Individual differences in childhood neurobehavior disinhibition predict decision to desist substance use during adolescence and substance use disorder in young adulthood: a prospective study

Genetic, physiological and psychological investigations have demonstrated that deficient inhibitory regulation amplifies the risk for substance use disorder (SUD). This study extends this line of research by determining the association between childhood neurobehavior disinhibition and decision to desist substance use following prevention intervention during adolescence. The sample consisted of 302 boys who were evaluated at ages 10-12, 12-14, 16, and 19. Results indicated that childhood neurobehavior disinhibition negatively covaried with decision to desist substance use during adolescence. These two variables predicted acceleration of drug consumption frequency during adolescence and DSM-IV diagnosis of SUD by age 19. Decision to desist drug use did not mediate the association between neurobehavior disinhibition and substance use/SUD. The findings indicate that substance abuse prevention would be potentiated by ameliorating childhood neurobehavior disinhibition.     

Adoption and implementation of new technologies in substance abuse treatment

In addition to clinical outcomes, understanding the adoption and implementation of new treatment interventions is essential. This analysis was designed to assess the predictive utility of organization-level features in understanding the adoption and implementation of new technologies in substance abuse treatment. Naltrexone, which was found to be in current use in 44.1% of a national sample of 400 private substance abuse treatment centers, was selected as an appropriate sample technology for study. Adoption of naltrexone is significantly related to both the treatment center's age and its administrative leadership. Naltrexone adoption is also significantly associated with the percentage of the center's caseload covered by managed care programs and by the percentage of relapsers represented in the caseload. The analysis was less successful in predicting naltrexone implementation for either primary alcohol dependence or primary opiate addiction.     

Course of self-reported symptoms of attention deficit and hyperactivity in substance abusers during early treatment

Attention deficit and hyperactivity disorder has been associated with poor outcome in studies of substance use disorders. This study aimed to assess the course of self-reported symptoms of both attention deficit and hyperactivity among adults presenting for treatment for substance use disorders. A sample of 75 substance abusers were assessed after they were admitted to a centralized intake unit, and followed at 3 and 6 months after intake by independent interviewers (follow-up rate 81%). Symptoms of attention deficit and hyperactivity were assessed with the Adult Self-report Scale for ADHD (ASRS). Both types of symptoms declined significantly during follow-up, but attention symptoms had a high intraclass correlation (0.79), and hyperactivity had a moderate intraclass correlation (0.64). Both baseline attention deficit and hyperactivity symptoms were associated with worse work and social adjustment after controlling for baseline functioning. Hyperactivity was associated with poorer substance use outcomes at the trend level. In conclusion, both dimensions of ADHD contribute to worse functioning during early treatment for substance abusers, and the ASRS is a reasonably stable measure of ADHD symptoms during early recovery.     

Time to change – an exploratory study of motivation among untreated and treated substance abusers

This exploratory study examines whether the attitudes towards change and treatment of untreated non-abstinent substance abusers differ from those of patients undergoing treatment in residential care. The sample (n?=?97) consists of untreated, voluntarily and compulsorily treated substance abusers who completed a questionnaire in 2003. Attitudes were measured with scales on e.g. problem recognition, desire for help, treatment readiness and aspects of time perspectives, e.g. past, present and future orientation. The attitudes of the three groups?–?untreated, voluntarily and compulsorily treated subjects?–?differed with respect to lifestyle change. Factor analysis of the measures revealed one component of primary interest, general willingness to change. Results show that willingness to change was correlated with other attitudinal characteristics in the three groups. The stability of substance abusers’ motivation is discussed with the focus on different social contexts’ influence on change-compliant attitudes and behaviour.     

