Readiness to change alcohol and illicit drug use among a sample of emergency department patients

Objective: This study sought to (1) provide estimates of alcohol and illicit drug use, alone and in combination, among a sample of adult emergency department patients and (2) examine readiness to change.

Methods: Consecutive emergency department patients ≥18 years of age from a large regional hospital in Camden, NJ, were enrolled from May to December 2005. Patients provided information on alcohol and illicit drug use, as well as on interest in quitting each of these substance classes.

Results: Of the 1549 subjects surveyed, 98 (6%) indicated weekly use of both alcohol and illicit drugs, and 58 (4%) indicated problems associated with use of both substance classes. Problem users of illicit drugs felt that quitting drugs was more important, that they were more ready and that they were more confident in quitting than problem users of alcohol.

Conclusion: Problem use of multiple substances was relatively common in this emergency department sample. A substantial proportion of problem users of both substance classes were highly motivated to quit the use of one, but not the other, substance class. Further longitudinal and clinical trial research is needed to study the implications of multiple substance use, motivation to change and cessation.     

Therapeutic alliance and change in psychiatric symptoms in adolescents and young adults receiving drug treatment

Background: Despite a significant literature examining the processes and outcomes of formal psychotherapeutic interventions, helping relationships outside of traditional psychotherapy settings have received less empirical attention. This study examined the effect of therapeutic alliance on client outcomes within two community‐based case management services for young drug users.

Methods: The impact of therapeutic alliance on substance use and mental health outcomes was assessed over two occasions in 100 young people (aged 16–22 years) receiving case management within two youth drug and alcohol services.

Results: At baseline, those clients with non‐substance‐related mental health disorders, especially PTSD, reported a significantly worse therapeutic alliance with their case manager. Clients who rated the therapeutic alliance more positively at the beginning of intervention were more likely to evidence improvement in depressive symptoms over the follow‐up period. Conversely, higher depressive symptoms at baseline predicted deterioration in therapist‐rated alliance over the follow‐up period. No significant associations were reported between substance use ratings and the therapeutic alliance.

Conclusions: These findings with young help‐seeking substance users suggest that therapeutic alliance has a significant impact on symptom change during drug treatment, but that it interacts more strongly with depressive than substance use symptomatology.     

Perceived risks of alcohol and illicit drugs: relation to prevalence of use on individual and country level

Background: Individual experience with substance use is considered as one of the principal factors influencing risk perception and attitudes of young people towards substance use. The aim of this article is to show the relationship between self‐reported prevalence and the subjectively perceived risks of substance use, both for individuals and at the country level.

Methodology: The relationships were analysed on a sample of students participating in the ESPAD survey in eight European countries. The sample of 22,899 students was divided into five groups: abstainers (9.3%), experimental alcohol consumers (52.0%), regular alcohol consumers (14.2%), experimental drug users (12.3%), and regular drug users (12.2%).

Findings: Significant differences were observed in the risk perception of use of selected substances among five types of users. The percentage of students perceiving moderate or great risks of substance use tends to fall across the groups with increasing prevalence of more risky patterns of substance use. Highest perceived risks of alcohol and illicit drugs use were found among abstainers and experimental alcohol consumers, while both experimental and regular drug users tend to perceive lower risks. Regular alcohol consumers perceive relatively high risks of illicit drug use, but they under‐estimate the risks of alcohol consumption. Country differences were observed in the level of perceived risks. These differences correspond to a different distribution of types of users and to the overall prevalence of substance use in individual countries.     

Methamphetamine use among incarcerated women

Problem Women face greater vulnerability to using stimulant drugs, their rate of incarceration for methamphetamine use is increasing, and women's issues have been historically neglected in substance abuse research. This study examined demographic, social and psychological characteristics of incarcerated methamphetamine‐using women that could influence service needs and utilization during incarceration.

