Adolescent substance use assessment in a primary care setting

Health initiatives suggest that adolescent substance use assessment may be beneficial as part of primary care to screen for early problematic behaviors. To examine the accuracy of such reporting, we compared the anonymous and confidential self-reports of 180 adolescents in a primary care setting. Matching samples to control for demographic variables, we found that adolescents were more likely to report marijuana use and substance use behaviors, such as selling drugs, when reporting anonymously vs. reporting confidentially. These results challenge the accuracy of confidential self-reports within this setting, and suggest further research is needed.     

Human Immunodeficiency Virus (HIV) and Substance Use Risk Behaviors among Tri-ethnic Adolescents of Florida

Previous research documents the co-occurrence of substance use and HIV risk behaviors, but most studies examined these behaviors among adults and White adolescents. The diversity of Florida’s adolescents presents a unique setting for examining the variations in these risk behaviors. An in-depth analysis of HIV and substance use behaviors among White, African American, and Hispanic adolescents in Florida was conducted. Results suggest that significant ethnic variations exist in lifetime alcohol and illicit drug use and HIV risk. Compared with Hispanics, African Americans were less likely and Whites were more likely to be frequent alcohol and illicit drug users. White and African American adolescents were 1.3 and 1.5 times, respectively, at higher risk of at least one HIV risk behavior compared with their Hispanic counterparts. Future research should seek to identify sources and consequences of such variations in risk behavior and design culturally appropriate prevention programs for adolescents.     

AIDSphobia litigation

A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health-care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.     

Interactive Voice Response Technology Applied to Sexual Behavior Self-reports: A Comparison of Three Methods

We tested the feasibility and performance of the Interactive Voice Response Technology (IVR) in the assessment of sexual behavior self-reports, relative to self-administered questionnaire (SAQ) and Timeline Followback (TLFB) methods. The sample consisted of 44 sexually active Hispanic students recruited at the University of Texas at El Paso who reported daily about sexual behaviors and substance use. Thirty-three participants (75%, 18 women, 15 men) were retained for at least 80 days of the 91-day IVR. At follow-up, sexual behaviors and substance use were assessed by questionnaire (summary) reports and by TLFB, referring to the same 3-month interval. ANOVAs with normalized variables indicated less reporting in the TLFB and over-reporting of substance use in the questionnaire relative to the daily IVR self-reports. Gender moderated the effects of assessment mode, which were observed among women only. HLM analyses indicated a significant decrease in self-reports over time, suggesting reactivity of self-monitoring via IVR on behavior.     

HIV Risk Behaviors: Risky Sexual Activities and Needle Use Among Adolescents in Substance Abuse Treatment

This study estimated prevalence of HIV risk behaviors and its association with substance use and mental health problems among adolescents in treatment. A pooled dataset of 9,519 adolescents admitted to substance abuse treatment programs between 2002 and 2006 was analyzed. HIV risk behaviors, substance use, and mental health problems were assessed at treatment intake. Sixty percent of adolescents were engaged in at least one sexual or needle use risk behavior in the year prior to entering treatment. Sex with multiple partners, sex under the influence of alcohol or drugs, and unprotected sex were the most prevalent HIV risk behaviors. Several gender differences were found for specific types of sexual and needle use behaviors. Adolescents with substance dependence or other comorbid mental health problems were at increased odds for HIV risk. Findings suggest treatment programs may benefit adolescents better by screening them consistently for HIV risk behaviors and incorporating tailored interventions.     

Under-reporting of alcohol and substance use versus other psychiatric symptoms in individuals living with HIV

