Indicators of Club Management Practices and Biological Measurements of Patrons’ Drug and Alcohol Use

Background: Electronic music and dance events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified. Objectives: The relationship between club management practices and biological measures of patrons’ alcohol/drug use is examined. Methods: Observational data from 25 events across six urban clubs were integrated with survey data (N = 738 patrons, 42.8% female) from patrons exiting these events, 2010–2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation. Results: Analyses revealed that serving intoxicated patrons and safety signs were related to substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. Conclusions/Importance: Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed.     

Can Assessment Reactivity Predict Treatment Outcome Among Adolescents with Alcohol and Other Substance Use Disorders?

Abstract

The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome. Participants were 177 adolescents with alcohol and other substance use disorders (AOSUD) in a 9-weekly group sessions of cognitive behavioral therapy. Drug urinalysis results at baseline assessment, first and last session and self-report for alcohol use were used as outcome measures. Participants showed a highly significant shift to non-use of both alcohol and of other substances from intake assessment to first session and from first to last session. Alcohol and substance use at first session predicted use at last session. This is the first study in youth asserting Assessment Reactivity as a valid construct during the pretreat-ment phase. AR should be considered in any analysis targeting treatment outcomes.     

The Role of Mental Health and Substance Use in Homeless Adults’ Tobacco Use and Cessation Attempts

Objective: Although tobacco use is prevalent among adults experiencing homelessness, research deficits exist regarding the mental health, substance use, and demographic correlates of tobacco use behaviors in this population. This study examined whether correlates of tobacco use among housed adults identified by the Center for Disease Control (CDC) were significant correlates of tobacco use and cessation attempts among a sample of homeless adults. Methods: Participants (N?=?421) were adults experiencing homelessness entering permanent supportive housing programs in Los Angeles. Multivariate logistic regression determined associations of lifetime mental health diagnoses, recent substance use, demographic characteristics, and lifetime literal homelessness with daily tobacco use and cessation attempts. Results: Lifetime diagnoses of schizophrenia, posttraumatic stress disorder, depression, bipolar disorder, and illicit substance use were associated with increased odds of daily tobacco use. A lifetime diagnosis of depression was associated with an increased likelihood of a past 3-month tobacco cessation attempt, while illicit substance use was associated with a lower likelihood of a cessation attempt. Conclusions: Findings suggest that demographic and clinical characteristics associated with tobacco use differ among this sample of homeless adults and those identified by the CDC among housed adults. Mental health conditions and substance use appear to be the primary correlates of tobacco use among adults experiencing homelessness and may be critical in efforts aimed at improving cessation.     

Alcohol Use and Alcohol Consumption–Related Problems in Rural Vietnam: An Epidemiological Survey Using AUDIT

This study aimed to assess alcohol use and alcohol consumption–related problems in different sociodemographic groups in a rural district in Vietnam. Interviews were completed between March 2004 and July 2004. The Alcohol Use Disorder Identification Test (AUDIT) was applied to interview 3423 people, who were randomly selected in a rural district (1695 men and 1728 women). People who had an AUDIT score greater than 7 (in men) or greater than 5 (in women) were identified as having alcohol consumption–related problems. Prevalences and adjusted odds ratios of alcohol use and alcohol consumption–related problems were estimated for different subgroups of the population. Weekly and daily “binge drinking” among men were 5.7 and 3.6%, while binge drinking in women was virtually nonexistent. The prevalence of alcohol consumption–related problems was 25.5% among men and 0.7% among women. The differences between sociodemographic groups were not strong, but women who were separated, divorced, or widowed as well as those with higher education had significantly higher rates of alcohol consumption–related problems than married women and those with lower education. This study indicates an urgent need for alcohol intervention programs focused on men. However, further monitoring of alcohol use and problems among women is important to follow-up changes in consumption pattern. The study's limitations are discussed.     

