Coping style and ecstasy use motives as predictors of current mood symptoms in ecstasy users

Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia

INTRODUCTION

Despite a decline in unintended teenage pregnancy in Australia, rates remain higher amongst justice-involved adolescent girls, who are more likely to be from disadvantaged socio-economic backgrounds, have histories of abuse, substance use and/or mental health issues. Furthermore, exposure to the criminal justice system may alter access to education and employment and opportunities, potentially resulting in distinct risk-factor profiles. We examine factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland.

METHODS

Data from the Mental Health, Sexual Health and Reproductive Health of Young People in Contact with the Criminal Justice System (MeH-JOSH) Study was analysed on 118 sexually active adolescent girls. Participants were aged between 14 and 17 years, purposefully sampled based on justice-system involvement and completed an anonymous telephone survey. We constructed two multivariate models taking reproductive outcomes as the dependent variables.

RESULTS

Over one quarter (26%, 30/118) reported a past unintended pregnancy, 54 did not use any contraception at their last sexual encounter, and 17 reported LARC use. Following adjustments in the multivariate analysis, lifetime ecstasy use was associated with both unintended pregnancy (aOR 3.795, p = 0.022) and non-contraception use (aOR 4.562, p = 0.004). A history of physical abuse was also associated with both any contraception (aOR 3.024, p = 0.041) and LARC use (aOR 4.892, p = 0.050). Identifying as Aboriginal & Torres Strait Islander, education/employment status and geographic location appeared to have no association.

CONCLUSION

Our findings suggest that justice-involved adolescent girls have distinct risk factors associated with unplanned pregnancy and contraception use compared to the general population, but more research is required to understand the mechanisms and contexts underlying these risk factors. How exposure to physical violence may encourage contraception and LARC use, in particular, warrants further attention as does the association with ecstasy use.

Development and initial validation of an MDMA/Ecstasy motives assessment

OBJECTIVE

MDMA/Ecstasy motives differ from those of other substances such as alcohol, cannabis, and methamphetamine. Previous literature on alcohol and cannabis use identified social, expansion, enhancement, coping, and conformism as primary motives for use. MDMA/Ecstasy users also report using the drug for increases in self-awareness and energy. The development of an MDMA/Ecstasy use motives assessment has potential to inform treatment interventions and public policy on harm reduction.

METHOD

An MDMA/Ecstasy use motives assessment was developed from alcohol and cannabis motives measures and qualitative feedback from MDMA/Ecstasy users. Participants included an international sample of adults (N = 1754) who completed an online questionnaire regarding their motives for using recreational MDMA/Ecstasy.

RESULTS

Exploratory and confirmatory factor analysis supported a 4-factor MDMA/Ecstasy motives scale. The four motive scales showed good internal consistency reliabilitySocial (α = 0.88) Expansion (α = 0.81), Coping (α = 0.82), and Energy (α = 0.75). Conformity and Enhancement did not emerge as significant factors. Analyses demonstrated convergent and discriminant validity with relevant constructs including quantity/frequency of use, MDMA use disorder, sensation seeking personality, and positive and negative consequences of use.

CONCLUSIONS

MDMA/Ecstasy use motives differ from those of other substances due to the distinctly stimulating, emotional, and empathic effects sought by users. By identifying salient MDMA/Ecstasy motives, this study highlights the unique aspects of recreational MDMA/Ecstasy use. This research has utility for informing clinical practice and contributing to public health harm reduction efforts.

The Role of Childhood Abuse and Psychological Symptoms in Discriminating Frequency of Drug Use and Self-Harm in Incarcerated Men Convicted of Robbery

The aim of the present study was to investigate the role of prior childhood abuse and current psychological symptoms on the frequency of drug use and self-harming behavior among a group of male prisoners convicted of robbery. The sample consists of 127 men convicted of armed, aggravated, unarmed/forced robbery, who were held in Metris T-type closed penitentiary state correctional institution. History of childhood abuse was assessed with The Childhood Trauma Questionnaire (CTQ) and psychological symptoms were assessed with The Brief Symptom Inventory (BSI). Frequency of drug use was assessed with three questions and self-harm was assessed through four questions both on the self-completed demographic information form. Among 127 men recruited, history of childhood abuse and psychological symptoms provided discrimination concerning frequency of drug use and self-harm. The rate of self-harming individuals in the present study was relatively high compared to the literature. There was a significant correlation between CTQ total and subscale scores and BSI total and subscale scores, except for the emotional neglect subscale.

Mediation by coping style in the association between stressful life events and depressive symptoms in young adults

PURPOSE

The association between stressful life events and depressive symptoms is well-established, but the role of coping style in this association is less clear. We examined whether problem-focused, emotion-focused or avoidant coping style mediated and/or moderated the association in young adults.

