Gender differences in predictors of initiation,retention, and completion in an HMO-based substance abuse treatment program

We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education. Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance. Clinical implications of results are discussed.     

Gender differences in predictors of drinking behavior in adolescents

This study explored the differences in the risk factors associated with alcohol use, problem drinking, and related consequences between male and female high school students in eastern Taiwan. A total of 771 10th grade students, including 327 boys (42.4%) and 444 girls (57.6%), from four randomly selected high schools in eastern Taiwan were included in the survey. Multiple logistic regression analyses were performed. In conclusion, paternal drinking was found to be an important factor for the development of alcohol use in adolescent boys but had less impact on girls when compared with maternal drinking. Peer norms and peer relationships had greater effects on drinking behavior in female than in male adolescents. Alcohol use appeared to be much more closely related to family relationships in female than in male adolescents. In adolescent boys, deviant self-image was the real factor causing problem drinking. Therefore, preventive intervention for boys should focus on managing psychological distress and strengthening positive self-image, while correcting peer drinking norms, learning of drinking refusal self-efficacy, establishing friendships without drinking, and positive parent-child communication should be enhanced for girls.     

Treatment completion on an inpatient detoxification unit: impact of a change to sublingual buprenorphine-naloxone

PURPOSE: Buprenorphine is commonly used for opioid detoxification. The goal of this study was to determine whether a change from the intramuscular (IM) buprenorphine to the sublingual (SL) formulation of buprenorphine-naloxone was associated with improved treatment completion rates on an inpatient detoxification unit. METHODS: This study was conducted at the Johns Hopkins Bayview Medical Center (JHBMC) Chemical Dependence Unit (CDU), a 26-bed, 3-day inpatient detoxification unit providing detoxification from opioids, alcohol, and sedatives. The opioid detoxification protocol was changed from IM buprenorphine (0.3 mg bid for 3 days) to SL buprenorphine-naloxone (8, 8, and 6 mg on sequential days, plus 2 mg on the morning of discharge). For the 3 months prior to and after the change in protocol, data were collected retrospectively on demographics, type of dependence being treated, and type of discharge. FINDINGS: A total of 1,168 patients were admitted to the JHBMC CDU during the period studied. In the 3 months prior to the change in buprenorphine protocol, 353 of 483 patients admitted for treatment of opioid dependence (73.1%) completed treatment, compared with 407 of 473 patients admitted after the change (86.0%); this difference was highly significant (p < .0001). Among 212 patients who did not receive treatment for opioid dependence over the same period, the rates of treatment completion did not change significantly (89.8% before vs. 83.0% after; p = .208). CONCLUSIONS: A change from IM buprenorphine to SL buprenorphine-naloxone for opioid detoxification was associated with a significant improvement in completion rates at this inpatient treatment program.     

General Practitioners' views of home detoxification

There is a growing movement towards community-based health care for the treatment and management of alcohol and drug problems across Australia. In spite of substantial evidence to support the clinical efficacy, cost-effectiveness, and the utility of home detoxification, it is not an activity that has been readily embraced by Australian General Practitioners (GPs). Thus, GPs' views on this issue are vital if there is to be any form of viable home detoxification programme for alcohol and/or other drugs. A qualitative study was undertaken to determine General Practitioners' views in regard to alcohol and drug home detoxification. A qualitative data collection method, focus groups, was used. Focus group participants were obtained from a maximum variation sampling technique. Twelve focus groups were conducted in rural and metropolitan Queensland Australia, over a fourmonth period. Fifty-two participants (43 general practitioners and 9 other health professionals, 20 females and 32 males). Mean age was 40.5 years (age range 19-70). Views about home detoxification were dependent on level of experience with substance abuse treatment. Overwhelmingly, GPs argued that for home detoxification to become viable, there would need to be a more responsive infrastructure, clear policy guidelines, training and more reasonable remuneration than currently exists. GPs require improved training in addiction and drug and alcohol problems. Revised remuneration schemes will facilitate better GP management of complex chronic problems such as addiction. Even though GPs' held quite negative views about alcohol and drug dependent patients there was a high level of willingness to become involved in their treatment and support. Although the clinical efficacy of home detox has been demonstrated GPs have understandably mixed views about their potential involvement. Improved training, support and resourcing is needed to substantially facilitate the expansion of GPs' role into this growing area of care.     