Testing Young Adults’ Reactions to Facebook Cues and Their Associations with Alcohol Use

Background: Alcohol cues on social media may influence young adults’ drinking patterns, these cues may be pro-social or pro-alcohol in nature. The influence of individual Facebook cues on young adults’ drinking intentions and behaviors remains unknown. Objectives: The purpose of this study was to assess how Facebook cues influence intention to drink, and how intention was associated with Theory of Reasoned Action constructs including alcohol-related attitudes and norms, and future behavior. Methods: Incoming university students completed a pre-college and a 2-year follow-up phone interview. A vignette presented individual Facebook cues representing “pro-social” or “pro-alcohol” sentiments. Participants indicated intention to drink alcohol and their rationale for this intention after each cue. Additional measures included TRA constructs of alcohol-related attitudes and norms, and problem alcohol use. Analyses included a qualitative approach to examine rationales for intention to drink in response to Facebook cues, and linear mixed effects models. Results: Of 338 participants, 56.1% were female, 74.8% were Caucasian. Alcohol-related attitudes and norms were positively associated with intention to drink in response to pro-social and pro-alcohol Facebook cues. Participants’ intention to drink in response to pro-alcohol cues was positively associated with problem alcohol use two years later. Conclusions/importance: Findings illuminate the influence of social media on alcohol-related behaviors and highlight potential future screening approaches.     

The Role of Companionship and Conflict in Perceptions of a Friend’s Heavy Alcohol and Marijuana Use

Individuals have been found to “project” their own substance use onto perceptions of their friends’ substance use. This study explores whether companionship and conflict relate to incorrect perceptions of a friend’s heavy alcohol and marijuana use after controlling for the behavior of the respondent and friend. Mixed models demonstrate that having higher levels of companionship, but not conflict, with a friend result in significantly higher perceptual levels of the friend’s heavy alcohol and marijuana use. While beneficial for the friendship, higher levels of companionship may result in a person overestimating the heavy alcohol and marijuana use of a friend.     

Drinkers’ Use of Physical Availability of Alcohol: Buying Habits and Consumption Level

On the aggregate level, physical availability of alcohol is related to per capita consumption, prompting the question whether high availability can increase consumption net of social norms which enhance drinking. This issue is investigated using individual-level data in a high-availability urban environment. Effortless, efficient purchase of alcoholic beverages explains a small but significant amount of the variance in consumption when normative factors are statistically controlled. Qualitative factors of availability are discussed, with particular emphasis on food stores, which account for more than half this sample's purchases.     

Alcohol Makes You Macho and Helps You Make Friends: The Role of Masculine Norms and Peer Pressure in Adolescent Boys’ and Girls’ Alcohol Use

Peer pressure and general conformity to adult norms have been found to be strongly associated with alcohol use among adolescents; however there is limited knowledge about the sociocultural factors that might influence this relationship. Theory and research suggest that masculine norms might directly and indirectly contribute to alcohol use through peer pressure and general conformity to adult norms. Whereas being male is typically identified as a risk factor for alcohol use, masculine norms provide greater specificity than sex alone in explaining why some boys drink more than others. There is growing evidence that girls who endorse masculine norms may be at heightened risk of engaging in risky behaviors including alcohol use. Data were provided by adolescents living in a rural area in the Northeastern United States and were collected in 2006. This study demonstrated that masculine norms were associated with peer pressure and general conformity and alcohol use for both adolescent girls (n = 124) and boys (n = 138), though the relationship between masculine norms and alcohol use was stronger for boys. The study's limitations are noted and theoretical and practical implications are discussed.     

The Validity of Truant Youths’ Marijuana Use and Its Impact on Alcohol Use and Sexual Risk Taking

Few studies investigating the validity of marijuana use have used samples of truant youths. In the current study, self-reports of marijuana use are compared with urine test results for marijuana to identify marijuana underreporting among adolescents participating in a longitudinal brief intervention for drug-involved truant youths. It was hypothesized that marijuana underreporting would be associated with alcohol underreporting and engaging in sexual risk behaviors. The results indicated marijuana underreporting was significantly associated with self-denial of alcohol use, but not associated with sexual risk behavior. Also, there was an age effect in marijuana use underreporting such that younger truant youths were more likely to underreport marijuana use, compared to older truant youths. Implications for policy and future research are discussed.     

Relationship Between School Administrators’ Reports of Parental Involvement in School and Students’ Substance Use: A National Study

This study examines the relationship between student substance use and school-level parental involvement as reported by administrators. Questionnaires were administered to school administrators and 111,652 students in 1,011 U.S. schools. Hierarchical logistic regression analyses conducted on 1998–2003 data from students and administrators indicate significantly lower prevalence of alcohol use among eighth-graders in schools where administrators reported high parental involvement. Overall, administrators’ reports of high parental involvement were unrelated to prevalence of substance use among tenth-graders and were associated with higher prevalence of alcohol use among twelfth-graders. Implications and limitations are discussed, along with suggestions for future research.     

