Treatment outcomes of stimulant misusers: one year follow-up results from the national treatment outcome research study (NTORS)

There are substantial gaps in knowledge about treatment outcomes for stimulant misuse. This paper investigates patterns of stimulant use and outcomes of stimulant misusers one year after starting treatment at 54 agencies within United Kingdom national services. In a prospective, longitudinal cohort study of 1,075 drug misusers, 637 were current users of stimulant drugs at intake to treatment. Most of the clients were multiple drug users. Stimulants were the main problem drug for 13% of the sample. The two most frequently used drugs were crack cocaine and amphetamine sulphate. The most frequently reported pattern of stimulant use was among heroin dependent clients who also used stimulants. The clients for whom stimulants were the main problem drug were most likely to approach residential rehabilitation programs for treatment. Overall, the stimulant users showed satisfactory outcomes with marked reductions in substance use and other problem behaviors at follow-up. Many clients with stimulant misuse problems were able to achieve substantial improvements after treatment within existing services.     

Motives for Smoking in Those With PTSD,Depression, and No Psychiatric Disorder

Abstract

Objective: Approaches for effectively treating smoking in those with posttraumatic stress disorder (PTSD) and with major depressive disorder (MDD) could be improved by identifying motivational processes underlying their tobacco dependence. The goal of this study was to identify the motivational processes influencing smoking dependence among smokers with PTSD and with MDD relative to non-diagnosed controls. Methods: Participants were United States (US) veterans who smoked daily (N?=?162) and met DSM-IV criteria for either PTSD (n?=?52), MDD (n?=?52), or no current psychiatric disorder (controls; n?=?58). Smoking dependence motives were assessed via the Brief Wisconsin Inventory for Smoking Dependence Motives (Brief WISDM). The 11 Brief WISDM subscales are categorized into two major factors: Primary Dependence Motives and Secondary Dependence Motives. Results: Smokers with PTSD scored higher than non-diagnosed controls on the following Primary Dependence Motives subscales: Automaticity, Craving, and Tolerance (all p-values <.05). Smokers with PTSD, relative to controls, also scored higher on the overall Secondary Dependence Motives subscale, and on five of the seven Secondary Dependence Motives subscales: Cue Exposure/Associative Processes, Affective Enhancement, Affiliative Attachment, Cognitive Enhancement, and Weight Control (all p-values < .05). Smokers with MDD scored significantly higher than controls on one Primary Dependence Motives subscale: Craving and on four of seven Secondary Dependence Motives subscales: Affective Enhancement, Affiliative Attachment, Cognitive Enhancement, and Weight Control (all p-values <.05). Finally, exploratory analyses directly contrasting the PTSD group with the MDD group showed that smokers with PTSD were higher than those with MDD in the overall Secondary Dependence Motives subscale and one of the seven Secondary Dependence Motives subscales: Cue Exposure/Associative Processes (all p-values < .05). Conclusions: Results suggest that both Primary Dependence Motives and Secondary Dependence Motives play a meaningful role in motivation to use tobacco in smokers with PTSD; smoking dependence in those with MDD may be primarily influenced by Secondary Dependence Motives.     

Heterogeneous Patterns of Marijuana Use Motives Using Latent Profile Analysis

Background: Given that marijuana use is often associated with detrimental physical and mental health problems, research examining motives for its use is critical for effective remedial and preventive treatment. To date, the majority of research on marijuana use motives has used variable-centered analyses, which overlooks potentially meaningful heterogeneous response patterns and the associations of those patterns with other risk/protective factors. Methods: To address this gap, in the current study, we conducted a person-centered analysis (latent profile analysis) to identify subgroups of participants based on endorsed marijuana use motives, and examined the construct validity of the optimal class solution (covariates included sociodemographic (e.g., age), psychiatric (e.g., depression), and marijuana-use indices (e.g., use-frequency, use-related problems). Participants were 898 college students (M_age?=?20.93, SD_age?=?3.10; 68.9% female) who completed an anonymous online survey examining substance use and psychological well-being, were 18?years or older, and endorsed lifetime marijuana use. Data were collected November 2016 through February 2018. Results: Results identified four unique classes of coping, conformity, social, and enhancement marijuana use motives: (a) “Low Motives” (37.6%), (b) “High Conformity” (4.9%), (c) “Low Conformity” (45.8%), and (d) “High Motives” (11.7%). In terms of covariates, higher motive classes tended to report more frequent and problematic use. The two classes uniquely characterized by conformity motives only differed on past-month marijuana use frequency. Conclusions/Importance: The current findings provide evidence that specific classes of motives were not only associated with marijuana use frequency and problems but other risk and protective factors, such as anxiety sensitivity and social support.     

The Interactive Effects of Drinking Motives,Age, and Self-Criticism in Predicting Hazardous Drinking

Background: Individuals who disclose hazardous drinking often report strong motives to drink, which may occur to modulate views of the self. Investigating self-criticism tendencies in models of drinking motives may help explain who is more susceptible to drinking for internal or external reasons. As much of the research on drinking motives and alcohol use is conducted in young adult or college student samples, studying these relations in a wider age range is clearly needed. Objectives: The current study examined the interactive relationship between drinking motives (internal: coping, enhancement; external: social, conformity), levels of self-criticism (internalized, comparative), and age to predict hazardous drinking. Methods: Participants (N = 427, M_age = 34.16, 54.8% female) who endorsed drinking within the last year completed an online study assessing these constructs. Results: Results indicated internalized self-criticism and drinking to cope interacted to predict hazardous drinking for middle-aged adults. However, comparative self-criticism and conformity motives interacted to predict greater hazardous drinking for younger-aged adults. In addition, both social and conformity motives predicted less hazardous drinking for middle-aged adults high in comparative self-criticism. Conclusions/Importance: Interventions that target alcohol use could minimize coping motivations to drink while targeting comparative self-criticism in the context of social, and conformity motives.     

Attitudes toward technology-based health information among adult emergency department patients with drug or alcohol misuse

Technology-based screening and interventions are emerging solutions to the challenge of addressing substance use in the emergency department (ED). A standardized questionnaire of adult patients at a large-volume, urban, academic ED assessed interest in, and potential barriers to, technology-based substance use information. Questionnaire topics included substance use, access to technology, preferences for health information, and perceived barriers to technology interventions. Among the 430 participants, mean age was 39 years and 55% were female; 37% reported alcohol misuse and 52% drug misuse. Access to technology was high. Technology was preferred by 46% of alcohol misusers (vs. 43% non-misusers, p = 0.65) but only 41.9% of drug misusers (vs. 56% non-drug misusers, p = 0.005). In multivariate analyses, drug misuse was associated with decreased interest in receiving technology-based information. Cited barriers included confidentiality, complexity, and time. Our findings suggest that drug misusers in particular may wish to have reassurances about the confidentiality of technology-based interactions.