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Bhuptani PH, Orchowski LM, Forkus SR, Newberger NG, Weiss NH. The impact of exposure to physical and sexual violence on opioid consequences among trauma-exposed individuals recruited from the community who use opioids. Harm Reduct J 2023; 20:167. [PMID: 37950215 PMCID: PMC10638719 DOI: 10.1186/s12954-023-00901-y] [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: 03/08/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the USA. The current study evaluated the consequences associated with opioid use (e.g., physical, social, interpersonal, intrapersonal, and impulse control) as a function of a history of exposure to interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of exposure to sexual violence in the context of opioid use disorder treatment.
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Affiliation(s)
- Prachi H Bhuptani
- Department of Adult Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Lindsay M Orchowski
- Department of Adult Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Shannon R Forkus
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Noam G Newberger
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, USA.
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Lopez CM, Baker NL, Moreland AD, Bisca E, Wilson T, Slick N, Danielson CK, Eckard AR, Madisetti M, Resick PA, Safren SA. Development and feasibility testing of an integrated PTSD and adherence intervention cognitive processing therapy-life steps (CPT-L) to improve HIV outcomes: Trial protocol. Contemp Clin Trials Commun 2023; 33:101150. [PMID: 37273831 PMCID: PMC10238849 DOI: 10.1016/j.conctc.2023.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023] Open
Abstract
Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.
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Affiliation(s)
- Cristina M. Lopez
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela D. Moreland
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Bisca
- Medical University of South Carolina, USA
| | | | - Nathalie Slick
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla K. Danielson
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Allison R. Eckard
- Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Bhuptani PH, Orchowski LM, Forkus SR, Newberger NG, Weiss NH. The Impact of Physical and Sexual Violence on Opioid Consequences among Trauma- exposed Individuals Recruited from the Community who Use Opioids. RESEARCH SQUARE 2023:rs.3.rs-2669901. [PMID: 36993534 PMCID: PMC10055686 DOI: 10.21203/rs.3.rs-2669901/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the United States. The current study evaluated the consequences associated with opioid use as a function of history of interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of sexual violence in the context of opioid use disorder treatment.
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Badour CL, Flores J, Hood CO, Jones AC, Brake CA, Tipsword JM, Penn CJ, McCann JP. Concurrent and proximal associations among PTSD symptoms, prescription opioid use, and co-use of other substances: Results from a daily monitoring study. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:367-376. [PMID: 35901427 PMCID: PMC10157500 DOI: 10.1037/tra0001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and nonmedical prescription opioid use (NMPOU) are linked. Much of the research documenting this association uses cross-sectional or longitudinal designs that describe patterns of use over extended intervals. The present study used a daily monitoring design to examine how daily fluctuations in PTSD symptoms predicted patterns of prescription opioid use (both medical and nonmedical) and co-use of other substances. This approach has distinct advantages for understanding proximal temporal relations between PTSD symptom variation and substance use patterns. METHOD Forty adults with clinical or subclinical PTSD and past-month NMPOU completed daily measures of PTSD symptoms, physical pain, prescription opioid use, and other substance use for 28 days using a smartphone application. RESULTS Same day co-use of prescription opioids and at least one other substance was common. Higher-than-typical PTSD symptoms on a given day (within-person) was associated with an increased likelihood of reporting NMPOU (overall and with co-use of one or more additional substances) on the same day. This association was specific to PTSD alterations in arousal and reactivity symptoms (Criteria E). Neither total PTSD symptoms nor individual PTSD symptom clusters prospectively predicted next-day prescription opioid use (overall or with co-use). Use of prescription opioids also did not predict next-day PTSD symptom severity. CONCLUSION This is the first study to demonstrate positive associations between day-to-day fluctuations in PTSD symptoms and NMPOU. Results from the current study also highlight the importance of examining polysubstance use patterns among individuals with PTSD who use prescription opioids. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Mehr JB, Bennett ER, Price JL, de Souza NL, Buckman JF, Wilde EA, Tate DF, Marshall AD, Dams-O'Connor K, Esopenko C. Intimate partner violence, substance use, and health comorbidities among women: A narrative review. Front Psychol 2023; 13:1028375. [PMID: 36778165 PMCID: PMC9912846 DOI: 10.3389/fpsyg.2022.1028375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.
