Women and Addiction: The Importance of Gender Issues in Substance Abuse Research

A Grounded Theory of Mothering in the Early Years for Women Recovering From Substance Use

Women in recovery from addiction experience significant sociostructural barriers to reestablishing self, family, and home after having a baby. The aim of this grounded theory study was to describe pathways that women and their families followed and how transitions were experienced in the early years after receiving services through an integrated community-based maternity program. Eighteen women completed questionnaires and participated in a series of semistructured interviews over 2 years. The overall process women experienced was that of holding it together, which women did by restoring their sense of self during recovery, becoming a strong center for their family, and creating a sense of home no matter what the circumstances. Key elements supporting women in their transition to recovery and parenthood included longer term health, social, and recovery programs and services that addressed determinants of health (in particular, gender, housing, and income), and receiving support provided from strengths-based perspectives.

Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

IMPORTANCE

Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy.

OBJECTIVE

To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt.

EXPOSURES

Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis.

MAIN OUTCOMES AND MEASURES

Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis.

RESULTS

Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001).

CONCLUSIONS AND RELEVANCE

In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.

First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania

High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.

Psychological stress has a higher rate of developing addictive behaviors compared to physical stress in rat offspring

Prenatal stress could have great influence on development of offspring and might alter cognitive function and other physiological processes of children. The current study was conducted to study the effect of physical or psychological prenatal stress on addictive and anxiety-like behavior of male and female offspring during their adolescence period (postnatal day (PND) 40). Adult female rats were exposed to physical (swimming) or psychological (observing another female rat swimming) stress from day six of gestation for 10 days. Male and female offspring were assayed for anxiety-like behavior, motor and balance function and morphine conditioned place preference using the open field, elevated plus maze (EPM), rotarod and wire grip assay and conditioned place preference. Offspring in both physical and psychological prenatal stress groups demonstrated significant increase in anxiety-like behavior in EPM paradigm, but no alterations were observed in motor and balance function of animals. Offspring in the psychological prenatal stress group had an increased preference for morphine in comparison to control and physical prenatal stress groups. Results of the current study demonstrated that animals exposed to psychological stress during fetal development are at a higher risk of developing addictive behaviors. Further research might elucidate the exact mechanisms involved to provide better preventive and therapeutic interventions.

Gender differences in discharge dispositions of emergency department visits involving drug misuse and abuse-2004-2011

Background

Drug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services. Yet, little is known about where patients go post discharge. We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences.

Methods

We extracted data from the 2004–2011 Drug Abuse Warning Network, a national probability sample of drug-related visits to hospital EDs in the U.S. We computed weighted multinomial logistic regression models to estimate discharge dispositions over time and to examine associations between gender and the relative risk of discharge dispositions, controlling for patient characteristics.

Results

The final pooled sample included approximately 1.2 million ED visits between 2004 and 2011. Men accounted for more than half (57.6%) of all ED visits involving drug misuse and abuse. Compared with women, men had a greater relative risk of being released to the police/jail, being referred to outpatient detox or other treatment, and leaving against medical advice than being discharged home. The relative risk of being referred to outpatient detox/drug treatment than discharged home increased over time for men versus women.

Conclusions

Greater understanding of gender-based factors involved in substance-related ED visits and treatment needs may inform discharge planning and preventive interventions.

Mothers with substance and alcohol abuse-support through pregnancy and early infancy

This article is about the support given to pregnant women and mothers, at an antenatal and child welfare team in Gothenburg (Sweden), specialised on working with mothers who abuse alcohol and/or other substances. The study consists of interviews with 17 women. The aim of the article is to account for how the women experienced the support they got and how they perceived the impact. The results show the importance for the staff of finding the balance between control and support and of creating a non-judgmental attitude in order to build trusting relationships with the women. The organization of the MBHV-team is a prerequisite for the staff to be able to design support based on an assessment of the mother's whole situation.

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial/ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy/binge alcohol use (n=52,496) and those with alcohol use disorder (n=22,966). Difference-in-differences models estimated service-related disparities before (2008-2009) and after (2011-2014) health care reform. A sub-analysis was conducted before (2011-2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy/binge drinking were excluded from SUD treatment and unmet need outcome models due to insufficient cell size. Among heavy/binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. MH treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. While there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.

Problematic alcohol use and problem gambling: Associations to structural and functional aspects of social ties in a Finnish population sample

Aims

This study aims to explore associations between structural and functional aspects of social networks and relationships (here labelled social ties) among individuals exhibiting problematic alcohol use and problem gambling, respectively.

Material & Methods

Data was collected in the 2011 Western Finland Mental Health Survey, a postal questionnaire survey applying a stratified random sampling approach. The survey response rate was 46.2% (n = 4624, age range 15–80 years). Problem behaviours were assessed using the CAGE and Lie/Bet tools. Logistic regression analyses were performed, with problematic alcohol use and problem gambling as dependent variables. Demographic variables, structural social tie factors (marital status, frequency of social contacts, engagement in association activities) and functional social tie factors (experienced loneliness, social support, neighbourhood trust, general trust) constituted explanatory variables.

