An interdisciplinary team model for substance abuse prevention in communities.

Recognizing the continuing threat of alcohol, tobacco, and other drug abuse and the mandate for health care reform with emphasis on community-based care and prevention, the University of Texas-Houston Health Science Center School of Nursing developed a model to link faculty to communities to provide culturally competent, scientifically based, preventive interventions. Faculty and community associates engaged in individual and group training activities such as seminars, courses, and off-site meetings. The Preventive Intervention Research Cycle was used to structure prevention activities and assure scientific rigor. In addition to the specific outcomes of five preventive interventions, the project resulted in increased faculty scholarship in the field, increased community awareness and sustained interventions related to substance abuse, enhanced curriculum for students, and expanded collaborations with other community-based organizations. Collaborative interdisciplinary partnerships between academic institutions and community organizations are critical to the development of the science of substance abuse prevention.     

Involving communities in community assessment

Focus groups provide an effective means of incorporating the perspectives of "hidden" populations in assessments of community health needs and assets. A series of focus groups was conducted with specifically targeted segments of a community to develop a comprehensive picture of community health. The authors describe the focus group process, major findings, and the use of focus group results in a highly multicultural community. Despite differences in age, length of residence, and ethnicity, the focus groups were remarkably similar in the issues raised. The majority of participants viewed the multicultural nature of the community as an asset but voiced some of the difficulties of living in a multiethnic and multilanguage environment. Similar areas of concern in the community arose from all of the focus groups, including housing and other environmental issues and problems of access to health care. Focus group findings have been used to initiate activity addressing identified community problems. Focus group participation had the added benefit of increasing community members' participation in other community endeavors.     

Initiation factors for substance abuse

AIM: The study reported in this paper investigated factors that led to the initial use and abuse of drugs in 237 addicts receiving treatment at the Psychological Medicine Hospital, Kuwait. METHOD: A self-administered questionnaire was designed to elicit information regarding socio-demographic data and initiation patterns. Questions about initiation patterns were related to personal, familial and social variables in addition to accessibility to drugs. RESULTS: Almost all the sample were male (99.2%) and 42.6% were married. The findings were grouped into (1) factors associated with drug abuse and (2) initial/ significant factors for drug abuse. One way ANOVA showed that there was a significant statistical association between current age and source of drug. Also, there was a significant statistical association between the age of the addict when first started on drugs, and the source of drugs. Multiple regression analysis was also computed for initial significant factors. One factor 'excessive unsupervised free time' was statistically significant. RECOMMENDATIONS: Strategies for primary, secondary and tertiary interventions in addition to recommendation for further studies are suggested.     

Alcohol and substance abuse

Substance abuse and dependence is a public health problem with far-reaching societal implications. The acute toxicity of substances of abuse and medical consequences of chronic use are substantial. On a more optimistic note, a great deal of progress has been made in understanding and treating substance use disorders. Expanding knowledge concerning the neurobiology of substances of abuse and substance use disorders has led to a growth in pharmacotherapeutic treatment options. A growth in understanding of behavioral processes, motivational issues, and processes of behavioral change has been important in designing new and increasingly more effective psychosocial treatments. A growing body of evidence indicates that the treatment of substance use disorders can be effective, making early diagnosis and treatment or referral increasingly important.     

Schizophrenia and comorbid substance abuse

Research suggests that nearly half of all patients with schizophrenia concurrently abuse substances. However, despite the prevalence of substance abuse among persons with schizophrenia, the effective treatment of these comorbid conditions has eluded mental health professionals for decades. Apart from the obvious problems associated with schizophrenia and alcohol or drug abuse, schizophrenic persons who abuse substances also experience increased rates of depression, suicide, homelessness, unemployment, and illegal activity. These diverse problems necessitate interventions that address the special needs of this population. Research indicates that the use of atypical antipsychotic agents with persons who have a dual diagnosis may prove to be efficacious with treatment, overall. This article reviews the current literature pertaining to the potential expanded therapeutic benefits of enhanced efficacy of atypical antipsychotic medication in association with decreased substance use and craving.     

Perinatal substance abuse and the drug-exposed neonate

Tobacco and alcohol are the substances most abused during pregnancy. Alcohol (ethanol) is the human teratogen that produces the most serious neurobehavioral effects on the fetus. Cocaine is associated with spontaneous abortions, premature labor, precipitous labor, stillbirths, meconium staining and abruptio placentae. Heroin use during pregnancy has been associated with low birth weight, miscarriage, prematurity, microcephaly and intrauterine growth retardation. Marijuana is not scientifically linked to significant teratogenic effects. Since most substance abusers use multiple drugs, a positive screen for marijuana may indicate a high-risk patient. Cigarette smoking has been associated with spontaneous abortions, premature rupture of membranes, preterm delivery, perinatal death, low birth weight infants, and deficits in learning and behavior.     

Therapeutic substance abuse treatment for incarcerated women

The purpose of this qualitative systematic review was to explicate attributes of optimal therapeutic strategies for treating incarcerated women who have a history of substance abuse. An expansive search of electronic databases for qualitative research reports relating to substance abuse treatment for incarcerated women was conducted. Nine qualitative research reports comprised the sample for this review. Findings from these reports were extracted, placed into a data analysis matrix, coded, and categorized. Memos were written and strategies for treating incarcerated women with alcohol problems were identified. Therapeutic effects of treatment programs for incarcerated women with substance abuse problems appear to be enhanced when trust-based relationships are established, individualized and just care is provided, and treatment facilities are separate from the general prison environment.     

