Substance use among school-based youths in Puerto Rico: differences between gender and grade levels

The present study examined substance use rates among adolescents in Grades 7-12 in Puerto Rico. Nine hundred eighty-nine students completed the Spanish version of the International Survey of Adolescent Health. More than 50% of middle school youths and 75% of high-school youths reported lifetime alcohol use. Female gender was associated with tobacco use in middle school while male gender was associated with marijuana use in high school. High-school females reported lower rates of tobacco use and marijuana use than middle-school females. High-school males exhibited substantially higher drug-use rates than middle-school males for each substance. These findings may suggest that universal drug prevention interventions may be needed for females in Puerto Rico before they enter middle school, while targeted interventions aimed at high-risk females who continue to smoke tobacco or marijuana may be more effective during high school. In contrast, targeted drug prevention interventions for males probably need to begin in middle school and be maintained if not increased in intensity throughout the high-school years.     

From basic research to public health policy: WHO report on the neuroscience of substance dependence

The World Health Organization (WHO) report on the Neuroscience of Psychoactive Substance Use and Dependence represents a summary of the latest scientific knowledge on the role of the brain in substance dependence. The findings of the report have important applications to both interventions and public health policy. Specifically, the report notes that psychoactive substances have physical and symbolic effects that are rewarding to the user. It notes that adverse consequences of psychoactive substance use are related to the level, pattern, mode, and context of use. Dependence is seen as a complex disorder involving brain mechanisms rather than a failure of will. The report notes that psychoactive substance use often coexists with other mental health problems, and that stigma associated with substance misuse inhibits treatment seeking. There is growing evidence for the efficacy and effectiveness of interventions, including advances in pharmacotherapy. However, these advances raise ethical issues that need to be addressed.     

Gender differences in stress reactivity among cocaine-dependent individuals

Rationale Recent investigations suggest that stress reactivity may play an important role in the relationship between stress and substance use. Important gender differences, such as reasons for using substances, have been well documented, and it is likely that men and women also differ in their stress response.Objectives In this study, gender differences in stress reactivity to two laboratory stress manipulations were examined among 18 men and 21 women with current cocaine dependence.Methods Participants completed a psychological stress task, the Mental Arithmetic Task (MAT), and a physical stress task, the Cold Pressor Task (CPT). Subjective stress responses (i.e., feelings of stress, anxiety, nervousness, pain, mood), physiological stress responses (i.e., heart rate, skin conductance), and cocaine craving were assessed.Results In response to both the MAT and the CPT, significant increases in subjective and physiological stress were observed among participants. Women, however, demonstrated greater subjective reactivity, as evidenced by significantly higher ratings of stress, nervousness, and pain as compared to men. Women also immersed their hand in the cold water bath for a significantly shorter period of time as compared to men.Conclusions The current findings are among the first to report on gender differences in stress reactivity among cocaine-dependent individuals. The findings suggest that the mechanisms linking stress and substance use may be gender-specific, and that stress reactivity may play a different role for women than for men. Future research and implications for clinical interventions are discussed.     

Managing anxiety and depression in alcohol and drug dependence

Previous research has highlighted the high prevalence (30–60%) of comorbid anxiety and mood disorders in clients with substance misuse disorders and, equivalently, a third of those with affective disorder report a history of substance use disorder Kessler et al. 1994, Regier et al. 1990 and Robins & Regier 1991. This article reviews the management of such cases and identifies key issues in the assessment process, as well as potential avenues for treatment. Other articles have highlighted the increased service utilisation and the cost of care and treatment of comorbidity. This article will primarily focus on the management of individual cases and will briefly refer to issues of service organisation. Although antidepressant or anxiolytic pharmacotherapy may have a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of side-effects or adverse reactions in individuals who continue to engage in substance misuse or who have medical complications associated with drug or alcohol dependency. Effective psychosocial approaches largely focus on brief, empirically tested manualised therapies such as cognitive therapy (Carroll, 1998a). However, modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients exhibiting comorbidity. The data available demonstrate some evidence for the benefits of structured psychological approaches, but more sophisticated randomized controlled trials are required to evaluate the efficacy of both psychological and pharmacological approaches.     