Ways of problem solving as predictors of relapse in alcohol dependent male inpatients

Aim

The purpose of this study was to identify how remitters and relapsers view their everyday problem solving strategies.

Method

A total of 128 male alcohol dependent male inpatients who were hospitalized at the Ankara University Psychiatry Clinic, Alcohol and Substance Abuse Treatment Unit were recruited for the study. Subjects demographic status and alcohol use histories were assessed by a self-report questionnaire. Also, patients were evaluated with The Coopersmith Self-esteem Inventory (CSI), The Spielberger State-Trait Anxiety Scale (STAI-I-II), and The Problem Solving Inventory (PSI). Patients were followed for six months with monthly intervals after hospital discharge. Drinking status was assessed in terms of abstinence and relapse. Data were assessed with Student t-test, and univariate and multivariate analyses. In the logistic regression analysis, age, marital status, employment status and PSI subscores were taken as the independent variables and drinking state at the end of six months as the dependent variable.

Results

There were significant differences in reflective and avoidant styles, and monitoring style of problem solving between abstainers and relapses. It was found that subjects who perceived their problem solving style as less avoidant and less reflective were at greater risk to relapse.

Conclusions

The findings demonstrated that active engagement in problem solving like utilizing avoidant and reflective styles of problem solving enhances abstinence. In treatment, expanding the behavior repertoire and increasing the variety of ways of problem solving ways that can be utilized in daily life should be one of the major goals of the treatment program.     

Gender differences in high-risk situations for drinking: Are they mediated by depressive symptoms?

Objective

The purpose of the present study was to examine gender differences in the frequency of high-risk drinking situations and to investigate the extent to which depressive symptoms mediate the relationship.

Method

Participants were 143 outpatient alcohol treatment seekers. Each participant completed the Beck Depression Inventory-II and Inventory of Drug-Taking Situations (IDTS) at baseline prior to treatment. Results: Multivariate analysis of variance was used to examine gender differences in drinking across eight categories of situations assessed on the IDTS. Mediational analyses tested whether gender differences on these IDTS subscales may be mediated by depressive symptoms. We found support for the hypothesis that women report drinking more than men in response to unpleasant emotions and conflict with others, and that these associations are significantly mediated by depression severity.

Conclusions

The current findings have important implications for appropriate treatment for alcohol-dependent women. In particular, such treatment should include training in affect regulation and interpersonal skills, as well as treatment for depression, when appropriate.     

Gender differences in abusers of amphetamine-type stimulants and ketamine in southwestern China

The objective of this study was to investigate abuse conditions of new-type drugs for users who are seeking treatment, gender differences, and differences between the amphetamine-type stimulants (ATS) users and mixed amphetamine-type stimulants and ketamine (ATS + K) poly-drug users. A retrospective analysis was conducted of patients with a final diagnosis of the substance use disorder according to the Diagnoses and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) who underwent treatment for exposure to new-type drugs at the mental health center of the West China Hospital from March 2009 to May 2011. A questionnaire was used to collect information about socio-demographics, drug abuse conditions and psychiatric co-morbidities. Male subjects were older (p = 0.026), had low level education (p = 0.003), were less previously married (p < 0.001), were more likely to be employed and to hold higher status jobs (p = 0.007); 77.1% of subjects had a psychotic disorder, 28.0% of subjects had a mood disorder, 39.7% had an anxiety disorder, and 45.0% had a cognitive impairment disorder. More men used methamphetamine MA (p < 0.001), tobacco (p = 0.014) and more than one drug substance (p = 0.004) compared to women; women were more vulnerable to mood disorders (p = 0.034) than men. For the males, the ATS + K patients were more likely to use 3, 4-methylenedioxymethamphetamine MDMA (p < 0.001) and develop more psychotic disorders (p = 0.04) than the ATS patients; for females, the ATS + K patients were more likely to use MDMA (p = 0.002), alcohol (p = 0.014) and develop more cognitive impairment disorder (p = 0.034). The present study found that the new-type drug patients have a high degree of psychiatric morbidities; more men were using MA, tobacco and multi-substance and more women patients experience mood disorder in the gender differences. For the males, the ATS + K patients were more likely to use MDMA (3, 4-methylenedioxymethamphetamine) and develop more psychotic disorders than the ATS patients; for females, the ATS + K patients were more likely to use MDMA, alcohol and develop more cognitive impairment disorder. These results suggested that the psychiatrists should focus on the mood disorder among females, psychotic disorders among males who abuse ATS and ketamine, and cognitive impairment disorder for the females who abuse ATS and ketamine.     

