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Martin EL, Baker NL, Ramakrishnan V, Neelon B, Saladin ME, McRae-Clark AL. Gender differences in circumstances associated with cannabis use. Am J Addict 2025. [PMID: 39934545 DOI: 10.1111/ajad.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 01/24/2025] [Accepted: 01/31/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Identifying circumstances associated with cannabis use is critical to the development of effective interventions for cannabis use disorder (CUD) and circumstances may differ by gender. The Inventory of Drug Taking Situations (IDTS) assesses the types of situations in which individuals most often use drugs through eight subscales: dealing with (1) Unpleasant Emotions; (2) Physical Discomfort; (3) Pleasant Emotions; (4) Testing Personal Control; (5) Urges/Temptations; (6) Conflict with Others; (7) Social Pressure; and (8) Pleasant Times with Others. The aims of this study were to determine if IDTS scores varied by gender in individuals with CUD, and to ascertain if behavioral factors such as cannabis use or stress were differentially associated with IDTS scores by gender. METHODS Baseline data were obtained from a study of 148 nontreatment-seeking individuals with CUD. Data included demographic characteristics, IDTS scores, self-reported past 90-day substance use, and measures of past-month and childhood stress. RESULTS Women reported using cannabis more than men in negative affective contexts, namely when experiencing conflict with others, testing personal control, physical discomfort, and unpleasant emotions. IDTS subscale scores associated with negative affect and pleasant emotions were positively associated with past 90-day cannabis use sessions across genders, use when experiencing negative affect was associated with childhood stress across genders, and use when experiencing unpleasant emotions was differentially associated with recent stress by gender. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Findings suggest gender differences in circumstances associated with cannabis use with implications for therapeutic development for CUD.
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Affiliation(s)
- Erin L Martin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Rogers AH, Pielech M, Ketterl TG, Palermo TM. Mental Health Consequences of Opioid Pain Medication Use Behaviors and Motives Among Adolescents and Young Adults With Cancer: Results From a National Survey. Psychooncology 2025; 34:e70082. [PMID: 39804296 PMCID: PMC11866406 DOI: 10.1002/pon.70082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 12/28/2024] [Accepted: 01/06/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND Adolescents and young adults (AYA) with cancer experience long-term consequences into survivorship that impact quality of life, including mental health symptoms, substance use, and persistent pain. Given the elevated rates of pain, AYA cancer survivors are at increased risk for opioid pain medication (OPM) exposure, increasing risk for opioid-related negative consequences, particularly for those with mental health symptoms. Minimal research has documented that a considerable proportion of AYAs with cancer receive OPM that continues into survivorship, yet the lack of consensus on the definition of problematic opioid use coupled with the high clinical need for OPM makes it particularly challenging to understand the impact of OPM use in this population. AIMS Therefore, the current study examined differences in opioid pain medication use, use behaviors, and motives between AYA cancer survivors and non-cancer controls. METHODS Using the National Survey on Drug Use and Health, we tested the impact of OPM use behaviors and motives on depressive symptoms and mental healthcare utilization variables. RESULTS Results show that, compared to non-cancer controls, AYA cancer survivors evince higher rates of opioid use, behaviors, and pain relief motives. Within the cancer survivor group only, there were differential patterns of associations between OPM behaviors, motives, depressive symptoms, and mental healthcare utilization, with using opioid pain medication for emotion coping/to get high showed the largest effect sizes with outcome variables. CONCLUSIONS The results highlight the importance of moving beyond use itself and examining how and why AYAs with cancer are using opioids to understand potential negative consequences.
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Affiliation(s)
- Andrew H. Rogers
- Division of Behavioral Medicine, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY
| | - Melissa Pielech
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Tyler G. Ketterl
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Hospital, Seattle, WA
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Washington School of Medicine, Seattle, WA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, WA
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Martucci KT. Neuroimaging of opioid effects in humans across conditions of acute administration, chronic pain therapy, and opioid use disorder. Trends Neurosci 2024; 47:418-431. [PMID: 38762362 PMCID: PMC11168870 DOI: 10.1016/j.tins.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
Evidence of central nervous system (CNS) exogenous opioid effects in humans has been primarily gained through neuroimaging of three participant populations: individuals after acute opioid administration, those with opioid use disorder (OUD), and those with chronic pain receiving opioid therapy. In both the brain and spinal cord, opioids alter processes of pain, cognition, and reward. Opioid-related CNS effects may persist and accumulate with longer opioid use duration. Meanwhile, opioid-induced benefits versus risks to brain health remain unclear. This review article highlights recent accumulating evidence for how exogenous opioids impact the CNS in humans. While investigation of CNS opioid effects has remained largely disparate across contexts of opioid acute administration, OUD, and chronic pain opioid therapy, integration across these contexts may enable advancement toward effective interventions.