The role of substance P in myocardial dysfunction during ischemia and reperfusion

Impairment of myocardial contraction (myocardial stunning) occurs during reperfusion after short ischemic periods. Substance P (SP) is widely distributed in heart and can be released by various stimuli including myocardial hypoxia. Our previous study shows SP has a negative inotropic effect in guinea pig heart. The objective of this study was to investigate whether SP contributes to the myocardial stunning after brief global ischemia. Guinea pig hearts in a Langendorff preparation were subjected to 15 min of global ischemia followed by 60 min reperfusion. Experiments were performed without and with pretreatment with neurokinin-1 (NK₁) receptor antagonists, spantide (10^–6 M) or CP-99,994-01 (10^–6 M) in order to study the role of SP. Experiments were also performed in hearts which were perfused with atropine, phentolamine, and nadolol (10^–6 M each) to examine the role of neurotransmitters and autonomic receptors. A group of hearts obtained from capsaicin-pretreated guinea pigs was also investigated. Left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), heart rate, and perfusion pressure were monitored. At the end of reperfusion, the LVDP of control hearts recovered to only 55 ± 6% ( ± SEM) of preischemic baseline and the LVEDP increased significantly (P > 0.05). With pretreatment with spantide or CP-99,994-01, LVDP recovered to 88 ± 2% or 78 ± 2% of the preischemic baseline, respectively. The LVEDP of these hearts was not different from preischemic baseline and much smaller than in control hearts. There were no differences in heart rate and perfusion pressure compared to baseline among all groups. Similar results were obtained in hearts perfused with autonomic blockers. However, recoveries of LVDP and LVEDP were faster in hearts perfused with autonomic blockers during the first 10 min of reperfusion. Pretreatment with capsaicin also significantly improved recovery of LVDP and LVEDP. In conclusion, substance P is involved in postischemic myocardial dysfunction and neurokinin-1 receptors mediate this action. The NK₁ receptor antagonists may be useful in prevention of myocardial stunning.     

Correlates of motivation to change in adolescents completing residential substance use treatment

This research identified psychosocial correlates of motivation to change in adolescents being discharged from residential treatment for substance use disorders. Using a naturalistic longitudinal design, adolescents in a residential treatment program in southeast Ohio were assessed at intake and discharge using self-administered questionnaires. Surveys assessed motivation to change one's drug and alcohol use, ways of coping to avoid future alcohol/substance use, and social support. The 68 participants (mean age = 16.0, range = 12-18) were predominantly Caucasian (87%) and male (69%). Over the course of treatment, adolescents reported significant increases in active-cognitive coping, avoidant-behavioral coping, and attachment and marginally significant increases in motivation to change and reliable alliance. Adolescents who reported higher discharge levels of motivation to change also reported greater levels of social integration at discharge. Strengthening adolescents' social integration may also increase their motivation to avoid using drugs and alcohol as they prepare to exit treatment and return to their home communities.     

脑梗死患者治疗前后血浆生长抑素和P物质含量的变化及临床意义

目的：探讨脑梗死患治疗前后血浆生长抑素（SS）和P物质（SP）含量的变化。方法：应用放射免疫分析法对33例脑梗死患进行了治疗前后血浆SS、SP含量测定，并以35名正常健康人作对照。结果：脑梗死患在治疗前血浆SS水平高于正常人组（P＜0．01），治疗后2周则与正常人组差异无显性（P＞0．05），SP在治疗前则显地低于正常人组（P＜0．01），治疗后2周SP水平有所升高，但与正常人比较差异有显性（P＜0．05）。结论：血浆SS、SP水平与脑梗死有关，可能参与脑梗死的发生与发展过程。     

Motivation for change and psychological distress in homeless substance abusers

This study explores the treatment needs of homeless individuals participating in a large urban day shelter program. Alcohol and drug use, psychological distress, and stage of change were assessed in 100 participants presenting for services. The associations among substance use, risk perception, and readiness to change were examined for alcohol and drugs separately. Participants had high levels of psychological distress compared to “non-patient” samples. Eighty percent had used alcohol in the past 6 months, with 65% of those drinking at higher-risk levels; 60% had used drugs, with 82% in the higher-risk levels. While the majority felt that they drank and/or used drugs “too much”, most were in precontemplation or contemplation stages of change. Intervention efforts for this population should focus on motivation, facilitation through the stages, and the associations between psychiatric symptoms and substance use.     