How Is Substance Use Linked to Psychosis? A Study of the Course and Patterns of Substance Dependence in Psychosis

ABSTRACT

Substance use in mentally ill patients is now a major problem that influences the course and outcome of psychosis. With prevalence ranging up to 60%, several theories were postulated to explain the link. It would be interesting to know if substances have different effects in persons with psychosis than in those without. This study aimed to explore patterns of symptomatology of dependence and comorbid psychiatric illness by comparing and contrasting it with a group suffering from pure substance dependence. Consecutively admitted patients who were matched for age, sex, and tobacco use were divided into 3 groups. These were substance dependence without any comorbid psychiatric disorder (SD; n = 32), schizophrenia with substance dependence (SC; n = 31), and bipolar disorder with substance dependence (BD; n = 31). Patients were administered the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and Mini International Neuropsychiatric Inventory (MINI) to evaluate the chronology of criterion of International Classificiation of Diseases (ICD)-10 dependence. Results showed that cannabis was the most common substance used by both the SC (100%) and BD (80%) groups. This was followed by alcohol as the most common substance used, with prevalence of 87% in SC and 77% in BD groups. There was a significant difference in the pattern of use of cannabis in patients with psychosis, who developed tolerance much faster (P = .018) and had longer durations of cannabis use (P = .001) than the SD group. The presence of “loss of control” over drug use criterion seems to be a specific marker predicting development of dependence and psychosis. Cannabis use is more strongly associated with development of psychosis than any other substance.     

African–American Women’s Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

Background: Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African–Americans. Substance use may be shaped by social contextual influences from families and peers in African–American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African–American women. Objectives: This study explores the effects of African–American women’s social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use. Methods: Survey data was collected in-person from 521 African–American women. Multivariate logistic models identified the significant correlates of women’s daily use of tobacco and marijuana in the past six months. Results: 52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one’s health was protective against daily marijuana use. Conclusions: Findings stress the need for prevention and intervention efforts for African–American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.     

15Substance Use Disorder-PTSD Comorbidity: Patients’ Perceptions of Symptom Interplay and Treatment Issues

Forty-two patients with both a current substance use disorder (SUD) and posttraumatic stress disorder (PTSD) were asked about the interrelationship of their two disorders, their treatment preferences and experiences, as well as possible deterrents to receiving PTSD treatment. Patients perceived their two disorders to be functionally related. They reported that when one disorder worsened, their other disorder was more likely to worsen; when one disorder improved, the other disorder similarly improved. Consistent with these perceptions, SUD-PTSD patients favored simultaneous treatment of their two disorders. The majority of SUD-PTSD patients were never referred to PTSD treatment. Although several possible deterrents to PTSD treatment were identified, only lack of trust appeared to differentiate PTSD treatment compliers versus noncompliers. Implications of these findings on referral and treatment practices are discussed.     

A Six-Community Prevention Trial to Reduce Alcohol and Drug Use–Related Problems in Sweden: Planning and Early Findings

The objective of this study was to evaluate a research and development project to reduce alcohol and drug use–related problems, conducted during 2003–2005, in six urban and rural municipalities in Sweden, Umeå, Kramfors, Solna, Kalmar, Laholm, and Lund. The development of alcohol and drug use trends and patterns will be followed through 2008 in the six targeted intervention communities and in the six matched control communities. The evaluation includes archival data, survey data, observational data, as well as process measures. The six communities have gradually reoriented their thinking about prevention from a single focus on youth activities to a broader approach involving the whole population. The project's and the study's limitations are noted and future needed research is suggested.     

Internal Medicine Residents’ Training in Substance Use Disorders: A Survey of the Quality of Instruction and Residents’ Self-Perceived Preparedness to Diagnose and Treat Addiction

ABSTRACT

Background: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. Methods: A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. Results: Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate year (PGY) level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all 6 knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. Conclusions: Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUDs. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.     