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Affiliation(s)
- Katherine T Martucci
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA; Center for Translational Pain Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
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Howell CM, Myers J. Substance use disorder and treatment in healthcare providers. JAAPA 2023; 36:1-4. [PMID: 37751264 DOI: 10.1097/01.jaa.0000977732.74264.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
ABSTRACT Substance use disorder (SUD) is associated with innumerable risk factors and patient presentations, and is a leading cause of preventable disease. Research continues to explore the role of biochemical and social constructs that may play a role in the foundation, perpetuation, and progression of SUD in at-risk populations. Healthcare providers develop SUD at lifetime rates similar to those of the general population, but detecting common signs and symptoms may be challenging, often delaying treatment until the course becomes more complicated. Compounding this are tangible and intangible reservations to care, including clinician fear of the financial cost for treatment, lost wages, and damage to professional esteem. Nonetheless, all clinicians must be able to recognize SUD and be aware of treatments for afflicted colleagues.
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Affiliation(s)
- Christopher M Howell
- Christopher M. Howell is program director and an associate professor in the PA program, at Miami University in Oxford, Ohio. At the time this article was written, he was an associate professor in another PA program, where Jade Myers was a student. Ms. Myers now practices in primary care with Kettering (Ohio) Health Medical Group. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Sherman BJ, Brasher ZE, Baker NL, McRae-Clark AL, Froeliger BE. Restructuring reward: A pilot study to enhance natural reward response in adults with cannabis use disorder. Drug Alcohol Depend 2023; 249:110830. [PMID: 37329729 PMCID: PMC10398752 DOI: 10.1016/j.drugalcdep.2023.110830] [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: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Hedonic dysregulation is a core mechanism of addiction. There is a dearth of research on hedonic dysregulation in cannabis use disorder (CUD). The current study tested whether personalized scripted imagery may be an efficacious approach to remediate reward functioning in adults with CUD. METHODS Adults with CUD (n=10) and non-CUD controls (n=12) completed a single session personalized scripted imagery procedure. Non-drug (i.e. natural) reward and neutral scripts were transcribed and participants listened to the scripts in counterbalanced order. Primary outcomes included positive affect (PA), galvanic skin response (GSR), and cortisol and were assessed at four timepoints. Mixed effects models were used to compare between and within subject effects. RESULTS Mixed effects models revealed a Condition (reward vs. neutral) X Group (CUD vs. control) interaction (p=0.01) on PA response, indicating blunted PA response to the neutral script relative to the reward script in CUD participants. Likewise, GSR response in CUD participants was decreased in response to the neutral script relative to the reward script (p=0.034; interaction n.s.). An interaction effect of Group X PA on cortisol response was found (p=.036) indicating that cortisol was positively correlated with PA in healthy control participants, but not CUD participants. CONCLUSIONS Adults with CUD may demonstrate acute deficits in hedonic tone under neutral conditions relative to healthy controls. Personalized scripted imagery may be an efficacious tool to remediate hedonic dysregulation in CUD. Cortisol may play a role in healthy positive affect regulation warranting further investigation.
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Affiliation(s)
- Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
| | - Zoe E Brasher
- Department of Psychiatry, University of California, Los Angeles, United States
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, United States
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States; Department of Neuroscience, Medical University of South Carolina, United States; Ralph H. Johnson, VA Medical Center, Charleston, SC, United States
| | - Brett E Froeliger
- Departments of Psychiatry and Psychological Sciences, University of Missouri, United States
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Amini K, Long T, Jafari Varjoshani N, Rabie Siahkali S. A comparison of risk factors for relapse in opiate-related and stimulant-related substance use disorders: A cross-sectional multicenter study. J Nurs Scholarsh 2023; 55:566-576. [PMID: 36596703 DOI: 10.1111/jnu.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Recognizing the specific factors in relapse disorders related to each substance can help improve treatment methods and adopt more effective preventive strategies. This study aimed to compare the situational factors associated with relapse in opiate-related disorders with stimulant-related disorders (SRDs) of those referred to substance misuse treatment centers. DESIGN This study was a cross-section type. METHODS The study participants were 150 clients with SRDs and 150 with opiate-related disorders. Samples were selected using two stages random sampling method. Data were collected through a demographic questionnaire and the Inventory of Drug-Taking Situations (IDTS). RESULTS The mean score of IDTS in the two groups was significantly different (X̄1 = 45.93 ± 11.12 vs. X̄2 = 48.34 ± 15.07; t = 3.32, p < 0.01). The mean scores of 'unpleasant emotions,' 'physical discomfort,' 'conflict with others,' and 'social pressure to use and urge/temptations' subscales were significantly higher in the stimulant group than in the opiate group (p < 0.05). However, the mean of the testing' personal control' subscale was higher in the opiate group than in the stimulant group (p < 0.05). CONCLUSION This study reveals that despite some similarities, relapse-related situational factors in opiates and stimulants differ. Some situational factors, such as social pressure and coping with unpleasant emotions, play a more critical role in relapse to both stimulant and opiate groups.
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Affiliation(s)
- Kourosh Amini
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Nasrin Jafari Varjoshani
- Department of Community Health Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
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Sagioglou C, Greitemeyer T. Motives Linking Subclinical Psychopathy and Benign Masochism to Recreational Drug use. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221145024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As the use of some psychoactive substances continues to be a global health risk, it is important to understand why people use them. We compared the predictive power of psychopathy and masochism with regard to lifetime recreational drug use and tested the underlying motives in a sample of 415 US-based adults. Psychopathy predicted use of illicit drugs, cannabis, and nicotine, while masochism predicted cannabis, alcohol, and caffeine use. Both traits were related to most motives, but the motives differentially predicted substance use. Expansion motivation was the sole motive for illicit drug use, whereas cannabis was predicted mainly by expansion and enhancement. Alcohol, nicotine, and caffeine were used to escape daily worries, and alcohol was further used for social reasons. Benign masochism is a newly identified predictor of popular drug use. Future research could investigate masochism and expansion motivation as predictors of potentially harmful substance use.
