Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders

Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in patients seeking treatment for substance use disorder. The prevalence rate of suicidal ideation and/or suicide attempts was explored among lifetime physically and/or sexually abused patients receiving treatment for drug addiction. The differential characteristics between these patients and those without suicidal behaviours were studied.

Method: Three hundred and seventy-five patients were assessed. Socio-demographic characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and psychopathological symptoms were explored.

Results: Eighty-two patients (21.9%) presented with a history of lifetime abuse and were included in the study (37 men and 45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2% in the last month), and 30.5% with suicide attempts (1.2% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R).

Conclusion: This study highlights the relationship between previous traumatic experiences and suicidal behaviours. According to these results, systematic screening of suicidal risk in patients seeking treatment in addiction centres with histories of abuse is recommended.     

Psychometric Properties of the Posttraumatic Diagnostic Scale (PDS) in Alcohol-Dependent Patients

ABSTRACT

Background: A high prevalence of comorbid posttraumatic stress disorder (PTSD) is found in patients with substance use disorders (SUDs). In the few existing studies, mixed results regarding the psychometric properties of common screening instruments for PTSD have been reported for patients with SUDs. No results are available for the Posttraumatic Diagnostic Scale (PDS), an established self-report measure for PTSD.Methods: The authors assessed 105 patients with alcohol dependence according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (70% male) 2 weeks after their admission to an inpatient detoxification unit. Participants were administered the PDS, the PTSD module of the Structured Clinical Interview for DSM-IV (SCID), as well as measures of depression and anxiety. Patients with other substance use disorders were excluded as were patients reporting no traumatic event. Results: Internal consistencies were good to very good for the total scale (.93) and the subscales of the PDS (.82–.91). In our sample, the PDS had a high specificity (.89) but only moderate sensitivity (.57). Diagnostic agreement with the SCID was 83% (.46). The results of a receiver operating characteristic (ROC) analysis suggested that a PDS score of 8 was the optimal cutoff to screen for PTSD. The highest diagnostic agreement between PDS and SCID (89%; .60) was achieved using a cutoff score of 24. Conclusions: These findings confirm previous results suggesting that the psychometric properties of self-report measures of PTSD in patients with SUDs might differ from those in the general population. When the PDS is used in recently detoxified patients with alcohol dependence, it seems advisable to modify the cutoff score of this instrument to improve its sensitivity and diagnostic accuracy.     

Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment

Background: Levels of mental distress are high in patients with substance use disorders (SUD) and investigation of correlates may broaden our understanding of this comorbidity. Objectives: We investigated self-reported symptoms of mental distress among individuals entering either outpatient opioid maintenance treatment (OMT) or other inpatient SUD treatment and related factors, with a particular focus on perceived self-control. Methods: A cross-sectional study including substance users (n = 548; mean age 34 years; 27% women) entering treatment at 21 different treatment-centers across Norway, interviewed between December 2012 and April 2015. Symptoms of mental distress were assessed with Global Symptom Index (GSI) score. Adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) were estimated through multinomial logistic regression. Results: More than half of the participants in both treatment groups reported mental distress (GSI) above clinical cut-off. The use of alcohol and exposure to violence were associated with increased likelihood of high GSI for both patient groups. Also, lower perceived self-control was related to high GSI in both treatment groups. Conclusion: Symptoms of mental distress were equally common among patients entering OMT and those entering other inpatient SUD treatment, even if the patients differed on a number of clinical characteristics. Use of alcohol and exposure to violence were associated with more mental distress in both groups. Perceived self-control also appeared to be important when explaining symptoms of mental distress among these SUD patients.     

Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate

Background: Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking. Objectives: To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients. Methods: One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4). Results: Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets. Conclusions/Importance: In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.     

Association of Physical Activity with Alcohol Abuse and Dependence in a Nationally-Representative U.S. Sample

Background: Alcohol use is a pervasive and costly public health problem in the United States. Relapse rates from alcohol use disorders are high. Although exercise has been proposed as a strategy to prevent relapse, lifestyle modification is the least studied aspect of relapse prevention programs, especially among racial/ethnic minority populations. Objective: The current study assessed whether being physically active was associated with remission from alcohol abuse or dependence among Black (African American and Afro Caribbean) adults in the U.S. Method: We utilized data on Black adult participants (n = 4,828) from the nationally representative National Survey of American Life (NSAL) conducted in 2001–2003. Logistic regression models were estimated to assess the odds of being in 12-month remission or currently meeting DSM-IV criteria for alcohol abuse or dependence based on level of physical activity, adjusting for socio-demographic and neighborhood characteristics. Results: People who endorsed being physically active had higher odds of being in 12-month remission from alcohol use problems (OR: 1.67, 95% CI: 1.28, 2.17) than people who were physically inactive, adjusting for individual- and neighborhood-level characteristics. People who were physically active did not differ significantly from those who were inactive with respect to odds of currently meeting DSM-IV criteria for alcohol abuse or dependence. Conclusions/Importance: Physical activity was positively associated with being in 12-month remission from alcohol use problems. Longitudinal studies are needed to establish temporal ordering and to explore exercise as a potential relapse prevention strategy for alcohol use problems.     