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Affiliation(s)
- Jacqueline B. Mehr
- School of Environmental and Biological Sciences, Rutgers University – New Brunswick, New Brunswick, NJ, United States
| | - Esther R. Bennett
- School of Social Work, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Julianne L. Price
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Elisabeth A. Wilde
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States
- George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - David F. Tate
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States
- George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - Amy D. Marshall
- Department of Psychology, College of the Liberal Arts, The Pennsylvania State University, State College, PA, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Wojciechowski T. Borderline Personality Disorder as a Predictor of Drug Use Variety: Cognitive Vs. Affective Mechanisms. J Psychoactive Drugs 2022; 54:452-461. [PMID: 34856887 DOI: 10.1080/02791072.2021.2009067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Borderline personality disorder has been identified as a risk factor for polydrug use. Despite this, there remains a lack of understanding of which characteristics of the disorder provide the mechanisms for this relationship. This study examined a set of constructs as mechanisms explaining the borderline personality disorder-polydrug use relationship that are divided into affective and cognitive categories. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to examine the direct relationship between borderline personality disorder and test for attenuation of this direct effect. A bootstrap resampling process was used to estimate standard errors utilized to specify specific and total indirect effects of mechanism variables and their significance level. Results indicated that greater symptom severity of borderline personality disorder predicted increased drug use variety. This relationship was attenuated by 70% when hypothesized mechanisms were included and became nonsignificant. It appeared that this attenuation was mainly due to sensation-seeking. Findings indicate that interventions for individuals suffering from borderline personality disorder with polydrug use issues may find utility in structuring programming around mitigating sensation-seeking.
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Werb D, Scheim AI, Soipe A, Aeby S, Rammohan I, Fischer B, Hadland SE, Marshall BDL. Health harms of non-medical prescription opioid use: A systematic review. Drug Alcohol Rev 2022; 41:941-952. [PMID: 35437841 PMCID: PMC9064965 DOI: 10.1111/dar.13441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
ISSUES Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
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Affiliation(s)
- Dan Werb
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ayorinde Soipe
- Department of Epidemiology, Brown University School of Public Health, Providence, USA.,Division of Nephrology, Department of Medicine, State University of New York, New York, USA
| | - Samantha Aeby
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, USA.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
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Ataiants J, Mazzella S, Roth AM, Robinson LF, Sell RL, Lankenau SE. Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1588-NP1613. [PMID: 32536256 PMCID: PMC7808297 DOI: 10.1177/0886260520927501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
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Victor GA, Staton M. Discriminant Function Analyses: Classifying Drugs/Violence Victimization Typologies Among Incarcerated Rural Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:889-911. [PMID: 32321355 DOI: 10.1177/0886260520913644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study examined the relationship between drug use and violence victimization among incarcerated women in Appalachian Kentucky. The purpose of this study was to test the utility of Goldstein's tripartite conceptual framework among rural incarcerated women, by examining whether distinct drugs/violence nexus groups could be classified based on psychopharmacological, economic-compulsive, and systemic factors. This study used secondary data from a National Institute on Drug Abuse (NIDA)-funded grant focused on risk reduction among high-risk incarcerated women in Appalachia (N = 400). Predicted drugs/violence groups were developed using a series of discriminant function analyses. The data yielded three statistically significant discriminant models. Findings of the classified groupings indicated support for three distinct drugs/violence victimization subgroups. The psychopharmacological group showed the greatest prevalence (n = 181; Wilks's λ = .389, F = 3.94, p < .001), followed by the economic-compulsive group (n = 77; Wilks's λ = .584, F = 11.86, p < .001) and systemic group (n = 55) significant (Wilks's λ = .994, F = 2.247, p < .035). To date, this is the first study to report a relationship between systemic violence victimization among rural communities. These findings could offer novel considerations for theory development and implications for clinical practice regarding the drug-related risks for violence victimization among rural incarcerated women.