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Abstract
OBJECTIVES This study aims to investigate racial-ethnic differences in reasons for misuse of prescription medications among a nationally representative sample of US adults. METHODS We analyzed data from the 2015-2019 National Surveys on Drug Use and Health. The study population includes US adults (18-49 years old) who reported misuse of 3 types of prescription drugs (stimulants [n = 6139], sedatives and tranquilizers [n = 5643], and pain relievers [n = 8780]) for 3 reasons: medical-only (eg, to help with pain), recreational-only (eg, to get high), or combined medical and recreational reasons. Multinomial logistic regressions assessed the association between reasons of misuse of prescription medications and self-identified race-ethnicity. RESULTS Misuse of the 4 types of prescription medications was primarily motivated by medical reasons (63%-80%). Compared to non-Hispanic Whites, non-Hispanic Blacks (nHB), and Hispanics (H) were less likely to report misuse of pain relievers for combined (nHB: adjusted relative risk ratio [aRRR] = 0.6, 95% confidence interval [CI]: 0.4, 0.7; H; aRRR = 0.7, 95% CI: 0.5, 0.9) or recreational reasons (nHB: aRRR = 0.8, 95% CI: 0.6, 1.0; H; aRRR = 0.7, 95% CI: 0.6, 0.9) rather than medical-only reasons. The odds of misuse of sedatives and tranquilizers for recreational-only reasons as opposed to medical-only reasons were higher among nHB (aRRR = 1.9, 95% CI: 1.3, 2.7) and H (aRRR = 1.9, 95% CI: 1.4, 2.4) than among non-Hispanic Whites. CONCLUSIONS The increased misuse of prescription pain relievers for medical reasons among racial-ethnic minority groups demonstrates a continued need to investigate underlying structural factors driving these behaviors. The higher odds of sedative and tranquilizer misuse for recreational purposes among racial-ethnic minority groups warrant further investigation.
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Zeng X, Chen Y. Associations of deviant peer affiliation with youths' substance use disorder abstention motivation: The mediating role of perceived social support and the moderating role of collective identity. J Ethn Subst Abuse 2020; 21:402-424. [PMID: 32543334 DOI: 10.1080/15332640.2020.1777608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the current study is to explore the mechanism by which deviant peer affiliation affects substance abusers' substance abstention motivation and the mediating role of perceived social support in the relationship between these concepts. Moreover, we also investigated whether collective identity moderates the relations among deviant peer affiliation, perceived social support, and substance rehabilitation. The participants were 430 male substance abstainers who completed a battery of questionnaires. The Chinese versions of the Deviant Peer Affiliation Questionnaire, Motivation for Abstention Scale, Perceived Social Support Scale and Identity Orientation Scale were used. The results showed that all the dimensions of deviant peer affiliation were negatively associated with the dimensions of substance abstention motivation. Moreover, perceived social support partially mediated the relations between deviant peer affiliation and substance abstention motivation. Additionally, collective identity was a significant moderator of the relations between perceived social support and substance abstention motivation. These findings provide a clearer understanding regarding the impact of deviant peer affiliation and perceived social support on substance abstention motivation in individuals with substance use disorder.
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Müller CP. Drug instrumentalization. Behav Brain Res 2020; 390:112672. [PMID: 32442549 DOI: 10.1016/j.bbr.2020.112672] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
Psychoactive drugs with addiction potential are widely used by people of virtually all cultures in a non-addictive way. In order to understand this behaviour, its population penetrance, and its persistence, drug instrumentalization was suggested as a driving force for this consumption. Drug instrumentalization theory holds that psychoactive drugs are consumed in a very systematic way in order to make other, non-drug-related behaviours more efficient. Here, we review the evolutionary origin of this behaviour and its psychological mechanisms and explore the neurobiological and neuropharmacological mechanisms underlying them. Instrumentalization goals are discussed, for which an environmentally selective and mental state-dependent consumption of psychoactive drugs can be learned and maintained in a non-addictive way. A small percentage of people who regularly instrumentalize psychoactive drugs make a transition to addiction, which often starts with qualitative and quantitative changes in the instrumentalization goals. As such, addiction is proposed to develop from previously established long-term drug instrumentalization. Thus, preventing and treating drug addiction in an individualized medicine approach may essentially require understanding and supporting personal instrumentalization goals.
