Substance Use and Associated Health Conditions throughout the Lifespan

Evaluation and Management of Alcohol use Disorder among Older Adults

Purpose of Review

The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management.

Recent Findings

The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines.

Summary

All older adults should be routinely screened for AUD with standardized screening tools. If a patient’s screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

A cross-sectional examination of caregiver mental health and childhood cancer survivors' tobacco, alcohol, and marijuana use

PURPOSE

As childhood cancer survivors (CCS) age, they face numerous long-term consequences, or late effects, from their cancer treatments. Late effects may be mitigated by health-promoting behaviors, including the avoidance of substance use. CCS with greater depression symptomology have reported greater substance use, but whether their habits are associated with the mental health of their caregivers is unknown. The aim of this study was to examine caregiver psychosocial correlates of CCS substance use.

METHODS

This study utilizes data from the Project Forward pilot study, which collected data from 129 CCS-caregiver dyads (CCS mean age = 19.43, SD = 2.78; years since diagnosis = 7.62, SD = 2.06) from two large hospitals in Los Angeles County. CCS provided self-reported information on substance use, while caregivers self-reported on posttraumatic stress symptomatology (PTSS) associated with their child's cancer and current depressive symptoms.

RESULTS

Among CCS, prior 30-day tobacco, marijuana, binge drinking, and polysubstance use were 12.50%, 14.17%, 13.18%, and 12.40%. In multivariable logistic regression models, caregiver PTSS was independently positively associated with CCS tobacco use. No other significant relationships between caregiver mental health (PTSS or depressive symptoms) and CCS substance use were observed.

CONCLUSION

These findings suggest that caregiver PTSS is partially associated with CCS behavioral health. Survivorship care may improve tobacco use prevention efforts by incorporating family or caregiver mental health needs. Future research should examine the potential mediating effect of CCS mental health, including depressive symptoms, on this relationship.

Substance use, mental disorders and COVID-19: a volatile mix

PURPOSE OF REVIEW

The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment.

RECENT FINDINGS

Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions.

SUMMARY

Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.

Tobacco and cannabis poly-substance and poly-product use trajectories across adolescence and young adulthood

Tobacco and cannabis poly-substance and poly-product use is common in adolescents and young adults (AYAs), but few studies have examined developmental trajectories of poly-use. This study characterized the prevalence, patterns, and racial/ethnic and sex differences of developmental trajectories of use and poly-use of 8 different widely-marketed tobacco and cannabis products across adolescence and young adulthood. 3322 AYAs from Los Angeles, California completed 5 surveys from fall of 11th grade (2015) to 1-2 years post-high school (2018-2019). Self-reported past 30-day use of three tobacco (nicotine vaping, cigarette, hookah) and five cannabis (combustible, blunt, edible, vaping, dabbing) products were analyzed using parallel growth mixture modeling to identify tobacco and cannabis use and poly-use trajectories; racial/ethnic and sex differences were evaluated as correlates of trajectory membership. Five trajectories were identified: Non-Users (58.6%); Young Adult-Onset Poly-Substance/Poly-Product Users (15.8%); Decreasing Moderate Poly-Substance/Poly-Product Users (9.8%); Increasing Predominant Cannabis Poly-Product Users (8.3%); and Chronic Poly-Substance/Poly-Product Users (7.3%). Within trajectories, developmental patterns of each tobacco and cannabis product were similar. Non-Hispanic White (vs. non-NH White) participants had higher odds of belonging to the Chronic Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 2.24[1.37,3.67]); females (vs. males) had higher odds of belonging to the Young Adult-Onset Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 1.30[1.02-1.66]). Tobacco and cannabis poly-substance use patterns, including use of various products, appear to be a common developmental trajectory during some point in adolescence and young adulthood. The interplay of tobacco and cannabis poly-substance/poly-product use merit attention in prevention and regulatory policies to protect AYA health.

Prosocialness in young males with substance and behavioral addictions

BACKGROUND AND AIMS

Social determinants are closely related to addiction, both as a cause and a consequence of substance use and other addictive behaviors. The present paper examines prosocialness (i.e. the tendency to help, empathize, and care for others) among a population of young males. We compared prosocialness across different types of addiction and examined whether prosocialness varied according to the presence of multiple addictions.

METHODS

A sample of 5,675 young males, aged 19-29 years old (Mean = 21.4; Median = 21), completed a questionnaire that included screening tools to identify addictive behaviors with regards to alcohol, nicotine, cannabis, gambling, and gaming. The questionnaire also included a scale to measure prosocialness.

RESULTS

Compared to a no-addiction control group, the subgroups of young men suffering from behavioral addictions (i.e., gambling and gaming) reported the lowest levels of prosocialness. Respondents with an alcohol addiction also showed lower prosocialness compared to no-addiction controls. By contrast, no significant differences in prosocialness were found between respondents with nicotine disorder or cannabis disorder and the no-addiction controls. Furthermore, the number of addictions had no clear, observable effects on prosocialness. Significant differences were found between the no-addiction control group and the groups reporting one or more addictions, but not between the separate groups reporting one, two, and three or more addictions.

DISCUSSION AND CONCLUSIONS

A better understanding of the social dimension affecting young males with addiction, particularly gambling and gaming addictions, may be useful for their prevention and treatment.

Impact of Alcohol Abuse on Susceptibility to Rare Neurodegenerative Diseases

Despite the prevalence and well-recognized adverse effects of prenatal alcohol exposure and alcohol use disorder in the causation of numerous diseases, their potential roles in the etiology of neurodegenerative diseases remain poorly characterized. This is especially true of the rare neurodegenerative diseases, for which small population sizes make it difficult to conduct broad studies of specific etiological factors. Nonetheless, alcohol has potent and long-lasting effects on neurodegenerative substrates, at both the cellular and systems levels. This review highlights the general effects of alcohol in the brain that contribute to neurodegeneration across diseases, and then focuses on specific diseases in which alcohol exposure is likely to play a major role. These specific diseases include dementias (alcohol-induced, frontotemporal, and Korsakoff syndrome), ataxias (cerebellar and frontal), and Niemann-Pick disease (primarily a Type B variant and Type C). We conclude that there is ample evidence to support a role of alcohol abuse in the etiology of these diseases, but more work is needed to identify the primary mechanisms of alcohol's effects.

Risk Factors of Binge Drinking in Adults Across Gender and Age Groups: Sixth Korea National Health and Nutrition Examination Survey 2014

Alcohol consumption has significantly increased in South Korea, with binge drinking looming as a serious issue. This study aimed to identify differences in drinking characteristics and the risk factors of binge drinking across three age groups: young adults, middle-aged adults, and seniors. This study was a descriptive, secondary analysis study based on the data from the Korean National Health and Nutrition Examination Survey 2014. In this study, we analyzed data from 5,604 respondents aged 20 years and older using Rao-Scott chi-square and analysis of variance. To analyze the risk factors of binge drinking by gender and age groups, multiple logistic regression analysis was applied. Results indicated that the three age groups were significantly different in terms of sociodemographic characteristics, health-related behaviors, and drinking characteristics. Rates of binge drinking were much higher in young adults in both men and women. The factors influencing binge drinking varied by age group and gender; however, in both men and women, participants who drank alcohol once a month or more showed a significantly higher risk of binge drinking than those who did not across all age groups. Younger initial drinking age and daily smoking were key risk factors of binge drinking among young and middle-aged adults in both men and women. Given the findings from this study, interventions considering the differences in drinking characteristics and risk factors of binge drinking across the age groups as well as focusing on the risk of binge drinking among young adults must be developed in communities and clinical settings.

Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients

Background

A common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients.

Methods

N = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated.

Results

A two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70).

Conclusion

This is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.

Brain circuitry underlying the ABC model of anxiety

Anxiety Disorders are prevalent and often chronic, recurrent conditions that reduce quality of life. The first-line treatments, such as serotonin reuptake inhibitors and cognitive behavioral therapy, leave a significant proportion of patients symptomatic. As psychiatry moves toward targeted circuit-based treatments, there is a need for a theory that unites the phenomenology of anxiety with its underlying neural circuits. The Alarm, Belief, Coping (ABC) theory of anxiety describes how the neural circuits associated with anxiety interact with each other and domains of the anxiety symptoms, both temporally and spatially. The latest advancements in neuroimaging techniques offer the ability to assess these circuits in vivo. Using Neurosynth, a large open-access meta-analytic imaging database, the association between terms related to specific neural circuits was explored within the ABC theory framework. Alarm-related terms were associated with the amygdala, anterior cingulum, insula, and bed nucleus of stria terminalis. Belief-related terms were associated with medial prefrontal cortex, precuneus, bilateral temporal poles, and hippocampus. Coping-related terms were associated with the ventrolateral and dorsolateral prefrontal cortices, basal ganglia, and anterior cingulate. Neural connections underlying the functional neuroanatomy of the ABC model were observed. Additionally, there was considerable interaction and overlap between circuits associated with the symptom domains. Further neuroimaging research is needed to explore the dynamic interaction between the functional domains of the ABC theory. This will pave the way for probing the neuroanatomical underpinnings of anxiety disorders and provide an evidence-based foundation for the development of targeted treatments, such as neuromodulation.

Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey

BACKGROUND

Substance use can exacerbate cancer-related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors.

METHODS

The authors used data from the National Survey of Drug Use and Health (2015-2018) to identify a nationally representative sample of AYAs aged 12 to 34 years. Outcomes assessed past-year tobacco, alcohol, marijuana, and illicit drug use; misuse of prescription opioids; SUDs; and SUD treatment. Multiple logistic regression was estimated to compare outcomes between 832 AYAs who reported a cancer history (survivors) and 140,826 AYAs who did not, adjusting sequentially for sociodemographic characteristics and health status.

RESULTS

In regressions adjusting for sociodemographic characteristics, survivors were more likely than a noncancer comparison group of peers to use alcohol (6% relative increase; P = .048) and illicit drugs (34% relative increase; P = .012), to misuse prescription opioids (59% relative increase; P < .001), and to have a marijuana (67% relative increase; P = .011), illicit drug (77% relative increase; P < .001), or prescription opioid (67% relative increase; P = .048) SUD. When further adjusting for health status, survivors were still 41% more likely (P < .001) to misuse prescription opioids than noncancer peers. Among those with SUDs, survivors were more likely than peers to receive treatment (unadjusted, 21.5% vs 8.0%; adjusted, P < .05).

CONCLUSIONS

AYA survivors were as likely as or more likely than noncancer peers to report substance use problems. These findings underscore the importance of interventions to reduce substance use and improve SUD treatment among AYA cancer survivors.

LAY SUMMARY

The authors assessed substance use, misuse, and substance use disorders, as well as the receipt of treatment for substance use disorders, among adolescent and young adult (AYA) cancer survivors. In a nationally representative AYA sample, cancer survivors, despite their increased risk for morbidity and early mortality, were as likely as or more likely than peers without cancer to experience substance use problems. In particular, survivors had a significantly higher rate of prescription opioid misuse than peers. However, only 1 in 5 AYA survivors who experienced substance use disorders received treatment. These findings underscore the importance of interventions toward reducing substance use and improving access to treatment among AYA survivors.

A Survey on Wellness and Its Predictors Amongst Fiji High School Students

Background: Adolescent population face a number of health concerns which calls for objective and comprehensive assessment of their wellness during their critical development phase. This study aimed to determine adolescent wellness and its predictors amongst adolescents in secondary schools in Fiji. Methods: This quantitative cross sectional study was conducted in four purposively selected schools in Suva and the greater Suva area, Fiji, between August and September, 2019. Students of Fijian nationality, enrolled into years 11-13 in the selected schools were purposively selected. A structured self-administered questionnaire was used to collect data on four dimensions of wellness including physical, emotional, social, and spiritual. Spearman's Rho correlation was conducted to test for associations. Descriptive and inferential statistical tests were applied to analyze the data by the SPSS software version 25. A p-value < 0.05 was considered significant. Results: A total of 350 students participated in the study. Mean raw scores for wellness dimensions were as follows: physical = 51 (out of 60), psychological = 63 (out of 80), social = 42 (out of 50), and spiritual = 34 (out of 40). For overall wellness, two significant differences were observed: students of Fijian Itaukei descent (193.68 ± 14.2) and participants with a family income of $40,000-50,000 (199.08 ± 12.60) (p = 0.04) had a higher overall wellness score. There were three significant differences observed for psychological wellness dimension; Fijians of Indian descent (64.68 ± 9.30), participants enrolled into year 13 (64.68 ± 9.30) and those with a family income of $40,000-50,000 had higher psychological score. For social wellness, a significant difference was observed: Itaukei participants had higher scores (43.34 ± 4.42) when compared to other ethnic groups (p < 0.05). In terms of spiritual wellness, a significant difference was observed for ethnicity: Itaukei participants had a higher mean score (35.59 ± 4.26) when compared to other ethnic groups (p < 0.05). Strong correlations were observed for all dimensions of wellness. Conclusions: Findings of this study highlighted different factors affecting adolescents' wellness in Fiji. It is recommended that health education and awareness program be carried out for developing adolescent wellness by considering these factors. It is also recommended that parental and family support are provided to adolescents.

Black and Latino Persons Living with HIV Evidence Risk and Resilience in the Context of COVID-19: A Mixed-Methods Study of the Early Phase of the Pandemic

The COVID-19 pandemic has great potential to disrupt the lives of persons living with HIV (PLWH). The present convergent parallel design mixed-methods study explored the early effects of COVID-19 on African American/Black or Latino (AABL) long-term survivors of HIV in a pandemic epicenter, New York City. A total of 96 AABL PLWH were recruited from a larger study of PLWH with non-suppressed HIV viral load. They engaged in structured assessments focused on knowledge, testing, trust in information sources, and potential emotional, social, and behavioral impacts. Twenty-six of these participants were randomly selected for in-depth semi-structured interviews. Participants were mostly men (64%), African American/Black (75%), and had lived with HIV for 17 years, on average (SD=9 years). Quantitative results revealed high levels of concern about and the adoption of recommended COVID-19 prevention recommendations. HIV care visits were commonly canceled but, overall, engagement in HIV care and antiretroviral therapy use were not seriously disrupted. Trust in local sources of information was higher than trust in various federal sources. Qualitative findings complemented and enriched quantitative results and provided a multifaceted description of both risk factors (e.g., phones/internet access were inadequate for some forms of telehealth) and resilience (e.g., “hustling” for food supplies). Participants drew a direct line between structural racism and the disproportional adverse effects of COVID-19 on communities of color, and their knowledge gleaned from the HIV pandemic was applied to COVID-19. Implications for future crisis preparedness are provided, including how the National HIV/AIDS Strategy can serve as a model to prevent COVID-19 from becoming another pandemic of the poor.

