Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities

Background: Little is known about characteristic profiles of substance use – and their individual- and neighborhood-level correlates – among high-risk youth. Objectives: To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors. Methods: Individual-level measures came from screening surveys administered to youth aged 14–24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership. Results: Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant. Conclusion: Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.     

Characterization of South African adolescents with alcohol use disorders but without psychiatric or polysubstance comorbidity

Background: Individuals who begin drinking during early adolescence and exhibit externalizing pathology and disinhibitory/dysregulatory tendencies are more vulnerable to developing alcohol use disorders (AUDs) in adulthood. Previous research has focused on in‐treatment populations with substantial comorbid psychopathology and polysubstance use. Here, we characterize a unique sample of treatment‐naïve adolescents without such comorbidity to help identify vulnerable youth who may benefit from early intervention. Methods: We compared externalizing propensity, disinhibitory characteristics, and school performance in adolescents with AUDs (but without comorbid psychopathology or other substance use; n = 70) to those of demographically matched controls (n = 70). Within the AUD group, we compared measures of substance use and the disinhibitory syndrome between boys and girls with differing severity of externalizing propensity. Results: Adolescents with AUDs demonstrated more externalizing propensity and disinhibitory personality traits (impulsivity, novelty seeking, and excitement seeking), poorer self‐monitoring and response inhibition, more bullying and sexual risk‐taking behavior, poorer first‐language performance, and greater use of alcohol, cannabis, and nicotine (p < 0.05). Within the AUD group, participants with higher externalizing propensity began drinking earlier, more frequently, and for a longer duration than those with lower externalizing symptoms (p < 0.05). Disinhibitory features (personality, cognition, and behavior) were, however, not stronger in those with higher externalizing propensity. Conclusions: We suggest that the constructs of externalizing propensity and disinhibitory syndrome are useful in characterizing treatment‐naïve adolescents with AUDs but without comorbid psychopathology or polysubstance use. These results support the importance of these constructs in understanding adolescent AUDs, even when the frank externalizing diagnoses of childhood (oppositional defiant disorder and conduct disorder) are excluded.     

Course,Severity, and Treatment of Substance Abuse Among Women Versus Men

Objective: To assess the course and severity of substance-related disorder (SRD) in relation to gender. Design: Retrospective data on course were obtained for several indices of substance use, abuse, and related morbidity. Setting: Two university medical centers with alcohol-drug programs located in departments of psychiatry. Subjects: A total of 642 patients were assessed, of whom 365 (57%) were men and 277 (43%) were women. Methods: Data on course included demographic characteristics, family history of substance abuse, lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems (one patient rated and one interviewer rated), substance abuse versus dependence, self-help activities, and previous treatment. Results: Women were more apt to be homemakers; to have a sibling or, if married, a spouse who abused substances; to be less apt to have ever used hallucinogens or inhalants; to have used substances for fewer years; to have used cannabis and inhalants for fewer days in the last year; to have a lower rate of current cannabis abuse/dependence; to have fewer legal problems related to substances (especially driving while intoxicated [DWI] charges); to have fewer outpatient admissions to treatment; to have fewer admissions to substance abuse treatment (all categories together), fewer lifetime days in treatment, and lower overall treatment cost (for all categories of treatment together). Conclusions: These data confirm earlier reports of a shorter course, less deviant drug usage, and—if married—a substance-abusing spouse. In addition, we found higher rates of familial substance abuse and lower rates of lifetime admissions, treatment days, and total cost of substance abuse treatment. Homemaking responsibilities, a substance-abusing spouse, a male-oriented treatment system, and/or a more rapid course may reduce substance abuse treatment for women.     

Perceived functions predict intensity of use and problems in young polysubstance users

Aims To model consumption patterns and problems associated with alcohol, cannabis, ecstasy, amphetamine and cocaine hydrochloride use in a non‐treatment sample of young polysubstance users. Design A cross‐sectional survey of 364 16–22‐year‐old (56.3% male) polysubstance users recruited and interviewed by peer interviewers. Measurements Structured questionnaires were used to gather identical datasets on the five target psychoactive substances, recording patterns of substance use; adverse consequences from use; negative effects; functions for substance use; and perceived peer use. Findings Functions for substance use strongly predicted intensity of use in all five substances when peer use, age of first use and demographics were controlled, explaining an additional 11–19% of the variance in scores. Functions also explained an average of 22% of the variance in problem scores over and above the effects of background variables and current intensity of use. In particular, functions concerned with relief from negative mood states were strong predictors of problem scores in alcohol, cannabis and cocaine. Conclusions The potential implications of using a functional approach to explaining and responding to substance use are considerable. This could help to enhance our understanding of how experimental substance use becomes regular and how regular use becomes problematic, and could thus inform prevention, education and intervention efforts.     