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Affiliation(s)
- Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Ahmed SH, Badiani A, Miczek KA, Müller CP. Non-pharmacological factors that determine drug use and addiction. Neurosci Biobehav Rev 2020; 110:3-27. [PMID: 30179633 PMCID: PMC6395570 DOI: 10.1016/j.neubiorev.2018.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/26/2018] [Accepted: 08/28/2018] [Indexed: 12/26/2022]
Abstract
Based on their pharmacological properties, psychoactive drugs are supposed to take control of the natural reward system to finally drive compulsory drug seeking and consumption. However, psychoactive drugs are not used in an arbitrary way as pure pharmacological reinforcement would suggest, but rather in a highly specific manner depending on non-pharmacological factors. While pharmacological effects of psychoactive drugs are well studied, neurobiological mechanisms of non-pharmacological factors are less well understood. Here we review the emerging neurobiological mechanisms beyond pharmacological reinforcement which determine drug effects and use frequency. Important progress was made on the understanding of how the character of an environment and social stress determine drug self-administration. This is expanded by new evidence on how behavioral alternatives and opportunities for drug instrumentalization generate different patterns of drug choice. Emerging evidence suggests that the neurobiology of non-pharmacological factors strongly determines pharmacological and behavioral drug action and may, thus, give rise for an expanded system's approach of psychoactive drug use and addiction.
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Affiliation(s)
- Serge H Ahmed
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Aldo Badiani
- Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, BN1 9RH Brighton, UK
| | - Klaus A Miczek
- Psychology Department, Tufts University, Bacon Hall, 530 Boston Avenue, Medford, MA 02155, USA; Department of Neuroscience, Sackler School of Graduate Biomedical Sciences, Boston, MA 02111, USA
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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AbdelWahab MA, Abou el Magd SF, Grella CE, Enaba DA, Abdel Maqsoud R. An examination of motives for tramadol and heroin use in an Egyptian sample. J Addict Dis 2019; 37:123-134. [DOI: 10.1080/10550887.2019.1623650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Christine E. Grella
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, CA, USA
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Moningka H, Lichenstein S, Yip SW. Current understanding of the neurobiology of opioid use disorder: An overview. Curr Behav Neurosci Rep 2019; 6:1-11. [PMID: 34485022 PMCID: PMC8412234 DOI: 10.1007/s40473-019-0170-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of the neurobiological mechanisms underlying opioid use disorder (OUD) drawing from genetic, functional and structural magnetic resonance imaging (MRI) research. RECENT FINDINGS Preliminary evidence suggests an association between OUD and specific variants of the DRD2, δ-opioid receptor 1 (OPRD1) and μ-opioid receptor 1 (OPRM1) genes. Additionally, MRI research indicates functional and structural alterations in striatal and corticolimbic brain regions and pathways underlying reward, emotion/stress and cognitive control processes among individuals with OUD. SUMMARY Individual differences in genetic and functional and structural brain-based features are correlated with differences in OUD severity and treatment outcomes, and therefore may potentially one day be used to inform OUD treatment selection. However, given the heterogeneous findings reported, further longitudinal research across different stages of opioid addiction is needed to yield a convergent characterization of OUD and improve treatment and prevention.
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Affiliation(s)
- Hestia Moningka
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
- University College London, Division of Psychology and Language Sciences, London WC1H 0AP
| | - Sarah Lichenstein
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
| | - Sarah W. Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
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Vest NA, Murphy KT, Tragesser SL. Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex. Addict Behav 2018; 87:46-54. [PMID: 29945027 DOI: 10.1016/j.addbeh.2018.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample. METHOD Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use. RESULTS BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females. CONCLUSIONS This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.
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Gender moderates the association between distress tolerance and alcohol use among individuals with opioid use disorder. Drug Alcohol Depend 2018; 190:9-12. [PMID: 29960920 PMCID: PMC6559221 DOI: 10.1016/j.drugalcdep.2018.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/18/2018] [Accepted: 05/18/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol use among individuals with opioid use disorder (OUD) can be dangerous, and understanding factors contributing to alcohol use in this population is important. The current study examined alcohol use among individuals with prescription OUD based on distress tolerance. It was hypothesized that individuals with greater distress tolerance abilities would have a lower frequency and quantity of alcohol use compared to individuals with less distress tolerance. It was also hypothesized that this association would differ based on gender. METHODS A total of 122 individuals with prescription OUD participated in the current study. Participants completed questionnaires regarding demographics, distress tolerance, mental health symptoms, and frequency and quantity of alcohol in the past 30 days. A regression model was conducted using the alcohol-related variables as outcomes. RESULTS There was a significant interaction between gender and distress tolerance on alcohol use frequency. Greater distress tolerance was associated with fewer alcohol use days in women, but there was no association between distress tolerance and alcohol use days in men. CONCLUSIONS The findings suggest that distress tolerance skills may be key to reducing alcohol use in women with prescription OUD.
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Clingan SE, Woodruff SI. Drug-Avoidance Self-Efficacy Among Exclusive Cannabis Users vs. Other Drug Users Visiting the Emergency Department. Subst Use Misuse 2017; 52:1240-1246. [PMID: 28605216 DOI: 10.1080/10826084.2017.1305412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Medical care in the emergency department (ED) is a growing and complex area of outpatient care, with about 256 visits made to EDs every minute in 2013. Studies report that, compared to people who do not use drugs, people who use illicit drugs are more likely to use the ED for their medical care. Self-efficacy has been shown to be a predictor of abstinence or reduced use among drug-using individuals. OBJECTIVES The current study describes drug avoidance self-efficacy among exclusive cannabis-using individuals and other drug-using individuals who use the ED for any reason. METHODS Participants were 693 adult patients visiting the trauma units and EDs of two large urban "safety net" hospitals (i.e., providing care to low-income, uninsured, and vulnerable population) in Southern California who reported using illicit drugs in the past 30 days. RESULTS For people who use only cannabis, higher drug-avoidance self-efficacy was associated with older age, lower drug involvement scores, lower drug severity scores, and higher readiness to change use. For people who use other drugs, higher drug avoidance self-efficacy scores was associated with lower drug severity scores, lower psychiatric severity scores, higher medical severity scores, and higher readiness to change use. CONCLUSION This study identified several factors (some common, some unique) related to higher drug-avoidance self-efficacy for both groups. Results may be important when designing intervention protocols for use in the ED.