Substance use is known to negatively impact outcomes in patients living with HIV by decreasing adherence to and effectiveness of antiretroviral therapies. Alcohol and other drug abuse and dependence are widespread among HIV-positive individuals, though reported rates vary greatly by study, suggesting the possibility of under-reporting. The extent to which patients minimize symptoms and the factors that influence reporting remain to be determined. The present study sought to gauge the degree to which substance use is under-reported in a primary care HIV clinic by evaluating the influence of anonymity versus confidentiality of self-report on endorsement rates. Patients (n = 55) currently receiving medical treatment completed a confidential questionnaire assessing the presence of alcohol abuse, other drug misuse, and Generalized Anxiety Disorder (GAD). Another group of 55 patients completed a comparable survey, but did so anonymously. The two groups were similar in terms of demographic characteristics, but self-report of substance use differed depending on how symptoms were assessed, with anonymous questionnaires yielding significantly (p<0.05) higher rates, compared to confidential surveys. Under-reporting appeared specific to alcohol and substance use, with no statistically significant differences between anonymous and confidential surveys in the proportion of patients endorsing symptoms of GAD. The fact that the screener specifically designed to identify patients in need of further evaluation produced lower rates of reported alcohol and drug use suggests that more work is needed to identify appropriate tools for accurately assessing substance use in HIV-positive patients so that adequate referrals and services can be offered to those in need.     

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings: Harm Reduction in Outpatient Addiction Treatment

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06904-4.KEY WORDS: harm reduction, opioid use disorder, substance use disorder, addiction     

The Impact of Publicly Funded Managed Care on Adolescent Substance Abuse Treatment Outcomes

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.     

The impact of publicly funded managed care on adolescent substance abuse treatment outcomes

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.     

Subject-collateral reports of drinking in inpatient alcoholics with comorbid cocaine dependence.

Greater substance abuse severity has been associated with less reliable self-reports of drinking in individuals with only an alcohol use disorder. In addition, individuals with multiple substance use disorders often report greater substance abuse severity. Therefore, it is important to be confident in the self-reports of substance use in individuals with multiple substance use disorders. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral agreement for individuals who meet the criteria for more than one substance use disorder is lacking. In this study, we examined subject-collateral reports of substance abuse in individuals presenting for alcohol treatment who met DSM-III-R criteria for alcohol and cocaine use disorder (n = 85). We then compared subject-collateral reports of those individuals to subject-collateral reports for individuals with only a diagnosis of alcohol abuse or dependence (n = 99). Overall, the results demonstrate that self-reports of individuals with alcohol and cocaine use disorders are generally valid. The results revealed no significant differences between groups on measures of subject-collateral consistency for several alcohol use variables. However, a significant difference was found for the number of days of drug use, with subject-collateral agreement being greater for individuals with an alcohol and cocaine use disorder. Additional analyses revealed that subject-collateral discrepancy scores were positively related to the participants' severity of alcohol and drug dependence. Recommendations for enhancing the accuracy of self-reports of drinking and drug use in alcoholics with comorbid cocaine use disorders are discussed.     

Addiction and "Generation Me:" Narcissistic and Prosocial Behaviors of Adolescents with Substance Dependency Disorder in Comparison to Normative Adolescents

The purpose of this study is to explore narcissistic and prosocial behaviors as reported by adolescents with and without substance dependency disorder (SDD). This study employs a quasi-experimental design using SDD adolescents compared with two normative samples of adolescents. In comparison to normative adolescents, adolescents with SDD were strongly distinguished by overt narcissistic behaviors and less monetary giving. Levels of narcissistic and prosocial behaviors among adolescents with SDD suggest a connection between self-centeredness and addiction. Results also suggest volunteerism as a potential option to counter narcissism in substance dependent adolescents.     

Substance use among adolescents with juvenile rheumatoid arthritis

Objective . To determine the prevalence of substance use among adolescents with juvenile rheumatoid arthritis and to assess available opportunities for rheumatologists to identify high risk teens. Methods . Fifty-two teens (mean age 13.9 years, 86% female) completed questionnaires regarding substance use (alcohol, tobacco, marijuana, and other illicit substances), functional disability, and frequency of health care contacts. Results . Alcohol use was reported by 30.7% of teens, including 23.5% of those for whom methotrexate was prescribed; 15.4% reported tobacco use in the last year, and 13.4% reported other illicit substance use in their lifetime, although most use was experimental. No teen reported marijuana use. The majority reported regular contact with their rheumatologist but only 26.9% were ever interviewed alone. Conclusion . Many teens with juvenile rheumatoid arthritis, including those prescribed methotrexate, used substances, especially alcohol. When rheumatologists see adolescents, particularly in situations where methotrexate may be prescribed, a clinical setting conducive to confidentiality, physician comfort in asking about sensitive topics such as substance abuse, and referral relationships with skilled adolescent health and substance abuse counseling providers are essential.     