History of Physical Abuse and Periconceptional Drinking in Pregnant Women

This study examines the relationship between physical abuse and periconceptional drinking in women presenting to a mid-Atlantic, urban hospital-based OB/GYN clinic serving a largely indigent population between April 2003 and May 2004. During their first prenatal visit, 308 women completed a screening battery that included the Abuse Assessment Screen (AAS) and measures of alcohol use, including the CAGE, T-ACE, TWEAK, and the PRIME-MD Patient Health Questionnaire (PHQ). Bivariate analyses, including odds ratios (ORs) and 95% confidence intervals (CIs), revealed that women with a history of physical abuse were more likely to report drinking alcohol within the 3 months prior to their prenatal care visit and were significantly more likely to meet criteria for risk drinking on multiple measures. A history of physical abuse appears to be associated with higher self-reported rates of periconceptional drinking in pregnant women. Study findings support the need for assessment of abuse history as a potential risk factor for alcohol use in pregnant women.     

Violence victimization,help-seeking,and one- and eight-year outcomes of individuals with alcohol use disorders

We examined the associations of recent victimization with subsequent participation in alcohol-related treatment and mutual help, and with short- and long-term drinking and health outcomes. Treatment-naïve men and women having an alcohol use disorder with (n = 73) or without (n = 491) recent violence victimization were assessed at baseline and 1 and 8 years later. Victimized individuals had more days intoxicated, drinking problems, symptoms of depression, and physical health problems at baseline, and were more likely to attend Alcoholics Anonymous (AA) during Year 1. Victimization at baseline predicted re-victimization at 1 year, and more depressive symptoms and physical health problems at 8 years. Participation in alcohol-related treatment or AA during Year 1 was associated with fewer drinking problems. In addition, treatment or AA participation was of greater benefit to victimized individuals in terms of reducing drinking-related or health problems. Alcohol use disorder interventions are effective for men and women with recent victimization, but additional services may be needed to remedy problems with depression and physical health and to prevent further victimization.     

Theoretical and observed subtypes of DSM-IV alcohol abuse and dependence in a general population sample

The purpose of this study was to quantify the degree of heterogeneity of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) alcohol abuse and dependence categories by comparing the number of theoretically predicted subtypes of each category with those observed in a nationally representative sample of the US general population. Among respondents classified with a past year diagnosis of abuse, only 11 (47.8%) of the 23 theoretically predicted subtypes of abuse were observed, while 53 (53.5%) of the 99 theoretically predicted subtypes of dependence were observed in this general population sample. Approximately 90% of the respondents classified with abuse could be represented by three subtypes of abuse and 70% of the respondents with current diagnoses of dependence could be characterized by six subtypes of dependence, indicating the relative homogeneity of both diagnostic categories. Sociodemographic differentials were also observed including the reduction in the number of observed subtypes of abuse and dependence with age as well as the larger numbers of subtypes associated with males and whites relative to females and blacks, respectively. Implications of these results are discussed in terms of increased physical morbidity and disruption of family life as persons with alcohol use disorders age, the potential role of physiological and impaired control over drinking indicators of dependence as critical features of the disorder, and the future need to examine the conceptual basis of the abuse category and to conduct longitudinal epidemiological research.     

Correlates of Co-Occurring Depressive Symptoms and Alcohol Use in an Older Primary Care Clinic Population

ABSTRACT

Objective: This report describes the prevalence and correlates of co-occurring depressive symptoms and alcohol use in an older Veteran's Affairs primary care clinic population.

Methods: Participants include 8,782 older primary care patients (age 65 +) who responded to a self-report, mailed survey. Patients were classified into six mutually exclusive groups based upon screening indicators for problem drinking (quantity/frequency questions) and depressive symptoms (General Health Questionnaire). Groups included: (a) neither problem drinking nor depressive symptoms (n = 6,415, 73.0%); (b) at-risk alcohol use (n = 761; 8.7%); (c) heavy alcohol use (n = 201; 2.3%); (d) depressive symptoms (n = 1,234, 14.1%); (e) depressive symptoms and at-risk alcohol use (n = 120; 1.4%); and (f) depressive symptoms and heavy alcohol use (n = 51; 0.6%). Chi-square and ANOVA were used to test for equality of demographic and clinical characteristics across groups.