Method Incarcerated women completed individual interviews and questionnaires regarding drug use and other psychosocial variables. Psychosocial factors were examined according to lifetime drug use history. Comparison groups were: (1) nonstimulant drug users (n=16); (2) noninjection methamphetamine users (n=24); and (3) injection methamphetamine users (n=31). Psychosocial factors were also examined according to recent methamphetamine use. Recent use comparison groups were: (1) no recent drug use (n=18); (2) nonstimulant drug use (n=17); (3) noninjected methamphetamine (n=22); and (4) injected methamphetamine (n=20).

Findings Nearly one‐third of these incarcerated drug‐using women had never before received substance abuse treatment. Drug abuse, sexual assault and concomitant psychiatric symptoms were high across the entire sample, but greatest for methamphetamine users.

Conclusion Results revealed the complex psychosocial needs and risks that confront incarcerated methamphetamine‐using women and pose serious threats to eventual drug recovery.     

Sedative use: its association with harmful alcohol use,harmful tobacco use and quality of life among health care workers in Thailand

Background: Health care workers (HCWs) may be at higher risk for sedative misuse due to potential access and self-medication behavior.

Objectives: To examine risk factors for harmful sedative use (HSedU) and its association with harmful alcohol use (HAlcU), harmful tobacco use (HTobU) and quality of life (QoL).

Methods: A survey was conducted in 2013 at an urban university hospital in Northern Thailand. Risk of harm was measured using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Harmful substance use defined as having at least moderate risk of harm. QoL was measured using SF-36 questionnaire.

Results: A sample of 3204 HCWs (59.7% response) participated. The prevalence of HSedU in past 3 months was 4.2%. Health professionals involved with prescribing or dispensing medication were at higher risk of HSedU (OR 1.80, 95% CI 1.21–2.67). Adjusting for confounders, HSedU was associated with HAlcU (OR 3.35, 95% CI 1.81–6.20) but not associated with HTobU. HSedU was associated with lower QoL score which was 7.78 and 5.52 points lower for physical (95% CI ?10.4 to ?5.18) and mental QoL (95% CI ?7.11 to ?3.93), respectively.

Conclusions: HCWs were at higher risk of HSedU. HSedU was associated with HAlcU and associated with lower physical and mental health QoL.     

Methamphetamine use and sexual risks for HIV infection in Cape Town,South Africa

Aims: The current study examined the use of methamphetamine (Meth) in relation to HIV risks in a South African community sample.

Design and setting: Street intercept methods were used to collect surveys of substance use and sexual behavior from 441 men and 521 women living in a racially mixed township in Cape Town South Africa.

Findings: Results showed that 78 (18%) men and 63 (12%) women had used Meth, and 49 (11%) men and 34 (6%) women ever had used Meth in the preceding 6 months. Other than alcohol, cannabis was the most commonly used drug followed by Meth. We found that Meth use was closely associated with other drug use, indicating a pattern of poly‐substance use among Meth users. Recent Meth use was associated with being male, engaging in unprotected intercourse and having multiple sex partners in the previous 6 months. Meth users also demonstrated greater condom use than non‐users, although less than half of all intercourse occasions among Meth users were condom protected.

Conclusions: Meth is used by a substantial number of people in one area of South Africa and the close association of Meth and sexual risk practices raises concern that Meth could fuel the spread of HIV infection in new South African sub‐populations.     

Self-reported depression and its associated factors among male inpatients admitted for substance use disorders in Saudi Arabia

Abstract

Background: The association between depression and substance abuse is well established. However, uncertainties exist about the prevalence and comorbidity of substance use disorders and depression in Saudi Arabia.

Methods: Data were collected from December 2012 to March 2013 from 165 male inpatients admitted for substance use disorders to a public health hospital in Jeddah. Participants completed a self-administered questionnaire. Depression was assessed using the Arabic version of the Beck Depression Inventory (BDI).