Results

In this representative population sample, only one structural social tie variable, marital status, proved to be significantly associated with one of the outcomes (problematic alcohol use). Identical functional social tie variables were associated with both problematic alcohol use and problem gambling: individuals exhibiting the problem behaviours experienced higher levels of experienced loneliness and low levels of neighbourhood trust. Identified interaction effects with demographic factors highlight the complexity of links.

Conclusions

Functional aspects of individual-level social ties appear to be more relevant when studying problematic alcohol use or problem gambling, similarly to other forms of mental health problems. The role of social ties as preventive or risk factors for problem behaviour development, as a part of problem behaviour maintenance or as a cessation and a recovery resource should be further explored, considering also interactions with demographic variables.

Long-term retention in Office Based Opioid Treatment with buprenorphine

BACKGROUND

Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine.

METHODS

This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations.

RESULTS

There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1year and a majority, 53.7% (664/1237), of patients had at least one ≥1year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10year increase [1.05, 1.34]) were associated with greater odds of ≥1year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1year retention.

CONCLUSIONS

Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.

Barriers and facilitators to successful transition from long-term residential substance abuse treatment

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment.

"I'm Stuck": Women's Navigations of Social Networks and Prescription Drug Misuse in Central Appalachia

This study utilizes anthropological analyses of kinship, care, gendered inequalities, and the state to examine how social networks affect women's substance use in a rural Appalachian county where the primary drug of choice is prescription opioids. Of 503 participants from a larger study of social networks among rural drug users, 16 women who reported using drugs with four or more other study participants (drug network members) were interviewed from November 2011 to February 2012. The purpose of interviews is to analyze the substance use patterns among participants who are highly connected in their networks. Female participants say they feel "stuck" in cycles of prescription drug misuse because of entrenchment in moral economies, intensive caretaking responsibilities, and violence from those in their networks. Although women demonstrate agency in their navigations of drug use, relationships, and economic and health inequalities, the factors that constrain women's actions culminate to create barriers for women accessing substance abuse treatment or decreasing substance use outside of treatment. This study adds to understandings of the relational and situational aspects of women's drug use and efforts to decrease use. Recognizing these aspects of women's lives will aid policies and programs in becoming more relevant to substance abusing women. (substance use; kinship; care; gendered inequalities; Appalachia).

Family systems therapy for substance-using mothers and their 8- to 16-year-old children

Family systems therapy has shown to be a powerful adjunct to substance use treatment for couples and for adolescent substance users (Rowe, 2012). However, studies including children (8-16 years of age) in the treatment of their substance using mothers have been overlooked and are essentially nonexistent. Addressing the quality of the mother-child relationship and communication through family systems therapy may prove to be a potent intervention focus for improving mothers' substance use outcomes and parent-child interaction. As such, the current study recruited 183 mothers who sought outpatient treatment through a local substance use treatment facility and randomly assigned them to also receive family systems therapy or Women's Health Education. Self-report and observational data were collected, and assessment interviews were completed at baseline and 3, 6, 12, and 18 months postbaseline. Findings showed that women assigned to family systems therapy showed a quicker decline in alcohol, marijuana, and cocaine use, supporting the efficacy of family therapy as an important addition to mother's substance use treatment plans. Data also revealed an association between change in observed autonomy-relatedness and substance use, though mediation was not found. To our knowledge this is the first effort to successfully document a family systems therapy for substance using mothers with minor children in their care. (PsycINFO Database Record

Monitoring neonatal abstinence syndrome in buprenorphine-exposed in vitro fertilization twins: A case study

BACKGROUND

Prior studies have reported on the pregnancies and outcomes of in vitro fertilization (IVF) in special subpopulations; however, there is a lack of studies on opioid-exposed IVF-conceived neonates.

CASE PRESENTATION

A young adult IVF-pregnant woman was maintained on buprenorphine throughout pregnancy and received follow-up from the addiction clinic from estimated gestational week 32. She delivered healthy dichorionic twins via cesarean section at 38 weeks gestational age (buprenorphine dose at time of delivery: 16 mg). All maternal supervised urinalysis taken as of gestational week 32 were negative for concomitant substances (prior to treatment initiation at the addiction clinic, only self-reports of abstinence from concomitant substances were available). Both healthy children (male birth weight: 3140 g, female birth weight: 2650 g) developed an unusual course of neonatal abstinence syndrome (NAS) requiring extensive treatment (total morphine dose male: 22 mg, and female: 26.75 mg; length of treatment: 33 and 34 days, respectively; duration of hospitalization: 40 days).

DISCUSSION

The highly severe and long-lasting NAS in both neonates represents a very unusual course following an uneventful pregnancy, and influencing iatrogenic factors cannot be ruled out. Given the multiple variables influencing infant outcomes, this highlights the importance of high-quality, evidence-based standard operating procedures, which (1) are initiated as early as possible during pregnancy to minimize risk factors for adverse infant outcomes, such as concomitant substance use during pregnancy; (2) support the substance-dependent woman throughout the postpartum period, especially in cases of multiple and/or IVF-conceived pregnancies, where additional challenges may arise; and (3) consider the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The association of specific traumatic experiences with cannabis initiation and transition to problem use: Differences between African-American and European-American women

INTRODUCTION

To examine the contribution of trauma exposure to cannabis initiation and transition to first cannabis use disorder (CUD) symptom in African-American (AA) and European-American (EA) emerging adults.