Gender Differences in the Use of Alcohol and Psychotropics in a Brazilian Population

This cross-sectional, interview-based survey aimed to assess the use of licit substances in terms of gender and sociodemographic factors in the city of Pelotas, southern Brazil. Subjects aged 15 years and over and living in urban areas were eligible and a total of 1277 subjects were interviewed. The prevalence of alcohol consumption was 54.2%; 11.9% (21.7% of men and 4.1% of women) reported potentially harmful levels of alcohol use (“at-risk alcohol intake”); 4.2% were classified as manifesting alcohol dependence by CAGE questionnaire. At-risk alcohol intake and subjects with a positive CAGE score were more common among males aged 35–54 yrs. Among the youngest age group, the prevalence of CAGE positive score was similar for males and females, while subjects with lower educational levels showed a higher prevalence. Women were more likely than men to report the use of psychotropic drugs (15% vs. 7%). These results highlight the importance of substance use in Brazil, and suggest that gender differences must to be taken into consideration when planning intervention programs in developing countries.     

社区心房颤动患者易患因素的性别差异

目的 探讨社区心房颤动(房颤)患者易患因素的性别差异.方法 对12家社区2009年5月至201 1年2月4600例房颤患者的年龄、吸烟史、房颤类型和病因按性别作回顾性分析.结果 男性1863例,占40.5％,女性2737例,占59.5％.年龄≥60岁者4416例,占96.0％.女性则占比例明显高于男性的因素包括年龄≥60岁[97.0％(2654例)比94.6％(1762例)]、阵发性房颤[19.8％(541例)比16.4％(305例)]、永久性房颤[57.0％(1561例)比53.9％(1004例)]、高血压病[24.1％(660例)比20.0％(372例)]、糖尿病[18.2％(497例)比14.7％(273例)]、冠心病[28.4％(776例)比25.0％(465例)]、心肌病[7.7％(212例)比5.9％(110例)]、风湿性心脏病[7.2％(197例)比5.5％(103例)]、瓣膜退行性变[13.6％(371例)比9.9％(184例)]、特发性房颤[5.4％(148例)比3.6％ (67例)]、原因不明[8.4％(229例)比6.1％(113例)](P＜0.05或P＜0.01);明显低于男性的因素有年龄＜60岁和吸烟史≥5年(P＜0.01);持续性房颤、肺源性心脏病、心包炎、甲状腺功能亢进、先天性心脏病、病窦综合征性别差异无统计学意义(P＞0.05).结论 社区房颤患者以老年为主,≥60岁患者中女性多见,＜60岁患者中男性多见.吸烟是男性房颤患者的高危因素.阵发性和永久性房颤女性多见.病因以冠心病、高血压病和糖尿病最多见,且女性明显多于男性.     

Alcohol dependent inpatients who receive general hospital care vs. detoxification in psychiatric care and alcohol problem 1 year later

Aim

The aims were to investigate differences between alcohol dependent inpatients who seek alcohol treatment and those who do not seek alcohol specific but general hospital treatment, and to investigate problem drinking 12 months after hospitalization.

Methods

Two samples of alcohol dependent inpatients were recruited: N = 571 at general hospitals and N = 473 at psychiatric alcohol detoxification units, and were followed-up 12 months later.

Results

Multivariate logistic regression analyses revealed that higher age, living alone, being employed, previous help-seeking, increased severity of dependence, increased adverse consequences from drinking and increased motivation were significant predictors of receiving alcohol detoxification vs. general hospital treatment. A composite assessment of motivation to change and to seek help was the strongest predictor of positive outcome 12 months later.

Conclusions

Alcohol dependent individuals who receive detoxification in psychiatric care have a more severe alcohol problem and fewer social resources than those treated in general hospitals. Interventions targeting at enhancing motivation to change and to seek help should be part of routine general hospital care and of detoxification treatment in psychiatric care.     