An investigation of stigma in individuals receiving treatment for substance abuse

This study examined the impact of stigma on patients in substance abuse treatment. Patients (N=197) from fifteen residential and outpatient substance abuse treatment facilities completed a survey focused on their experiences with stigma as well as other measures of drug use and functioning. Participants reported experiencing fairly high levels of enacted, perceived, and self-stigma. Data supported the idea that the current treatment system may actually stigmatize people in recovery in that people with more prior episodes of treatment reported a greater frequency of stigma-related rejection, even after controlling for current functioning and demographic variables. Intravenous drug users, compared to non-IV users, reported more perceived stigma as well as more often using secrecy as a method of coping. Those who were involved with the legal system reported less stigma than those without legal troubles. Higher levels of secrecy coping were associated with a number of indicators of poor functioning as well as recent employment problems. Finally, the patterns of findings supported the idea that perceived stigma, enacted stigma, and self-stigma are conceptually distinct dimensions.     

Feasibility of audit methods to study access to substance use treatment

Audit studies represent an emerging method for examining disparities in access to care, like substance use treatment, whereby fake patients (i.e., actors) attempt to procure a service with one or more characteristics isolated across condition. This allows for manipulation of variables, like insurance status, that are normally fixed or impossible to standardize with precision when studying actual patients. This pilot study explored whether these methods were feasible for the examination of community-based substance use treatment access. Masked telephone calls (n = 48) were made to providers (k = 8) in a single city seeking an appointment. A male and female “patient” made calls in three insurance status conditions: no insurance, state-funded insurance, and private insurance. All other subject characteristics were held constant. Results showed an audit design to be a feasible method for examining disparities in access and demonstrated substantial barriers to voluntary treatment. Implications and future directions are discussed.     

The autoradiographic distribution of kassinin and substance K binding sites is different from the distribution of substance P binding sites in rat brain

In the present report we have used autoradiographic receptor binding techniques to compare the distribution of substance K (SK), kassinin (K) and substance P (SP) binding sites in the rat brain. Whereas the distribution of K and SK binding sites appeared to be identical, notable differences are apparent when comparing these binding sites to the distribution of SP binding sites. These results demonstrate that in many areas of the rat brain K and SK binding sites have a different distribution than SP binding sites. These results further suggest that different classes of mammalian tachykinins may each have their own set of receptors.     

高效液相色谱法测定沙丁胺醇的有关物质

目的建立高效液相色谱法测定沙丁胺醇中的有关物质。方法采用C18柱,以庚烷磺酸钠溶液（庚烷磺酸钠2.87g、磷酸二氢钾2.5g,加水溶解并稀释至1000mL,用稀磷酸调节pH值至3.65）-乙腈（78∶22）为流动相,检测波长220nm。结果沙丁胺醇与其降解产物在该色谱条件下能够有效分离。结论方法简便、专属性强,可用于沙丁胺醇中有关物质的测定。     

高效液相色谱法同时测定葛花中染料木苷和鸢尾苷的含量

目的:建立葛花中染料木苷和鸢尾苷两个异黄酮成分的HPLC含量测定方法。方法:Agilent ZORBAX Eclipse XDB-C₁₈色谱柱 (4.6 mm×150 mm,5 μm);以不同浓度的乙腈-1‰磷酸水为流动相梯度洗脱,流速0.8 ml·min^-1,检测波长270 nm,柱温30 ℃。结果:染料木苷和鸢尾苷的线性范围分别为46.7~747.2 μg·ml^-1 (r=0.999 9)和54.1~864.8 μg·ml^-1 (r=0.999 9);平均回收率分别为101.1%(RSD为1.46%)和100.2%(RSD为1.58%)。结论:本方法简单,专属性强,重复性好,可用于葛花药材的质量控制。     

Cerebrospinal neuropeptide Y and substance P in suicide attempters during long-term antidepressant treatment

This study describes cerebrospinal fluid (CSF), neuropeptide Y (NPY) and substance P (SP) in patients with a recent suicide attempt and during antidepressant treatment. Seven out of 13 patients received antidepressants. The patients were examined on three separate occasions, i.e. at pre-treatment, followed by every 3 or 4 months. Antidepressant treatment seemed to affect the levels of CSF NPY, which decreased significantly between the second and last lumbar puncture despite no significant changes of clinical scores. When the whole group was taken into consideration, both CSF NPY and SP decreased significantly. At pre-treatment, Brief Scale of Anxiety scores were significantly and negatively correlated to CSF SP and tended to be negatively correlated to CSF NPY. There were also significant positive correlations between CSF NPY and SP during the entire study in the whole group, possibly reflecting an inter-relationship between these neuropeptides.     

