Substance misuse and substance use disorders in sex offenders: a review

Substance abuse has often been associated with committing sex offenses. In this article, the following will be reviewed: 1) studies that assessed substance abuse in sex offenders; 2) differences in substance abuse among different types of sex offenders; 3) differences in substance abuse between sex offenders and nonsexual offenders and substance abuse in the normal population; 4) sex offenders’ intoxication at the time of the offense; and 5) differences in intoxication at the time of the offense among different types of sex offenders. Studies will be discussed according to the method they used to assess substance abuse, i.e., file research, screening instruments or semi-structured interviews. This review shows that about half of the sex offenders has a history of substance abuse, a quarter to half of the sex offenders has a history of alcohol misuse and that about one fifth to a quarter of the sex offenders has a history of drug misuse. Furthermore, about a quarter to half of the sex offenders appeared to be intoxicated at the time of the offense. The review results in recommendations for future research. Because of the high prevalence of substance abuse in sex offenders it is advisable to routinely screen for substance abuse and, if necessary, to treat substance abuse.     

Electrodermal reactivity and its association to substance use disorders

Poor electrodermal response modulation is associated with substance use disorders, but the specificity of the relationship has not been tested. To test this, 112 college students were assessed for psychiatric symptoms using structured interviews and for ability to modulate skin conductance responses to 2-s 92- or 110-dB white noise blasts that varied in temporal predictability. Twenty-eight good and 28 poor modulators were compared on symptoms of alcohol and illicit drug use disorders, personality disorders (antisocial, borderline, histrionic, and narcissistic), social and specific phobia, and depression. As expected, poor modulators had significantly more symptoms of substance use disorders than good modulators. Groups did not differ in symptoms of anxiety disorder, depression, or personality disorders marked by disinhibition. Poor electrodermal response modulation may reflect a biological risk factor for substance use disorders in particular.     

Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention

This review examines the empirical literature on the relationship between internalizing disorders and substance use disorders (SUDs) in youth in terms of (a) comorbidity rates, (b) risk relationships, (c) temporal sequencing, and (d) implications for intervention. Findings from community and clinical samples suggest that comorbidity rates range from 9.0 to 47.9%. The majority of the evidence supports the temporal precedence of internalizing disorders before substance use disorders and a unidirectional risk model in which internalizing disorders increase risk for later substance use disorders. Implications of this relationship for interventions are considered, both in terms of treatment outcome for principal disorders and in terms of the potential “secondary benefit” of treating one disorder for preventing or reducing risk of the other. Finally, recommendations for future research on the relationship between internalizing disorders and SUDs in youth are discussed.     

New clinical strategies of assessment of comorbidity associated with substance use disorders

The introduction of “dual diagnosis” had the merit of drawing attention on substance use among patients with mental illness. In due course, as what often happens with innovations, the concept of dual diagnosis displayed considerable limitations and was progressively replaced by comorbidity.This paper critically reviews the limitations of dual diagnosis and comorbidity and formulates an alternative proposal based on clinimetric methods.In many instances of diagnostic reasoning in psychiatry and in clinical psychology, the process ends with the identification of the disorders and their diagnoses. However, diagnostic end-points, the customary guidance of diagnostic reasoning, should be replaced by the conceptualization of disorders as “transfer stations,” which are amenable to longitudinal verification and modification. Indeed, diagnoses might encompass a wide range of manifestations, seriousness, prognosis, and response to treatment that need to be evaluated. A new clinimetric approach which takes advantage of clinimetric methods (including macro-analysis, micro-analysis, staging, and evaluation of subclinical symptoms) is proposed. This approach may allow an accurate analysis of the different problem areas of each patient and their hierarchical organization and may yield important implications for mental health and substance abuse clinics.     

The relationship among social support,self‐esteem,affect balance and loneliness in individuals with substance use disorders in China

This study analyzed the potential mediating role of self‐esteem and affect balance on the relationship between social support and loneliness. Respondents were 426 substabce use disorders from the Shifosi and Dalianshan rehab facilities in China who had completed the Multidimensional Scale of Perceived Social Support, Rosenberg Self‐Esteem Scale, Positive and Negative Affect Scales, and UCLA Loneliness Scale. The results indicated that self‐esteem and affect balance fully mediated the relationship between perceived social support and loneliness and all the paths, ranging from social support through self‐esteem and affect balance to loneliness, were significant. Finally, we analyzed possible approaches to decreasing individuals with substance use disorders' loneliness.     

A systematic review of the relationship between psychological disorders or substance use and self-reported cognitive failures

Introduction: Cognitive failures are errors in normal everyday functioning. Individuals with psychological disorders may possess heightened vulnerability. We sought to review the literature on cognitive failures in psychological disorders to determine the nature of this association, and whether failures relate to neuropsychological performance. We also examine the relationship between cognitive failures and substance use since it is relevant to everyday cognition and co-occurs in many psychological disorders.