Results: High BDI scores were reported by 95.2% of participants with more than two-thirds scoring severe (37%) or very severe (33.9%). Multivariate logistic regression indicated that those who had abused substances for more than 10 years were double the risk for depression compared to participants who had abused substances for less than 5 years (AOR?=?2.16; 95% CI: 1.09–9.11). Those abusing substances for a duration of 5–10 years were likely to have a threefold risk for depression relative to participants who had a substance abuse history of less than 5 years (AOR?=?3.08; 95% CI: 1.23–43.6).

Conclusion: There is high prevalence of depression among substance users in Saudi Arabia. Prevalence and comorbidity is significantly associated with duration of substance abuse. Such findings have implications for treatment and service development as patients with these co-morbidities will require complex management.     

French validity of two substance‐use screening tests among adolescents: A comparison of the CRAFFT and DEP‐ADO

Aim: The objective of this study was to compare the criterion validity of the CRAFFT and DEP‐ADO.

Method: One hundred and sixty‐three adolescents (80 from the general population and 83 regular substance users) completed the ADAD and the MINI questionnaires, as well as either the CRAFFT or the DEP‐ADO in roughly equal proportions, between March 2002 and August 2003. Sensitivity and specificity were calculated.

Results: Both questionnaires had high sensitivity but the DEP‐ADO showed a better specificity than CRAFFT. A score equal or higher than 8 on the scale of DEP‐ADO appeared to be an appropriate threshold for problems related to substance use. DEP‐ADO had a sensitivity of 92.0% and a specificity of 80.6% with severity rating scores of ADAD (alcohol and drug areas combined). With the MINI diagnoses, DEP‐ADO had a sensitivity of 95.1% and a specificity of 68.9%.

Conclusion: DEP‐ADO appears to have higher diagnostic utility for identifying substance use than CRAFFT in regard to sensitivity and specificity. However, the CRAFFT has the advantage of considering substance use over a lifetime period. Further studies should be targeting younger subjects and more diverse substance‐use patterns.     

Methoxetamine: prevalence of use in the USA and UK and associated urinary problems

Background: Methoxetamine is a novel psychoactive substance and a legal alternative to ketamine in many countries, including parts of the United States. Frequent recreational ketamine use can cause lower urinary tract symptoms, whereas methoxetamine was originally marketed as “bladder friendly”.

Aims: (1) To determine changes in prevalence of methoxetamine use between 2011 and 2012 in the USA and UK and (2) to investigate the prevalence of urinary symptoms in group of methoxetamine users, who had also used ketamine at least once in their lifetime.

Methods: Cross-sectional, anonymous online surveys exploring patterns of drug use were conducted in late 2011 (n?=?15?200) and late 2012 (n?=?22?289).

Results: Reported lifetime, past 12 months, and last month methoxetamine use significantly increased in the USA between 2011 and 2012; whereas, during the same period, past 12 months and last month methoxetamine use significantly decreased in the UK. Of the methoxetamine users questioned in the 2012 survey, 23.0% (n?=?98) reported experiencing urinary symptoms. Prevalence of at least one urinary symptom was related to frequency of methoxetamine use in the last month.

Conclusions: Methoxetamine use appeared to increase in the United States and decrease in the UK between 2011 and 2012. Approximately, one-quarter of methoxetamine users questioned reported urinary symptoms; however, previous ketamine use cannot be ruled out as the cause of the symptoms.     

Understanding how medications contribute to clinical deterioration and are used in rapid response systems: A comprehensive scoping review