National Trends of Tobacco, Alcohol, and Drug Use in Patients Admitted With Acute Myocardial Infarction

BACKGROUND

Acute myocardial infarction (AMI) is a significant health and economic burden in the US. Tobacco, alcohol, and drug use are established risk factors. We sought to evaluate the national trend of use of each substance in patients admitted with AMI.

METHODS

We used the National Inpatient Sample between 2005 and 2017. We included adult patients hospitalized with AMI. International Classification of Diseases, Ninth and Tenth Revisions codes were used to define tobacco, alcohol, cocaine, opioid, cannabis and other drug use. Trends of each substance use were assessed using multivariable Poisson regression, and were expressed as annual percent change (APC) with their 95% confidence intervals (CIs).

RESULTS

A total of 10,796,844 hospitalizations with AMI were included. Among all substances used, tobacco was the most common (32.7%), followed by alcohol (3.2%). Between 2005 and 2017, the prevalence ratio of tobacco use increased from 21.5% to 44.5% with an APC +6.2% (95%CI 6.2%-6.2%). Tobacco users had more percutaneous coronary intervention (41%vs25%) and coronary artery bypass surgery (6.9%vs4.9%), p < 0.001. Further, there were positive trends in alcohol (APC +3.1%; 95%CI 3.0%-3.2%), opioid (APC +9.0%; 95%CI 8.7%-9.2%), cannabis (APC + 7.2; 95% CI 7%-7.4%), and combined all drug use (+7.1%; 95%CI 7%-7.2%). Meanwhile, there was a slight negative trend in cocaine use.

CONCLUSIONS

This analysis outlines the national trends of substance use in patients admitted with AMI and reveals an increasing prevalence of tobacco use, alcohol and drug use. More effective cessation measures are necessary to reduce the risk for AMI and its burden on the healthcare system and economy.

Examining the Coevolution of Drug Use Variety and Different Types of Offending Frequency Among Justice-Involved Adolescents

Past research demonstrates a strong link between drug use and crime among justice-involved adolescents, yet little is known about the joint development between drug use variety and various types of criminal offending frequencies from adolescence to young adulthood. Using a sample of male adolescent offenders ( N = 842), this article examines the coevolution of drug use variety and three separate types of offending frequencies. First, four group-based trajectory models identify unique group developmental patterns for drug use variety, drug sales offending, property offending, and violent offending. Next, three dual-trajectory models examine the coevolution between drug use variety and each type of criminal offending. Findings reveal a general pattern of desistance for both drug use and offending, while also illustrating notable variability in group trajectory patterns for drug use variety and criminal behavior. This article concludes that adolescents with elevated drug use variety make up a large proportion of frequent offenders.

Food and alcohol disturbance in a broad age-range adult sample

Food and alcohol disturbance involves restricting, purging, or excessively exercising to compensate for the calories consumed from drinking alcohol, or to enhance intoxication levels. But these compensatory behaviors, colloquially termed "drunkorexia," have only been investigated in young adult samples-primarily college students-who are presumed to be at risk due to their high episodic drinking rates. Therefore, this study sought preliminary evidence that food and alcohol disturbance occurs in a broader age-range sample of adult drinkers. We recruited 253 participants aged 18 to 76 (M_age = 38.71) from Mechanical Turk. Rates of food and alcohol disturbance (measured by the Compensatory Eating Behaviors in Response to Alcohol Consumption) were high: 64% of the sample endorsed performing at least one compensatory behavior in the past three months. There were no gender differences in overall prevalence, though men were more likely than women to engage in food and alcohol disturbance to enhance intoxication levels. Drinking habits, drinking motivated by conformity, and abnormal eating attitudes were the strongest predictors of food and alcohol disturbance. However, eating attitudes were a stronger predictor of these behaviors in men than women, whilst drinking habits were a stronger predictor of these behaviors in women than men. The high prevalence of food and alcohol disturbance in our broad age-range sample, alongside the far-reaching health consequences of these behaviors, highlights the need for increased awareness in younger, middle, and older adults alike.

Increased prevalence of non-communicable physical health conditions among autistic adults

LAY ABSTRACT

Previous research indicates autistic individuals die at a younger age than others and that this is possibly due in part to chronic physical health conditions. The present study used an anonymous, online survey to determine how common certain physical health conditions are among autistic adults, compared with non-autistic adults. We found autistic adults are more likely to develop heart conditions, lung conditions, and diabetes than non-autistic adults. Autistic females may be at higher risk of developing certain conditions (including respiratory conditions, asthma, and prediabetes) than autistic males. Finally, autistic individuals have increased health risks even when considering lifestyle factors (such as smoking, alcohol, and body mass index). This is still a relatively small study, and future research needs to confirm these findings and identify why these risks exist.

24-h Movement Guidelines and Substance Use among Adolescents: A School-Based Cross-Sectional Study

Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen time, and sleep duration recommendations have previously been associated with substance use among adolescents. However, previous research has mainly examined these factors individually rather than looking at how these indicators could concurrently relate to substance use in this age group. Therefore, this study examined the associations between meeting the 24-h movement guidelines for screen time, sleep duration, and physical activity (independent variables) with substance use outcomes including alcohol consumption, cannabis use, and cigarette smoking (dependent variables) among adolescents. Self-reported data from a cross-sectional and representative sample of 10,236 students (mean age = 15.1 years) in Ontario, Canada were analyzed. Logistic regression models stratified by gender were adjusted for potential confounders. Combinations of 24-h movement guidelines was differentially associated with substance use in boys and girls. Overall, findings showed that meeting 24-h movement guidelines is associated with lower odds of alcohol consumption, cannabis use, and cigarette smoking differentially with type of recommendation met and gender. Given that the associations between 24-h movement guidelines and substance use differ between boys and girls, future efforts should take this into consideration.

Family and parent-child relationship correlates of pediatric cancer survivors' substance use

OBJECTIVE

The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns.

METHODS

Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; M_age = 17.15, SD_age = 2.86) and their caregivers (M_age = 46.54, SD_age = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors.

RESULTS

Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use.

CONCLUSION

AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Depression and substance use: The CES-D's utility in predicting treatment outcomes in a longitudinal multi-site study of residential treatment centers

This investigation utilized a large sample of individuals undergoing substance use treatment to examine the CES-D's structural validity and establish its predictive utility relative to treatment discharge. The sample included 5750 individuals who were receiving substance abuse treatment at 19 different residential treatment facilities. The CES-D was administered to participants over the course of their time in a residential inpatient substance use treatment program. The present study used a split sample method to conduct both exploratory (EFA) and confirmatory (CFA) factor analyses. Results of both the EFA and CFA indicated that the CES-D contains three first order factors measuring negative mood, positive affect, and interpersonal interactions as well as a second-order high score factor which can be used to guide interpretation and symptom monitoring. Individuals receiving residential treatment fell into one of three distinct groups based on their CES-D scores, and that their scores (and subsequent trajectories of scores over time) were differentially related to discharge status. Implications for practice and the utility of the CES-D within substance use populations are discussed.