Gender differences in the subjective effects of MDMA

RATIONALE: 3.4-Methylenedioxymethamphetamine (MDMA) mainly releases serotonin (5-HT) and is contained in the recreational drug Ecstasy. 5-HT is known to play an important role in mood and anxiety disorders, for which there is a female preponderance. To date, there are no systematic data on gender differences in the subjective effects of MDMA. OBJECTIVES: The present work analyzed the pooled data from three controlled studies on the psychological and physiological effects of MDMA in healthy volunteers with no or minimal MDMA experience. A particular focus of the analyses were possible gender differences. METHODS: A total of 74 subjects (54 male, 20 female) participated in all three studies. MDMA in oral doses ranging from 70-150 mg (1.35-1.8 mg/kg) was administered under double-blind placebo-controlled conditions. Subjective peak changes were assessed by standardized psychometric rating scales. Physiological measures were blood pressure, heart rate, and peripheral body temperature. Adverse drug effects were assessed during the experimental session and after 24 h. RESULTS: Psychoactive effects of MDMA were more intense in women than in men. Women especially had higher scores for MDMA-induced perceptual changes, thought disturbances, and fear of loss of body control. The dose of MDMA positively correlated with the intensity of perceptual changes in women. Acute adverse effects and sequelae were also more frequent in female than in male subjects. In contrast, men showed higher increases in blood pressure than woman. CONCLUSIONS: The fact that equal doses of MDMA per kilogram body weight produce stronger responses in women compared to men is consistent with an increased susceptibility of women to the 5-HT-releasing effects of MDMA. Our results also indicate that increasing doses of MDMA produce more hallucinogen-like perceptual alterations, particularly in women.     

Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors

BackgroundThe results of several studies suggest that economy-related stressors are less distressing for women compared with men. This study proposed to examine the relationship of perceived job insecurity with the use of licit drugs using a theoretical model that considered antecedents and mediators of this association, in order to identify differences between working men and women.MethodsUsing information from the Catalan Health Survey (2010–2014), we selected working individuals aged 16–64 who were primary providers of household income (N = 5315). The outcomes were two measures of alcohol consumption (heavy drinking and binge drinking) and the use of hypnotics/sedatives. As antecedents of the exposure to job insecurity we considered the type of contractual relationship and occupational class. The mediating factors were poor mental health, household structure and the hours of housework per week. The theoretical model was assessed using path analysis where the moderating effect of gender was considered in all the associations.ResultsNo differences in the prevalence of job insecurity were found between men and women (17%). Job insecurity (Odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23–1.48) and house workload (OR = 1.01, 95% CI = 1.00–1.02) were positively associated with poor mental health, with no significant interactions with gender. Poor mental health was significantly associated with binge drinking (OR = 1.23, 95% CI = 1.13–1.33) and with the use of hypnotics/sedatives (OR = 1.71, 95% CI = 1.53–1.91). House workload showed a direct negative association with binge drinking (OR = 0.99, 95% CI = 0.98–1.00), while those in households with no children were more likely to be binge drinkers, with no significant interactions with gender. An alternative model had better fitting results for heavy drinking.ConclusionNo gender differences were found in the association of job insecurity with mental health nor with the use of substances among primary providers of household income, emphasising the importance of social roles when assessing differences in mental health among men and women.     

Relapse determinants reported by men treated for alcohol addiction: the prominence of depressed mood

Men treated for alcohol addiction who relapsed after residential treatment were surveyed to identify high-risk events, which had functioned as relapse determinants. The investigation was guided by G. Alan Marlatt's relapse prevention model. Participants endorsed one of nine relapse determinants listed on the study's relapse questionnaire most directly related to their first use of alcohol or drugs after treatment. The relapse determinants most consistently endorsed were intrapersonal in nature. The relapse determinant most frequently endorsed was depressed mood, consistent with the study's hypothesis. A rationale was presented for future research to isolate risk factors for relapse episodes organized on the basis of relapse determinants.     

127例海洛因依赖者自愿戒毒动机和住院时间与复吸关系的研究

目的：探讨海洛因依赖者自愿住院戒毒的动机、住院时间、出院后复吸情况。方法：采用自编调查问卷，包括一般人口学特征、戒毒动机，住院时间、出院后复吸情况等，就有关问题进行调查。结果：海洛因依赖者以吸毒减量动机为多；住院时间以5～6天为主；出院后第1天复吸者占80％。结论：自愿戒毒所主要功能：维护吸毒人员身体健康，减少毒品对身体伤害。     