BackgroundIn hospitals, rapid response systems (RRSs) identify patients who deteriorate and provide critical care at their bedsides to stabilise and escalate care. Medications, including oral and parenteral pharmaceutical preparations, are the most common intervention for hospitalised patients and the most common cause of harm. This connection between clinical deterioration and medication safety is poorly understood.ObjectivesTo inform improvements in prevention and management of clinical deterioration, this review aimed to examine how medications contributed to clinical deterioration and how medications were used in RRSs.Review methodsA scoping review was undertaken of medication data reported in studies of clinical deterioration or RRSs in diverse hospital settings between 2005 and 2017. Bibliographic database searches used permutations of “rapid response system,” “medical emergency team,” and keyword searching with medication-related terms. Independent selection, quality assessment, and data extraction informed mapping against four medication themes: causes of deterioration, predictors of deterioration, RRS use, and management.ResultsThirty articles were reviewed. Quality was low: limited by small samples, observational, single-centre designs and few primary medication-related outcomes. Adverse drug reactions and potentially preventable medication errors, involving sedatives, analgesics, and cardiovascular agents, contributed to clinical deterioration. While sparsely reported, outcomes included death and escalation of care. In children, administration of antibiotics or nebulised medications appeared to predict subsequent deterioration. Cardiovascular medications, sedatives, and analgesics commonly were used to manage deterioration but further detail was lacking. Despite reported potential for patient harm, evaluation of medication management systems was limited.ConclusionsMedications contributed to potentially preventable clinical deterioration, with considerable harm, and were common interventions for its management. When assessing deteriorating patients or caring for patients who require escalation to critical care, clinicians should consider medication errors and adverse reactions. Studies with more specific medication-related, patient-centred end points could reduce medication-related deterioration and refine RRS medication use and management.     

Non‐therapeutic omission of medications in acutely ill patients

Aims and objectives: To examine documentation of medication administration in medical and surgical patients. Study objectives: (1) Determine the point prevalence of non‐therapeutic medication omissions; (2) identify documented reasons for non‐therapeutic medication omissions; (3) examine the relationship between length of stay and medication omissions; and (4) explore the impact of outlier status (e.g. medical patients managed on surgical wards) on medication administration. Background: Acutely ill patients are particularly sensitive to health care errors. We previously identified a 26% rate of non‐therapeutic medication omissions in patients admitted unexpectedly to intensive care unit (ICU) from medical and surgical wards. Design: A point prevalence survey of 162 medical and surgical patients across four sites in the South West of England. Method: Data collected included: all instances of, and reasons for, non‐therapeutic medication omission. We also recorded whether the patient was an ‘outlier’ and examined nursing documentation where no reason for medication omission was given on the drug chart. Results: The number of patients who missed at least one medication was high across all sites (n = 129/162; 79.6%, range 60–88%), with a total of 1077 doses omitted. Patients who were outliers (e.g. surgical patients on a medical ward) were more likely to miss medications (100% versus 74%, p < 0.001). The most common missed medications were analgesia and anti‐inflammatory drugs (28%, 299/1077); 203 of these were due to patient refusal. Conclusions: The extent of medications omitted for non‐therapeutic reasons in medical and surgical patients is of concern. None were recorded as an adverse drug event; however, the extent of omitted or refused medications suggests the need for a review of prescribing and drug administration processes. These findings have important implications for the role of ICU outreach and liaison services, for example, including medication management in the monitoring of patients pre/post‐ICU admission and support/education provided for ward staff. Relevance to clinical practice: Detailed analysis of medication records suggests a number of areas of medication administration that would benefit from review.     

Risks of combined alcohol/medication use in older adults

Background:Many older adults (ie, those aged ≥65 years) drink alcohol and use medications that may be harmful when consumed together.Objective:This article reviews the literature on alcohol and medication interactions, with a focus on older adults.Methods:Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966–August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources.Results:Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol and medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications.Conclusions:Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances.     