Primary medical care and reductions in addiction severity: a prospective cohort study

AIMS: To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions. DESIGN: We studied a prospective cohort of adults enrolled in a randomized trial to improve linkage with primary medical care. METHODS: Subjects at a residential detoxification unit with alcohol, heroin or cocaine as a substance of choice, and no primary medical care were enrolled. Receipt of primary medical care was assessed over 2 years. Outcomes included (1) alcohol severity, (2) drug severity and (3) any substance use. FINDINGS: For the 391 subjects, receipt of primary care (> or = 2 visits) was associated with a lower odds of drug use or alcohol intoxication (adjusted odds ratio (AOR) 0.45, 95% confidence interval (CI) 0.29-0.69, 2 d.f. chi(2)P = 0.002). For 248 subjects with alcohol as a substance of choice, alcohol severity was lower in those who received primary care [predicted mean Addiction Severity Index (ASI) alcohol scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.30, 0.26 and 0.34, P = 0.04]. For 300 subjects with heroin or cocaine as a substance of choice, drug severity was lower in those who received primary care (predicted mean ASI drug scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.13, 0.15 and 0.16, P = 0.01). CONCLUSIONS: Receipt of primary medical care is associated with improved addiction severity. These results support efforts to link patients with addictions to primary medical care services.     

Correlates of early substance use and crime among adolescents entering outpatient substance abuse treatment

Although many studies have examined the relationship between early deviant behavior and subsequent life problems among adolescents drawn from the general population, such relationships have not been examined for youth attending substance abuse treatment. Based on in-depth psychosocial assessments conducted with adolescents entering an outpatient substance abuse treatment program (N = 193), the current study examines individual characteristics, life circumstances, and other behavioral and psychological characteristics that are correlated with the age at which these youth initiated substance use and criminal activity. Early onset of substance use was associated with greater levels of family deviance and a variety of problems including school adjustment, drug use, criminal involvement, bullying and cruelty to people and animals, and involvement in risky sexual activities. In contrast, early onset of crime was related only to male gender, early onset of substance use, and cruelty to people. Findings suggest that treatment providers may need to consider the ages at which their adolescent clients initiated substance use given its association with illegal activity, other deviant behavior, and precocious and high-risk sexual behaviors.     

Consistency of Recall of Sexual and Drug-Using Behaviors for Homeless Persons with Dual Diagnosis

In this paper we present data from a study of the consistency of recall of several sexual and drug-using behaviors gathered from face-to-face interviews with homeless persons who have dual diagnosis (severe mental illness plus a substance use disorder). Factors associated with inconsistent reporting are also examined. One hundred and thirty-three individuals participating in a longitudinal study of HIV risk behaviors were recruited for a retrospective recall study. Participants were completing monthly interviews that included assessments of sexual behaviors and drug use. Participants completed an additional interview using the same instruments and were randomly assigned to a 3- or 6-month recall condition; the data from the additional interview were correlated with the regular, monthly interviews. Results indicated that reports of sexual and substance-using behaviors were generally reported consistently for both 3- and 6-month recall periods; however, coefficients for the 3-month interval were generally better than those for the 6-month interval. One exception was that protected intercourse was generally not reported consistently. Inconsistent reporting of sexual and drug-using behaviors was associated with the severity of substance abuse; inconsistent reporting of sexual behaviors was also associated with African-American race. Our data suggest that a 3-month recall interval is generally superior to a 6-month interval for persons with severe mental illness.     

Individual-level predictors of nonparticipation and dropout in a life-skills HIV prevention program for adolescents in foster care

The purpose of this study is to identify individual-level characteristics of foster care adolescents who are more likely to not participate in, and drop out of, a life-skills HIV prevention program delivered over 8 months. Structured interviews were conducted with 320 foster care adolescents (15-18 years). Logistic regression and survival analyses (Cox Proportional Hazards Regression) determined the influence of demographics, HIV sexual risk behaviors, substance use, mental health problems, and other individual-level risk factors on nonparticipation and dropout. Older age and having vaginal intercourse without a condom were significant predictors of nonparticipation. Older age and marijuana use significantly increased the hazard of dropping out of the program. Foster care adolescents at increased risk for HIV infection were more likely to never participate in and drop out of the program. To improve initial and ongoing participation, HIV prevention efforts for adolescents in foster care should be tailored to individual-level HIV risk behaviors and incorporate early and ongoing engagement and retention strategies.     