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Affiliation(s)
- Sarah E Clingan
- a Center for Alcohol and Drug Studies, School of Social Work , San Diego State University , 5500 Campanile Drive, San Diego , California , USA
| | - Susan I Woodruff
- a Center for Alcohol and Drug Studies, School of Social Work , San Diego State University , 5500 Campanile Drive, San Diego , California , USA
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Abstract
PURPOSE OF REVIEW Although peer influence is an important factor in the initiation and maintenance of cannabis use, few studies have investigated the neural correlates of peer influence among cannabis users. The current review summarizes research on the neuroscience of social influence in cannabis users, with the goal of highlighting gaps in the literature and the need for future research. RECENT FINDINGS Brain regions underlying peer influence may function differently in cannabis users. Compared to non-using controls, regions of the brain underlying reward, such as the striatum, show greater connectivity with frontal regions, and also show hyperactivity when participants are presented with peer information. Other subcortical regions, such as the insula, show hypoactivation during social exclusion in cannabis users, indicating that neural responses to peer interactions may be altered in cannabis users. SUMMARY Although neuroscience is increasingly being used to study social behavior, few studies have specifically focused on cannabis use, and therefore it is difficult to draw conclusions about social mechanisms that may differentiate cannabis users and controls. This area of research may be a promising avenue in which to explore a critical factor underlying cannabis use and addiction.
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Neural mechanisms of sensitivity to peer information in young adult cannabis users. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2017; 16:646-61. [PMID: 27068178 DOI: 10.3758/s13415-016-0421-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Though social influence is a critical factor in the initiation and maintenance of marijuana use, the neural correlates of influence in those who use marijuana are unknown. In this study, marijuana-using young adults (MJ; n = 20) and controls (CON; n = 23) performed a decision-making task in which they made a perceptual choice after viewing the choices of unknown peers via photographs, while they underwent functional magnetic resonance imaging scans. The MJ and CON groups did not show differences in the overall number of choices that agreed with versus opposed group influence, but only the MJ group showed reaction time slowing when deciding against group choices. Longer reaction times were associated with greater activation of frontal regions. The MJ goup, compared to CON, showed significantly greater activation in the caudate when presented with peer information. Across groups, caudate activation was associated with self-reported susceptibility to influence. These findings indicate that young adults who use MJ may exhibit increased effort when confronted with opposing peer influence, as well as exhibit greater responsivity of the caudate to social information. These results not only better define the neural basis of social decisions, but also suggest that marijuana use is associated with exaggerated neural activity during decision making that involves social information.
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Stange K, Krüger M, Janke E, Lichtinghagen R, Bleich S, Hillemacher T, Heberlein A. Positive association of personal distress with testosterone in opiate-addicted patients. J Addict Dis 2017; 36:167-174. [DOI: 10.1080/10550887.2017.1303980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katrin Stange
- Center for Addiction Research (CARe), Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Germany
| | | | - Eva Janke
- Center for Addiction Research (CARe), Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Germany
| | | | - Stefan Bleich
- Center for Addiction Research (CARe), Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Germany
| | - Thomas Hillemacher
- Center for Addiction Research (CARe), Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Germany
| | - Annemarie Heberlein
- Center for Addiction Research (CARe), Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Germany
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Marks KR, Leukefeld CG. A Preliminary Study Examining Women's Physical Health and Nonmedical Prescription Opioid Use in a Recovering Framework. J Womens Health (Larchmt) 2017; 26:286-293. [PMID: 28072916 DOI: 10.1089/jwh.2016.5961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a growing need for research on women recovering from nonmedical prescription opioid use. A paradigm shift is to focus on wellness and factors that support, rather than hinder, recovering women. For example, although physical health is impacted by nonmedical prescription opioid use, improved health may be a strength-based factor among recovering women. The aim of this preliminary study was to examine physical health in a recovering framework as women begin recovering from nonmedical prescription opiate use. MATERIALS AND METHODS This study conducted secondary data analysis using self-report data from Kentucky's Targeted Assessment Program (TAP). TAP assesses and provides pretreatment for problems impeding work or interfering with parental responsibilities. Data included 1247 adult women reporting a history of nonmedical prescription opioid use and receiving pretreatment. Bivariate and logistic regression analyses examined whether physical health and access to health services at baseline were associated with substance-related behavior change upon completion of pretreatment. RESULTS Women reporting better physical health and fewer days with no activities due to health barriers were more likely to engage in pretreatment substance-related behavior change [χ2(8) = 34.6, p < 0.05]. However, ∼40% of women reported barriers in accessing healthcare. CONCLUSION Using a recovering framework, women's physical health, as expected, is associated with engagement in pretreatment substance-related behavior change. Ongoing service coordination with practitioners and medical providers should be incorporated into care to meet the need. Future research should continue to examine factors that support recovering women, using a recovering framework.
