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Brown JK, Papp LM. COVID-19 pandemic effects on trajectories of college students' stress, coping, and sleep quality: A four-year longitudinal analysis. Stress Health 2024; 40:e3320. [PMID: 37712515 PMCID: PMC10940199 DOI: 10.1002/smi.3320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
College students' stress levels, coping strategies, and sleep quality are important indicators of functioning and further predict their health and well-being. The current study utilises data repeatedly collected over more than 4 years from students enroled at a large public research university in the Midwestern US. Our data collection period coincided with the COVID-19 pandemic's onset, facilitating systematic examination of whether and how college students' trajectories (i.e., level and slopes) of stress, coping, and sleep quality changed as the pandemic progressed. Across five waves, surveys assessed multiple outcome and predictor domains every 6 months. Analyses revealed differential courses of change for the outcomes. Stress levels were overall lower immediately after the onset but trended upwards as the pandemic continued. Reported coping reduced significantly after the onset and showed a steeper decline as the pandemic wore on. Sleep quality showed no significant pandemic changes over time, though sleep duration and timing showed initial onset effects. College students' stress, coping, and sleep changed in complex and nuanced ways after the pandemic's onset and findings from our longitudinal analyses expand upon those from previous limited repeated measure and cross-sectional studies. Altogether, findings demonstrate multifaceted changes that may have ongoing effects to affect well-being during key developmental stages.
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Affiliation(s)
- Joshua K. Brown
- Human Development & Family Studies, University of Wisconsin-Madison
| | - Lauren M. Papp
- Human Development & Family Studies, University of Wisconsin-Madison
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Palamar JJ, Le A, Cleland CM, Keyes KM. Trends in drug use among nightclub and festival attendees in New York City, 2017-2022. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104001. [PMID: 36934660 PMCID: PMC10164102 DOI: 10.1016/j.drugpo.2023.104001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Drug use is prevalent among people who attend electronic dance music (EDM) parties at nightclubs or festivals. This population can serve as a sentinel population to monitor trends in use of party drugs and new psychoactive substances (NPS) that may diffuse through larger segments of the population. METHODS We surveyed adults entering randomly selected EDM parties at nightclubs and dance festivals in New York City about their drug use in 2017 (n=954), 2018 (n=1,029), 2019 (n=606), 2021 (n=229), and 2022 (n=419). We estimated trends in past-year and past-month use of 22 drugs or drug classes based on self-report from 2017-2022 and examined whether there were shifts pre- vs. post-COVID (2017-2019 vs. 2021-2022). RESULTS Between 2017 and 2022, there were increases in past-year and past-month use of shrooms (psilocybin), ketamine, poppers (amyl/butyl nitrites), synthetic cathinones ("bath salts"), and novel psychedelics (lysergamides and DOx series), increases in past-year cannabis use, and increases in past-month use of 2C series drugs. Between 2017 and 2022, there were decreases in past-year heroin use and decreases in past-month cocaine use, novel stimulant use, and nonmedical benzodiazepine use. The odds of use of shrooms, poppers, and 2C series drugs significantly increased after COVID, and the odds of use of cocaine, ecstasy, heroin, methamphetamine, novel stimulants, and prescription opioids (nonmedical use) decreased post-COVID. CONCLUSIONS We estimate shifts in prevalence of various drugs among this sentinel population, which can inform ongoing surveillance efforts and public health response in this and the general populations.
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Affiliation(s)
- Joseph J Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA; Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, USA.