METHODS

Data were drawn from a 20-year longitudinal study that included 1294 students' age 12-13 years recruited in 1999-2000 from ten high schools in Montreal, Canada. Herein we report an analysis that included 782 participants aged 24 years on average with data on covariates collected at age 20. Using VanderWeele's four-way decomposition approach, the total effect of stressful life events on depressive symptoms considering coping styles was decomposed into four components: moderation only, mediation only, mediated interaction, no mediation or moderation.

RESULTS

We observed mediation only by emotion-focused coping ([Formula: see text](95%CI) = 0.15(0.04, 0.24)) suggestive that individuals who experienced more stressful life events also reported greater use of emotion-focused coping and higher levels of depressive symptoms. We found moderation only by problem-focused coping ([Formula: see text](95%CI) = - 1.51(- 2.40, - 0.53)) and by emotion-focused coping ([Formula: see text](95%CI) = 1.16(0.57, 1.69). These results suggest that individuals reporting more problem-focused coping experienced fewer depressive symptoms after exposure to stressful life events; those reporting more emotion-focused coping experienced more depressive symptoms. Avoidant coping did not mediate or moderate the association between stressful life events and depressive symptoms.

CONCLUSION

Interventions that aim to reduce depressive symptoms in young adults who experience stressful life events may need to reinforce problem-focused coping and minimize emotion-focused coping strategies.

Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders

BACKGROUND

Post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur in adolescent patients. Previous research has shown that these patients differ from SUD patients without PTSD in terms of their substance use patterns. In this study, we aimed to test whether substance use in this population is related to an attempt to self-medicate PTSD-related symptoms.

METHODS

German adolescent patients (aged 13-18 years) at an outpatient clinic for SUD treatment, n = 111 (43% female), completed a self-designed questionnaire on use motives, a measure of PTSD-related experiences, and underwent a standardized psychiatric interview including structured substance use questions. Participants were subsequently classified as 'no traumatic experiences ('noTEs' but SUD), 'traumatic experiences but no current PTSD diagnosis' ('TEs' with SUD), and 'PTSD' with SUD. After establishing a self-designed motive measurement through exploratory and confirmatory factor analyses, we calculated non-parametric group differences and a mediation analysis in a linear regression framework.

RESULTS

The past-year frequency of MDMA use was highest in the PTSD group and lowest in the noTE group (H (2) = 7.2, p = .027, η2 = .058), but no differences were found for frequencies of tobacco, alcohol, cannabis, or stimulant use (all H ≤ 4.9, p ≥ .085, η2 ≤ .033). While controlling for sex, the three groups showed a similar pattern (highest in the PTSD group and lowest in the noTE group) for coping scores (F (103) = 5.77, p = .004, η2 = .101). Finally, mediation analyses revealed an indirect effect of coping score (b = 0.61, 95% CI [0.29, 1.58], p = .145) on the association between group membership and MDMA use frequency.

CONCLUSIONS

In adolescent SUD patients, we found an association of current PTSD and lifetime traumatic experiences with higher MDMA use that could be partially explained by substance use being motivated by an attempt to cope with mental health symptoms. This indicates a coping process involved specifically in MDMA use compared to the use of other psychoactive substances, possibly due to unique psychoactive effects of MDMA.

Different phases of ATS use call for different interventions: a large qualitative study in Europe

BACKGROUND

Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use.

METHODS

Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily.

RESULTS

Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country.

CONCLUSIONS

These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment.

Cultural Adaptation and Validation of the Urdu Version of the Cognitive Emotion Regulation Questionnaire (CERQ) in Male Patients With Substance Use Disorders (SUDs) in Pakistan

BACKGROUND

Adults with substance use disorders (SUDs) often have co-occurring mental health problems. Emotion regulation may play a vital role in mental health problems. The Cognitive Emotion Regulation Questionnaire (CERQ) is a widely used measure for assessing cognitive emotion regulation. However, it has not been used in Pakistan on patients with co-occurring SUDs and mental health issues. The present study aims to translate and adapt the CERQ into the Urdu language and to determine its reliability and convergent validity in a sample of male patients with SUDs in Pakistan.

METHOD

Participants completed a demographic information form, the CERQ, the Depression, Anxiety, and Stress Scale Short Form [DASS-21)], and the Rosenberg Self-Esteem Scale [RSES)] in Urdu.