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Affiliation(s)
- Katherine R Marks
- Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Carl G Leukefeld
- Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
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21
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Gilman JM, Lee S, Kuster JK, Lee MJ, Kim BW, van der Kouwe A, Blood AJ, Breiter HC. Variable activation in striatal subregions across components of a social influence task in young adult cannabis users. Brain Behav 2016; 6:e00459. [PMID: 27257518 PMCID: PMC4873656 DOI: 10.1002/brb3.459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/27/2016] [Accepted: 02/28/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Decades of research have demonstrated the importance of social influence in initiation and maintenance of drug use, but little is known about neural mechanisms underlying social influence in young adults who use recreational drugs. METHODS To better understand whether the neural and/or behavioral response to social influence differs in young adults using illicit drugs, 20 marijuana-using young adults (MJ) aged 18-25, and 20 controls (CON) performed a decision-making task in the context of social influence, while they underwent functional magnetic resonance imaging scans. A priori analyses focused on the nucleus accumbens (NAc), with post hoc analyses in the rest of the striatum. In this task, participants could choose to either follow or go against group influence. RESULTS When subjects applied social information to response choice selection (independent of following or going against group influence), we observed activation in the middle striatum (caudate), in the MJ group only, that extended ventrally into the NAc. MJ users but not CON showed greater activation in the NAc but not the caudate while making choices congruent with group influence as opposed to choices going against group influence. Activation in the NAc when following social influence was associated with amount of drug use reported. In contrast, during the feedback phase of the task we observed significant NAc activation in both MJ and CON, along with dorsal caudate activation only in MJ participants. This NAc activation did not correlate with drug use. CONCLUSIONS This study shows that MJ users, but not CON, show differential brain activation across striatal subregions when applying social information to make a decision, following versus going against a group of peers, or receiving positive feedback. The current work suggests that differential neural sensitivity to social influence in regions such as the striatum may contribute to the development and/or maintenance of marijuana use.
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Affiliation(s)
- Jodi M Gilman
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115
| | - Sang Lee
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129
| | - John K Kuster
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Myung Joo Lee
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011
| | - Byoung Woo Kim
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011
| | - Andre van der Kouwe
- Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Laboratory for Computational Neuroimaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Anne J Blood
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Hans C Breiter
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
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Hall MT, Golder S, Higgins GE, Logan T. Nonmedical prescription opioid use among victimized women on probation and parole. Addict Behav 2016; 53:113-9. [PMID: 26476007 DOI: 10.1016/j.addbeh.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/16/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonmedical prescription opioid use (NPOU) is a major public health concern and few studies have described this phenomenon among victimized women involved in the criminal justice system. OBJECTIVE This study will describe the relationship between victimization, psychological distress, health status and NPOU among the vulnerable population of victimized women on probation and parole. METHODS A sample of 406 women on probation and parole responded to items assessing victimization history, self-reported health status, physical pain, psychological distress, and post-traumatic stress disorder. Multiple logistic regression analysis was utilized to differentiate NPOUs versus nonusers. RESULTS Overall, 169 (41.6%) women reported lifetime NPOU, and 20% reported use in the past year. Compared to women who did not report NPOU, NPOUs were more likely to be White, have poorer general health, and more severe psychological distress across nine symptom domains. In multiple logistic regression models, each year of age reduced the odds of NPOU by 4%; White women were twice as likely as women of other races to report NPOU; each unit increase in the measure for physical pain was associated with a 30% increase in the odds of NPOU; and participants who met diagnostic criteria for PTSD were 60% more likely to report NPOU compared to individuals who did not. CONCLUSION Victimized women on probation and parole report high rates of NPOU and comorbid mental and physical health problems. The criminal justice system should routinely screen for NPOU, as well as untreated or poorly managed physical pain and psychological distress, which may increase risk of NPOU.
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Gilman JM, Curran MT, Calderon V, Schuster RM, Evins AE. Altered Neural Processing to Social Exclusion in Young Adult Marijuana Users. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2015; 1:152-159. [PMID: 26977454 DOI: 10.1016/j.bpsc.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies have reported that peer groups are one of the most important predictors of adolescent and young adult marijuana use, and yet the neural correlates of social processing in marijuana users have not yet been studied. In the current study, marijuana-using young adults (n = 20) and non-using controls (n = 22) participated in a neuroimaging social exclusion task called Cyberball, a computerized ball-tossing game in which the participant is excluded from the game after a pre-determined number of ball tosses. Controls, but not marijuana users, demonstrated significant activation in the insula, a region associated with negative emotion, when being excluded from the game. Both groups demonstrated activation of the ventral anterior cingulate cortex (vACC), a region associated with affective monitoring, during peer exclusion. Only the marijuana group showed a correlation between vACC activation and scores on a self-report measure of peer conformity. This study indicates that marijuana users show atypical neural processing of social exclusion, which may be either caused by, or the result of, regular marijuana use.