The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment

The present study examined the unique contribution of emotion regulation difficulties to past-year risky sexual behavior (RSB) among substance use disorder (SUD) patients (above and beyond other known RSB risk factors). A sample of 177 SUD patients completed a series of questionnaires. At the zero-order level, emotion regulation difficulties, were significantly positively associated with the number of commercial sexual (i.e., the exchange of sex for drugs or money) partners with which penetrative sex occurred and significantly negatively associated with the likelihood of using a condom when having sex with a commercial partner under the influence of drugs. Emotion regulation difficulties also significantly predicted these RSB indices above and beyond other RSB risk factors, including demographics, depression, sensation seeking, traumatic exposure, and substance use severity. The specific emotion regulation difficulty of lack of emotional clarity emerged as a unique predictor of RSB. The implications of these findings for understanding motivations for RSB and developing targeted interventions for RSB among SUD patients are discussed.     

Elevated Substance Use Among Lesbian and Bisexual Women: Possible Explanations and Intervention Implications for an Urgent Public Health Concern

Potential explanations for the elevated rates of substance use among lesbian and bisexual women relative to heterosexual women are provided by focusing on substance use differences among lesbian and bisexual women. The three explanations include butch versus femme (i.e., gender atypicality) differences in substance use, lesbian versus bisexual disparities in substance use, and disparities associated with socializing in substance-using settings, such as bars. Implications for interventions to reduce substance use and abuse among lesbian and bisexual women are addressed.     

Elevated substance use among lesbian and bisexual women: possible explanations and intervention implications for an urgent public health concern

Potential explanations for the elevated rates of substance use among lesbian and bisexual women relative to heterosexual women are provided by focusing on substance use differences among lesbian and bisexual women. The three explanations include butch versus femme (i.e., gender atypicality) differences in substance use, lesbian versus bisexual disparities in substance use, and disparities associated with socializing in substance-using settings, such as bars. Implications for interventions to reduce substance use and abuse among lesbian and bisexual women are addressed.     

Ethnicity and Drug Use: exploring the nature of particular relationships among diverse populations in the United Kingdom

This paper explores the substance use and misuse issues in the main visible minority ethnic communities in the UK. Trends in choice of substance, culturally specific attitudes, age and gender are explored amongst the African, African-Caribbean, Asian and Cypriot communities. It presents an outline of the patchy epidemiological data that is currently available. The paper also explores the service utilisation by minority ethnic groups and looks at the major barriers to service uptake. Increasing access to services by practical interventions to overcome barriers and prevention strategies are discussed. The difficulties of undertaking research in this field, and the translation of small local non-controlled studies to national strategies are highlighted whilst suggesting avenues for future research.     

Ethnicity and Drug Use: exploring the nature of particular relationships among diverse populations in the United Kingdom

This paper explores the substance use and misuse issues in the main visible minority ethnic communities in the UK. Trends in choice of substance, culturally specific attitudes, age and gender are explored amongst the African, African-Caribbean, Asian and Cypriot communities. It presents an outline of the patchy epidemiological data that is currently available. The paper also explores the service utilisation by minority ethnic groups and looks at the major barriers to service uptake. Increasing access to services by practical interventions to overcome barriers and prevention strategies are discussed. The difficulties of undertaking research in this field, and the translation of small local non-controlled studies to national strategies are highlighted whilst suggesting avenues for future research.     

Examining marianismo gender role attitudes,ethnic identity,mental health,and substance use in Mexican American early adolescent girls

Given the increased trend in substance use patterns among Latina adolescents in recent years, the need for research that identifies gender-specific and culturally relevant protective factors is essential in tailoring interventions. The current study examined the links between marianismo gender role attitudes, ethnic identity, and substance use abstinence among 277 low-income Mexican American early adolescent girls. Mental health was also examined as a potential moderator in these links. Results of linear regression analysis revealed that familismo, virtuous/chaste, and spiritual marianismo gender role attitudes were predictive of stronger ethnic identity; conversely, self-silencing marianismo attitudes were predictive of weaker ethnic identity. Second, results of hierarchical logistic regressions revealed that both virtuous/chaste marianismo gender role attitudes and mental health (low rates of psychological distress) were inversely linked with substance use; furthermore, they had a combined link that was related to even lower rates of substance use among participants. However, ethnic identity did not have a direct or moderating effect on substance use. Findings suggest that the promotion of positive components of marianismo and mental health may have a protective effect against early substance use in Mexican American early adolescent girls.     