Results: 12.9% of patients reported alcohol use consistent with problem drinking (including 10.0% with at-risk alcohol use and 2.9% with heavy alcohol use) and 16.1% screened positive for possible depressive symptoms (including 2.0% with co-occurring at-risk or heavy alcohol use). The combination of heavy alcohol use and depressive symptoms was associated with the highest rates of death and suicidal ideation; living alone; being divorced, separated, or widowed; and regular cigarette smoking. The presence of depressive symptoms (regardless of amount of alcohol use) was associated with worse perceived health, and perceived lack of social support. Finally, individuals with at-risk alcohol use alone were younger and had better perceived health compared to those with non-problem alcohol use or no alcohol use. However, there were no differences between those with at-risk drinking and depressive symptoms and those with depressive symptoms alone.

Conclusions: Self-reported heavy alcohol use combined with depressive symptoms identifies a subgroup of older primary care patients at especially high risk with respect to suicidal ideation and poor mental and physical well-being. In contrast, older adults with depressive symptoms and self-reported “at-risk” alcohol use were not differentiated from older persons with depressive symptoms reporting non-problematic or nonuse of alcohol.     

Physical pain and impulsivity in alcohol-dependent patients

Background: Physical pain and impulsivity are considered to be prevalent and significant factors that influence the course of alcohol dependence. The aim of the study was to investigate relationships between different dimensions of impulsivity and the current experience of physical pain in individuals entering alcohol treatment.

Method: A sample of 366 (73.5% men and 26.5% women) DSM-IV alcohol-dependent subjects was recruited in alcohol treatment centers in Poland. The study sample was divided into a ‘mild or no pain’ group (65.6%) and a ‘moderate or greater pain’ group (34.4%). Levels of impulsivity were measured by the stop-signal task as well as the total and subscale scores of the Barratt Impulsiveness Scale (BIS-11).

Results: The experience of physical pain was significantly associated with higher levels of impulsivity as measured by both total BIS-11 scores and longer stop reaction times. Physical pain remained as independent correlate of behavioral impulsivity (stop reaction time) and the BIS-11 subscale of attentional impulsivity while controlling for other variables. An additional analysis revealed that BIS-11 scores were not associated with stop reaction times.

Conclusions: Physical pain is an independent correlate of both subjectively reported and objectively measured levels of impulsivity. Therapeutic interventions aimed at reducing pain in alcohol-dependent individuals should be studied to evaluate their impact on improving attention and behavioral control.     

癌症疼痛患者阿片类药物的滥用风险评估和管理

阿片类药物是癌症疼痛(简称癌痛)治疗的基础用药,因其安全性良好、给药途径多样、易于剂量滴定、对所有类型疼痛有效而广泛用于癌痛的治疗。随着癌症诊疗技术的提高和患者生存期的延长,癌痛患者接受阿片类药物治疗的时间可能更长,其滥用风险可能高于既往认知。该文旨在综述阿片类药物滥用的危险因素、风险评估工具和监测方法,以期更好地预测、识别和管理癌痛患者阿片类药物滥用行为,优化阿片类药物的可及性、有效性和安全性之间的平衡。     

Comparison of Substance Use Milestones in Cannabis- and Cocaine-Dependent Patients

Objectives: To compare the progression of substance use milestones between cocaine- and cannabis-dependent patients. Methods: Using data gathered from two separate clinical studies for treatment of cocaine dependence and cannabis dependence, 130 cannabis-dependent and 112 cocaine-dependent individuals were compared on milestones related to their substance use. Results: In cannabis- vs. cocaine-dependent patients, the mean age of first use, regular use and first treatment contact differed significantly. No statistically significant differences were found between the two groups for other measured milestones. Conclusions: These results differ from most epidemiologic studies that suggest cocaine users progress more rapidly to regular use and treatment contact.     

Physical Dependence on Ethanol During Multiple Intoxication and Withdrawal Episodes in the Rat: Evidence of a Potentiation

Abstract: An animal model of repeated alcohol intoxication-withdrawal episodes consisting in a 2-day period of intoxication followed by 5 days abstinence in a 17 week period of study is presented. Gastric intubation was used. As a group the animals presented a statistically significant increase of convulsive withdrawal phenomena which during the 10th and 17th episode was comparable to the withdrawal reaction in abstinent 4-day alcohol-intoxicated animals. It is suggested that the present model may represent a paradigm for the study of effects of multiple ethanol withdrawal episodes.     