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Affiliation(s)
- Jodi M Gilman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Max T Curran
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA
| | - Vanessa Calderon
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA
| | - Randi M Schuster
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Harvard Medical School, Boston, MA, USA
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Palamar JJ, Griffin-Tomas M, Kamboukos D. Reasons for recent marijuana use in relation to use of other illicit drugs among high school seniors in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:323-31. [PMID: 26115351 DOI: 10.3109/00952990.2015.1045977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Studies show that illicit cannabis (marijuana) use is related to use of other illicit drugs and that reasons for use are related to frequency of marijuana use. However, research is needed to examine whether specific reasons for marijuana use are associated with use of other illicit drugs. METHODS Data from recent marijuana-using high school seniors were examined from 12 cohorts of Monitoring the Future (Weighted n = 6481) to examine whether reasons for recent marijuana use are associated with use of eight other illicit drugs. RESULTS Using "to experiment" decreased odds of reporting use of each drug and using to decrease effects of other drugs increased odds of reporting use of each drug. In multivariable models, using marijuana "to experiment" decreased the odds for reporting use of hallucinogens other than LSD and narcotics other than heroin. Using marijuana for "insight" increased the odds for use of hallucinogens other than LSD, and use due to "boredom" increased the odds for reporting use of powder cocaine and hallucinogens other than LSD. Using marijuana to increase effects of other drugs increased odds of reporting use of each of the eight drugs, and using it to decrease other drug effects increased odds of reporting use of crack, hallucinogens other than LSD, and amphetamine/stimulants. CONCLUSIONS This study helped identify illicit marijuana users who are more likely to report use of other illicit drugs. Prevention efforts need to focus on students who report certain reasons for marijuana use as they may be at risk for use of other illicit drugs.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center , New York , NY
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25
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Schmidt T, Zimam A, Nielsen A, Wakeland W. Data Sources Regarding the Nonmedical Use of Pharmaceutical Opioids in the United States. REVIEWS IN HEALTH CARE 2014; 5:33-50. [PMID: 25525498 DOI: 10.7175/rhc.v5i1.883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. This work offers a systematic categorization of data sources regarding the nonmedical use of pharmaceutical opioids in the United States. METHODS A list of keywords regarding the nonmedical use of pharmaceutical opioids was used to conduct systematic searches in PubMed®. Filtration of search results generated 92 peer-reviewed academic articles, published between January 1995 and April 2012, as well as a number of primary data sources. Lists of topics were developed independently by two researchers which were later compared and consolidated. All sources were then categorized according to their relevance to each of these topics and according to their capacity for geographical and longitudinal trend analysis. RESULTS Tables cataloging data sources can be used to identify data relevant to specific topics in diversion, nonmedical use, and adverse outcomes associated with pharmaceutical opioids, and they illustrate global trends in data coverage, identifying several topics that have minimal data. A network diagram illustrates global trends in data coverage, showing variation among sources in the number of topics they cover, as well as variation among topics in the number of sources that cover them. CONCLUSIONS The categorization of data sources is hoped to facilitate ongoing research, analysis, and evaluation of this public health problem by serving as a guide for researchers, policy makers, and others who seek data regarding the nonmedical use of pharmaceutical opioids in the United States.
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Affiliation(s)
- Teresa Schmidt
- Systems Science Graduate Program Portland State University
| | - Amanuel Zimam
- Systems Science Graduate Program Portland State University
| | | | - Wayne Wakeland
- Systems Science Graduate Program Portland State University
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McCauley JL, Mercer MA, Barth KS, Brady KT, Back SE. Pain management perceptions among prescription opioid dependent individuals. Drug Alcohol Depend 2014; 142:354-8. [PMID: 25034899 PMCID: PMC4127153 DOI: 10.1016/j.drugalcdep.2014.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/09/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nearly two-thirds of prescription opioid dependent individuals report chronic pain conditions as both an initial and current motivation for prescription opioid use. However, to date, limited information exists regarding perceptions of the adequacy of pain management and pain management behaviors among prescription opioid dependent individuals with a history of treatment for chronic pain. METHODS The current study examined perceptions of the medical management of chronic pain among community-recruited individuals (N=39) who met DSM-IV-TR criteria for current prescription opioid dependence and reported a history of treatment for chronic pain. Prescription opioid dependence, symptoms of depression, and pain management perceptions were assessed using the Structured Clinical Interview for DSM disorders, Beck Depression Inventory, and the Pain Management Questionnaire, respectively. RESULTS Reports of insufficient pain management were common (46.2%), as was utilization of emergency room services for pain management (56.4%). Nearly half reported a physician as their initial source (46.2%) and pain management as their primary initial reason for prescription opioid use (53.8%), whereas 35.9% reported pain relief as their primary reason for current prescription opioid use. Symptoms of depression were common (51.3%), as was comorbid abuse of other substances and history of treatment for substance abuse. CONCLUSIONS Results highlight the complicated clinical presentation and prevalent perception of the under-treatment of pain among this population. Findings underscore the importance of interdisciplinary approaches to managing the complex presentation of chronic pain patients with comorbid prescription opioid dependence. Implications for future research are discussed.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
| | - Mary Ashley Mercer
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kelly S Barth
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
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Influences of motivational contexts on prescription drug misuse and related drug problems. J Subst Abuse Treat 2014; 48:49-55. [PMID: 25115134 DOI: 10.1016/j.jsat.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 11/20/2022]
Abstract
Prescription drug misuse has emerged as a significant problem among young adults. While the effects of motivational contexts have been demonstrated for illicit drugs, the role of motivational contexts in prescription drug misuse remains understudied. Using data from 400 young adults recruited via time-space sampling, we examined the role of motivational contexts in the frequency of misuse of three prescription drug types as well as drug-related problems and symptoms of dependency. Both negative and positive motivations to use drugs are associated with increases in prescription drug misuse frequency. Only negative motivations are associated directly with drug problems and drug dependence, as well as indirectly via prescription pain killer misuse. Addressing positive and negative motivational contexts of prescription drug misuse may not only provide a means to reduce misuse and implement harm reduction measures, but may also inform the content of treatment plans for young adults with prescription drug misuse problems.