Comparison of social and sociodemographic characteristics and treatment goals of persons with alcohol versus drug use disorders: Result from a national census of inpatients in specialized treatment for substance use

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A national census of patients in residential substance use treatment.

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We compared inpatients with primary alcohol use disorders vs. drug use disorders.

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Patients with drug use disorders were more likely sociodemographic disadvantaged.

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Patients with drug use disorders more likely had poor friend relationships.

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Treatment goal differences disappeared when adjusted for sociodemographic variables.

Introduction

We examined differences in social and sociodemographic characteristics and treatment goals between people with primary alcohol use disorder (AUD) versus those with a primary drug use disorder receiving inpatient treatment for a substance use disorder (SUD).

Methods

A national census utilizing a cross sectional design included 56 of 60 specialized inpatient SUD treatment clinics in Norway and all patients receiving treatment on a specific date (responserate = 70%). Data on substance use, social and sociodemographic characteristics, and patient-reported treatment goals were collected. Patients were classified as having primary AUD or a drug use disorder based on the main SUD diagnosis relevant to the treatment episode.

Results

The analytic sample included 1093 patients. Patients with primary AUD (n = 362) were more often older, had a higher educational level and income from work, and lived in permanent housing compared with patients with a drug use disorder (n = 731). Patients with AUD were more likely to have good relationships with friends. The higher frequency of reported reduced substance use (versus quitting substance use) as the treatment goal among AUD patients disappeared when controlled for sociodemographic factors.

Conclusions

Knowledge about the different characteristics of inpatients with AUD versus a drug use disorder is relevant when conducting research involving the SUD treatment population and for facilitating treatment. The lower frequency of perceived support from friends among patients with a drug use disorder suggests a need for targeted efforts in (re)building supportive social relationships for inpatients being treated for SUD.

How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)

OBJECTIVE

To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings.

DESIGN

Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach.

PARTICIPANTS

Adults aged 18 years or older, receiving OST in UK-based primary care services.

RESULTS

Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals' experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals' commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan.

CONCLUSIONS

This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.

Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross-sectional study

BACKGROUND

Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life.

METHODS

The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated.

RESULTS

About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only.

CONCLUSION

The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.

Exploring Factors Associated with Alcohol and/or Substance Use During the COVID-19 Pandemic

This study explored the relationship between alcohol and substance use in the general population during the early stages of COVID-19 as related to individual, family, and community stressors. A convenience sample of adults who resided in the USA and Canada was utilized. An online survey was conducted. Over one-third of the sample reported utilizing alcohol and substances as a means to cope during the pandemic. A linear regression revealed that use of social media as a source of information, being personally affected by COVID-19, experiencing child care challenges, and not being associated with a religious community were related to increased likeliness for alcohol and/or substance use. Future research should explore these concepts further within the general population.

Using administrative health data to estimate prevalence and mortality rates of alcohol and other substance-related disorders for surveillance purposes

INTRODUCTION

Administrative health databases (AHD) are critical to guide health service management and can inform the whole spectrum of substance-related disorders (SRD). This study estimates prevalence and mortality rates of SRD in administrative health databases.

METHODS

The Quebec Integrated Chronic Disease Surveillance System consists of linked AHD. Analyses were performed on data of all Quebec residents aged 12 and over and eligible for health-care coverage using the International Classification of Diseases (ninth or tenth revision) for case identification. Mortality rate ratios stratified by causes of death were obtained to calculate an excess of mortality.

RESULTS

Since 2001-2002, the annual age-adjusted prevalence rate of diagnosed overall SRD remained stable (8.6 per 1000 in 2017-2018). In any given year, the annual prevalence rate was significantly higher in males; adolescents had the lowest rate, while adults 65 years and older the highest. The annual 2017-2018 rate was 2.1 per 1000 for alcohol-induced disorder, 1.9 for other drug-induced disorder, 0.7 for alcohol intoxication and 0.6 for other drug intoxications. Cumulative rate of any diagnosis related to alcohol was 32 per 1000 females and 53 per 1000 males (2001-2018), and 33 per 1000 females and 49 per 1000 males for any diagnosis related to other drugs. There was an excess of all-cause mortality among individuals with SRD compared to the general population.

DISCUSSION AND CONCLUSIONS

AHD can complement epidemiological surveys in monitoring SRD jurisdiction-wide. Surveillance of services utilisation and interventions, coupled with health outcomes like mortality, could be useful in guiding health services planning.

Associations Between Multiple Leisure Activities, Mental Health and Substance Use Among Adolescents in Denmark: A Nationwide Cross-Sectional Study

Background: Previous research has suggested that leisure activity may benefit mental health and protect against substance use among adolescents, but more research is needed to asses associations with a wide range of outcomes. The aim of this study was to assess associations between multiple leisure activities and (1) mental health outcomes and (2) substance use outcomes in a sample of Danish adolescents.

Methods: Using data from the Danish part of the European School Survey Project on Alcohol and Other Drugs (ESPAD) collected in 2019, nation-wide cross-sectional data from 2,488 participants aged 15 or 16 in Denmark were analyzed to assess associations between number of leisure activity types and outcomes pertaining to mental health and substance use.

Results: Our results show that engaging in multiple activity types at least once a week—as compared to one single type of activity—is associated with increased odds for high mental well-being, and reduced odds for mental health problems. Engaging in multiple activity types is also associated with reduced odds for overall substance use and for using substances as a coping method. Among those using substances, engaging in multiple activity types is associated with reduced odds of above average substance use.

Conclusion: Increasing opportunities for adolescents to engage in leisure activities is suggested to be useful in enhancing mental health and preventing substance use and promoting mental health. Promoting and increasing access to leisure activities among adolescents could be a promising avenue for policy and practice.

Self-reported PTSD is associated with increased use of MDMA in adolescents with substance use disorders

BACKGROUND

Adolescent patients with a substance use disorder (SUD) often fulfil the criteria for a co-occurring post-traumatic stress disorder (PTSD). However, it is not clear if these dual-diagnosed adolescents present with unique levels of substance use and how their substance use relates to PTSD symptom clusters.

OBJECTIVE

To investigate substance use in adolescents with co-occurring PTSD and SUD. Additionally, we explored how the use of specific substances is related to specific PTSD symptom clusters.

METHOD

We recruited n = 121 German adolescent SUD patients, in three groups: no history of traumatic events (TEs) (n = 35), TEs but not PTSD (n = 48), probable PTSD (n = 38). All groups were administered a trauma questionnaire and were asked to report their past-month substance use.