Behavioral and physiologic adverse effects in adolescent and young adult emergency department patients reporting use of energy drinks and caffeine

Abstract

Introduction. This pilot study assessed the prevalence of physiologic and behavioral adverse effects among adolescent (13–17 years) and adult (18–25 years) emergency department patients who reported energy drink and/or caffeinated-only beverage use within the 30 days prior to emergency department presentation. It was hypothesized that energy drink users would report more adverse effects than those who used only traditional caffeinated beverages such as coffee, tea, or soft drinks. Methods. This cross-sectional pilot study was conducted in two urban emergency departments, one adult and one pediatric. Eligible patients were enrolled during a 6-week period between June and August 2010. Participants completed a tablet computer-based, self-administered, anonymous questionnaire about their past 30-day energy drink and/or caffeinated-only beverage use, substance use, and experience of 10 physiologic and 10 behavioral symptoms. Multivariable logistic regression and negative binomial regression models, adjusted for age, gender, and substance use, were created to compare the occurrence of each adverse effect between energy drink and caffeinated-only beverage users. Odds ratios (ORs) and incidence rate ratios (IRRs) were estimated. Results. Of those enrolled, 53.3% reported consuming energy drinks, 39.1% caffeinated-only beverages, and 7.6% no energy drinks or caffeinated-only beverages within the past 30 days. In multivariable logistic regression models, energy drink users were more likely than caffeinated-only beverage users to report having “gotten into trouble at home, school, or work” in the past 30 days (OR: 3.12 [1.24–7.88]). In the negative binomial regression multivariable models, more behavioral effects were reported among drug users (IRR: 1.50 [1.18–1.93]), and more physiologic effects were reported among tobacco users (IRR: 1.42 [1.13–1.80]) and females (IRR: 1.48 [1.21–1.80]), but not among energy drink users. Conclusions. Energy drink users and substance users are more likely to report specific physiologic and behavioral adverse effects. Emergency department clinicians should consider asking patients about energy drink and traditional caffeine usage and substance use when assessing patient symptoms.     

Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: prevalence and risk factors

Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or sedatives among 1,848 integrated care plan members who were prescribed chronic opioid therapy (COT) for chronic noncancer pain. Concurrent sedative use was defined by receiving sedatives for 45+ days of the 90 days preceding the interview; concurrent alcohol use was defined by consuming 2+ drinks within 2 hours of taking an opioid in the prior 2 weeks. Some analyses were stratified by substance use disorder (SUD) history (alcohol or drug). Among subjects with no SUD history, 29% concurrently used sedatives versus 39% of those with an SUD history. Rates of concurrent alcohol use were similar (12 to 13%) in the 2 substance use disorder strata. Predictors of concurrent sedative use included SUD history, female gender, depression, and taking opioids at higher doses and for more than 1 pain condition. Male gender was the only predictor of concurrent alcohol use. Concurrent use of CNS depressants was common among this sample of COT users regardless of substance use disorder status. PERSPECTIVE: Risks associated with concurrent use of CNS depressants are not restricted to COT users who abuse those substances. And, the increased risk of concurrently using CNS depressants is not restricted to opioid users with a prior SUD history. COT requires close monitoring, regardless of substance use disorder history.     

Problematic use of psychoactive substances in undergraduates: a comparison of four patterns of substance use

The aim of the study was to examine the difference between alcohol-related and illicit drug-related negative consequences in a sample of undergraduates. The survey study was conducted on a sample of 458 lifetime drug users among second-year students, aged between 19 and 25 years (M?=?21.24, SD?=?1.15). The Chi-square test of independence revealed a significant dominance of alcohol-related consequences, in comparison to drug-related ones. Separate repeated measures analyses of variance (ANOVAs) were performed to examine mean differences between substance-related consequences (alcohol-related and illicit drug-related) among the groups of current substance users in four patterns: (1) frequency of alcohol use (non-users, occasional, regular), (2) quantity of alcohol use (non-users, moderate, binge), (3) frequency of illicit drug use (non-users, occasional, regular) and (4) concurrent alcohol and illicit substance use (non-user, alcohol only user, concurrent alcohol and drug user). The strongest association was found between regular illicit drug users and substance-related consequences, when comparing four models of multivariate analysis of variances (MANOVAs). Collectively, these results extend previous findings that identification of regular illicit drug users among undergraduates may be a powerful tool for predicting both alcohol-related and drug-related negative consequences and a potential target for clinical intervention and prevention efforts at universities.