| | - Austin Le
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA; New York University College of Dentistry, New York, NY, USA
| | - Charles M Cleland
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA; Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, USA
| | - Katherine M Keyes
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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Van Dyck E, Ponnet K, Van Havere T, Hauspie B, Dirkx N, Schrooten J, Waldron J, Grabski M, Freeman TP, Curran HV, De Neve J. Substance Use and Attendance Motives of Electronic Dance Music (EDM) Event Attendees: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031821. [PMID: 36767188 PMCID: PMC9914168 DOI: 10.3390/ijerph20031821] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 06/01/2023]
Abstract
EDM event attendees are a high-risk population for substance use and associated adverse effects. The aim of this study was to examine substance use at EDM events, focusing on associations between attendance motives and substance use. Sociodemographic characteristics, event specifics, past-year use, and attendance motives were assessed through an online survey. Participants were 1345 Belgian EDM event attendees (69.44% male, Mage = 22.63, SDage = 4.03). Ecstasy/MDMA/Molly (52.28%), other synthetic hallucinogens (53.68%), ketamine (42.13%), amphetamines (40.45%), and alkyl nitrites (poppers) (32.76%) were most frequently used at festivals/outdoor parties/raves. In nightclubs, cocaine (32.29%) was shown to be prevalent as well, while other synthetic hallucinogens (15.79%) were less often consumed. At events with a more private character, cannabis (68.88%) and magic mushrooms (66.44%) were most frequently used. Aside from alcohol (47.76%), substance use in pubs/bars was negligible. Overall enjoyment was demonstrated to be the key attendance motive, which was succeeded by those relating to music and socialization. A wide range of motives proved to be more important to users (e.g., dance, exploration, escapism, excitement, alcohol, drugs) than non-users, while some were associated with the use of particular substances. The prevalence of substance use was shown to be dependent on the specifics of the setting. Moreover, the idea of a three-dimensional classification of the most principal motives for music event attendance was supported. Finally, correlations were estimated between attendance motives and substance use as well as specific substances. Results could enable more tailored approaches in prevention and harm reduction efforts as well as event management strategies.
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Affiliation(s)
- Edith Van Dyck
- Institute for Psychoacoustics and Electronic Music (IPEM), Department of Art History, Musicology and Theatre Studies, Ghent University, 9000 Ghent, Belgium
| | - Koen Ponnet
- Research Group for Media, Innovation and Communication Technologies, Department of Communication Sciences, IMEC-MICT, Ghent University, 9000 Ghent, Belgium
| | - Tina Van Havere
- Substance Use and Psychosocial Risk Behaviours (SUPR-B), University of Applied Sciences and Arts, 9000 Ghent, Belgium
| | - Bert Hauspie
- Research Group for Media, Innovation and Communication Technologies, Department of Communication Sciences, IMEC-MICT, Ghent University, 9000 Ghent, Belgium
- Substance Use and Psychosocial Risk Behaviours (SUPR-B), University of Applied Sciences and Arts, 9000 Ghent, Belgium
| | - Nicky Dirkx
- Substance Use and Psychosocial Risk Behaviours (SUPR-B), University of Applied Sciences and Arts, 9000 Ghent, Belgium
| | | | - Jon Waldron
- Clinical Psychopharmacology Unit, University College London, London WC1E 7HB, UK
| | - Meryem Grabski
- Clinical Psychopharmacology Unit, University College London, London WC1E 7HB, UK
| | - Tom P. Freeman
- Clinical Psychopharmacology Unit, University College London, London WC1E 7HB, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - Helen Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London WC1E 7HB, UK
| | - Jan De Neve
- Department of Data-Analysis, Ghent University, 9000 Ghent, Belgium
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Palamar JJ, Le A, Rutherford C, Keyes KM. Exploring Potential Bellwethers for Drug-Related Mortality in the General Population: A Case for Sentinel Surveillance of Trends in Drug Use among Nightclub/Festival Attendees. Subst Use Misuse 2022; 58:188-197. [PMID: 36469638 PMCID: PMC9877192 DOI: 10.1080/10826084.2022.2151315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Drug-related deaths in the US continue to increase. Sentinel surveillance of high-risk populations can provide early warning for shifts in trends. Nightclub/festival attendees have high levels of drug use, so we explored whether use among this population can serve as a potential bellwether or indicator for use-related mortality in the general population.Methods: Trends in past-year cocaine and methamphetamine use were estimated from nightclub/festival attendees in New York City (NYC) and among NY residents, and trends were estimated for related death rates in NYC (2014/15-2019/20). Using national data from England and Wales (2010-2019), trends in past-year cocaine and ecstasy use (among the full population and among nightclub attendees) and related deaths were also estimated.Results: In NY/NYC, cocaine use remained stable in the general population, but use among nightclub/festival attendees and cocaine-related deaths doubled. Methamphetamine use among nightclub/festival attendees and death rates also more than doubled while use among the general population remained stable. In UK countries, increases in cocaine and ecstasy use were larger for infrequent/frequent nightclub attendees than in the general population, with 3.6- and 8-fold increases in related deaths, respectively. In UK countries, the association between nightclub attendance and death rates increased in a dose-response-like manner with larger associations detected when death rates were lagged by one year.Conclusions: Patterns of use among nightclub/festival attendees, more so than patterns in the general population, were similar to patterns of drug-related deaths. Use among this subpopulation could possibly serve as a bellwether for use-related outcomes. Continued surveillance is recommended.