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.     

Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders

A complicating factor affecting the treatment of individuals with coexisting substance use problems and serious mental illness is their motivation for change and how these interacting, chronic conditions affect the entire process of intentional behavior change. This selective review explores conceptual and assessment issues related to readiness to modify substance use and readiness to initiate behaviors helpful for managing mental illness in the search for a better understanding of patient motivation for change. The recent but limited research on motivation and stages of change among dually diagnosed patients indicates that these individuals appear to access and use an intentional behavior change process. However, it is not completely clear how this process works and what precise adaptations are needed to assess and to access motivation to change to encourage sustained behavior change in this population. Nevertheless, motivation and readiness to change are important dimensions that need to be addressed in treatment and research with dually diagnosed populations.     

Precipitants of first substance use in recently abstinent substance use disorder patients with PTSD

Patients with substance use (SUD) and posttraumatic stress disorders (PTSD) are at high risk for relapse. This study examined the reasons patients identify for their first substance use following discharge from SUD treatment. A total of 65 patients with and without PTSD completed clinical interviews, including an adapted version of the Relapse Interview [RI; Miller, W.R., & Marlatt, G.A. (1996). Appendix A: Relapse Interview. Addiction, 91(Suppl), 231-240.] at a 6-month follow-up. Qualitative data from the RI was consensus coded using Marlatt's taxonomy of relapse situations. Results indicated that patients with PTSD were less likely to report first substance use triggered by cue-based urges and more likely to report use in response to negative emotions of an interpersonal nature than those patients without PTSD. Other characteristics of first use associated with PTSD included greater subjective urges right before using, greater efforts to obtain substances and more likelihood to use to intoxication. Patients with unremitted PTSD reported poorer outcome and self-efficacy expectations than those without PTSD or with remitted PTSD. Implications for self-medication theory and clinical practice are discussed.     

All-cause mortality in criminal justice clients with substance use problems—A prospective follow-up study

Background

Mortality in previously incarcerated individuals is known to be elevated, with high proportions of drug-related deaths. However, there is less documentation of whether specific substance use patterns and other clinical characteristics predict increased mortality in the group.

Methods

This is a follow-up study of mortality and causes of death in ex-prisoners with substance use problems prior to incarceration (N = 4081), who were followed during an average of 3.6 years from release from prison until death or until data were censored. Baseline predictors of mortality, derived from interviews with Addiction Severity Index (ASI) in prison, were studied in a Cox regression analysis.

Results

During follow-up, 166 subjects (4.1%) died. Standardized mortality ratios were 7.0 (3.6–12.2) for females and 7.7 (5.6–9.0) for males. In 84% of cases, deaths were unnatural or due to substance-related disease. Most common causes of death were accidental poisoning (27%), transport accidents (13%), poisoning/injury with undetermined intent (12%), and suicide (10%). Death was positively predicted by heroin use, overdose, and age, and negatively predicted by a history of depression.

Conclusions

A vast majority of deaths after release from prison in individuals with substance use are due to violent or substance-related causes. Significant predictors identified were mainly related to patterns of drug use, and need to be addressed upon incarceration as risk factors of death. The findings have implications for referral and treatment upon release from prison.     

Emotion concepts in models of substance abuse

Research and theoretical perspectives of substance abuse are reviewed from an emotion theory perspective. Emotion permeates many important concepts in substance abuse research, such as trait anxiety, disinhibition, environmental cue reactivity, cognitive and mood regulation and behavioral motivation. Emotion theory and research may help integrate findings central to substance abuse such as predicting onset of use and describing end-state dysfunction. Increased incorporation of emotion concepts and measures in substance abuse research will increase the ecological validity of future research and provide more sophisticated understandings of substance abuse behavior. \[Quirk SW. Emotion concepts in models of substance abuse. Drug Alcohol Rev 2001;20:95-104]