METHODS

Data are from the Missouri Adolescent Female Twins Study [(N=3787); 14.6% AA; mean age=21.7 (SD 3.8)]. Trauma exposures (e.g. sexual abuse, physical abuse, witnessing another person being killed or injured, experiencing an accident, and experiencing a disaster) were modeled as time-varying predictors of cannabis initiation and transition to CUD symptom using Cox proportional hazards regression. Other substance involvement and psychiatric disorders were considered as time-varying covariates.

RESULTS

Analyses revealed different trauma-related and psychiatric predictors for cannabis use supporting racially distinct etiologic models of cannabis involvement. For AA women, history of witnessing injury/death or experiencing a life-threatening accident was associated with cannabis initiation across the complete emerging adult risk period while sexual abuse predicted cannabis initiation only before 15 years old. For EA women, history of sexual or physical abuse and major depressive disorder (MDD) predicted cannabis initiation and physical abuse and MDD predicted transition from initiation to first CUD symptom. No association was discovered between trauma exposures and transition to first CUD symptom in AA women.

CONCLUSIONS

Results reveal trauma exposures as important contributors to cannabis initiation and to a lesser extent transition to CUD symptom, with different trauma types conferring risk for cannabis involvement in AA and EA women. Findings suggest the importance of considering racial/ethnic differences when developing etiologic models of cannabis involvement.

Gender difference in prescription opioid abuse: A focus on oxycodone and hydrocodone

Several data gathered in the last decade indicate an increase of abuse of prescription opioid drugs oxycodone (OXY) and hydrocodone (HYDRO) in women. However, to date there are no conclusive evidences investigating the gender-dependent abuse liability of prescription opioids. This study aims to supply a specific focus on women's data through a selective summary of the literature analyzing gender differences in the pharmacokinetic and pharmacodynamic dimension of OXY and HYDRO. Findings from this study suggest that the majority of OXY and HYDRO pharmacokinetic and pharmacodynamic effects do not differ according to gender, though confirming a significant difference in the incidence of adverse effects as demonstrated by the increased gastrointestinal adverse reactions in female subjects. Although the majority of recent clinical studies include an equal number of female and male subjects, the main outcome parameters do not relate specifically to gender differences. Due to the gender influence in activity of CYP3A4 and its crucial role in metabolism of both OXY than HYDRO, we suggest that assessing pharmacokinetic and pharmacodynamic interactions in clinical studies may be useful to clarify the effect of the higher CYP3A4 activity in female in relation to CYP2D6 genotype. Overall, considering the paucity of data regarding gender differences in European Union, this work highlights that impact of new abuse deterrent formulations should be assessed with a special focus on data concerning female subjects.

Misuse of Prescription Opioid Medication among Women: A Scoping Review

Background. National data from Canada and the United States identify women to be at greater risk than men for the misuse of prescription opioid medications. Various sex- and gender-based factors and patient and physician practices may affect women's use and misuse of prescription opioid drugs. Objectives. To explore the particular risks, issues, and treatment considerations for prescription opioid misuse among women who experience chronic noncancer pain and trauma. Methods. A scoping review for articles published between January 1990 and May 2014 was conducted on sex- and gender-based risks and treatment considerations among women who experience chronic noncancer pain and trauma. Results. A total of 57 articles were identified. The present narrative review summarizes the specific risks for the misuse of prescription opioid medication among women who have experienced violence and trauma, Aboriginal women, adolescents and young women, older women, pregnant women, women of a sexual minority, and transwomen. Discussion. The majority of the literature is descriptive, with few studies that evaluate approaches and interventions to respond to the issue of chronic pain, trauma, and misuse of prescription opioids among women, particularly vulnerable subgroups of women. Conclusions. Trauma-informed and women-centred approaches that address women's vulnerabilities and complex needs require further attention.

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OBJECTIVES

The Main dans la main initiative relies on collaboration between child protection and hospital-based social workers to help substance-abusing expectant mothers maximize their chances of caring for their newborn. The article describes the positive outcomes of this initiative for the women, based on the experiences and perception of the participants and social workers involved.

METHOD

A case study was conducted with 21 participants using three data sources: 1) a semi-structured interview with the mothers at two points in time; 2) a semi-structured interview with social workers; and 3) the tools of the initiative. The data were analyzed based on content condensation and data presentation.

RESULTS

A majority of participants experienced changes in their various spheres of life: personal (positive changes in substance-abuse habits), parental (improved self-confidence as a parent, reduced stress due to the fear of losing custody of their newborn), and social/relational (improved relationships with social support network and support services).

CONCLUSION

The results confirm the relevance and potential for change of a short intervention model during the perinatal period based on inter-professional collaboration with substance-abusing expectant mothers. Further research is needed to validate the hypothesis on the effectiveness of this initiative.

Pathways to Addiction: A Gender-Based Study on Drug Use in a Triangular Clinic and Drop-in Center, Kerman, Iran

Background

Addiction is characterized differently among women and men, and they begin using drugs for different reasons and motives.

Objectives

The aim of the study was to explore the gendered experiences and patterns of illicit drug use initiation in an Iranian context.

Patients and Methods

A total of 29 participants (15 men and 14 women) took part in in-depth interviews conducted at a HIV triangulation clinic (for men and women) and drop-in-center for women in Kerman in 2011.