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Affiliation(s)
- Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Austin Le
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- New York University College of Dentistry, New York, NY, USA
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Liu Y, Vaddiparti K, Cheong J, Cottler LB. Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis. J Addict Med 2020; 15:211-218. [PMID: 33009168 DOI: 10.1097/adm.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We identified the patterns of cocaine use during individuals' heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns. METHODS Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity. RESULTS Four patterns were identified: a "low use" class (72.6%), a "moderate use" class (8.2%), a "daily use" class (17.9%), and a "very high quantity use" class (1.3%). Relative to non-Hispanic White and the "low use" class, non-Hispanic Black was associated with increased odds to be in the "moderate use" and "daily use" classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the "very high quantity use" class relative to other classes; increased risk of using other substances was associated with the "daily use" class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the "low use" class. CONCLUSIONS People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL (YL, KV, LBC); Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL (JWC)
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Fedorova EV, Schrager SM, Robinson LF, Roth AM, Wong CF, Iverson E, Lankenau SE. Developmental trajectories of illicit drug use, prescription drug misuse and cannabis practices among young adult cannabis users in Los Angeles. Drug Alcohol Rev 2020; 39:743-752. [PMID: 32390280 PMCID: PMC7652718 DOI: 10.1111/dar.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Young adults have the highest rates of drug use and contribute significantly to the growing population of medical cannabis patients (MCP). This study examined relationships between longitudinal patterns of illicit/prescription drug use/misuse and cannabis practices among young adult cannabis users. DESIGN AND METHODS In 2014-2015, 210 young adult MCP and 156 nonpatient users were recruited in Los Angeles and surveyed annually over four waves. The analytical sample was limited to completers of all four waves (n = 301). Distinct developmental trajectories of illicit drug use and prescription drug misuse were identified. Fixed effects regression analysis evaluated changes in cannabis practices by trajectory groups. RESULTS Results supported two-trajectory solutions (high/low) for illicit drug use and prescription drug misuse. Decreases in use within all four trajectories occurred by wave 4. Low illicit drug use trajectory members were more likely to self-report medical cannabis use. Membership in both types of high-use trajectories was associated with use of concentrates and edibles. The prevalence of MCP, edibles use and cannabis days decreased significantly by wave 4. DISCUSSION AND CONCLUSIONS While alternative cannabis forms use was associated with membership in high drug use trajectories, self-reported medical cannabis use (not MCP) was negatively associated with high illicit drug use trajectory membership. Reductions in the prevalence of MCP, cannabis days, edibles use and other drug use by wave 4 alongside stable levels of self-reported medical cannabis use might reflect the changing legal status of cannabis in California, maturing out phenomenon and safer patterns of cannabis use.