RESULTS

Adolescents with probable PTSD and SUD report a higher frequency of MDMA use than adolescents with no PTSD and no TE (PTSD vs. noTE: U = 510.5, p = .016; PTSD vs. TE: U = 710.0, p = .010). The use of MDMA was more frequent in adolescents with avoidance symptoms (X² (1) = 6.0, p = .014). Participants report using substances at a younger age (PTSD vs. noTE: U = 372.0, p = .001; PTSD vs. TE: U = 653.5, p = .022) and PTSD symptom onset was on average 2.2 years earlier than first MDMA use (t (26) = -2.89, p = .008).

CONCLUSIONS

Adolescent SUD patients with probable PTSD are more likely to use MDMA than SUD patients without PTSD. The use of MDMA was associated with reported avoidance symptoms. The first age of MDMA use is initiated after PTSD onset. It is unclear whether the association of MDMA use with avoidance symptoms is due to efforts to reduce these symptoms or a result of regular MDMA use.

Improving Medication Access within Integrated Treatment for Individuals with Co-Occurring Disorders in Substance Use Treatment Agencies

BACKGROUND

The best approach to provide comprehensive care for individuals with co-occurring disorders (CODs) related to substance use and mental health is to address both disorders through an integrated treatment approach. However, only 25% of behavioral health agencies offer integrated care and less than 7% of individuals who need integrated treatment receive it. A project used a cluster-randomized waitlist control group design to evaluate the effectiveness of Network for the Improvement of Addiction Treatment (NIATx) implementation strategies to improve access to addiction and psychotropic medications.

METHODS

This study represents a secondary analysis of data from the NIATx project. Forty-nine agencies were randomized to Cohort1 (active implementation group, receiving the NIATx strategy [n=25]) or Cohort2 (waitlist control group [n=24]). Data were collected at three time points (Baseline, Year1 and Year2). A two-level (patient within agency) multinomial logistic regression model investigated the effects of implementation strategy condition on one of four medication outcomes: both medication types, only psychotropic medication, only addiction medication, or neither medication type. A per-protocol analysis included time, NIATx fidelity, and agency focus as predictors.

RESULTS

The intent-to-treat analysis found a statistically significant change in access to addiction versus neither medication, but Cohort1 compared to Cohort2 at Year1 showed no differences. Changes were associated with the experimental intervention and occurred in the transition from Year 1 to Year 2, where greater increases were seen for agencies in Cohort2 versus Cohort1. The per-protocol analysis showed increased access to both medications and addiction medications from pre- to post-intervention for agencies in both cohorts; however, differences in change between high- and low-implementation agencies were not significant.

CONCLUSIONS

Access to integrated services for people with CODs is a long-standing problem. NIATx implementation strategies had limited effectiveness in improving medication access for individuals with CODs. Implementation strategy adherence is associated with increased medication access.

Electronic Vaping Product Use among Young Adults Who Receive Care at a Major Medical Institution

Background: National estimates of electronic vaping product (EVP) use exist, but little is known about young adult EVP users who interact with the healthcare setting. Methods: Cross-sectional survey of 18-25 year olds receiving care in our ambulatory medical practice. Population differences were evaluated with the chi square test reporting unadjusted odds ratios (ORs). Results: Response rate was 16.6% (n = 1,017/6,119). The prevalence of ever EVP use was 46.0% of whom 13.9% used every day. Each additional day of alcohol use (past 30 days) was associated with increased odds of being an EVP user (OR = 1.06, 95% CI 1.02-1.09), and cannabis use (past 30 days) was associated with a higher odds of being an EVP user compared to non-cannabis users (OR = 40.0, 95% CI 17.4 - 111.8). Observing a biological parent (OR = 2.89, 95% CI 1.98-4.24), step parent (OR = 2.03, 95% CI 1.02-4.19) and full sibling (OR = 2.31, 95% CI 1.78-3.00) using inhaled substances (past 30 days) was associated with increased odds of being an ever EVP user. Ever EVP users had lower odds than never users to report that EVPs with nicotine are "a little" or "a lot" more harmful than smoking "regular" tobacco cigarettes (OR = 0.53, 95% CI 0.37 - 0.76). Conclusion: Our survey is limited by a low response rate but confirms observed associations between EVP use and substance use and social influences. Our data also suggest that professionals should regularly screen for EVP use among young people, especially those with exposure to family members who used inhaled substances.

Prevalence and Correlates of Illicit Drug Use among Norwegian Nightlife Patrons

BACKGROUND

Nightclubs and bars are recreational settings with extensive availability and consumption of alcohol and recreational drugs.

OBJECTIVES

This study aims to determine the proportion of nightclub patrons in Norway that tested positive for illicit drugs, moreover, we examined the correlation between positive test results and demographic and substance use characteristics.

METHODS

Patrons were recruited outside nightclubs on Friday and Saturday nights between 10:00 pm and 04:00 am. Substance use was determined by breath testing and oral fluid testing for alcohol and drugs, respectively, using accurate and specific analytical methods. Questionnaires recorded demographic and substance use characteristics.

RESULTS

Of the 1988 included nightclub patrons, 90% tested positive for alcohol, 14% for illicit drug use, and 3% for two or more illicit drugs. The proportion of patrons who tested positive for illicit drugs was highest in the early hours of the morning. Nine out of ten who tested positive for illicit drugs also consumed alcohol. Testing positive for one or more illicit drugs was most strongly correlated with being male and unemployed, using tobacco or other nicotine products, and early on-set illicit drug use; further the correlations were strongest among those who tested positive for two or more illicit drugs.Conclusions/Importance: Patrons who used illicit drugs before or during nightclub visits most often combined drug use with alcohol consumption. Substituting alcohol with cannabis or other drugs was not common in this cohort. The study results provide evidence to introduce harm-reduction prevention programs to address illicit drug and excessive alcohol consumption.

Influence of Family and Community Socioeconomic Status on the Risk of Adolescent Drug Use

Background: Adolescent drug use increases the risk of mental, physical and social problems later in life and so it is important to understand its complex etiology that likely includes socioeconomic status (SES). We undertook the present analysis using data from a population-based retrospective cohort study to examine the influence of family and community SES in relation to adolescent drug use. We hypothesized that lower levels of community and parental SES would increase the risk of use and that there would be stronger associations for the more proximate family-level factors. Methods: We used self-administered questionnaires (N=1,402) to obtain information on use of marijuana, inhalants, heroin, cocaine/crack, psychedelics/hallucinogens, Ritalin without a prescription, and club drugs during adolescence. Family SES was gathered from birth certificate data on maternal educational level and paternal occupation. Community SES characteristics at birth, age 10 and age 18 were obtained from the US Census Bureau. Results: An increased risk of adolescent drug use was associated with lower maternal education, non-white collar occupations among fathers, and lower community median income, and poverty and unemployment levels at age 18. The strongest associations were seen for the use of multiple drugs (Risk Ratio (RR): 1.7, 95% CI: 1.4-2.2), inhalants (RR: 2.5, 95% CI: 1.5-2.2), crack/cocaine (RR: 2.8, 95% CI: 1.7-4.5), psychedelics/hallucinogens (RR: 1.8, 95% CI: 1.4-2.4), and club/designer drugs (RR: 1.8, 95% CI: 1.2-2.7) among adolescents whose mothers had only a high school education. Conclusions: These results suggest that use of certain drugs during adolescence is associated with both family and community SES measures. However, maternal education appears to have the greatest influence on use, suggesting that a multi-level approach that engages mothers is needed to prevent adolescent drug use.