Results

The results of the study suggest that patterns of drug use are different among Iranian men and women. Men often transit to drug use from cigarette smoking, whereas women’s drug use practices often begins with opium. Unlike women, men who used drugs were often single at their drug use debut.

Conclusions

Different patterns of first exposure to drug use among men and women highlight the role of gendered expectations and socio-cultural norms in shaping drug use experiences of people who use drugs and call for gender-specific harm reduction interventions.

Social Support and Treatment Outcome in Alcohol Dependence Syndrome in Armed Forces

INTRODUCTION

Social factors play vital role in unfolding of alcohol use disorders in any given population. Several factors beyond the confines of treatment settings influence treatment outcome in alcohol dependence syndrome. Social support has positive effect in treatment outcome of alcohol dependence syndrome. This has not been much studied in India in past. Therefore we decided to study the perception of social support in cases of alcohol dependence syndrome admitted in a busy hospital in armed forces.

AIM

The aim was to study the perception of social support across relapsed and abstinent group and see if it reached any statistical proportion and also to see if any socio-demographic variables also affected perception of social support.

MATERIALS AND METHODS

Fifty five consecutive male patients of alcohol dependent syndrome without a co-morbid neurological/psychiatric diagnosis were assessed for their perception of social support after taking informed consent. They were explained the procedure and their alcoholic milestones were recorded in specially designed pro-forma. Subjects were then divided in abstinent and relapsed group. Subsequently they were assessed for their perception of social support by administering Social provision scale and Social support questionnaire.

STATISTICAL ANALYSIS

Data were tabulated and statistically analysed by using chi square test, Mann Whitney U-Test and Rank ANOVA test where applicable p-value <.05 was taken as significant.

RESULTS

Results indicated that perception of social support across abstinent (n=18) and relapsed (n= 37) group reached significant statistical proportion as measured by social provision scale and social support questionnaire. Duration of use, dependence and family history of alcoholism did not influence perception of social support across patient population. There was inverse relationship between patients with alcohol related problem and their perception of social support. Professional and qualified soldiers perceived higher social support than soldiers and lesser qualified individuals.

CONCLUSION

Abstinent group perceived better social support than relapsed group and soldiers in upper socio-occupational status and less alcohol related problems perceived more social support than soldiers with lower socioeconomic status and more alcohol related problems. Psychosocial therapy must be incorporated in management of Alcohol dependence syndrome.

Incarcerated women's relationship-based strategies to avoid drug use after community re-entry

While recent research has stressed the supportive role that family and friends play for incarcerated persons as they re-enter the community, drug-using incarcerated women re-entering the community often have to rely on family, community, and intimate relationships that have played a role in their substance abuse and criminalization. In this study the authors conducted qualitative analysis of clinical sessions with rural, drug-using women (N = 20) in a larger prison-based HIV risk reduction intervention in Kentucky during 2012-2014 to examine incarcerated women's perceptions of the role of their family, community, and intimate relationships in their plans to decrease their substance abuse upon community re-entry. Women stressed the obstacles to receiving support in many of their family and drug-using relationships after community re-entry. Nonetheless, they asserted that changes in their relationships could support their desires to end their substance abuse by setting limits on and using their positive relationships, particularly with their children, to motivate them to change. Interventions to promote incarcerated women's health behavior changes-including substance abuse-must acknowledge the complex social environments in which they live.

Usefulness of Gamma Glutamyl Transferase as Reliable Biological Marker in Objective Corroboration of Relapse in Alcohol Dependent Patients

INTRODUCTION

The development of reliable diagnostic tool for assessing alcoholism is an utmost necessity in treating and preventing damage due to alcoholism to both individual and armed forces as alcoholism represents a serious health issue with major socioeconomic consequences.

AIM

To observe, gamma glutamyl transferase (GGT) can serve the practical utility of firmly establishing alcohol dependence /relapse in Armed Forces patients and aid in fair disposals.

MATERIALS AND METHODS

Fifty two consecutive cases of alcohol dependence syndrome admitted to a peripheral hospital were evaluated for the biological marker gamma glutamyl transferase (GGT) and compared against the gold standard of psychiatrist assessment. The cases were followed up for one year at three months, six months, nine months and 12 months interval. The GGT value of the cases was correlated with the abstinent /relapse status to find the cutoff levels of the GGT as a biological marker.

RESULTS

At cutoff level of 50 IU/lit GGT exhibited specificity of 100% and sensitivity varying from 56% to 100%. At lower cut off levels chances of false positive cases with adverse consequences on service prospects of the individuals are high. The mean difference in GGT levels across relapse and abstinent group reached significant statistical proportion at admission and during follow-up at 3 months /6 months/9 months and 12 months.

CONCLUSION

GGT can serve the practical utility of firmly establishing alcohol dependence syndrome in armed forces to aid in fair disposal of cases. It helps in providing motivational inputs to patients. Clinician should pay due consideration to clinical profile, ward observation and unit report as the diagnosis of alcohol dependence syndrome has serious implications towards service prospects of a soldier.

Binge Drinking and Risk Taking Behavior Among Adolescent Females in Israel

PURPOSE

This prospective study examined binge drinking and alcohol-related problem behavior among Israeli adolescent females attending public school or a residential facility for substance abuse treatment.