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Affiliation(s)
- Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Sheree M Schrager
- Department of Research and Sponsored Programs, California State University Northridge, Los Angeles, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Palamar JJ, Keyes KM. Trends in drug use among electronic dance music party attendees in New York City, 2016-2019. Drug Alcohol Depend 2020; 209:107889. [PMID: 32050110 PMCID: PMC7127946 DOI: 10.1016/j.drugalcdep.2020.107889] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Electronic dance music (EDM) party attendees are a high-risk population for drug use and associated adverse effects. We examined trends in past-year drug use within this population to better inform prevention and harm reduction efforts. METHODS Each summer from 2016 through 2019, we used time-space sampling to survey a cross-section of adults entering EDM parties at randomly selected nightclubs and at dance festivals in New York City. Ns ranged from 504 (2019) to 1,087 (2016). We estimated log-linear trends in past-year use of 16 different synthetic drugs or drug classes. RESULTS Between 2016 and 2019, estimated past-year prevalence of use of ketamine increased from 5.9% to 15.3% (a 157.6% relative increase; P = .007), LSD use increased from 9.9% to 16.6% (a 67.7% relative increase, P < .001), powder cocaine use increased from 17.3% to 35.2% (a 103.5% relative increase, P < .001), and GHB use increased from 1.0% to 4.2% (a 311.8% relative increase; P = .002). Past-year use of >3 drugs increased from 12.7% to 20.5% (a 61.4% relative increase; P = .013); however, estimated past-year use of unknown powders decreased from 2.0% to 1.1% (a relative 44.7% decrease; P = .038) and ecstasy/MDMA/Molly use was stable across years (at 25.0 to 28.5 %; P = .687). CONCLUSIONS Reports of powder cocaine, LSD, ketamine, and GHB are becoming more prevalent among EDM party attendees. Prevention and harm reduction efforts are needed to address increasing use. Research is also needed to examine whether increasing media coverage of medical use of ketamine and other psychedelics affects prevalence of recreational use.
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Affiliation(s)
- Joseph J. Palamar
- New York University School of Medicine, Department of Population Health, New York, NY
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Roos CR, Nich C, Mun CJ, Mendonca J, Babuscio TA, Witkiewitz K, Carroll KM, Kiluk BD. Patterns of Cocaine Use During Treatment: Associations With Baseline Characteristics and Follow-Up Functioning. J Stud Alcohol Drugs 2020. [PMID: 31495380 DOI: 10.15288/jsad.2019.80.431] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Abstinence outcomes are typically prioritized in the treatment of cocaine use disorder while ignoring patterns of low-frequency cocaine use. This study examined patterns of cocaine use frequency during treatment and evaluated how these patterns related to baseline characteristics and functioning outcomes 6 and 12 months after treatment. METHOD We used a pooled dataset (N = 720) from seven randomized clinical trials for cocaine use disorder. The Addiction Severity Index (ASI) was used to assess functioning. Repeated-measures latent class analysis was used to derive patterns of cocaine use. RESULTS Three patterns were identified: abstinence (10.6%), low-frequency use (approximately 1 day/week; 66.3%), and persistent frequent use (approximately 4 days/week; 23.1%). The low-frequency group was associated with male gender, younger age, and a criminal justice referral. The abstinent group had the highest alcohol problem severity score at baseline. At Month 6, the low-frequency group reported lower problem severity than the persistent frequent use group across multiple ASI areas, including the cocaine use as well as psychological, family, employment, and legal domains. At Month 12, the low-frequency group did not differ from the abstinent group in problem severity on any ASI domain and, relative to the persistent frequent use group, had lower cocaine use and employment problem severity. CONCLUSIONS These findings highlight the importance of adopting a harm reduction approach and recognizing the potential clinical benefits associated with nonabstinent outcomes.
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Affiliation(s)
- Corey R Roos
- Yale University School of Medicine, New Haven, Connecticut
| | - Charla Nich
- Yale University School of Medicine, New Haven, Connecticut
| | - Chung Jung Mun
- John Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | | | - Brian D Kiluk
- Yale University School of Medicine, New Haven, Connecticut
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Elliott L, Haddock CK, Campos S, Benoit E. Polysubstance use patterns and novel synthetics: A cluster analysis from three U.S. cities. PLoS One 2019; 14:e0225273. [PMID: 31794586 PMCID: PMC6890248 DOI: 10.1371/journal.pone.0225273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/31/2019] [Indexed: 02/04/2023] Open
Abstract
The rapid emergence of novel psychoactive substances within the past decade has raised new concerns about the harms associated with unregulated drug use. Synthetic analogues-chemically related to established psychoactive substances like cannabis sativa and catha edulis-in particular have proliferated rapidly, allowing little opportunity for scientific research or the establishment of informal guidelines for safe use among consumers. To explore how synthetic substance use relates to other forms of use, this paper presents an analysis of polysubstance use among a sample of 676 people who use illicit substances in the United States. Participants were sampled from three greater metropolitan areas (Houston/Galveston, Texas; New York City; and New Orleans, Louisiana). Study researchers used cluster-type analyses to develop dendrogram visualizations of the interrelationships between substance types. Results suggest a considerable variation in substance and polysubstance use patterns across states in the U.S. Polysubstance use clustered around well-observed combinations like MDMA/cannabis and cocaine/heroin. Synthetic cannabinoids and cathinones showed no strong clustering with other substances. High rates of binge drinking among users of other substances further support the importance of interventions sensitive to the clinical challenges of polysubstance use.