Inhalant Abuse and the Abuse of Other Drugs*

Aims: To examine the relationship between inhalant abuse and other substances of abuse. Design: Survey using a structured interview administered by a single trained interviewer. Setting: A juvenile detention facility. Participants: 209 children incarcerated at the facility over a 3-month period. Selection Procedure: Consecutive sample. Interventions: None. Measurements/Findings: The structured interview was adapted from the American Drug and Alcohol Survey, which has been extensively used to obtain substance abuse epidemiologic data. We collected information on inhalants, alcohol, marijuana, downers, pep pills, lysergic acid diethylamide (LSD), cocaine, designer drugs, phencyclidine (PCP), Talwin and Ritalin, speed, and narcotics. The chi-square or Fisher exact test were used when appropriate. Mean ages of initial experimentation were as follows: inhalants, 9.7 years; marijuana, 11.9 years; alcohol (inebriated), 12.0 years; cigarettes, 11.2 years; for the remaining substances of abuse, the mean age was 13.2–14.7 years. Thirty subjects had used inhalants. Significant relationships were found between inhalants and cocaine (p =. 004), Talwin and Ritalin (p =. 001), downers (p =. 01), and narcotics (p =. 003). Conclusions: For children incarcerated in a juvenile detention facility in our community, inhalant abuse is associated with the later use of other substances of abuse. If this finding is replicated in other populations, it underscores the need for effective preventive strategies.     

American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions

Background: American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. Objectives and Methods: The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. Results: Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. Conclusions: Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.     

Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy

Pregnancy is a time of relative urgency and opportunity for the treatment of substance use disorders in women, yet little is known about modifiable factors that contribute to successful abstinence. We examined self-worth, depression, anxiety, and novelty seeking in the context of substance use cessation during pregnancy in a sample of women with a high prevalence of substance abuse. Subjects were 448 birth mothers who participated in a prospective adoption study. Discontinuation rates were: tobacco 22.2%, alcohol 64.7%, marijuana 77.2%, and other drugs, 73.7-100%. Depression, anxiety, and novelty seeking were lower among women who discontinued substance use, compared to those who did not. Self-worth was higher in women who discontinued substance use. Among 110 polysubstance users, the number of substances discontinued during pregnancy was correlated with depression, anxiety, and self-worth in the hypothesized direction. Possible clinical implications are discussed.     

Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology

Background: Adolescent cannabis use is associated with increased risk for psychological problems, with evidence for more severe problems among youth who use cannabis in combination with other substances (i.e., polysubstance use). Juvenile offenders engage in both cannabis use and polysubstance use at higher rates than the general adolescent population. Yet, limited research has examined the relationship between cannabis poly-use (e.g., cannabis and alcohol use) and functional or psychological problems among juvenile offenders.

Objectives: The current study addresses this gap by examining the association of polysubstance use of cannabis compared to cannabis only use with cognitive functioning, psychological distress, and substance-related problems among juvenile detainees.

Methods: Participants were 238 detained youth ages 12–18 (80.4 % male, 77.3% non-White) who completed assessments of substance use, intellectual functioning, psychological symptoms, and substance-related problems. Youth were also assessed by a clinical psychologist for substance use disorder.

Results: Four cannabis-use typologies were identified; cannabis and alcohol use was the largest class, followed by cannabis only use, cannabis, alcohol and other drug use, then cannabis and other drug use. Polysubstance use was associated with lower scores on measures of intellectual functioning, more externalizing and internalizing symptomology, and more substance-related problems relative to cannabis only use. However, the relationship between polysubstance use and problems varied by typology.

Conclusions: Findings suggest that justice-involved youth engaged in polysubstance use may be at greater need for concurrent academic, affective, and behavioral support in their rehabilitation and transition back to the community.     

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia

ABSTRACT

Background: While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. Objectives: To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. Methods: A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Results: Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Conclusion: Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.     

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

Abstract

Background: Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients. Objectives: This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment. Methods: Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n?=?66), past but not current use (n?=?124) or current use (n?=?49). Results: Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI]?=?3.9 [1.0–15.7] and 5.2 [1.6–17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI]?=?2.9 [1.1–7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI]?=?8.1 [1.94–33.44]). Conclusion: Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.     