PROBLEM

Scant information is known about adolescent females, especially those with high-risk (e.g., school dropout and immigrant origin) characteristics.

METHODS

The authors hypothesized that school, residential treatment, and mothers' country of origin status are associated with binge drinking and problem behavior.

FINDINGS

Females in residential treatment reported higher levels of binge drinking and problem behavior as expected. However, country of origin was not a significant factor differentiating the female adolescents in school or a residential facility. Logistic regression points to current cigarette smoking, ease of purchasing alcohol, unsupervised night activity, low religiosity, and being physically threatened as predictors of binge drinking and problem behavior.

CONCLUSION

The lack of differences based on country of origin status points to acculturation as a possible reason for the homogeneity. Further research is needed to study the impact of acculturation as well as monitor the alcohol use patterns and problems of adolescents over time and across locations to address prevailing needs.

Gender differences in mortality among treated opioid dependent patients

AIMS

To assess gender differences in characteristics, mortality rates, and the causes and predictors of death among treated opioid-dependent individuals.

METHODS

Linked vital statistics data were obtained for all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California from 2006 to 2010. Standardized mortality ratios (SMR) were calculated by gender. Cox proportional hazards models with time-varying covariates were fitted to determine the effect of gender on the hazard of all-cause mortality, controlling for covariates.

RESULTS

Over a median 2.6 years (interquartile range: 1.4-3.7), 1.031 deaths were observed, including 2.2% (259/11,564) of women and 3.7% (772/20,758) of men. Women had a greater increased risk of mortality compared to the general population (SMR 5.1 95% CI: 4.5, 5.7) than men (SMR 4.3 95% CI: 4.0, 4.6). The relative risk of death for women compared with men was 1.18 (95% CI: 1.02, 1.36). Women had a lower instantaneous hazard of all-cause mortality than men (HR 0.58, 95% CI 0.50, 0.68), controlling for other factors. Significant interaction effects indicated that among men, mortality risk was decreased by full-time employment and increased by non-daily heroin use (relative to daily use) and medical problems. Concurrent opioid and methamphetamine/cocaine use increased mortality risk among women and decreased it among men.

CONCLUSIONS

Treatment for opioid dependence is likely to reduce mortality risk among men by addressing employment and medical problems, and via interventions to reduce overdose risk after heroin abstinence, and among women by attending to the concurrent use of methamphetamine/cocaine and opioids.

Profiles Associated Respectively with Substance Dependence Only, Mental Disorders Only and Co-occurring Disorders

This study sought to identify profiles associated with substance dependence only, mental disorders only and co-occurring disorder respectively, using a broad range of socio-demographic, socio-economic, health beliefs, clinical and health services utilization variables concurrently. Based on a broad analytic framework, 423 participants diagnosed with substance dependence only, mental disorders only or co-occurring disorders within a 12-months period were studied. The study used comparison analysis, and a multinomial logistic regression model. Participants with dependence only and mental disorders only were in contrast in terms of gender, age, marital status, self-perception of physical health, perception of the physical conditions of their neighbourhood, impulsiveness, psychological distress and visit with a family physician in previous 12-months, while those with co-occurring disorders were in an intermediary position between the other two groups. Public authorities should especially promote strategies that could increase the capacity of family physicians to take care of individuals with substance dependence only.

Women Who Use or Inject Drugs: An Action Agenda for Women-Specific, Multilevel, and Combination HIV Prevention and Research

Women account for more than half of all individuals living with HIV globally. Despite increasing drug and HIV epidemics among women, women who use drugs are rarely found in research, harm reduction programs, or drug and HIV treatment and care. Women who use drugs continue to face challenges that increase their vulnerability to HIV and other comorbidities because of high rates of gender-based violence, human rights violations, incarceration, and institutional and societal stigmatization. This special issue emphasizes how the burdens of HIV, drug use, and their co-occurring epidemics affect women in a global context. Articles included focus on the epidemiologies of HIV and hepatitis C virus and other comorbidities; HIV treatment, prevention, and care; and policies affecting the lives of women who use drugs. This issue also highlights the state of the science of biomedical and behavioral research related to women who use drugs. The final article highlights the major findings of articles covered and presents a call to action regarding needed research, treatment, and preventive services for women who use drugs. To address these needs, we advocate for women-specific thinking and approaches that consider the social, micro, and macro contexts of women's lives. We present a women-specific risk environment framework that reflects the unique lives and contexts of women who use drugs and provides a call to action for intervention, prevention, and policies.

Sex effects in cocaine-using methadone patients randomized to contingency management interventions

Contingency management (CM) is an effective treatment for promoting cocaine abstinence in patients receiving methadone maintenance. However, few studies have examined the effect of sex on treatment outcomes in this population. This study evaluated the impact of sex on longest duration of abstinence (LDA) and percent negative urine samples in 323 cocaine-using methadone patients from 4 randomized clinical trials comparing CM to standard methadone care. Overall, women had better treatment outcomes compared with men, demonstrated by an increase in both LDA and percentages of negative samples. Patients receiving CM also had significantly higher LDA and percentages of negative samples compared to patients receiving standard care, but sex by treatment condition effects were not significant. These data suggest that cocaine-using methadone patients who are women have better substance use outcomes than men in interventions that regularly monitor cocaine use, and CM is equally efficacious regardless of sex.

Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder Treatment

OBJECTIVE

The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use.

METHODS

Data were provided by 4447 women treated for SUD in California during 2000-2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (>6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns.

RESULTS

In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.69, p<0.01), longer SUD treatment retention (OR 1.00, p<0.01), treatment desire (ORs 1.46, p<0.001), and co-occurring disorder diagnosis (ORs 2.89-44.93, p<0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years.

CONCLUSIONS

Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services.

HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment

BACKGROUND

Although an estimated 3.5 million women inject drugs globally, women are outnumbered 4 to one by men who inject drugs and are often ignored or overlooked in the development and delivery of prevention and treatment services for this population. This study aimed to identify key comorbidities prevalent among women who inject drugs (WWID), consider factors that contribute to vulnerability of this population, and examine implications for prevention and treatment.

METHODS

The literature was reviewed to examine the specific challenges and needs of WWID. We searched health-related bibliographic databases and grey literature to identify studies conducted among WWID and studies conducted among people who inject drugs (PWID), where results were disaggregated by gender and policies/guidelines/reports relevant to WWID.

RESULTS

WWID face a range of unique, gender-specific, and often additional challenges and barriers. The lack of a targeted focus on WWID by prevention and treatment services and harm-reduction programs increases women's vulnerability to a range of health-related harms, including blood-borne viral and sexually transmitted infections, injection-related injuries, mental health issues, physical and sexual violence, poor sexual and reproductive health, issues in relation to childbearing and child care, and pervasive stigma and discrimination.

CONCLUSIONS

There is a need to improve the collection and reporting of gender-disaggregated data on prevalence of key infections and prevention and treatment service access and program coverage. Women-focussed services and integrating gender equity and human rights into the harm-reduction programming will be a prerequisite if improvements in the health, safety, and well-being of this often invisible and highly vulnerable population are to be achieved.

Alcohol mixed with energy drink use among u.s. 12th-grade students: prevalence, correlates, and associations with unsafe driving

PURPOSE

The consumption of alcohol mixed with energy drinks (AmED) is a risky drinking behavior, most commonly studied using college samples. We know little about rates of AmED use and its associations with other risk behaviors, including unsafe driving, among high school students. This study examined the prevalence and correlates of AmED use among high school seniors in the United States.

METHODS

Nationally representative analytic samples included 6,498 12th-grade students who completed Monitoring the Future surveys in 2012 and 2013. Focal measures included AmED use, sociodemographic characteristics, academic and social factors, other substance use, and unsafe driving (i.e., tickets/warnings and accidents) after alcohol consumption.

RESULTS

Approximately one in four students (24.8%) reported AmED use during the past 12 months. Rates of AmED use were highest among males and white students. Using multivariable logistic regression models controlling for sociodemographic characteristics, results indicate that students who cut class, spent more evenings out for fun and recreation, and reported binge drinking, marijuana use, and illicit drug use had a greater likelihood of AmED use. AmED use was also associated with greater odds of alcohol-related unsafe driving, even after controlling for sociodemographic, academic, and social factors and other substance use.

CONCLUSIONS

AmED use among 12th-grade students is common and associated with certain sociodemographic, academic, social, and substance use factors. AmED use is also related to alcohol-related unsafe driving, which is a serious public health concern.

Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users

BACKGROUND

Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help.

OBJECTIVE

The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO.

METHODS

Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined.

RESULTS

Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001).

CONCLUSIONS

Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.

Women's injection drug practices in their own words: a qualitative study

Background

There are significant gender differences in injection drug practices and relative risks involved for women who inject drug compared with men. This qualitative study aims to explore the social, contextual, and behavioral dimensions of injecting practices among women who inject drugs.

Methods

Participants were selected by purposive venue-based sampling from a syringe exchange program in 2012–2013. In-depth interviews were conducted with 26 women to elicit detailed perspectives regarding injection drug use practices and women-focused decision-making. All interviews were transcribed verbatim and analyzed with Atlas.ti.

Results

Participant’s mean age was 43.2 years, 48% Caucasian, 36% African American, and 16% Latina, poorly educated, mostly single, and heroin self-injectors. Three themes emerged; a) transitioning from non-injection to injection drug use; b) patterns and variations of initiation to injecting; and c) shifting toward autonomy or reliance on others. Women were predominantly influenced to transition to injection drug use by other women with their claims that injecting was a way to curtail their daily drug expenditure. More than half the women received their first injection from another woman in their social network rather than a male sexual partner. Self-injecting women exhibited agency around the circumstances of injection safety and potential risks. Other women revealed that their inability to inject themselves could and did make them dependent on others for unsafe injection practices.

Conclusions

The finding that many women were influenced to transition to injection drug use and receive the first injection from a woman is contrary to literature claims that male sexual partners introduce and initiate women to injection drug use. Self-injecting women possessed capacity to act in a way that produced the results they wanted, not sharing prepared drugs or injecting equipment. In stark contrast, women assisted with injections could and did make them vulnerable to unsafe injecting. Findings support early prevention strategies that discourage women’s transition from non-injection to injection and development of female peer-driven experiential interventions to dispel myths for non-injection women and to increase personal capability to self-inject for women who require assistance with injecting, to reduce injection-related harm.