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Affiliation(s)
- Luther Elliott
- New York University, College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, New York, United States of America
- * E-mail:
| | | | - Stephanie Campos
- New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | - Ellen Benoit
- North Jersey Community Research Initiative, Research Division, Newark, New Jersey, United States of America
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Roos CR, Nich C, Mun CJ, Mendonca J, Babuscio TA, Witkiewitz K, Carroll KM, Kiluk BD. Patterns of Cocaine Use During Treatment: Associations With Baseline Characteristics and Follow-Up Functioning. J Stud Alcohol Drugs 2019; 80:431-440. [PMID: 31495380 PMCID: PMC6739643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/06/2019] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Abstinence outcomes are typically prioritized in the treatment of cocaine use disorder while ignoring patterns of low-frequency cocaine use. This study examined patterns of cocaine use frequency during treatment and evaluated how these patterns related to baseline characteristics and functioning outcomes 6 and 12 months after treatment. METHOD We used a pooled dataset (N = 720) from seven randomized clinical trials for cocaine use disorder. The Addiction Severity Index (ASI) was used to assess functioning. Repeated-measures latent class analysis was used to derive patterns of cocaine use. RESULTS Three patterns were identified: abstinence (10.6%), low-frequency use (approximately 1 day/week; 66.3%), and persistent frequent use (approximately 4 days/week; 23.1%). The low-frequency group was associated with male gender, younger age, and a criminal justice referral. The abstinent group had the highest alcohol problem severity score at baseline. At Month 6, the low-frequency group reported lower problem severity than the persistent frequent use group across multiple ASI areas, including the cocaine use as well as psychological, family, employment, and legal domains. At Month 12, the low-frequency group did not differ from the abstinent group in problem severity on any ASI domain and, relative to the persistent frequent use group, had lower cocaine use and employment problem severity. CONCLUSIONS These findings highlight the importance of adopting a harm reduction approach and recognizing the potential clinical benefits associated with nonabstinent outcomes.
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Affiliation(s)
- Corey R. Roos
- Yale University School of Medicine, New Haven, Connecticut
| | - Charla Nich
- Yale University School of Medicine, New Haven, Connecticut
| | - Chung Jung Mun
- John Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | | | - Brian D. Kiluk
- Yale University School of Medicine, New Haven, Connecticut
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Grov C, Rendina HJ, John SA, Parsons JT. Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research. AIDS Behav 2019; 23:1277-1286. [PMID: 30306433 PMCID: PMC6458096 DOI: 10.1007/s10461-018-2309-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 W 125th Street, New York, NY, 10027, USA.
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
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A latent class analysis of the past-30-day substance use patterns among lifetime cocaine users: Findings from a community sample in North Central Florida. Addict Behav Rep 2019; 9:100170. [PMID: 31193730 PMCID: PMC6542739 DOI: 10.1016/j.abrep.2019.100170] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 01/03/2023] Open
Abstract
Objectives Cocaine use is increasing and many cocaine users engage in polysubstance use. Within polysubstance use, relationships among use of individual substances are necessarily complex. To address this complexity, we used latent class analysis (LCA) to identify patterns of polysubstance use among lifetime cocaine users and examine associations among these patterns, demographics, and risk profiles. Methods Members of HealthStreet, an ongoing community engagement program, were asked about lifetime and past 30-day use of cocaine, alcohol, tobacco, marijuana, and prescription medications, mental health conditions, recent Emergency Department (ED) visits and demographics. LCA was used to identify classes of past 30-day polysubstance use among individuals who endorsed lifetime cocaine use. Multinomial logistic regression identified factors associated with these classes. Results Among 1797 lifetime cocaine users, a five-class LCA model was identified: 1) past 30-day tobacco use only (45%), 2) past 30-day alcohol, marijuana and tobacco use (31%), 3) past 30-day tobacco, prescription opioid and sedative use (13%), 4) past 30-day cocaine, alcohol, marijuana and tobacco use (9%), 5) past 30-day cocaine and multiple polysubstance use (2%). Demographics, ED visits and mental health conditions were associated with class membership. Conclusions Approximately 11% of lifetime cocaine users used cocaine in the past 30 days with two different concurrent substance use patterns. Prescription medication (opioids and sedatives) and complex polysubstance use patterns were stronger indicators of negative outcomes than current cocaine use. Cocaine was not used frequently with other stimulants. In addition to polysubstance use, prescription medication use should be targeted for intervention among lifetime cocaine users.