Glutathione and redox signaling in substance abuse

Throughout the last couple decades, the cause and consequences of substance abuse has expanded to identify the underlying neurobiological signaling mechanisms associated with addictive behavior. Chronic use of drugs, such as cocaine, methamphetamine and alcohol leads to the formation of oxidative or nitrosative stress (ROS/RNS) and changes in glutathione and redox homeostasis. Of importance, redox-sensitive post-translational modifications on cysteine residues, such as S-glutathionylation and S-nitrosylation could impact on the structure and function of addiction related signaling proteins. In this commentary, we evaluate the role of glutathione and redox signaling in cocaine-, methamphetamine- and alcohol addiction and conclude by discussing the possibility of targeting redox pathways for the therapeutic intervention of these substance abuse disorders.     

Hospitalization for caffeine abuse is associated with abuse of other pharmaceutical products

Study Objective

The aim of this study was to examine the characteristics and outcomes of patients seeking treatment for abuse of supplemental caffeine.

Methods

This was a 3-year analysis conducted of all consecutive cases involving caffeine abuse in patients 10 years and older reported to a regional poison center. Excluded were suicide attempts, therapeutic errors, and cases involving only a coffee or tea product.

Results

Two hundred fifty-four cases met inclusion criteria. Mean age was 20.5 years, 50% were women. Caffeine was in the form of a nondietary medication in 201 cases, a dietary supplement in 35 cases, and a caffeine-enhanced beverage in 35 cases. Caffeine was abused alone in 174 (68%), with alcohol in 7, illegal drugs in 6 cases, and with other pharmaceutical products in 81 (29%) cases. Thirty-four patients (13% of total) were hospitalized for medical complications from caffeine. Only concomitant abuse of other pharmaceutical products was associated with hospitalization (odds ratio, 3.8; 95% CI, 1.8-8.8; P = .0004).

Conclusion

In this cohort, supplemental caffeine was abused primarily by young adults. Concomitant recreational abuse of other pharmaceuticals was associated with hospitalization and warrants further investigation.     

Childhood sexual abuse and substance abuse in relation to depression and coping

Objectives: To examine relationships between childhood sexual abuse (CSA), substance abuse, substance abuse relapse, depression and coping styles in an Australian sample. Methods: Participants were 79 adults actively seeking treatment for substance abuse or CSA. CSA and substance use history were assessed using a purpose built questionnaire. Depression was assessed using the Beck Depression Inventory Second Edition (BDI‐II), and coping styles were evaluated using the Coping Scale for Adults.

Results: Among substance abusers, self‐reported CSA history was associated with (1) severe depression; (2) less optimistic coping; (3) longer duration of substance abuse; and (4) the use of drugs to alleviate negative moods. A non‐substance‐abusing CSA group was remarkably similar to the CSA substance‐abusing group on all measures. Penetrative abuse, younger age at CSA onset, and lack of confidence in dealing with CSA were associated with more severe depression in CSA victims.

Conclusions: Despite several limitations of the present study, these findings have implications for treatment of substance abusing CSA victims and suggest directions for future research on the CSA‐substance disorder relationship.     

Screening for substance abuse in a primary care setting

This article addresses the need for the nurse practitioner functioning in nearly any type of primary care setting to appreciate the potential of substance abuse in the client population. The addiction assessment tool serves as a guide for obtaining a precise health history regarding substance abuse. This information can assist the health provider in selecting the appropriate treatment strategy. A brief synopsis of substance abuse treatment modalities summarizes the vast field of research and referral sources which are available to the client. Hallmarks of recovery attempt to direct the nurse practitioner toward a realistic treatment plan.     

PET and SPECT in drug and substance abuse

The use of imaging in the evaluation of the brain under the influence of drugs has evolved into a functional assessment of its processes. It has been shown that SPECT and PET imaging studies demonstrate selected areas that are affected by multiple drugs among substance abusers. This paper illustrates examples of different drugs and how their effect on the brain may be portrayed by imaging applications. The developing "road maps" that we have obtained possess multidimensional applications. They can be useful to confirm specific diseases, clarify diagnosis wherein the clinical picture is not observed, aid in the development of new treatment evaluations and also provide researchers a better insight in the detection and functionality of dementia and specific mental illnesses processes.     

Recognition of alcohol and substance abuse

Ten percent of the population abuses drugs or alcohol, and 20 percent of patients seen by family physicians have substance-abuse problems, excluding tobacco use. These patients can be identified by relying on regular screening or a high index of suspicion based on "red flags" that can be noted in various clinical situations. The modified CAGE questionnaire is an excellent screening instrument, but several alternatives are available. The best screening test is one that the physician will routinely use well. Laboratory indicators such as gamma-glutamyl transpeptidase, mean corpuscular volume, and carbohydrate-deficient transferrin are nonspecific but can add to the evidence of alcohol abuse. If problem alcohol use is diagnosed, even brief physician advice can be helpful. If the problem has progressed to addiction, referral to an addiction specialist or treatment center is recommended. Special issues arise in dealing with substance abuse in adolescents, elderly patients, and patients with mental illness, but the family physician can play an important role in recognizing this common problem.