Male and female rural probationers: HIV risk behaviors and knowledge

Individuals involved in the criminal justice system are at substantial risk for HIV infection and have elevated rates of AIDS. Offenders under community supervision, such as probationers, have substantially more opportunities to engage in high-risk behaviors than prisoners. Furthermore, probationers in rural areas are at risk because rural areas may be slower to adopt HIV risk-reduction approaches. Consequently, the primary goal of this study is to describe the HIV risk behaviors and level of HIV knowledge of 800 rural felony probationers. Bivariate results indicate that males have substantially greater criminal histories and engage in more substance use risk behaviors than females. Overall, there was minimal and inconsistent use of condoms, but there were no significant differences by gender. Gender differences prevailed in perceived HIV knowledge, with females reporting high levels of perceived HIV knowledge. Multivariate models did not support the hypothesis that perceived knowledge would be a more robust correlate of scores on the HIV Risk Behavior Knowledge Test for males than females. Results suggest that rural residents are not protected from engaging in HIV risk behaviors and future studies should examine gender discrepancies between perceived and actual HIV knowledge among offenders under community supervision.     

Substance abuse in early adolescents and HIV preventive behaviors: findings from a school-based cross-sectional survey for the period from 2009 to 2013, Bangkok Thailand

This study is first of its kind in Bangkok, and is a five-year (2009–2013) cross-sectional web-based survey to examine HIV preventive behaviors related to substance abuse among adolescents (N?=?16,913). The questionnaire was self-administered. Logistic regression was used to analyze the data. The relationship between different types of substance abuse with risky and preventive behaviors was assessed. Male participants reported more substance abuse as compared to females. The risk behaviors observed among the substance abusers include increased sexual experience, multiple sex partners, no use of condoms, and injection drug use. The preventive behaviors include having a high self-risk assessment, going for HIV testing (highest in methamphetamine users), and screening for sexually transmitted infection. Logistic regression suggests that risky behaviors (e.g., sexual experience, injection drug use) are more common in substance abusers. Adolescents are clearly at a high risk. Behavioral preventive measures are needed to reduce or delay premature substance exposure to prevent a wide range of health problems and risks such as HIV and AIDS, injection drug use and unprotected sex.     

Health Behaviors among Adolescents and Young Adults with Congenital Heart Disease

Objectives. Document the frequency of substance use and oral hygiene among adolescents and young adults with moderate to complex congenital heart disease (CHD). Background. Patients' knowledge of health behaviors, including substance use and oral hygiene, has been examined among patients with CHD, but patients' actual behavior has not been studied. Understanding patients' behavior is needed to inform interventions that enhance healthy lifestyles, and in turn encourage patients to better care for their own health. Methods. Young adults (19 or 20 years old) and older adolescents (16–18 years old) with moderate or complex CHD (n = 328) reported their substance use (i.e., smoking, marijuana, alcohol, other illicit drugs) and oral hygiene. Rates of these health behaviors were contrasted with comparison samples of peers of the same age. Results. Just over half of the young adults (54%) and over one‐quarter of the adolescents (28%) reported significant substance use (i.e., smoking cigarettes on more than 2 days, using marijuana or other illicit drugs at least once, or binge drinking) during the previous 30 days. Rates of significant substance use among the patients with CHD were either comparable to, or lower than, rates in comparison samples of similar aged peers. Only about 15% of the patients with CHD had excellent oral hygiene (i.e., self‐reported annual teeth cleaning by dentist, brushing and flossing daily); however, virtually all patients (>95%) brushed daily. Patients with CHD generally had comparable oral hygiene to comparison samples in previously published data. Conclusions. Many older adolescents and young adults with CHD are engaging in behaviors that may compromise their health. The impact of substance use and poor dental hygiene warrants further investigation. Nevertheless, health behaviors should be routinely discussed in this population.