New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders Study

Aims   The purpose of this study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD).
Design   This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up.
Setting   Multiple clinical sites in four northeastern US cities.
Participants   A total of 175 patients with BPD and 396 patients with OPD (mean age 32.5 years) were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72 and 84 months.
Measurements   The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along version of the DIPD-IV and the Longitudinal Interval Follow-up Evaluation at the follow-up evaluations. Kaplan–Meier analyses were calculated to generate the time to new onsets.
Findings   BPD patients showed a shorter time to new onsets of SUD. Thirteen per cent of BPD patients developed a new alcohol use disorder and 11% developed a new drug use disorder, compared to rates of 6% and 4%, respectively, for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD.
Conclusions   BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients.     

Alcohol use disorders in Australia

Alcohol use disorders are common in Australia and are often unrecognised. Alcohol places a significant burden on our healthcare system by increasing the risk of injuries as well as many chronic medical conditions. Diagnosis requires a high index of suspicion and can be aided by the use of specific questionnaires, such as the Alcohol Use Disorder Identification Test‐C. The current available laboratory tests are of limited sensitivity and specificity, but can nevertheless aid in the diagnosis in some circumstances. Newer tests, such as ethyl‐glucuronide and phosphatidylethanol, are more sensitive and specific but are costly and not widely available. The effective management of alcohol use disorder entails psychosocial or pharmacological treatments or a combination of both. In those who cannot reduce alcohol consumption, harm reduction strategies can be applied to reduce the burden of harm to the drinkers as well as the community at large.     

Decision-making processes as predictors of relapse and subsequent use in stimulant-dependent patients

ABSTRACT

Background: Decision-making processes have been posited to affect treatment outcome in addicted patients. Objective: The present multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients. Methods: A total of 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (STAGE-12) were assessed. Decision-making processes of risk and delay (Iowa Gambling Task [IGT]) and response reversal (Wisconsin Card Sorting Task [WCST]) were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the 6-month period following post-randomization were evaluated. Results: Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, worse performance on the IGT was associated with a fewer number of stimulant use days (p = 0.001). In contrast, worse performance on the WCST (more perseverative errors) was associated with a greater number of stimulant use days (p = 0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and Minority participants. Conclusions: Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of non-drug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use.     

Barriers and levers in screening and care for alcohol use disorders among French general practitioners: results from a computer-assisted telephone interview-based survey

Alcohol use disorders (AUD) is a major public health concern. General practitioners (GP) must play a key role in identifying this disorder and offering appropriate interventions. The authors conducted a survey among French GP in the Provence – Alpes – Côte-d’Azur (PACA) region to better understand their practices regarding AUD. Random sampling was used to enrol 101 GP in a 15-minute survey. A Computer-Assisted Telephone Interview exploring demographic and professional characteristics was conducted using a questionnaire. One third (31.7%) of the participants systematically addressed alcohol use with their patients whereas six (5.9%) never addressed it. Logistic regression analyses showed that after adjustment for the number of AUD patients followed up (odds ratio [OR] = 1.92; 95% confidence interval [CI] [1.19, 3.08]) and GP interest in addiction medicine (5.41 [2.17, 13.40]), GP who systematically screened patients for AUD were more likely to accept controlled drinking as a therapeutic goal (5.41 [2.17, 13.33]), and to perceive patient denial of AUD as a major barrier to care (1.39 [0.60, 3.22]). GP providing care for AUD were more likely to monitor tobacco cessation (9.08 [2.60, 31.64]) and to prescribe opioid maintenance treatment (7.35 [2.52, 21.41]). Alcohol screening is insufficient in general practice in France. Providing updated guidelines is essential to foster experience in this field among GP.     

Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain

Background: Pain catastrophizing refers to the tendency to interpret pain as harmful, intolerable, or uncontrollable. Greater pain catastrophizing is associated with more pain-related negative phenomena, such as pain reactivity, pain disability, and emotional distress related to pain. Several studies of patients seeking chronic pain treatment have identified an association between pain catastrophizing and misuse of opioids and alcohol; however, it is unknown whether this association would be similarly present in patients with chronic pain seeking substance use disorder treatment.

Objectives: The current study examined whether pain catastrophizing is associated with worse pain-related outcomes and psychological functioning in individuals receiving inpatient substance use disorder treatment who endorsed current chronic pain.

Methods: In a series of regression models, we tested the associations between pain catastrophizing and functioning, specifically pain interference, craving, anxiety, and days of mood difficulties in a cross-sectional sample of patients seeking substance use disorder treatment with co-occurring chronic pain (N = 244, 67.6% female).

Results: Greater pain catastrophizing was associated with more pain interference, higher levels of craving, more anxiety symptoms and more days of mood difficulties, adjusted for demographic characteristics and pain severity.

Conclusion: In patients with comorbid substance use disorder and chronic pain, pain catastrophizing may offer a potential therapeutic target to improve substance use treatment outcomes.     

The Role of Ego Networks in Studies of Substance Use Disorder Recovery

Those who study treatment and recovery from alcohol use disorder (AUD) and substance use disorder (SUD) generally agree that an individual’s social context affects his or her success (or failure) in recovery. Recently, as the use of social network analysis has increased, studies on SUD recovery and treatment have adopted ego networks as a research tool. This review aims to tie together a thread of research for an efficient and effective summary. The authors selected peer-reviewed articles on individuals receiving treatment an intervention for SUD or AUD that used ego network measures of individual social networks. Ego networks have been studied as treatment outcomes, predictors of treatment outcomes in general, and how an individual’s ego network might be used to predict what specific treatment is most likely to succeed. The authors discuss relevant findings of studies using ego networks, the strengths and weaknesses of ego network approaches, and how future studies may benefit from the use of ego networks.     

Intimate Violence and Post-Traumatic Stress Disorder Among Individuals with Cocaine Dependence

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.