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Wojciechowski T. The relevance of post-traumatic stress disorder as a moderator of the relationship between experience of violent or sexual assault and opioid use in adulthood. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2021; 31:410-420. [PMID: 34755403 DOI: 10.1002/cbm.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Past research has indicated that individuals suffering from post-traumatic stress disorder (PTSD) may demonstrate increased sensitivity to stress exposure following onset of the disorder. Thus, having PTSD may amplify the effects of subsequent stressors. This has been found to be relevant in some forms of substance use but relationships between PTSD, new stress and opioid use specifically has not been examined. AIMS To explore interactions between PTSD, new victimisation and opioid use and test the hypothesis that PTSD will moderate any victimisation-opioid use relationship. METHODS The pathways to desistance data were used in analyses. A series of logistic regression models were used to test both direct effects of victimisation and PTSD on opioid use and interactions between them. RESULTS The sample was comprised of a male majority (male N = 1,170; female N = 184). Results indicated that neither PTSD nor victimisation were significant predictors of opioid use. PTSD was found to moderate the relationship between victimisation and opioid use in the hypothesised manner. CONCLUSIONS There may be clinical implications of these results relating to both inpatient and outpatient treatment. Regular trauma screening, additional victims' services and trauma-informed care may help to reduce the risk of opioid use among individuals suffering from PTSD.
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Affiliation(s)
- Thomas Wojciechowski
- School of Criminal Justice, Michigan State University, East Lansing, Michigan, USA
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Sirdifield C, Brooker C, Marples R. Substance misuse and community supervision: A systematic review of the literature. FORENSIC SCIENCE INTERNATIONAL. MIND AND LAW 2020; 1:100031. [PMID: 33458713 PMCID: PMC7790447 DOI: 10.1016/j.fsiml.2020.100031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022]
Abstract
A narrative systematic review was undertaken of the literature concerning the health of people on probation or parole (community supervision). In this paper, we provide an up-to-date summary of what is known about substance misuse in this context. This includes estimates of the prevalence and complexity of substance misuse in those under community supervision, and studies of the effectiveness of approaches to treating substance misuse and engaging and retaining this population in treatment. A total of 5125 papers were identified in the initial electronic searches, and after careful double-blind review only 31 papers related to this topic met our criteria. In addition, a further 15 background papers were identified which are reported. We conclude that internationally there is a high prevalence and complexity of substance misuse amongst people under community supervision. Despite clear benefits to individuals and the wider society through improved health, and reduced re-offending; it is still difficult to identify the most effective ways of improving health outcomes for this group in relation to substance misuse from the research literature. Further research and investment is needed to support evidence-based commissioning by providing a detailed and up-to-date profile of needs and the most effective ways of addressing them, and sufficient funds to ensure that appropriate treatment is available and its impact can be continually measured. Without this, it will be impossible to truly establish effective referral and treatment pathways providing continuity of care for individuals as they progress through, and exit, the criminal justice pathway.
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Affiliation(s)
| | - Charlie Brooker
- Centre for Sociology and Criminology, Royal Holloway, University of London, UK
| | - Rebecca Marples
- School of Law and Social Sciences, University of Suffolk, Waterfront Building, Neptune Quay, Ipswich, Suffolk, IP4 1QJ, UK
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Wojciechowski T. PTSD as a Risk Factor Predicting Polydrug Use: A Dual Systems of Self-Control Mediation Model. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620958198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with increased risk for polydrug use. Low self-control is a key characteristic of the disorder and is predictive of polydrug use. However, there is a dearth of research focused on the relevance of a dual systems model delineation of self-control into the constructs of risk-seeking and impulsivity as it pertains to polydrug use and PTSD. This study tested dual systems mediation of this relationship. Generalized structural equation modeling was used to test for mediation effects. Results indicated that more PTSD symptoms predicted increased drug use variety (coefficient = 0.024; confidence interval [CI] = [0.001, 0.046]). Inclusion of dual systems constructs fully attenuated this relationship. The total indirect effect achieved marginal significance (coefficient = 0.005; CI = [>−0.001, 0.009]). Sensitivity analyses of the specific indirect effect of impulsivity as the sole mediator indicated significant mediation. These results provide some indication that impulsivity-based programming may help to treat polydrug use among those with severe PTSD.