Trends and correlates of Internet support group participation for mental health problems in the United States, 2004-2018

PURPOSE

This study sought to examine the trends in Internet support group (ISG) participation among U.S. adults and to investigate the sociodemographic and behavioral health profiles of ISG participants.

METHODS

Data was derived from the National Survey on Drug Use and Health (2004-2018, n = 625,883). Logistic regression was used to examine significance of trend year and correlates of ISG participation. Latent class analysis was conducted to identify subtypes of ISG participants.

RESULTS

The proportion of U.S. adults participating in ISG increased significantly from 2.29% (2004-2007) to 3.55% (2016-2018). ISG participants were less likely to be male, 35 or older, be part of an ethnic/racial minority group, or have household incomes between $20,000 and $49,999. Black/African American participants and those classified as "other" race showed the largest percent increases, while Hispanics showed no change. ISG participants were more likely to have experienced a depressive episode and to have used cannabis. Three subtypes of ISG participants were identified, including the Lower Behavioral Health Risk group (62%), the Elevated Behavioral Health Risk group (24%), and the Depression, Cigarettes, and Cannabis group (14%).

CONCLUSION

Overall, we found an increasing trend in seeking mental health care through ISG among US adults since the early 2000s. While disparities among some disadvantaged groups such as Blacks/African Americans and individuals with lower household income were diminishing, continuing efforts to engage men, older adults, and Hispanics in ISG are needed. This investigation also identified distinct subtypes of ISG participants and provides important implications for future research on ISG.

An analysis of within-subject and population level risk related to substance use and mental health outcomes among adolescents in the PATH study

INTRODUCTION

The objective of this study was to understand how adolescent substance use patterns may lead to negative mental health outcomes.

METHODS

Data from adolescents (12-17 years old at baseline, Wave 1) who participated in the first 3 waves of the Population Assessment of Health and Tobacco (PATH) study were used. Self-reported data on past 30-day substance use and internalizing/externalizing problems were used to conduct within-subject (fixed-effects model) and population-averaged (GEE model) analyses.

RESULTS

In both within-subject and between-subject analyses, the use of other illicit drugs (e.g., opioids, cocaine, prescription drugs for non-medical use) was positively associated with internalizing problems (within-subject estimate, AOR: 1.65, 95 % CI = 1.36-2.01; between-subject estimate, AOR: 1.53, 95 % CI = 1.32-1.78) and alcohol use was positively associated with externalizing problems (within-subject estimate, AOR: 1.66, 95 % CI = 1.43-1.93; between-subject estimate, AOR: 1.67, 95 % CI = 1.48-1.89). Additionally, within-subject analysis suggested that alcohol, marijuana, and other illicit drugs were associated with increased odds of comorbid internalizing and externalizing problems (ranging from marijuana, AOR: 1.18, - alcohol, AOR: 1.58).

DISCUSSION

Using within-subject and between-subject comparisons, this study demonstrated associations between adolescent substance use and internalizing and externalizing problems. Results suggest not only the need for individual level assessment and early intervention, but also the development and implementation of public health policy aimed at preventing or mitigating the negative effects of substance use in adolescence to promote improved mental health outcomes for this at-risk group.

High levels of the openness trait are associated with better parental reflective functioning in mothers with substance use disorders

•

Mothers with high levels of Openness had better parental reflective functioning.

•

Mothers with low Openness need training in interpreting mental states in their children.

•

It is important to assess the mothers personality before selecting form of treatment.

Aims

Mothers with substance use disorders (SUD) often show impairments in parental reflective functioning (PRF), which may have adverse effects on their capacity for sensitive caregiving. Parenting personality is also associated with caregiving. However, no studies have investigated how these individual factors may contribute to variance in PRF in mothers with SUD. In this study PRF and personality were assessed in 43 mothers with SUD.

Methods

PRF was assessed by the Parent Development Interview. Personality traits were assessed by the Revised Neuroticism-Extraversion-Openness Personality Inventory.

Results

The results indicate that higher levels of the Openness trait are associated with better PRF.

Conclusion

Mothers low in Openness may need more specific and situational training in interpreting mental states in their children. Highly open mothers with SUD will likely need more help distinguishing the child’s mental states from their own, and might need help to maintain mutuality and regulating the intensity of their responses to the child’s behavior.

A delicate compromise: Striking a balance between public safety measures and the psychosocial needs of staff and clients in residential substance use disorder treatment amid COVID-19

In response to COVID-19, residential SUD treatment providers have significantly changed operations and clinical care to mitigate risk of infection for both clients and staff. While treatment facilities must enforce public safety measures in residential SUD treatment to protect the health of clients and staff, these measures create additional barriers to treatment engagement as well as health anxiety. We consider strategies to adjust clinical programming, enhance treatment engagement, and promote employee well-being in light of public safety measures and the chronic stressor of COVID-19.

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study

Background

Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service.

Methods

We analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings.

Results

Clients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model.

Conclusions

Addiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05861-8.

Gender and racial/ethnic differences in physiologic responses in the Stimulant Reduction Intervention using Dosed Exercise Study

Exercise may be beneficial for individuals in substance use disorder (SUD) treatment given the higher rates of both medical and psychiatric comorbidity, namely mood and anxiety disorders, compared to the general population. Gender and/or racial/ethnic differences in health benefits and response to prescribed exercise have been reported and may have implications for designing exercise interventions in SUD programs.

METHOD

Data are from the National Drug Abuse Treatment Clinical Trials Network (NIDA/CTN) Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial. Gender differences across racial/ethnic groups in physiological responses and stimulant withdrawal severity across time were analyzed using linear mixed effects models.

RESULTS

Males completed significantly more exercise sessions than females and were more adherent to the prescribed exercise dose of 12 Kcal/Kg/Week. Controlling for age, race/ethnicity, treatment group and stimulant withdrawal severity, there was a significant gender by time interaction for body mass index (BMI) (p < 0.001), waist circumference (p < 0.001) and heart rate measured prior to exercise sessions (p < 0.01). For females, body mass index (BMI) and waist circumference increased over time while for males BMI and waist circumference stayed unchanged or slightly decreased with time. Heart rate over time significantly increased for females at a higher rate than in males. Stimulant withdrawal severity was similar in males and females at baseline but males exhibited a significant decrease over time while females did not. Although baseline differences were observed, there were no time by race/ethnicity differences in physiologic responses.

DISCUSSION

Gender differences in response to exercise may have implications for developing gender specific exercise interventions in SUD programs.

E-cigarette use among young adults: A latent class analysis examining co-use and correlates of nicotine vaping

INTRODUCTION

Although a significant proportion of young adults report e-cigarette use (nicotine vaping), little is known about co-use with other substances, including correlates that predict co-use. The current study aimed to identify co-occurring substance use patterns and evaluate multiple correlates in a college student sample.