Methods: We conducted a systematic review of self-reported cognitive failures in psychological disorders and substance use, identifying 21 papers in total.

Results: Papers identified studied trauma, mood, and anxiety disorders, and schizophrenia. Substance use papers included nicotine, alcohol, cannabis, and ecstasy use. Cognitive failures were increased in some but not all papers; the most consistent findings were for depression, PTSD, and daily smokers of nicotine. Subjective failures did not correlate closely with neuropsychological outcomes in any disorders. We were unable to discern distinct profiles of failures for each disorder; rather they may reflect emotional dysregulation more broadly.

Conclusions: The real world cognitive experiences of people with psychological disorders may differ to their performance in the clinic or lab. It is important that self-reports of minor cognitive issues are considered as both a potential risk and a maintaining factor of illness. Substance use also needs to be considered in assessing cognitive failures.     

Addressing tobacco use disorder in smokers in early remission from alcohol dependence: The case for integrating smoking cessation services in substance use disorder treatment programs

Despite the declining overall rate of cigarette smoking in the general population in the United States, the prevalence of smoking is estimated to be as high as 80% among treatment-seeking alcoholics. The serious adverse health effects of tobacco and heavy alcohol use are synergistic and recent evidence suggests that smoking slows the process of cognitive recovery following alcohol abstinence. In addition, substantial evidence shows that treatment for tobacco dependence does not jeopardize alcohol abstinence. In this paper, we focus on the impact and treatment implications of tobacco dependence among treatment-seeking alcoholics through a review of five areas of research. We begin with brief reviews of two areas of research: studies investigating the genetic and neurobiological vulnerability of comorbid tobacco and alcohol dependence and studies investigating the consequences of comorbid dependence on neurobiological and cognitive functioning. We then review literature on the effects of smoking cessation on drinking urges and alcohol use and the effectiveness of smoking cessation interventions with alcoholic smokers. Finally, we offer recommendations for research with an emphasis on clinical research for enhancing smoking cessation outcomes in this population.     

Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: a review

This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders.     

Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis

Narrative reviews conclude that behavioral couples therapy (BCT) produces better outcomes than individual-based treatment for alcoholism and drug abuse problems (e.g., [Epstein, E. E., & McCrady, B. S. (1998). Behavioral couples treatment of alcohol and drug use disorders: Current status and innovations. Clinical Psychology Review, 18(6), 689-711; O'Farrell, T. J., & Fals-Stewart, W. (2003). Alcohol abuse. Journal of Marital and Family Therapy, 29(1), 121-146]). However, the strength and consistency of this effect favoring BCT has not been examined because a meta-analysis of BCT studies has not been reported. This meta-analysis combines multiple well controlled studies to help clarify the overall impact of BCT in the treatment of substance use disorders. A comprehensive literature search produced 12 randomized controlled trials (n=754) that were included in the final analyses. There was a clear overall advantage of including BCT compared to individual-based treatments (Cohen's d=0.54). This was true across outcome domains (frequency of use d=0.36, consequences of use d=0.52, and relationship satisfaction d=0.57). However the pattern of results varied as a function of time. BCT was superior to control conditions only in relationship satisfaction at posttreatment (d=0.64). However, at follow-up BCT was superior on all three outcome domains (frequency of use d=0.45, consequences of use d=0.50, and relationship satisfaction d=0.51). In addition to other control conditions, BCT also outperformed individual cognitive behavioral therapy without couples therapy (d=0.42). Larger sample sizes were associated with higher effect sizes (p=0.02). However, treatment dose and publication year were not related to effect size. Overall, BCT shows better outcomes than more typical individual-based treatment for married or cohabiting individuals who seek help for alcohol dependence or drug dependence problems. The benefit for BCT with low severity problem drinkers has received little attention and one study suggests its efficacy may not extend to this subgroup.     

Life events and suicidal ideation and behavior: A systematic review

Despite the sustained theoretical and empirical interest over the past 40 years in the association between life events and suicidal ideation and behavior, the literature in this area has yet to be systematically reviewed. The current article provides a comprehensive review of the empirical literature pertaining to life events in relation to at least one aspect of suicidal ideation and behavior (i.e., suicidal ideation, plans, attempts, degree of suicidal intent, medical severity of attempt, repeat versus first lifetime attempt status, and death by suicide). A total of 95 articles meeting inclusion criteria were identified by a literature search using Medline and PsycINFO. Evidence for an association between negative life events and suicidal ideation and behavior was generally consistent, with strongest support found for more severe than with less severe forms of suicidal ideation and behavior. Support for an inverse relation between positive events and suicidal ideation and behavior was generally lacking. Although there is general support for life stressors as a risk factor for suicidal ideation and behavior, interpretation of these findings is constrained by methodological limitations prevalent in much of the literature, particularly in the case of suicidal ideation and suicide plans. Recommendations for future research are provided.     