Community’s Role and School’s Role in Protecting against Student Substance Use: A Spatial Analysis

Employing school catchment areas (SCAs) to represent communities in Alabama, this study hypothesized that student substance use would be most prevalent where structural disadvantages were most numerous and school- and community-bestowed encouragement of or rewards for students’ prosocial behaviors were scant. We employed data from the 2000 census and a secondary data set produced by the Alabama Department of Mental Health. Overall, we observed significant, strong effects on student substance use wielded by the community’s and school’s protective roles. Our results confirmed location as an explanatory factor, in that substance use in one community affected substance use in neighboring communities.     

Religiosity and Alcohol Use: Is Religiosity Important for Abstention and Consumption Levels in the Second Half of Life?

Objective: The aim of this study was to investigate the relative role of religiosity for alcohol abstention and consumption levels among individuals aged 40 years or above. Method: A two-wave prospective survey was conducted among Norwegians aged 40 to 80 years (Time 1 in 2002/2003, and Time 2 in 2007/2008). The analytical sample of this study constituted those who responded to the questionnaire survey at both time points (n = 2671). Results: The findings showed that religiousity was strongly associated with abstention and less consumption while adjusting for demographics and health variables. The results also reflected that females and those with higher age were more likely to abstain from alcohol than males and those with lower age, respectively. Individuals with high education were less likely to abstain than those with basic education. Females and those with high age also reflected less alcohol consumption than males and individuals of lower age, respectively. Further, people who were married or with a registered partner consumed less alcohol than people who were not married or with a registered partner. High education and good physical health was associated with higher consumption. The main results were consistent across prospective and cross-sectional models. Conclusion: Religiosity seems to be important both for abstention and alcohol consumption levels in the second half of life.     

Trend Analysis of Substance Abuse Treatment Admissions in New Orleans From 2000–2012: A Population-Based Comparison Pre- and Post-Hurricane Katrina

Background: Substance abuse treatment following a natural disaster is often met with challenges. If treatment is available, facilities may be unequipped to service an influx of patients or provide specialized care for unique populations. Objectives: This paper seeks to evaluate trends in substance abuse treatment over time and assess changes pre- and post-Hurricane Katrina. Methods: Substance abuse treatment admission data (N = 42,678) from New Orleans, Louisiana, for years 2000 through 2012 were obtained from the Treatment Episode Data Set. Admissions were examined to evaluate demographic, socioeconomic, psychiatric, and criminality trends in substance abuse treatment and assess changes following Hurricane Katrina. Results: Treatment admissions have decreased from 2000 to 2012. About one in five admissions had a psychiatric illness in addition to a substance abuse problem. A staggering 76% of admissions with a psychiatric illness were referred by the criminal justice system post-Katrina as compared to pre-Katrina. Rates of alcohol and marijuana admissions have remained stable from 2000 to 2012. Cocaine/crack admissions have declined and admissions who abused heroin have increased over time. Conclusions: Treatment admissions stabilized following Hurricane Katrina; however, since 2009, they have begun to decline. Targeted exploration of factors affecting admission to treatment in New Orleans with populations such as the homeless, those with a psychiatric illness in addition to a substance abuse problem, and those referred by the criminal justice system is essential. The results of this study assist in identifying variations in substance abuse treatment characteristics for those admitted to treatment in New Orleans.     

Girls’ Tobacco and Alcohol Use During Early Adolescence: Prediction From Trajectories of Depressive Symptoms Across Two Studies

Associations between trajectories of depressive symptoms and subsequent tobacco and alcohol use were examined in two samples of girls assessed at age 11.5 (T1), 12.5 (T2), and 13.5 (T3). Two samples were examined to ascertain if there was generalizability of processes across risk levels and cultures. Study 1 comprised a United States-based sample of 100 girls in foster care; Study 2 comprised 264 girls in a United Kingdom community-based sample. Controlling for T1 aggression and T1 substance use, individual variation in intercept and slope of depressive symptoms was associated with tobacco use at T3 in both samples: greater intercept and increases in depressive symptoms increased the risk for T3 tobacco use. A similar pattern of associations was found for alcohol use in Study 1. The replicability of findings for the prediction of tobacco use from trajectories of depressive symptoms suggests potential benefit in identifying girls with elevated depressive symptoms for tobacco use prevention programs, prior to the transition to secondary school.