METHODS

435 participants (21.4 ± 2.9 years; 57% women; 41% Hispanic/Latina/o, 29% Asian-American/Pacific Islander, 17% Caucasian/White, 6% Multiracial, and 5% African-American/Black) from a large, urban university were recruited in-person and completed an online survey in the fall of 2018 and the spring of 2019.

RESULTS

Using latent class analysis (LCA), four substance use patterns were identified: Binge Drinkers (7%); e-cigarette Users (8%); Cannabis Users (14%); and Low Substance Users (71%). The e-cigarette Users class was characterized by moderate or greater use (>5 days of nicotine vaping in past 30-days) as well as past 30-day binge drinking and cannabis use. Higher levels of deviant peer affiliation (aOR = 1.28[1.11-1.47], p < .01), impulsivity-lack of premeditation (aOR = 1.36[1.05-1.78], p < .05), and lower levels of social anxiety (aOR = 0.94[0.88-0.99], p < .05), predicted membership in the e-cigarette Users class.

CONCLUSIONS

The most pervasive co-occurring substance use was observed among the e-cigarette Users class. Young adults reporting moderate or greater levels of nicotine vaping tended to engage in binge drinking and cannabis use, which may ultimately increase risk of deleterious health outcomes. Deviant peer affiliation and impulsivity-lack of premeditation (but not internalizing symptoms) predicted membership in the e-cigarette Users class; consequently, public health efforts may benefit from increased selectivity in targeting young adults for e-cigarette prevention and intervention services.

Prevalence, Characteristics, and Management of Chronic Noncancer Pain Among People Who Use Drugs: A Cross-Sectional Study

INTRODUCTION

Most studies on chronic noncancer pain (CNCP) in people who use drugs (PWUD) are restricted to people attending substance use disorder treatment programs. This study assessed the prevalence of CNCP in a community-based sample of PWUD, identified factors associated with pain, and documented strategies used for pain relief.

METHODS

This was a cross-sectional study nested in an ongoing cohort of PWUD in Montreal, Canada. Questionnaires were administered to PWUD seen between February 2017 and January 2018. CNCP was defined as pain lasting three or more months and not associated with cancer.

RESULTS

A total of 417 PWUD were included (mean age = 44.6 ± 10.6 years, 84% men). The prevalence of CNCP was 44.8%, and the median pain duration (interquartile range) was 12 (5-18) years. The presence of CNCP was associated with older age (>45 years old; odds ratio [OR] = 1.8, 95% CI = 1.2-2.7), male sex (OR = 2.3, 95% CI = 1.2-4.2), poor health condition (OR = 1.9, 95% CI = 1.3-3.0), moderate to severe psychological distress (OR = 2.9, 95% CI = 1.8-4.7), and less frequent cocaine use (OR = 0.5, 95% CI = 0.3-0.9). Among CNCP participants, 20.3% used pain medication from other people, whereas 22.5% used alcohol, cannabis, or illicit drugs to relieve pain. Among those who asked for pain medication (N = 24), 29.2% faced a refusal from the doctor.

CONCLUSIONS

CNCP was common among PWUD, and a good proportion of them used substances other than prescribed pain medication to relieve pain. Close collaboration of pain and addiction specialists as well as better pain assessment and access to nonpharmacological treatments could improve pain management in PWUD.

Literature review: Substance use screening and co-morbidity in medically hospitalized youth

OBJECTIVES

Pediatric and young adult patients frequently present to medical inpatient (MIP) units for treatment of substance use disorder (SUD). Given the risk of lifelong dependence and related complications in early life substance use (SU), a review of the literature is warranted.

METHODS

We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of literature published through April, 62,020, which examined incidence, screening, and complications of pediatric and young adult SU in the MIP setting.

RESULTS

8843 articles were screened, and 28 articles were included for final qualitative synthesis. The overall prevalence of SU-related discharge diagnoses ranged from 1.3% to 5% for patients aged 0 to 26 years. When compared to adult patients, nearly double the rate of co-morbid psychopathology was observed. Three studies utilized systematic screening tools, with the remainder relying on biologic screens and admission or discharge diagnoses.

CONCLUSIONS

The results of our review indicate that current screening practices for SU in the MIP clinical setting are subpar and likely result in an underestimation of incidence and morbidity due to limited use of systematic screening tools. Despite this, incidence of SU hospitalizations and related medical and psychiatric complications continue to rise.

Characterizing substance use in a sample of lesbian, gay, bisexual, and transgender adults in Mexico

Background: Research from high-income countries on substance use among lesbian, gay, bisexual, and transgender (LGBT) adults is growing; however, limited empirical research exists on LGBT adults in Mexico. Filling this gap is critical as LGBT adults experience unique stressors that may place them at risk for substance use-related health outcomes. Objectives: This study sought to characterize substance use prevalence and magnitude among a convenience sample of Mexican LGBT adults. Methods: A cross-sectional online survey was conducted using a sample of Spanish-speaking, self-identified LGBT adults (n = 92) residing in Mexico who were recruited through online forums of LGBT-focused organizations. Descriptive and frequency analyses were conducted. Results: Participants predominantly identified as cisgender men (n = 44) and gay/lesbian (n = 68). Participants reported high rates of past 90-day legal substance use (>93% for alcohol and >57% for tobacco). The most commonly reported illicit drug used in the past 90 days was marijuana (>29%). Conclusions: While the sample reported lower prevalence and magnitude of substance use relative to other Mexican or United States LGBT samples, the findings highlight that legal and illicit substance use presents health risks for Mexican LGBT individuals. LGBT identity-affirming substance use treatment may reduce substance use-related health burden among this population.

Trajectories of Nicotine and Cannabis Vaping and Polyuse From Adolescence to Young Adulthood

IMPORTANCE

Little is known about cannabis vaping trajectories across adolescence and young adulthood or the co-occurrence with nicotine vaping.

OBJECTIVE

To evaluate nicotine vaping and cannabis vaping trajectories from late adolescence to young adulthood (≥18 years of age) and the extent of polysubstance vaping.

DESIGN, SETTING, AND PARTICIPANTS

In this prospective cohort study, 5 surveys (including information on substance vaped) were completed at 10 high schools in the Los Angeles, California, metro area. Students were surveyed at 6-month intervals from fall of 11th grade (October to December 2015; wave 5) through spring of 12th grade (March to June 2017; wave 8) and again approximately 1 to 2 years after high school (October 2018 to October 2019; wave 9).

EXPOSURES

Past 30-day nicotine and cannabis vaping frequency across 5 waves.

MAIN OUTCOMES AND MEASURES

Self-reported frequency of nicotine vaping and cannabis vaping within the past 30 days across 5 time points from late adolescence to young adulthood. Trajectories were measured with these past 30-day use frequencies at each wave. Parallel growth mixture modeling estimated conditional probabilities of polysubstance vaping.