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McCreary AC, Müller CP, Filip M. Psychostimulants: Basic and Clinical Pharmacology. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 120:41-83. [PMID: 26070753 DOI: 10.1016/bs.irn.2015.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Substance use disorder, and particularly psychostimulant use disorder, has considerable socioeconomic burden globally. The psychostimulants include several chemical classes, being derivatives of benzoylecgonine, phenethylamine, phenylpropanolamine, or aminoaryloxazoline. Psychostimulant drugs activate the brain reward pathways of the mesoaccumbal system, and continued use leads to persistent neuroplastic and dysfunctional changes of a variety of structures involved in learning and memory, habit-forming learning, salience attribution, and inhibitory control. There are a variety of neurochemical and neurobehavioral changes in psychostimulant addiction, for example, dopaminergic, glutamatergic, serotonergic (5-HT-ergic), and γ-amino butyric acid (GABA) changes have all noted. In this chapter, we will review pharmacological changes associated with psychostimulant use and abuse in humans and animals, and on the basis of the best characterized and most widely abused psychostimulants (amphetamines, cocaine) discuss why use transitions into abuse and review basic science and clinical strategies that might assist in treating psychostimulant abuse.
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Affiliation(s)
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Małgorzata Filip
- Laboratory of Drug Addiction Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland; Department of Toxicology, Faculty of Pharmacy, Jagiellonian University, Krakow, Poland.
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Abstract
Purpose
– The prevalence of cocaine use has been increasing since the mid-1990s in many European countries, Italy included. There is a large variety of patterns of cocaine use in natural settings, but on the whole, the existence of different patterns of cocaine use remains widely unknown to drug professionals, as well as to public opinion. The purpose of this paper is to investigate patterns and trajectories of use, the meaning of use within the context of users’ life styles, the perception of controlled/uncontrolled use, personal strategies to keep drug use “under control”.
Design/methodology/approach
– This paper illustrates findings from a qualitative study among 115 cocaine users. Participants were recruited using the snow ball sampling (a minimum lifetime experience of 20 instances of cocaine use was required).
Findings
– The findings confirm the variability of cocaine use trajectories and the prevalent tendency towards more moderate patterns of use. Such variability is in patent contrast to the disease model of addiction and its assumed predetermined linear trajectories. Set, and particularly setting and all the environmental factors, such as life events, appear to be the variables that can better explain the dynamic course of patterns of use.
Research limitations/implications
– The main limit concerns the non-randomisation in the selection of the nominees. Participants were recruited in the night entertainment scene of the main Tuscan cities through personal contacts of staff from risk reduction facilities: in spite of the personal and confidential approach, the number of “non institutionalized” users willing to collaborate was too low, therefore the authors decided to omit the randomisation.
Social implications
– The findings bear social implications as they can contribute to a change in the social representation of users so as to reduce the stigma. They can also prompt innovation in the operational models of drug services.
Originality/value
– It is the first qualitative research from the “control” perspective ever led in Italy.