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Ford JA, Pomykacz C, Ortiz K, McCabe SE, Schepis TS. Educational attainment and prescription drug misuse: The importance of push and pull factors for dropping out. JOURNAL OF CRIMINAL JUSTICE 2020; 66:101636. [PMID: 32863457 PMCID: PMC7449532 DOI: 10.1016/j.jcrimjus.2019.101636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Young adults who do not complete high school are at increased risk for substance use and offending behavior. A limitation of this research is that dropouts are often treated as a homogeneous group, which ignores the various push (e.g., academic failure or disciplinary problems) and pull (e.g., family responsibility or economic need) factors for leaving school. METHODS The current study relies on multiple years of data from the National Survey on Drug Use and Health (2009-2014) and examines several dependent variables, including prevalence of prescription drug misuse, frequent prescription drug misuse, and prescription drug-related substance use disorder symptoms. We assess the importance of push and pull factors for dropping out, and compare dropouts to respondents who completed school. RESULTS Multivariable logistic regression analyses produce two important findings. First, push factors increase the risk of various types of prescription drug misuse compared to pull factors. Additionally, respondents who attend college are at a decreased risk for various types of prescription opioid and sedative/tranquilizer misuse and disorder. DISCUSSION The current research identifies important differences in prescription drug misuse and disorders among dropouts based on the reason they left school. Additionally, college attendance appears to be a strong protective factor.
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Affiliation(s)
- Jason A. Ford
- Department of Sociology, University of Central Florida
| | | | - Kasim Ortiz
- Department of Sociology & Criminology, University of New Mesico
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
- Center for Human Growth and Development, University of Michigan
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15
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Influence of Abuse History on Concurrent Benzodiazepine and Opioid Use in Chronic Pain Patients. THE JOURNAL OF PAIN 2019; 20:473-480. [DOI: 10.1016/j.jpain.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022]
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Enang I, Murray J, Dougall N, Wooff A, Heyman I, Aston E. Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review. HEALTH & JUSTICE 2019; 7:2. [PMID: 30825016 PMCID: PMC6717956 DOI: 10.1186/s40352-019-0083-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a 'last line of support' and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. RESULTS Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For "vulnerable groups", the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. CONCLUSIONS This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved.
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Affiliation(s)
- Iniobong Enang
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Jennifer Murray
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Andrew Wooff
- School of Applied Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Inga Heyman
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Elizabeth Aston
- School of Applied Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Bilevicius E, Sommer JL, Asmundson GJG, El-Gabalawy R. Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey. Drug Alcohol Depend 2018; 188:119-125. [PMID: 29775955 DOI: 10.1016/j.drugalcdep.2018.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic pain conditions and posttraumatic stress disorder (PTSD) commonly co-occur and are associated with opioid use disorder (OUD). The aims of this paper were to identify prevalence estimates of OUD among individuals with and without PTSD and assess independent and combined contributions of PTSD and chronic pain conditions on OUD in a nationally representative sample. METHODS Data were extracted from 36,309 individuals from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Past-year PTSD and OUD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 edition. Respondents reported physician-confirmed, past-year chronic pain conditions, categorized into musculoskeletal pain (e.g., arthritis), digestive pain (e.g., pancreatitis), and nerve pain (e.g., reflex sympathetic dystrophy). We examined the weighted prevalence of OUD among those with and without PTSD. Multiple logistic regressions examined the association between PTSD and chronic pain conditions on OUD. RESULTS The prevalence of OUD was higher among those with PTSD than those without. Comorbid PTSD/musculoskeletal pain and PTSD/nerve pain conditions were associated with increased odds of OUD, compared to those with neither PTSD nor chronic pain conditions. Digestive pain conditions were not associated with OUD. Comorbid PTSD/musculoskeletal pain conditions demonstrated an additive relationship on OUD compared to musculoskeletal pain conditions and PTSD alone. CONCLUSIONS Results reveal that musculoskeletal pain and nerve pain conditions are associated with increased odds of OUD, but only musculoskeletal pain conditions display an additive relationship on OUD when combined with PTSD. These findings have implications for opioid management and screening among those with comorbid conditions.