RESULTS

The analytic sample included 3322 participants with at least 1 time point of data (mean [SD] age, 16.50 [0.42] years at baseline; 1777 [53.5%] female; 1573 [47.4%] Hispanic or Latino). Growth mixture modeling identified the 5-trajectory model as optimal for both nicotine vaping and cannabis vaping. Trajectories for nicotine and cannabis vaping were similar (nonusers: 2246 [67.6%] nicotine, 2157 [64.9%] cannabis; infrequent users: 566 [17.0%] nicotine, 608 [18.3%] cannabis; moderate users: 167 [5.0%] nicotine, 233 [7.0%] cannabis; young adult-onset frequent users: 213 [6.4%] nicotine, 190 [5.7%] cannabis; adolescent-onset escalating frequent users: 131 [3.9%] nicotine, 134 [4.0%] cannabis). Males had greater odds of belonging to the adolescent-onset escalating frequent users nicotine (adjusted odds ratio, 2.88; 95% CI, 1.58-5.23; P < .01) and cannabis (adjusted odds ratio, 1.95; 95% CI,1.03-3.66; P < .05) vaping trajectories compared with nonusers. Polysubstance vaping was common, with those in trajectories reflecting more frequent nicotine vaping (adolescent-onset escalating frequent users and young adult-onset frequent users) having a high probability of membership (85% and 93%, respectively) in a cannabis-use trajectory.

CONCLUSIONS AND RELEVANCE

In this cohort study, the prevalence and type of nicotine vaping and cannabis vaping developmental trajectories from late adolescence to young adulthood were similar. Polysubstance vaping was common from late adolescence to young adulthood, particularly among those reporting more frequent vaping use. The findings suggest that public health policy and clinical interventions should address polysubstance vaping in both adolescence and young adulthood.

Substance use prevalence rates among migrant and native adolescents in Europe: A systematic review

ISSUES

Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe.

APPROACH

In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment.

KEY FINDINGS

Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed.

IMPLICATIONS

The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country.

CONCLUSION

Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level.

Gender discrimination and illicit drug use among African American and European American adolescents and emerging adults

Objective: The present study aimed to characterize the association of perceived gender discrimination and illicit drug use among a sample of African American (AA) and European American (EA) adolescent girls and young women. Method: Data were drawn from a high-risk family study of alcohol use disorder of mothers and their offspring (N = 735). Multinomial regressions were used to examine whether experience of offspring and maternal gender discrimination were associated with offspring illicit drug use (cannabis, cocaine, ecstasy, PCP, opiates, hallucinogens, solvents, sedatives, or inhalants). Outcomes included offspring age of drug use initiation (age ≤ 14) and lifetime heavy drug use (≥ 50 times) of 1 or more illicit substances. Interactions between race and offspring gender discrimination were modeled to assess for race differences. Results: Results revealed that gender discrimination was associated with a greater likelihood of offspring early initiation (relative risk ratio [RRR] = 2.57, 95% CI [1.31, 5.03]) versus later initiation (RRR = 1.33, 95% CI [0.80, 2.24]). Offspring gender discrimination was associated with offspring heavy drug use (RRR = 2.09, 95% CI [1.07, 4.06]) and not associated with moderate/light use (RRR = 1.44, 95% CI [0.86, 2.42]), but post hoc tests revealed no significant group differences. Conclusions: Findings suggest that perceived offspring gender discrimination is associated with early drug use initiation. Gender discrimination, particularly at an early age, has a potential to cause harm, including drug use. Implementation of policies that foster environments that eliminate gender bias and discrimination at an early age should be prioritized. Gender-responsive treatment merits consideration by substance use treatment providers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 and addiction

BACKGROUND AND AIMS

2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction.

METHODS

Pubmed and Google Scholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Addiction", "Opioid", "Alcohol", "Smoking", "Addiction Psychiatry", "Deaddiction", "Substance use disorders", "Behavioral addiction". Few newspaper reports related to COVID-19 and addiction have also been added as per context.

RESULTS

People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means.

CONCLUSION

COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.

Effects of Social Development Intervention in Childhood on Adult Life at Ages 30 to 39

Elementary schools can be effective sites for universal preventive interventions. Less is known about how long effects of intervention in elementary grades last. Can they improve outcomes in adulthood? To test effects of a social developmental intervention in the elementary grades on adult life through the 30s, the Seattle Social Development Project, a nonrandomized controlled trial, followed all consenting 5th-grade students (N = 808) from 18 Seattle public elementary schools from age 10 (in 1985) to age 39 (in 2014), with 88% retention. The sample was gender balanced and ethnically and economically diverse. The full intervention, called Raising Healthy Children, continued from Grades 1 through 6 and consisted of teacher in-service training in classroom management and instructional methods; cognitive, social, and refusal skills training for children; and parent workshops in child behavior monitoring and management, academic support, and anticipatory guidance. Using structural equation modeling, we examined intervention effects from age 30 to age 39 across 9 constructs indicating 3 domains of adult life: health behavior, positive functioning, and adult health and success. An omnibus test across all 9 constructs indicated a significant positive overall intervention-control difference. Examined individually, significant intervention effects included better health maintenance behavior, mental health, and overall adult health and success. Significant effects were not found on substance use disorder symptoms, sex-risk behaviors, or healthy close relationships in the 30s. Results indicate that sustained, theory-based, multicomponent intervention in the elementary grades can produce lasting changes in health maintenance, mental health, and adult functioning through the 30s.

Impact of psychiatric comorbidities on outcomes related to thyroid and parathyroid operations

BACKGROUND

We examined the effect of psychiatric comorbidities on perioperative surgical outcomes and the leading causes of readmissions in patients who underwent thyroid and parathyroid operations.

METHOD

Patient information was retrieved from the Nationwide Readmission Database (2010-2017). Multivariate analysis was used to identify predictors for hospital readmissions.

RESULTS

A total of 181,007 and 53,808 patients underwent thyroid and parathyroid operations, respectively. Of those, 8,468 (4.7%) and 6,112 (11.4%) patients were readmitted within 30 days. Psychiatric comorbidities were more frequent in readmitted cohorts after thyroidectomies (14.9% vs 10.4%; P < .001) and parathyroidectomies (16.8% vs 11.5%; P < .001), with anxiety being the most frequent cause (thyroid: 7.87%, parathyroid: 6.8%). Psychiatric comorbidities were associated with greater risk of in-hospital mortality (thyroid: odds ratio = 2.07, 95% confidence interval = 1.13-3.53; P = .015 and parathyroid: odds ratio = 1.67, 95% confidence interval = 1.04-2.70; P = .005), postoperative complications (thyroid: odds ratio = 1.528, 95% confidence interval = 1.473-1.585; P < .001 and parathyroid: odds ratio = 3.26, 95% confidence interval = 2.84-3.73; P < .001), prolonged duration of stay (thyroid: beta coefficient = 1.142, 95% confidence interval = 1.076-1.207; P < .001 and parathyroid: beta coefficient = 2.15, 95% confidence interval = 1.976-2.32; P < .001), and 30-day readmissions (thyroid: hazard ratio = 1.18, 95% confidence interval = 1.03-1.18; P = .047 and parathyroid: hazard ratio = 1.23, 95% confidence interval = 1.11-1.36; P < .001). Psychosis had the greatest risk of readmission (thyroid: hazard ratio = 1.51 and parathyroid: hazard ratio = 1.42), and dementia (odds ratio = 2.58) had the greatest risk of postoperative complications.

CONCLUSION

Concomitant psychiatric conditions after thyroid and parathyroid operations were associated with increased risk of postoperative complications, prolonged hospital stays, and greater rates of readmissions.