物理疗法结合推拿治疗颈肩综合征30例临床观察

目的:观察物理疗法结合推拿治疗颈肩综合征的效果.方法:将60例患者随机分为治疗组和对照组,每组各30例.治疗组给予超短波、中频和推拿按摩治疗,对照组仅给予超短波和中频治疗.2个疗程之后比较2组疗效差别.结果:治疗组有效率96.7%,明显优于对照组的83.3%.结论:物理因子结合推拿治疗颈肩综合征能够取得更加明显的疗效,...     

基层医院社区癌症患者疼痛治疗分析

目的评价社区癌症患者疼痛的治疗用药。方法 对84例门诊癌痛患者的疼痛治疗方案和不良反应预防的情况进行回顾性分析。结果按指南标准进行首次治疗处理的共41例(占48.81%),按指南标准进行后续治疗处理的共28例(占33.33%),按指南标准进行阿片类药物的处方、滴定和维持,并阿片类药物间剂量换算正确的共16例(占19.05%);按指南标准正确给予治疗方案后治疗有效率为100%;未按指南标准正确给予治疗方案的治疗有效率为72.06%。同时给予缓泻剂通便治疗的占15.48%。结论社区癌症患者疼痛治疗存在差距,治疗水平有待提高。     

换用文拉法辛或度洛西汀对抑郁症残留症状的疗效观察

目的 探索文拉法辛或度洛西汀对选择性五羟色胺再摄取抑制剂（selective serotonin reuptake inhibitor,SSRI）类药物抗抑郁疗效不佳抑郁症患者的疗效及安全性。方法 对2015年11月-2016年10月间就诊且SSRI类抗抑郁药疗效不佳或有残余症状的96例首发抑郁症患者,以单纯随机的方式分为2组,经洗脱期后,分别给予可变剂量的文拉法辛或度洛西汀治疗,进行为期12周的前瞻性研究,在基线及第2,4,6,8,12周末评定汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD-17）、汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、治疗出现的不良反应量表（Treatment Emergent Symptom Scale,TESS）;同时由患者自评快感缺失量表（Snaith-Hamilton Pleasure Scale,SHAPS）、愉快情绪体验量表（Temporal Experience Pleasure Scale,TEPS）,分析和评价2组的疗效及安全性。结果 12周末,换用去甲肾上腺素和五羟色胺再摄取抑制剂（serotonin and norepinephrine reuptake inhibitor,SNRI）类药物后,患者总体有效率和治愈率分别为73.96%和39.58%,同治疗前相比,HAMD-17、HAMA、SHAPS、TEPS分值均有较大改善（P<0.05或P<0.01）,但文拉法辛组及度洛西汀组间的疗效无统计学差异（P>0.05）。2组的不良反应相似,主要为口干、便秘、乏力、性功能障碍等,但文拉法辛组的血压增高现象略多（P<0.05）。结论 SSRI类药物抗抑郁疗效不佳者,换用SNRI类药物后能有效改善包括快感缺失在内的抑郁症状。文拉法辛和度洛西汀疗效相近,安全性均较好,其中文拉法辛对血压影响较度洛西汀明显,应慎用于高血压患者。     

Anxiety and Suicidal Ideation Predict Successful Completion of Substance Abuse Treatment in a Criminal Justice Sample

The goal of this study was to identify predictors of successful substance abuse treatment in an out-patient clinic for individuals being monitored under community corrections supervision. Of the 615 participants, 117 (19%) successfully completed treatment. The results of a multivariate logistic regression analysis indicated that successful treatment was associated with several baseline characteristics including: older age, White race, having greater than a high school education, lower level of care, meeting criteria for an anxiety disorder, reporting suicidal ideation, and not having a history of opioid use. The value of self-report of problems and its influence on treatment in the culture of the criminal justice population is discussed in this article.     

Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.     

Risky alcohol use and age at onset of regular alcohol consumption in relation to frontal lobe indices,reward sensitivity,and rash impulsiveness

Excessive alcohol consumption has been linked to predisposing traits that may reflect frontal lobe functioning, an idea explored by this study. The study recruited 132 adults of both genders aged 18–68 years who completed an online questionnaire battery. Sensitivity to punishment was the primary variable associated with age of onset for weekly drinking. The relationship between disinhibition and drinking behavior, as assessed by the AUDIT, was partially mediated by sensitivity to reward. The findings of this study suggest that several interrelated and heritable personality and neurobehavioral traits may promote earlier as well as riskier alcohol consumption.