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Affiliation(s)
- Elena Bilevicius
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave, Winnipeg, MB, R3E 0Z2, Canada
| | - Jordana L Sommer
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave, Winnipeg, MB, R3E 0Z2, Canada
| | - Gordon J G Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave, Winnipeg, MB, R3E 0Z2, Canada; Department of Clinical Health Psychology, University of Manitoba, PZ350-771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada.
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Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program. Drug Alcohol Depend 2017; 180:340-348. [PMID: 28950240 DOI: 10.1016/j.drugalcdep.2017.08.034] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Kratom use in the West has increased recently, yet the prevalence and motives for use among individuals with a history of substance use disorder (SUD) have not been fully examined. Kratom has been documented as a means of treating chronic pain, mitigating drug dependence, and easing withdrawal symptoms, yet it is unclear if substance users are utilizing kratom as a self-medication. Abuse liability, side effects, and overall appeal of kratom remain uncertain. METHODS In April 2017, an anonymous survey regarding kratom use and motivations was completed by clients enrolled in a 12-Step-oriented residential program. 500 respondents with a self-reported history of SUD completed the survey. RESULTS 20.8% of respondents endorsed lifetime kratom use and 10.2% reported past-12-month use. Kratom-users were younger (=32.1 vs. 35.9, p<0.001) and were more versatile substance users. A majority (68.9%) of kratom-users reported having used the drug as a means of reducing or abstaining from non-prescription opioids (NPO) and/or heroin, and 64.1% reported using kratom as a substitute for NPO/heroin. 18.4% of kratom-users reported using the drug due to a disability or chronic pain. One-third of kratom-users stated that kratom was a helpful substance and that they would try it again. However, kratom was not preferred and was indicated as having less appeal than NPO, heroin, amphetamines, and Suboxone. CONCLUSIONS Among substance users, kratom use may be initiated for a variety of reasons, including as a novel form of harm-reduction or drug substitution, particularly in the context of dependence and withdrawal from other substances.
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Hassan AN, Le Foll B, Imtiaz S, Rehm J. The effect of post-traumatic stress disorder on the risk of developing prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. Drug Alcohol Depend 2017; 179:260-266. [PMID: 28818717 DOI: 10.1016/j.drugalcdep.2017.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/24/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the effect of baseline post-traumatic stress disorder (PTSD) and each symptoms cluster on the risk of developing opioid use disorder (OUD) in those exposed to opioid painkillers and to assess the effect of comorbid PTSD and OUD on functioning, OUD severity, and treatment seeking compared with individuals with OUD only. METHODS We obtained data from 4025 individuals exposed to opioid painkillers from the National Epidemiologic Survey on Alcohol and Related Conditions III. We matched individuals with baseline PTSD with individuals without PTSD on demographics, developmental background, family history, personalities, and exposure to stressful life events with propensity score methodology. We controlled for clinical diagnoses and other risk factors that may have occurred after PTSD onset. Quality of life was assessed with the SF-12; the number of diagnostic criteria met indicated OUD severity. RESULTS Baseline PTSD predicted OUD after controlling for matching variables and other risk factors, including baseline mood/anxiety disorders and other substance use disorders (odds ratio[OR]: 1.58; 95% confidence interval[CI]: 1.14-2.17; p=0.02). Among individuals with PTSD, arousal/reactivity cluster predicted OUD. Individuals with comorbid PTSD and OUD had lower mean scores on the SF-12 scale and greater severity of OUD than individuals with OUD. There were no differences in help-seeking. CONCLUSION Baseline PTSD increases the risk of developing OUD after exposure to opioid painkillers. Clinicians should screen for PTSD diagnosis and arousal/reactivity symptoms prior to prescribing painkillers. Integrated treatments are strongly recommended for patients with this dual diagnosis.
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Affiliation(s)
- Ahmed N Hassan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Departments of Family and Community Medicine, Pharmacology and Toxicology, and Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sameer Imtiaz
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto,155 College Street, Toronto, Ontario, Canada
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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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