysis of polysubstance use,sexual risk behaviors,and infectious disease among South African drug users

Background

HIV transmission risk among non-injection drug users is high due to the co-occurrence of drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use among polysubstance users within a high HIV prevalence population.

Methods

The study sample included 409 substance users from the Pretoria region of South Africa. Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination, marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression analyses compared classes on demographics, sexual risk behavior, and disease status.

Results

Four classes of substance use were found: MJ + Cig (40.8%), MJ + Her (30.8%), Crack (24.7%), and Low Use (3.7%). The MJ + Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use drugs before/during sex with steady partners than the Crack class. The MJ + Cig class was 16 times more likely to use alcohol before/during sex with steady partners than the MJ + Her class. The Crack class was 6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex than the MJ + Her class.

Conclusions

Findings illustrate patterns of drug use among a polysubstance using population that differ in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.     

Emerging adulthood themes,role transitions and substance use among Hispanics in Southern California

Introduction

Hispanic emerging adults appear to be at especially high risk for substance use but little is known about their risk and protective factors. A crucial next step to reducing substance use among this priority population may involve understanding how transition-to-adulthood themes are associated with substance use. Intervention and prevention programs could also benefit from information about which if any specific transitions undergone in emerging adulthood are associated with substance use.

Methods

Hispanic emerging adults (aged 18 to 24) completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and use of alcohol and marijuana. Logistic regression models were used to examine the associations between transition-to-adulthood themes and past-month binge drinking and marijuana use, controlling for age and gender. Separate logistic regression models explored the association between each individual role transition and past-month binge drinking and marijuana use, controlling for age and gender and using a Bonferonni correction.

Results

Among the participants (n = 1,390), 41% were male, the average age was 21, 24% reported past-month marijuana use and 34% reported past-month binge drinking. Participants who felt emerging adulthood was a time of focusing on others were less likely to report marijuana use and binge drinking. Among the 24 transitions, five were significantly associated with past-month marijuana use and 10 were significantly associated with past-month binge drinking.

Conclusion

Findings suggest transition-to-adulthood themes as well as specific changes experienced by emerging adults are meaningful for Hispanics and should be explored in prevention and intervention programs in the future. Future research should determine what specific mechanisms are making these transitional processes risk factors for substance use.