Substance use among bi/multiracial youth in the United States: Profiles of psychosocial risk and protection

Background: Bi/multiracial youth face higher risk of engaging in substance use than most monoracial youth. Objectives: This study contrasts the prevalence of substance use among bi/multiracial youth with that of youth from other racial/ethnic groups, and identifies distinct profiles of bi/multiracial youth by examining their substance use risk. Methods: Using data from the National Survey on Drug Use and Health (collected between 2002 and 2014), we analyze data for 9,339 bi/multiracial youth ages 12–17 living in the United States. Analyses use multinomial regression and latent class analysis. Results: With few exceptions, bi/multiracial youth in general report higher levels of tobacco, alcohol, marijuana, and other illicit drug use compared to other youth of color. Bi/multiracial youth also report higher levels of marijuana use compared to non-Hispanic white adolescents. However, latent class modeling also revealed that a majority (54%) of bi/multiracial youth experience high levels of psychosocial protection (i.e., strong antidrug views and elevated parental engagement) and low levels of psychosocial risk (i.e., low peer substance use, school-related problems, and social-environmental risk), and report very low levels of substance use. Substance use was found to be particularly elevated among a minority of bi/multiracial youth (28%) reporting elevated psychosocial risk and low levels of protection. Bi/multiracial youth characterized by both elevated psychosocial risk and elevated psychosocial protection (22%) reported significantly elevated substance use as well. Conclusions: While bi/multiracial youth in general exhibit elevated levels of substance use, substantial heterogeneity exists among this rapidly-growing demographic.     

Local spatial clustering in youths’ use of tobacco,alcohol, and marijuana in Boston

ABSTRACT

Background: Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods. Objectives: The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana. Methods: Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13–19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included “none,” “1–2,” “3–9,” and “10 or more.” The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan? software package. Results: Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models. Conclusion: Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.     

Personality traits and negative consequences associated with binge drinking and marijuana use in college students

Background: Binge drinking is common in college students, and many drink in quantities greater than the standard definition of bingeing. Combined use of additional substances, particularly marijuana, is also common. Objectives: Increased impulsivity and sensation seeking are risk factors for bingeing, and this study was designed to characterize their association with extreme compared to standard bingeing, as well as with combined bingeing and marijuana use. Negative consequences of alcohol use were also investigated. Methods: Self-report personality measures and a measure of the negative consequences of alcohol use were given to a sample of 221 college students (109 females) sorted into a control and 4 binge groups based upon their patterns of bingeing and marijuana use. Narrowly defined, non-overlapping measures of impulsivity and sensation seeking were analyzed to assess the association of these personality measures with substance-use patterns and negative consequences of bingeing. Results: Standard bingers did not differ from non-bingeing controls on either impulsivity or sensation seeking, whereas extreme bingers had significantly higher impulsivity and sensation seeking scores than controls and also significantly higher sensation seeking than standard bingers. Exploratory analyses of a broader set of personality scales showed that a disinhibition scale was also significant predictor of substance use group. A number of personality traits significantly predicted substance use patterns as well as specific negative consequences of bingeing. Conclusions: Impulsivity, sensation seeking and disinhibition are significant associates of substance use patterns and the negative consequences of use in college students.     

Conjoint developmental trajectories of young adult substance use

Background. Despite the prominence of comorbidity among substances and the recent attention focused on trajectory‐based approaches to characterizing developmental change, little research in the substance use field has simultaneously considered both course and comorbidity. Methods. Using nationally representative panel data from the Monitoring the Future Project (MTF; n = 32,087; 56% female; 82% Caucasian), we identified developmental courses of heavy drinking, smoking, and marijuana use using 4 waves of data spanning ages 18 to 26 in a multi‐cohort young adult sample. Comorbidity was examined by cross‐classifying group membership in substance use trajectories. Finally, the extent to which risk factors (sex, race, alcohol expectancies, delinquency, sensation seeking, depressive affect, religiosity, academic achievement, and parent education) accounted for combinations of comorbidity that occurred at a rate greater than chance was examined. Results. For each substance, we identified 4 courses of substance use that were largely consistent with those found in the literature (chronic high use, late‐onset use, developmentally limited use, and low‐use), with a fifth moderate smoking group. Heavy drinking, smoking, and marijuana use were each highly associated, and distinct patterns of comorbidity were evident, with greatest agreement along the diagonal. All risk factors explained comorbidity to some degree, with delinquency, sensation seeking, alcohol expectancies, and religion in particular predicting combinations of comorbidity that were characterized by early onset and chronic high use. Conclusions. Cross‐substance trajectory concordance was high, with parallel changes in substance use over emerging adulthood. This suggests similar developmental timing of use, perhaps due to the experience of developmental transitions that have a common influence on use of different substances. Prediction of combinations of comorbidity characterized by early onset and persistently high use suggests that to some extent, individuals use multiple substances because of a common vulnerability to each, rather than directional relations among substances (e.g., cross‐tolerance, cueing).     