RESULTS

Male participants (N = 237) 18-50 years of age (M = 29.8, SD = 8.1) were recruited from four substance use disorder treatment centers and hospitals in Karachi. The reliability of the Urdu version of the CERQ was based on an examination of its internal consistency reliability (Cronbach's α) and test-retest reliability for both the total scale and its subscales. Internal consistency for the CERQ total (α = 0.80) was adequate, as it was for subscales of self-blame, (0.76) acceptance (0.78), rumination (0.72), positive refocusing (0.79), focus on planning (0.89), positive reappraisal (0.81), putting into perspective (0.83), catastrophizing (0.73), and other blame (0.70). The 10-14 day test-retest reliability of the CERQ total score was 0.86. Higher CERQ scores were significantly (ps < 0.001) negatively associated with DASS-21depression (r = -0.24), anxiety (r = -0.23), and stress (r = -0.27) subscales, as well as the DASS-21 total score (r = -0.26) and positively associated with the RSES self-esteem score (r = 0.30).

CONCLUSION

The Urdu version of the CERQ is a reliable measure for investigating cognitive emotion regulation strategies related to mental health and SUDs in Pakistan.

Individual differences in distress, impulsivity, and coping motives for use as predictors of problematic ecstasy use

BACKGROUND

Ecstasy users who report problematic use of ecstasy experience adverse social, psychological, and health-related consequences not reported by non-problem users. Relatively little is known about the risk factors for the development of problematic ecstasy use. Such information would be valuable for targeted intervention, prevention, and education AIMS: The current study aimed to fill this gap by investigating several hypothesised risk factors for problematic use and the relationships between them.

METHODS

Self-reported impulsivity, psychological distress, sex, and coping motives for ecstasy use were investigated as predictors of problematic ecstasy use in a cross-sectional online survey.

RESULTS

The sample consisted of 483 individuals (60.5% male, 38.3% female, 1.2% other) aged 18-62 years, reporting ecstasy use on an average of 59.7 occasions (SD = 167.8). Both higher self-reported impulsivity and psychological distress predicted problem ecstasy use, and both these relationships were partially mediated by coping motives. When these variables were examined in a combined mediation model accounting for their covariance, psychological distress still predicted problematic use partially via an effect on coping motives, while impulsivity showed only a direct effect on problem use. No sex differences in problem ecstasy use were observed.

CONCLUSIONS

Increased trait impulsivity and psychological distress appear to confer greater risk of problematic ecstasy use. Targeting these factors, as well as coping motives for ecstasy use, may be useful in efforts to prevent and reduce problematic ecstasy use among those who use the drug.

Association Between Alexithymia and Immature Coping Styles Is Mediated by Self-Inconsistency and Is Correlated to Obsessive-Compulsive Symptoms

This study aimed to investigate whether a multivariate association between alexithymia and coping styles is affected by self-inconsistency and whether the association contributed to obsessive-compulsive symptoms in 34 patients with obsessive-compulsive disorder (OCD) and 53 healthy participants. Alexithymia, coping styles, self-inconsistency, and obsessive-compulsive symptoms were evaluated using the Toronto Alexithymia Scale-20, the Coping Style Questionnaire, the Self-Consistency and Congruence Scale, and the Vancouver Obsessive-Compulsive Inventory, respectively. We found that self-inconsistency partially mediated the association between alexithymia and immature coping styles in the OCD patients but fully mediated the association in the healthy participants. Moreover, in the two groups, the alexithymia-coping coupling was related to contamination, obsession, indecisiveness, and ritualization, but not the checking symptom dimension. The findings suggest that the disturbance in identifying and describing feelings is associated with immature coping styles through disharmony between self-recognition and experience. The mechanism of the checking symptom seems to be distinct from other obsessive-compulsive symptoms.

Coping Strategies in Male Patients under Treatment for Substance Use Disorders and/or Severe Mental Illness: Influence in Clinical Course at One-Year Follow-Up

Coping strategies have an impact on substance use disorders (SUD), relapses, and clinical variables, but knowledge on this area is scarce. We explored the coping strategies used during treatment in patients with dual diagnosis (DD), SUD, and severe mental illness (SMI), and the relation with clinical course and relapses at one-year follow-up. A sample of 223 patients was divided into three groups depending on diagnosis: DD (N = 80; SUD with comorbid schizophrenia or major depressive disorder), SUD only (N = 80), and SMI only (N = 63; schizophrenia or major depressive disorder). MANCOVA analyses reflected differences in self-criticism and problem avoidance, with a higher use of these in the DD and SUD groups. The coping strategies used differed depending on the presence/absence of a SUD, but not depending on psychiatric diagnosis. At one-year follow-up, social support was the only strategy that predicted the presence of relapses in DD patients with schizophrenia (positively), and in SMI patients with major depressive disorder (negatively). Thus, social support was associated with relapses, but the relationship was different depending on psychiatric diagnosis. Further studies should analyze the implications of social support as a coping strategy in different mental disorders, as well as its usefulness in individualized interventions.