Women, drug dependency and consequences: a study from a developing country

Introduction. Addiction in women can expose them to malnutrition, high blood pressure, cancer, and some other dangerous diseases like hepatitis, AIDS, or other sexual transmitted diseases. The aim of this study was to assess illegal sexual relations in three groups of women. Methods. This is a cross-sectional study that was done on 236 girls and young women aged 16–25 years in 2012 in three groups: vulnerable women who have substance dependency (crimes that had made women incarcerated were considered as vulnerability in this study), invulnerable women who have substance dependency (substance dependent women without a history of incarceration), and a control group (women with no history of substance dependency or being in prison). Results. 43.8% of vulnerable women who have substance dependency had extramarital sexual relations; this percentage was 55.8% in invulnerable women who have substance dependency and 1.4% in the control group. Crystal and methamphetamine abuse was higher in addicts who had extramarital sexual relations and alcohol abuse was correlated with unsafe sexual intercourse (r = 0.36, P = 0.001). There was a statistically significant difference in extramarital sexual relation based on marital status (P < 0.001). Conclusions. Poverty, drug dependency, divorce, and alcohol consumption make women prone to other high risk behaviors that need more attention.

Social stress, economic hardship, and psychological distress as predictors of sustained abstinence from substance use after treatment

Social characteristics associated with disadvantage, such as racial/ethnic minority status, female gender, and low socioeconomic status (SES), are often associated with increased psychological distress and substance use disorders. This project tests a conceptual model derived from Pearlin's social stress theory for predicting abstinence from substance use between baseline and 1-year follow-up in secondary data from a large statewide sample of Kentucky substance abuse treatment participants (N = 1,123). Racial minority status, employment, and higher education level were predictive of substance use at follow-up, while female gender was predictive of abstinence. Limitations, implications for practice, and suggestions for future research are discussed.

Gender differences in subjective discontinuation symptoms associated with ketamine use

Background

Recent substance abuse research indicates gender differences in the substance-related epidemiology, biological responses, progression to dependence, medical consequences and treatments. Studies exploring human sex-different responses to ketamine are rare and there has been no systemic survey of gender differences in ketamine use. Determining whether females are more susceptible than males to ketamine withdrawal symptoms and adverse effects is important, because it associated with treatment retention and outcome in drug users.

Methods

The Taiwanese juridical system has implemented a new regulation on ketamine in the year 2009. Ketamine users who are caught by the police, are mandated to attend an educational program. We recruited ketamine offenders from February 2010 to May 2012 at the Kunming branch of the Taipei City Hospital, where the educational classes are held. A designed questionnaire was performed to gather information about demographic characteristics, discontinuation symptoms, concomitant use of other substances, and subjective experience of memory impairment or urinary discomforts, and to compare the gender differences.

Results

A total of 1,614 ketamine users were surveyed and most of them were males (83.8%), with an average age of 26.3 ± 5.4 years. Female ketamine users presented significantly more discontinuation symptoms such as anxiety, dysphoria, and tremors compared with male users. 72.4% of total ketamine users smoked cigarettes concomitantly. Male ketamine users had a higher rate of concomitant betel nut use, while female ketamine users had a higher rate of concomitant hypnotic and alcohol use. 76% of total ketamine users reported cognitive impairment and 51.6% mentioned urinary symptoms. Furthermore, female ketamine users self-reported significantly greater levels of severity in cognitive impairment and urinary discomforts compared with male users. Less than 10% of total ketamine users in our study reported the desire to transfer for medical intervention or treatment, despite the high rates of discontinuation symptoms and negative physical side effects.

Conclusions

Gender differences were noted in the subjective experience of discontinuation symptoms, concomitant substance use, and severity of impairment related to ketamine use. However, the probable cause of the gender differences found in this study requires further investigation. We hoped our study will stimulate further research in this field.

Experiences of everyday life in men with alcohol dependency--a qualitative study

The aim of the present study is to describe and understand the meaning of living with alcohol dependency (AD) as a man. Studies point out a high prevalence of AD in men and the reasons for, and consequences of, that are complex. However, today there is a lack of knowledge about men's lived experiences of having AD. In-depth interviews were conducted with 15 alcohol dependent men and analyzed using a phenomenological-hermeneutic approach. In the comprehensive understanding, findings from the naïve understanding and the structural analysis were interpreted with help from both gender and caring theoretical perspectives. "A Fallible Man" and "A Man with Powerfulness" were disclosed as two main gender formations influencing senses of well-being. A Fallible Man involved varying experiences of restrictions, being in control, and meaninglessness. Being in control promoted a sense of well-being. A Man with Powerfulness involved energetic activity, and the development and maintaining of interests as well as risk-taking. Being powerful diminished feelings of meaninglessness, cravings, and social alienation. The results show, among other things, that the men live an incompatible life and, because of that, need support and guidance to find a more meaningful life. This can be accomplished if caregivers allow men to be in focus and involved in planning their own care. To avoid limiting the men while they are in treatment, the health care professionals also need to focus on the men's everyday life. This focus involves acknowledging the men's individual experiences of what enriches and limits their everyday lives.