Alcohol relapse repetition, gender, and predictive validity

Earlier exploratory work on a scoring algorithm for the Reasons for Drinking Questionnaire [Zywiak, W. H., Westerberg, V. S., Connors, G. J., & Maisto, S. A. (2003). Exploratory findings from the Reasons for Drinking Questionnaire. Journal of Substance Abuse Treatment, 25, 287–292.] presented a number of interesting findings, but was limited by a fairly low consistency in type of relapse between the first relapse and the second relapse (63%). This scoring algorithm objectively classifies alcohol relapses into one of three types (negative affect, social pressure, or craving/cued). While examining gender differences in the type of first relapse, evidence indicating that relapses were more consistent for men (81%) than for women (44%) was uncovered. For initial posttreatment relapses, women were more likely to have negative affect relapses, and men were more likely to have social pressure relapses. For men, negative affect relapses were predicted by the Beck Depression Inventory score. For women, negative affect relapses were predicted by the Alcohol Dependence Scale score, and craving/cued relapses were predicted by situational craving.     

Gender Differences in Alcohol Use and Alcohol Problems: Mediation by Social Roles and Gender-Role Attitudes

This study assesses the causal place of Traditional Gender Role Attitudes (TGRA) in models for men and women, which also include social roles by explanatory variables for alcohol use and alcohol problems. Mediation of gender differences by TGRA occurs mainly in abstinence. Interaction effect is weak for alcohol consumption and frequency of “heavy drinking.” The most important explanatory variables are the status factors age and education, which are mediated by TGRA in a small way. Specific aspects of alcohol-related problems are analyzed separately for the problem drinking category. Differences in results with other studies are discussed, and further study is proposed.     

Gender,history of alcohol use and number of drinks consumed predict craving among drinkers in a field setting

To the extent that craving serves to compel excessive drinking, it would be important to predict the intensity of an individual's craving over the course of a drinking episode. Previous research indicates that regular alcohol use (measured by the AUDIT) and the number of drinks individuals have already consumed that evening independently predict craving to drink (Schoenmakers & Wiers, 2010). The current study aims to replicate those findings by testing whether these same variables predict craving to drink in a sample of 1320 bar patrons in a naturalistic setting. In addition, we extend those findings by testing whether regular alcohol use and self-reported number of drinks consumed interact to predict craving, and whether gender independently predicts craving or interacts with other variables to predict craving. Results indicate that for men, AUDIT score alone predicted craving, whereas for women, AUDIT score and number of drinks consumed interacted to predict craving, with craving highest among women with either high AUDIT scores or relatively high consumption levels. Our findings have implications for targeted intervention and prevention efforts, as women who have a history of harmful alcohol use and consume several drinks in an evening might be at the greatest risk for continued alcohol consumption.     

急性心肌梗死患者疲劳症状性别差异的观察

目的观察急性心肌梗死（AMI）病人疲劳症状的性别差异性。方法对116例AMI患者于入院时及出院30d后进行问卷调查,利用POMS—F积分方法评估疲劳程度,利用POMS—D评价抑郁情绪。结果女性AMI患者入院时POMS—F积分较出院30d后高（P〈0．05）,而男性患者POMS—F积分不存在这种差别（P=O．213）。相对于男性,女性AMI患者入院时POMS—F积分较高[（15．80±7．33）VS．（11．19±7．04）,P=O．004],这种差异一直维持到出院30d后（P=0．02）。同时发现,疲劳与抑郁情绪显著相关（／2=0．308～0．480,P〈0．05）。结论AMI患者疲劳程度及变化存在明显的性别差异,疲劳与性别及抑郁情绪明显相关。     

The route to change: Within-session predictors of change plan completion in a motivational interview

This study is the first to examine within-session therapist and client language/process predictors of a client's decision to complete a written Change Plan in an alcohol-focused motivational interview (MI). Data were from an ongoing hospital-based clinical trial (N = 291). Trained raters coded audiorecorded MI sessions using the Motivational Interviewing Skill Code. Logistic regression analyses found that therapist MI-consistent behaviors (b = .023, p < .001) and client change talk (b = .063, p < .001) were positive predictors, and client counter change talk (b = −.093, p < .001) was a negative predictor of the decision to complete a Change Plan regarding alcohol use. Mean comparisons showed that compared to noncompletion, Change Plan completion did not result in significantly greater changes in client motivational readiness. Completion of a Change Plan is a proximal outcome in MI that is associated with client intention to change (change talk) and may predict follow-up alcohol outcomes. Analyses of such theory-driven proximal client mechanisms provide a more complete model of MI process and may inform MI providers of necessary treatment ingredients.