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Shafiei E, Hoseini AF, Bibak A, Azmal M. High risk situations predicting relapse in self-referred addicts to bushehr province substance abuse treatment centers. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e16381. [PMID: 25032159 PMCID: PMC4080483 DOI: 10.5812/ijhrba.16381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/26/2014] [Accepted: 04/14/2014] [Indexed: 11/16/2022]
Abstract
Background: Relapse prevention is a medical intervention designed for educating cognitive and behavioral skills to avoid continued drug abuse and relapse. Objectives: This study examined high risk situations for relapse for self-referred addicts are related in Bushehr province substance abuse treatment centers. Patients and Methods: The present study is descriptive cross-sectional. The sample size consisted of 609 self-referred addicts to Bushehr province substance abuse centers. IDTS Marlatt questionnaire was used. Analytical and descriptive statistics were used to analyze the data. Results: The findings showed that 73.1% of addicts have used substance during the past 12 months, and 72% have experienced a full relapse. Unpleasant emotions and physical discomfort was the most important reason for relapse and testing personal control and pleasure emotions the least important reason. Interpersonal factors have also a great role in this regard. Conclusions: Considering the high rates of relapse, more attention should be paid to reasons for relapse. It seems necessary that both clinical and psychological approaches would be undertaken simultaneously.
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Affiliation(s)
- Ebrahim Shafiei
- Department of Cardiac Surgery, Bushehr University of Medical Sciences, Bushehr, IR Iran
| | - Agha Fatemeh Hoseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Bibak
- Department of Psychology, Bushehr University of Medical Sciences, Bushehr, IR Iran
| | - Mohammad Azmal
- Department of Mental Health, Bushehr University of Medical Sciences, Bushehr, IR Iran
- Corresponding author: Mohammad Azmal, Department of Mental Health, Bushehr University of Medical Sciences, Bushehr, IR Iran. Tel: +98-9177727019, Fax:+98-217712528819, E-mail:
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Meier A, Lambert-Harris C, McGovern MP, Xie H, An M, McLeman B. Co-occurring prescription opioid use problems and posttraumatic stress disorder symptom severity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:304-11. [PMID: 24809229 DOI: 10.3109/00952990.2014.910519] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prescription opioids are the most rapidly growing category of abused substances, and result in significant morbidity, mortality and healthcare costs. Co-occurring with psychiatric disorders, persons with prescription opioid problems have negative treatment outcomes. Data are needed on the prevalence of co-occurring prescription opioid abuse and specific disorders, such as posttraumatic stress disorder (PTSD), to better inform clinical practice. OBJECTIVE To determine prevalence rates of current co-occurring prescription opioid use problems and PTSD symptom severity among patients in community addiction treatment settings. METHODS We abstracted administrative and chart information on 573 new admissions to three addictive treatment agencies during 2011. Systematic data were collected on PTSD symptoms, substance use, and patient demographics. RESULTS Prescription opioid use was significantly associated with co-occurring PTSD symptom severity (OR: 1.42, p < 0.05). Use of prescription opioids in combination with sedatives (OR: 3.81, p < 0.01) or cocaine (OR: 2.24, p < 0.001) also were associated with PTSD severity. The odds of having co-occurring PTSD symptoms and prescription opioid use problem were nearly three times greater among females versus males (OR: 2.63, p < 0.001). Younger patients (18-34 years old) also were at higher risk (OR: 1.86, p < 0.01). CONCLUSIONS Prescription opioid use problems are a risk factor for co-occurring PTSD symptom severity. Being female or younger increase the likelihood of this co-morbidity. Further research is needed to confirm these finding, particularly using more rigorous diagnostic procedures. These data suggest that patients with prescription opioid use problems should be carefully evaluated for PTSD symptoms.
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Affiliation(s)
- Andrea Meier
- Departments of Psychiatry, Geisel School of Medicine at Dartmouth , Lebanon, New Hampshire , USA
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Padwa H, Ni YM, Barth-Rogers Y, Arangua L, Andersen R, Gelberg L. Barriers to drug use behavior change among primary care patients in urban United States community health centers. Subst Use Misuse 2014; 49:743-51. [PMID: 24354547 PMCID: PMC4026246 DOI: 10.3109/10826084.2013.866962] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed.
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Affiliation(s)
- Howard Padwa
- 1Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
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