An Examination of Marijuana Use Among a Vulnerable Population in Canada

OBJECTIVES

Although the perceived risk of cannabis has decreased over the last few years, the contribution of marijuana use to the burden of disease on society is significant. Globally, Indigenous peoples have rates of marijuana use that are significantly higher than that of the general population. Understanding patterns of use is fundamental to developing appropriate policy and programming strategies to improve health and well-being.

METHODS

This study examined the characteristics of respondents who had ever been frequent marijuana users (used more than once a week), among a cross-sectional sample of 340 people, aged 18 and over, from Kettle and Stony Point First Nation in Ontario, Canada. The research incorporated Aboriginal-specific measures, examining issues related to colonialism and racism. Logistic regression models were used to assess the extent that sociodemographic variables, body mass index, mental health (depression, anxiety), licit substance use (alcohol and tobacco), Historical Loss Scale, Childhood Trauma Scale, and Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale predicted ever having been a frequent marijuana user.

RESULTS

Aboriginal-specific issues were not associated with marijuana use nor was marijuana use related to depression or anxiety. However, ever engaging in frequent marijuana use was reported by more than half of the sample and associated with being younger, male, and a smoker.

CONCLUSIONS

The high prevalence of frequent marijuana use (53.2 %) suggests normalization of the substance that may indicate a potentially large public health problem.

Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes

OBJECTIVE

The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan.

DESIGN

A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes.

RESULTS

Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women.

CONCLUSION

Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.

Effect of criminal justice mandate on drug treatment completion in women

BACKGROUND

Drug and alcohol abuse among women is a growing problem in the United States. Drug treatment is an effective way to manage the psychological, biological, financial, and social cost of drug abuse. Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women.

OBJECTIVES

This study uses the Treatment Episodes Datasets Discharge 2006-2008 (TEDS-D) to explore the association between coercion and treatment completion among women.

METHODS

Analysis compared primary treatment episodes of coerced women to those who entered treatment voluntarily. A logistic model of the odds of treatment success was performed controlling for race/ethnicity, age, education, employment, primary substance of abuse, number of substances reported at admission, referral source, treatment setting, and treatment duration.

RESULTS

582 671 primary treatment episodes were analyzed comparing women with coercion referrals (n = 196 660) to those who entered treatment voluntarily (n = 390 054). Results of multivariable logistic modeling showed that coerced women had better odds of completion or transfer than women who entered voluntarily. However, this association was modified by treatment setting with better odds in ambulatory (OR = 1.49 [1.47, 1.51]) than in inpatient (OR = 1.06 [1.03, 1.10]) and worst outcomes in detoxification (OR = 0.89 [0.84, 0.96]).

CONCLUSION

These results dispute the broad effectiveness of legal mandates across all drug treatment settings among women. They show the need for further recognition of female-specific characteristics that can affect motivation and treatment success to better inform healthcare and judicial policies on drug treatment services for women.

A 5-year follow-up study of adolescents who sought treatment for substance misuse in Sweden

Previous studies have shown that substance misuse in adolescence is associated with increased risks of hospitalizations for mental and physical disorders, convictions for crimes, poverty, and premature death from age 21 to 50. The present study examined 180 adolescent boys and girls who sought treatment for substance misuse in Sweden. The adolescents and their parents were assessed independently when the adolescents first contacted the clinic to diagnose mental disorders and collect information on maltreatment and antisocial behavior. Official criminal files were obtained. Five years later, 147 of the ex-clients again completed similar assessments. The objectives were (1) to document the prevalence of alcohol use disorders (AUD) and drug use disorders (DUD) in early adulthood; and (2) to identify family and individual factors measured in adolescence that predicted these disorders, after taking account of AUD and DUD in adolescence and treatment. Results showed that AUD, DUD, and AUD + DUD present in mid-adolescence were in most cases also present in early adulthood. Prediction models detected no positive effect of treatment in limiting persistence of these disorders. Thus, treatment-as-usual provided by the only psychiatric service for adolescents with substance misuse in a large urban center in Sweden failed to prevent the persistence of substance misuse. Despite extensive clinical assessments of the ex-clients and their parents, few factors assessed in mid-adolescence were associated with substance misuse disorders 5 years later. It may be that family and individual factors in early life promote the mental disorders that precede adolescent substance misuse.

Predictors of alcohol and drug dependence

OBJECTIVE

Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances from the general population; and to determine predictors of substance dependence over a 2-year period. Variables that differentiate people dependent on substances according to sex and age were also assessed.

METHODS

Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only. Using a comprehensive framework, various aspects were considered as predictors for multivariate statistics.

RESULTS

Participants with substance dependence at time 2 only showed worse clinical conditions, life events, life and health perception, and neighbourhood characteristics than other participants, but only 2.5% used health care services. Male sex, younger age, stigmatization, and impulsiveness were predictors of substance dependence. Regarding sex, females with dependence were only more likely to suffer from social phobia than males. In terms of age categories, participants over 50 with substance dependence were more likely to have a lower household income and less social support than younger people.

CONCLUSION

Stigmatization was the strongest predictor of substance dependence. Our study also confirmed that males and younger people were more likely to have substance dependence. Anti-stigmatization, prevention, and outreach programs are needed to overcome the reluctance of this clientele to use health care services. Health professionals should also pay more attention to life and health perception and neighbourhood characteristics of newly identified drug users.