Use of Salvia divinorum in a Nationally Representative Sample

Background: Salvia divinorum has known hallucinogenic effects and is legal in most parts of the United States. Given that this psychoactive substance has a potential of misuse and abuse, further data regarding the clinical and psychosocial factors associated with use are needed. Objectives: To examine the clinical and psychosocial characteristics associated with use of salvia. Methods: The study uses data from the National Survey on Drug Use and Health, 2008 (N = 55,623). Results: The results of this study suggest that salvia use is most common among young adults aged 18–25 years as well as individuals who had engaged in risk-taking behaviors (selling illicit drugs, stealing) or illicit drug use (especially other hallucinogens/ecstasy). Self-reported depression and anxiety were also associated with salvia use. Conclusions/Scientific Significance: The results provide evidence that salvia use is part of a broader constellation of psychosocial and behavioral problems among youth and young adults. The accessibility, legal status, and psychoactive effects of salvia can be a potentially complicating health risk to young people, especially among those with existing substance use problems.     

Course, severity, and treatment of substance abuse among women versus men

OBJECTIVE: To assess the course and severity of substance-related disorder (SRD) in relation to gender. DESIGN: Retrospective data on course were obtained for several indices of substance use, abuse, and related morbidity. SETTING: Two university medical centers with alcohol-drug programs located in departments of psychiatry. SUBJECTS: A total of 642 patients were assessed, of whom 365 (57%) were men and 277 (43%) were women. METHODS: Data on course included demographic characteristics, family history of substance abuse, lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems (one patient rated and one interviewer rated), substance abuse versus dependence, self-help activities, and previous treatment. RESULTS: Women were more apt to be homemakers; to have a sibling or, if married, a spouse who abused substances; to be less apt to have ever used hallucinogens or inhalants; to have used substances for fewer years; to have used cannabis and inhalants for fewer days in the last year; to have a lower rate of current cannabis abuse/dependence; to have fewer legal problems related to substances (especially driving while intoxicated [DWI] charges); to have fewer outpatient admissions to treatment; to have fewer admissions to substance abuse treatment (all categories together), fewer lifetime days in treatment, and lower overall treatment cost (for all categories of treatment together). CONCLUSIONS: These data confirm earlier reports of a shorter course, less deviant drug usage, and--if married--a substance-abusing spouse. In addition, we found higher rates of familial substance abuse and lower rates of lifetime admissions, treatment days, and total cost of substance abuse treatment. Homemaking responsibilities, a substance-abusing spouse, a male-oriented treatment system, and/or a more rapid course may reduce substance abuse treatment for women.     

Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth

Background: American Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15–24. Objectives: This article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US. Methods: White Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15–24 years. Findings regarding characteristics of co-occurrence – including differences in the type of self-harm behavior, gender, and reported reasons for the act – were interpreted through a community-based participatory research process. Results: From 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15–24 were “drunk or high” at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were “drunk or high” during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males. Conclusion: High rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions. Scientific Significance: Tribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.     

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 an international nightlife resort in the proliferation of recreational drugs

Aims The study compares types, frequencies and quantities of substances used by young people while holidaying in the international dance resort of Ibiza (Spain) with their patterns of use in the United Kingdom. It measures changes in substance use at both locations between 1999 and 2002 and examines the role of dance resorts in recruiting individuals into using new substances. Design Data were collected from visitors to Ibiza in 1999 (n = 846) and 2002 (n = 868). Information on drug use was surveyed through a short anonymous questionnaire. Setting Individuals were sampled at Ibiza airport just prior to returning to the UK. Findings Most individuals visiting Ibiza used illicit drugs in the United Kingdom (57.4% in 2002), with nearly all users continuing to use in Ibiza. Use of most drugs in Ibiza was characterized by binge behaviour, with many individuals using drugs 5 or more nights per week. Proportions using cocaine, ecstasy and GHB have risen significantly (1999–2002) in both locations, as have numbers of ecstasy tablets taken on a usual night. Substance use was associated positively with number of previous visits to Ibiza and new users were recruited into use while abroad (17.4 and 33.1 per 1000 people were introduced to cocaine and ecstasy use, respectively, in Ibiza). Conclusions The emergence of international nightlife resorts increasingly links drug use abroad with that in individuals’ countries of origin. Our results indicate that resorts such as Ibiza offer tourists the opportunity to increase levels of drug consumption and try different substances in an atmosphere conducive to experimentation. Patterns of recreational drug use in leading international resorts may help predict developments in drug use elsewhere and as such be an important tool in planning appropriate interventions.