Family therapy for schizophrenia: co-occurring psychotic and substance use disorders

People with schizophrenia have a high prevalence of co-occurring substance use disorders, which is related to a worse course of psychiatric illness, more frequent relapses, and increased depression and suicide, compared with those with schizophrenia alone. The Family Intervention for Dual Diagnosis (FIDD) program, which includes psychoeducation and goal setting and focuses on building communication and problem-solving skills within the family, can aid in decreasing the stress related to having a close relationship with someone with a dual disorder. Here, the case of a young man with psychosis and marijuana dependence is examined. This article describes how the FIDD intervention helped him with his problematic substance use, as well as to build skills within his relationship for increased empathy and reduced interpersonal stress.     

酒精所致精神障碍患者生活事件和社会支持调查

目的：了解生活事件和社会支持与酒精所致精神障碍发病的关系。方法：采用生活事件量表和社会支持评定量表作评定工具．对47例酒精所致精神障碍患者和47例正常人进行对照研究。结果：酒精所致精神障碍患者负性事件、独立性事件、家庭有关问题、工作学习中的问题及生活事件频数和紧张值均显著高于正常人组，而主观感受分、客观支持分、支持利用分及社会支持量表总分均低于正常人组。结论：不良生活事件频数和紧张值及社会支持不足与酒精所致精神障碍的发病密切相关。     

Exploring African-American womens' experiences with substance use treatment: A review of the literature

The aim of this systematic review is to synthesize evidence on treatment barriers among African-American women who seek treatment for substance use disorders. The authors reviewed articles from 1995 to 2018 on the topic of substance use disorders among African-American women. Based on the review of 13 articles, we found African-American women were more likely to encounter treatment readiness barriers compared to access barriers and system-related barriers. Personal and interpersonal barriers were more readily identified throughout the literature reviewed. However, African-American women did encounter other barriers such as access- and system-related barriers. In addition, the intersection of race, gender, and class was not addressed in the specific articles, but should be considered when working to remove treatment barriers for this population. While prevalence of alcohol and drug use is limited among African-American women, it is important to understand how treatment readiness barriers may limit successful completion of treatment and ongoing progress. Implications for treatment and future research in addressing barriers to treatment for African-American women are discussed.     

Life events and the dexamethasone suppression test in affective illness

Forty patients with primary endogenous major depression were followed up during a 12-month period after recovery, on maintenance therapy. Neither the results of the DST, nor the life events reported could predict the occurrence of affective relapses although bereavement life events tended to be observed more frequently in patients relapsing, regardless of the type of antidepressant treatment.     

Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse

ObjectiveIndividuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants’ self-efficacy.MethodsWe applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes.ResultsReceiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12.ConclusionThese results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants’ role (giver or receiver), and their self-efficacy.Practice implicationsWe discuss implications for designing and using peer-to-peer support platforms.     

Pre-ejection period reactivity and psychiatric comorbidity prospectively predict substance use initiation among middle-schoolers: a pilot study

Youth with conduct problems (CPs) or depression are at high risk for early initiation of substance use, and for future substance use disorders (SUDs). Comorbid CPs and depression increase risk even further, yet understanding how these conditions interact remains elusive. One hypothesis is that altered mesolimbic dopamine function contributes to symptoms of CPs, depression, and SUDs. Cardiac pre-ejection period (PEP) reactivity to incentives is linked theoretically and functionally to central dopamine responding. We evaluated PEP reactivity to reward as a prospective biomarker of substance use in a study of 206 youth with depression, CPs, CPs and depression, or no psychiatric condition. Children were 8-12 years old at the first of three annual assessments. Reduced PEP reactivity was associated with increased likelihood of future alcohol use, and CPs interacted with anxiety and depression to double risk for marijuana and other substance use.     

Hepatitis C screening and treatment outcomes in patients with substance use/dependence disorders

The authors evaluated the association between hepatitis C virus (HCV) seropositivity status and substance use treatment outcomes in an alcohol- and substance-dependent population undergoing rehabilitation. The second aim was to assess the impact of early screening for HCV infection and substance use treatment on HCV treatment outcomes. HCV-antibody testing of 338 patients attending a substance-use residential program was performed. HCV antibody status, lifetime comorbid psychiatric diagnoses, program completion rates, and 6-month abstinence rates after program discharge were assessed. HCV treatment outcomes were followed in patients who remained abstinent 6 months after completion of substance-use treatment. Almost one-fourth (23.1%) of patients were HCV antibody-positive. HCV-seropositive patients were more likely to complete the 28-day program and more likely to remain abstinent at 6 months after program discharge. HCV seropositive status was the strongest predictor for the likelihood of completing the program, and remaining abstinent for 6 months afterward. Patients with HCV who completed a substance-use treatment program were more likely to receive HCV treatment than substance-dependent patients with HCV who never attended a substance-use treatment program. Detecting HCV infection in the structured setting of substance-use treatment is ideal to initiate management of this infection, and it has a positive influence on the outcomes of both substance-use treatment and HCV treatment.