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation

Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the     

Reflections on volatile substance dependency treatment. Negotiating the boundary between inner and outer reality

A brief review of the causal and treatment literature relating to volatile substance dependency suggests the interaction between individual and system requires careful attention and understanding. A model is tentatively and provisionally adumbrated to help clarify the main factors involved from a dynamic biopsychosocial perspective. Ego boundary disturbances emerge from and reciprocally influence behaviour and social interactions. These disturbances can be avoided temporarily, although inevitably deepened in the long-term, by substance dependence. Two case examples, selected because they differ in many respects, including relative treatment effectiveness, illustrate this integrative perspective. The discussion focuses on explaining the differing outcomes in terms of the extent to which the inner-outer boundary is open to modification and how far it can be successfully negotiated and clarified. A major factor in differentiating between inside and outside is thought to be causal perceptions or "attributions." Successful differentiation tends to facilitate change, as opposed to reinforcing maladaptive homeostasis. Key issues for therapists overlap with addictions treatment in general, including emotional blocks or barriers in patients, difficulty engaging systems in a strategic manner, and countertransference problems. It is argued that these difficulties in therapy might respond to integrative psychotherapeutic responses, provided the differences in perspective are sufficiently understood.     

Secondary prevention of alcohol related problems

It is argued that the secondary prevention of alcohol related problems cannot be undertaken within the methods currently employed to deal with a chronic drinking population. It is argued that fresh initiatives are required, involving seeking out the target population in venues other than treatment units. The interventions can be less intensive than those generally adopted and will preferably be conducted by non-specialists. The treatment goal will in all likelihood be for a moderating of consumption and a non-confrontational style of counselling is required. A broader model of what constitutes an alcohol related problem is discussed, as are the implications of such initiatives for the specialist alcohol worker.     

Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions.     

Substance Use in Young Swiss Men: The Interplay of Perceived Social Support and Dispositional Characteristics

Background: Social environment plays a central role in substance use behaviors. However, it is not clear whether its role varies as a function of individual dispositional characteristics. Objectives: To investigate the interaction between dispositional characteristics (i.e. sensation seeking, anxiety/neuroticism) and social environment (i.e. perceived social support [PSS]) in association with substance use. Methods: A representative sample of 5,377 young Swiss males completed a questionnaire assessing substance use, sensation seeking, anxiety/neuroticism, and PSS from friends and from a significant other. Results: Sensation seeking and anxiety/neuroticism were positively related to most substance use outcomes. PSS from friends was significantly and positively related to most alcohol and cannabis use outcomes, and significantly and negatively associated with the use of hard drugs. PSS from a significant other was significantly and negatively associated with most alcohol and cannabis use outcomes. The associations of sensation seeking with drinking volume, alcohol use disorder and the use of illicit drugs other than cannabis were stronger in individuals reporting high levels of PSS from friends than those with low levels. The associations of sensation seeking with risky single-occasion drinking and the use of hard drugs were weaker in participants reporting high levels of PSS from a significant other than in those with low levels. Conclusions: Sensation seeking and anxiety/neuroticism may constitute risk factors for substance use and misuse. PSS from friends may amplify the risk for alcohol and illicit drug use (other than cannabis) associated with high sensation seeking, whereas the PSS from a significant other may reduce it.     

The relationship between early maladaptive schemas and eating-disorder symptomatology among individuals seeking treatment for substance dependence

Numerous studies have examined early maladaptive schemas (EMS) and their relationship to psychological disorders, including eating disorders (EDs) and substance use disorders (SUDs). However, to date, there are no empirical investigations that have examined the relationship between EMS and EDs among individuals seeking treatment for substance use. In an attempt to further elucidate this relationship, the purpose of the current, exploratory study was to examine the relationship between EMS, ED symptomatology (i.e. bulimia and binge-eating but not anorexia) and substance use and to directly compare EMS among individuals with and without a probable ED diagnosis. Participants were 387 men and 132 women seeking residential treatment for substance use. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS. Results suggest that EMS are prevalent among individuals with ED pathology seeking treatment for substance use. Thus, treatment programs could potentially benefit from the assessment and treatment of EMS among dually diagnosed patients. Given the exploratory and preliminary nature of the study, continued research is needed to further examine the relationship between EMS, EDs and substance use.     