Comparing Mental Health across Distinct Groups of Users of Psychedelics, MDMA, Psychostimulants, and Cannabis

Differences in mental health (MH) of users of distinct psychoactive substances have been shown. Both substance use (SU) and MH in users are influenced by stressful life events. This study compared MH parameters in distinct groups of substance users and evaluated the impact of stress factors on these outcomes. Data stem from the longitudinal Swiss Cohort Study on Substance Use Risk Factors (C-SURF) involving 4,475 young adult men. Distinct groups were created for the past 12 months' use of psychedelics, MDMA, psychostimulants, and cannabis. MH measurements (depressive symptoms, overall MH, perceived stress, life satisfaction) were used as outcome variables, while indicators of past family functioning and stressful life events served as covariates. The MH of psychedelics users was not significantly different from the no-drug-use group, whereas poorer MH was found in the other SU groups. Observed effects were influenced by the tested stress factors. The absence of association between use of psychedelics and worsening of MH deserves further investigation in male and female samples. Stressful life experiences must be considered when assessing the MH of users of illicit substances. These findings suggest that some men practice SU as self-medication to cope with life adversity.

Coping via substance use, internal attribution bias, and their depressive interplay: Findings from a three-week daily diary study using a clinical sample

BACKGROUND

The relationship between depression and coping-oriented substance use is extensively documented; however, the cognitive processes moderating this bidirectional relationship are not well-understood. The present study investigated whether internal attribution bias coupled with a tendency to use drugs and/or alcohol to cope predicts increases in depression and daily-levels of general negative affectivity, sadness, and hostility.

METHOD

Sixty-seven adults diagnosed with depression were recruited from out-patient treatment settings (66% female, 81% White, M_age = 31, SD_age = 13.2). Participants completed measures on substance-related coping, depression, attributional style, and daily affect over a three-week period.

RESULTS

Substance use to cope predicted increases in depression among individuals with high-level internal attribution bias. Further, coping via substance use moderated the relationship between internal attribution bias and daily-level sadness, such that sadness was highest among individuals with a high internal attribution bias coupled with greater levels of coping via substance use. A modest, yet, non-significant upward trend in daily-level hostility was also observed.

CONCLUSIONS

Results suggested that depressed individuals who habitually perceive themselves as being responsible or blameworthy for negative life events are at an increased risk of worsening depressive symptoms and experiencing greater daily levels of sadness over a relatively brief period of time, particularly, when tending to engage in substance use as a mechanism to cope. This interaction effect can elicit greater daily-level sadness as well. Findings may aid in the identification and treatment of individuals at risk of maintaining or worsening their depressive symptoms.

Correlates of Recreation- Versus Academic-Motivated Misuse of Prescription Stimulants

Our goal was to compare and contrast the correlates of academic- and recreation-motivated misuse of prescription stimulants (MPS). Questionnaires were distributed to a probability sample of students attending two universities. We used a series of logistic regression analyses to examine intrapersonal, interpersonal, and environmental correlates of use among academic-motivated users (versus nonacademic-motivated users) and recreation-motivated users (versus nonrecreation-motivated users; N = 257 students with MPS experience). Sensations seeking, older age, academic concern, family perception of MPS, family and faculty endorsement of MPS, perceived prevalence of MPS among friends, and financial stress were unique correlates of recreation-motivated MPS. Inattention, friends’ perception of MPS, friend endorsement of MPS, perception of willingness of health care providers to write prescriptions and negative expectancies were unique correlates of academic-motivated MPS. Variables that were correlates of both motives were race/ethnicity, year in school, avoidance self-efficacy, diversion, positive MPS expectancies, MPS intention, and other substance use. These findings have important prevention and intervention implications.

Strategies to cope with treatment in substance use disorder male patients with and without schizophrenia

Coping strategies (CS) are the efforts made by an individual to manage the internal and external demands of stressful situations. Studies showed that in patients with Substance Use Disorder (SUD), adaptive and problem-focused CS are related to fewer relapses and better treatment outcomes. Considering the high rates of comorbidity between SUD and schizophrenia (SZ), and the deficiencies observed in SZ patients in the use of active problem-focused CS, this study aims to explore CS used by SUD patients with and without SZ to deal with treatment. 82 males (18-55 year) under treatment for a SUD were considered in two groups: SUD without psychiatric comorbidity (SUD; N=43) and SUD with SZ (SZ+; N=39) and assessed through The Coping Strategies Inventory (CSI). Our results indicated that SUD and SZ+ patients only differed in the amount of Engagement strategies they used. Compared to SUD, SZ+ patients showed lesser use of Problem Solving, Social Support and Self-Criticism, and lower Self-Perceived Capacity to engage the Problem. Besides, compared to norms, SUD and SZ+ patients were less likely to use adaptive CS, although this was more remarkable for SZ+ group. Further studies are needed to explore possible benefits of improving CS as part of treatment outcomes.