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Marijuana and self-regulation: examining likelihood and intensity of use and problems. Addict Behav 2014; 39:709-12. [PMID: 24315407 DOI: 10.1016/j.addbeh.2013.11.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/14/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022]
Abstract
It is important to understand the individual differences that contribute to greater frequency or intensity of marijuana use, or greater frequency of experiencing marijuana-related problems. The current study examined several elements of behavioral and emotional self-regulation as predictors of the likelihood and intensity of both marijuana use and marijuana-related problems. As predicted, indices of behavioral self-regulation (self-control, sensation seeking) were better predictors of marijuana use, while indices of emotional self-regulation (affect, distress tolerance, and emotional instability) better predicted marijuana-related problems. Surprisingly, urgency was not related to use but was predictive of problems, and there were no significant interactions between behavioral and emotional self-regulation in predicting either use or problems. From these findings we conclude that while behavioral dysregulation may put individuals at risk for using marijuana, or using it more frequently, it is those individuals with difficulty in emotional self-regulation that are at risk for experiencing negative consequences as a result of their marijuana use. Clinically, these data are relevant; clinicians might focus more on addressing emotional regulation in order to lessen or eliminate the consequences of marijuana use.
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Smirnov A, Najman JM, Hayatbakhsh R, Plotnikova M, Wells H, Legosz M, Kemp R. Young adults' trajectories of Ecstasy use: a population based study. Addict Behav 2013; 38:2667-74. [PMID: 23899430 DOI: 10.1016/j.addbeh.2013.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/10/2013] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
Young adults' Ecstasy use trajectories have important implications for individual and population-level consequences of Ecstasy use, but little relevant research has been conducted. This study prospectively examines Ecstasy trajectories in a population-based sample. Data are from the Natural History Study of Drug Use, a retrospective/prospective cohort study conducted in Australia. Population screening identified a probability sample of Ecstasy users aged 19-23 years. Complete data for 30 months of follow-up, comprising 4 time intervals, were available for 297 participants (88.4% of sample). Trajectories were derived using cluster analysis based on recent Ecstasy use at each interval. Trajectory predictors were examined using a generalized ordered logit model and included Ecstasy dependence (World Mental Health Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young Adult Self Report) and contextual factors (e.g. attendance at electronic/dance music events). Three Ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 1-2 days Ecstasy use per week. Decreasing frequency of use was observed for intermediate and high-use trajectories from 12 months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past Ecstasy consumption (>70 pills) and attendance at electronic/dance music events. High-use trajectory members were unlikely to have used Ecstasy for more than 3 years and tended to report consistently positive subjective effects at baseline. Given the social context and temporal course of Ecstasy use, Ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use patterns.
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Affiliation(s)
- Andrew Smirnov
- Queensland Alcohol and Drug Research and Education Centre, School of Population Health, The University of Queensland, Herston Rd, Herston, QLD 4006, Australia.
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Crits-Christoph P, Gallop R, Gibbons MBC, Sadicario JS, Woody G. Measuring Outcome in the Treatment of Cocaine Dependence. JOURNAL OF ALCOHOLISM AND DRUG DEPENDENCE 2013; 1:108. [PMID: 26366427 PMCID: PMC4564116 DOI: 10.4172/2329-6488.1000108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little in known about the extent to which outcome measures used in studies of the treatment of cocaine dependence are associated with longer-term use and with broader measures of clinical improvement. The current study examined reductions in use, and abstinence-oriented measures, in relation to functioning and longer-term clinical benefits in the treatment of cocaine dependence. METHODS Overall drug use, cocaine use, and functioning in a number of addiction-related domains for 487 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions in the NIDA Cocaine Collaborative Treatment Study were assessed monthly during 6 months of treatment and at 9, 12, 15, and 18 month follow-up. RESULTS Measures of during-treatment reduction in use were moderately correlated with drug and cocaine use measures 12 months, but showed non-significant or small correlations with measures of functioning at 12 months. Highest correlations were evident for abstinence measures (maximum consecutive days abstinence and completely abstinent) during treatment in relation to sustained (3 month) abstinence at 12 months. Latent class analysis of patterns of change over time revealed that most patients initially (months 1 to 4 of treatment) either became abstinent immediately or continued to use every month. Over the couse of follow-up, patients either maintained abstinence or used regularly - intermittent use was less common. CONCLUSIONS There were generally small associations between various measures of cocaine use and longer-term clinical benefits, other than abstinence was associated with continued abstinence. No one method of measuring outcome of treatment of cocaine dependence appears superior to others.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Robert Gallop
- Applied Statistics Program, Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383, USA
| | | | - Jaclyn S. Sadicario
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
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