Domains and Perceived Benefits of Treatment Among Patients With and Without Co-Occurring Disorders in Inpatient Substance Use Treatment

Objective: Persons with substance use disorders often have comorbid psychiatric problems, and treating all problem domains is important for treatment success and recovery. This study examined reported interventions provided to patients as well as patients’ reports of domains of help received, perceived areas of greatest benefit, and satisfaction with substance use disorder treatment. We also compared patients with co-occurring disorders and patients with only substance use disorders to see whether there were significant differences across groups on these measures. Methods: Patients receiving inpatient substance use treatment at clinics in Norway were recruited for the study; 85 completed a cross-sectional survey prior to discharge. Treatment personnel also completed a separate survey and gathered information from patient charts. Results: The most frequently provided treatment interventions involved improving relationships with family and important others, applied relaxation, psychodynamic therapy, cognitive behavior therapy, and motivational interviewing. Patients reported receiving the most help in domains of relapse prevention, physical health, daily functioning, relationships with people, psychological health, and self-esteem. They benefited most from physical activities, support from co-patients, group therapy, counseling, and assessment/treatment of psychological health. Patients with co-occurring disorders were given more exposure therapy, motivational interviewing, and cognitive behavior therapy interventions than those without comorbidity. Patients with co-occurring disorders self-reported receiving more help with self-esteem and coping with psychiatric symptoms and benefiting more from interventions involving psychological health, acute help, and social situations. Conclusions: Patients perceived psychological and physical health as important areas for improvement. There were differences between patients with co-occurring disorders and those with substance use disorders only in several measures. It is important to acknowledge that patients with substance use disorders and co-occurring mental problems are heterogeneous groups with unique but overlapping needs.     

Heterogeneity among Latinas and Latinos entering substance abuse treatment: findings from a national database

The current study examined differences in 30-day and lifetime substance use for a sample of Mexican American, Puerto Rican, and Cuban American men and women from the Drug Evaluation Network System, a national database on individuals seeking substance abuse treatment. There were significant gender and ethnic differences in recent and lifetime substance use after controlling for age, years of education, employment, medical, and psychological problems. Lifetime and 30-day substance use rates found in this study do not coincide with prevalence rates found in community samples of Latinas/os, indicating that the patterns of substance use may be different among individuals who seek substance abuse treatment than among those in the general population. The results of this study highlight the heterogeneity of Latinas/os who abuse substances.     

Therapeutic jurisprudence: judicial and corrections panel

Innovative therapeutic initiatives for the treatment of persons with substance abuse problems have been implemented in the criminal justice systems of California and Arizona. Judicial perspectives and reflections on these programs reveal the multiple issues inherent in innovation and day-to-day operations, from collaboration to implementation, including attitudinal shifts, resource allocation, client issues, and the changing role of judges who practice therapeutic jurisprudence. A pioneering program of treatment for dual disorders among male offenders addresses multiple issues in the provision of psychological services in a forensic setting in California.     

Problem severity profiles of substance abusing women in European Therapeutic Communities: influence of psychiatric problems

This article aims to search for a specific female, psychiatric profile based on a large European sample of substance dependent clients (828) entering therapeutic communities. First, all six areas of functioning of the EuropASI were included, using the composite scores to search for gender differences. Next, the 'psychiatric' status section was selected for further study. A binary logistic regression was performed with gender as the dependent variable, and nine individual psychiatric items, country, and age as predictors. According to this model a number of problem variables could be identified as being reported more often by women than by men in therapeutic community treatment. Women are more likely to report serious depression, problems in understanding, concentrating or remembering, being prescribed medication, and serious thoughts about suicide; they have also attempted suicide more often than men. Women find treatment for these psychological problems more important than their male counterparts. They also have a more severe history of abuse. Women in therapeutic communities may need specific treatment interventions for their more severe psychiatric needs.