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Drouard G, Wang Z, Heikkinen A, Foraster M, Julvez J, Kanninen KM, van Kamp I, Pirinen M, Ollikainen M, Kaprio J. Lifestyle differences between co-twins are associated with decreased similarity in their internal and external exposome profiles. Sci Rep 2024; 14:21261. [PMID: 39261679 PMCID: PMC11390871 DOI: 10.1038/s41598-024-72354-7] [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: 02/29/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024] Open
Abstract
Whether differences in lifestyle between co-twins are reflected in differences in their internal or external exposome profiles remains largely underexplored. We therefore investigated whether within-pair differences in lifestyle were associated with within-pair differences in exposome profiles across four domains: the external exposome, proteome, metabolome and epigenetic age acceleration (EAA). For each domain, we assessed the similarity of co-twin profiles using Gaussian similarities in up to 257 young adult same-sex twin pairs (54% monozygotic). We additionally tested whether similarity in one domain translated into greater similarity in another. Results suggest that a lower degree of similarity in co-twins' exposome profiles was associated with greater differences in their behavior and substance use. The strongest association was identified between excessive drinking behavior and the external exposome. Overall, our study demonstrates how social behavior and especially substance use are connected to the internal and external exposomes, while controlling for familial confounders.
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Affiliation(s)
- Gabin Drouard
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.
| | - Zhiyang Wang
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Aino Heikkinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Maria Foraster
- PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Llull (URL), Barcelona, Spain
| | - Jordi Julvez
- Clinical and Epidemiological Neuroscience (NeuroÈpia), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- ISGlobal, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Katja M Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.
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Li X, Kass G, Wiers CE, Shi Z. The Brain Salience Network at the Intersection of Pain and Substance use Disorders: Insights from Functional Neuroimaging Research. CURRENT ADDICTION REPORTS 2024; 11:797-808. [PMID: 39156196 PMCID: PMC11329602 DOI: 10.1007/s40429-024-00593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
Purpose of Review The brain's salience network (SN), primarily comprising the anterior insula and anterior cingulate cortex, plays a key role in detecting salient stimuli and processing physical and socioemotional pain (e.g., social rejection). Mounting evidence underscores an altered SN in the etiology and maintenance of substance use disorders (SUDs). This paper aims to synthesize recent functional neuroimaging research emphasizing the SN's involvement in SUDs and physical/socioemotional pain and explore the therapeutic prospects of targeting the SN for SUD treatment. Recent Findings The SN is repeatedly activated during the experience of both physical and socioemotional pain. Altered activation within the SN is associated with both SUDs and chronic pain conditions, characterized by aberrant activity and connectivity patterns as well as structural changes. Among individuals with SUDs, functional and structural alterations in the SN have been linked to abnormal salience attribution (e.g., heightened responsiveness to drug-related cues), impaired cognitive control (e.g., impulsivity), and compromised decision-making processes. The high prevalence of physical and socioemotional pain in the SUD population may further exacerbate SN alterations, thus contributing to hindered recovery progress and treatment failure. Interventions targeting the restoration of SN functioning, such as real-time functional MRI feedback, neuromodulation, and psychotherapeutic approaches, hold promise as innovative SUD treatments. Summary The review highlights the significance of alterations in the structure and function of the SN as potential mechanisms underlying the co-occurrence of SUDs and physical/socioemotional pain. Future work that integrates neuroimaging with other research methodologies will provide novel insights into the mechanistic role of the SN in SUDs and inform the development of next-generation treatment modalities.
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Affiliation(s)
- Xinyi Li
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Gabriel Kass
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Corinde E. Wiers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
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Sung B. Effect of Social Vulnerability on Cocaine-Related Mortality Rates in U.S. Counties. J Psychoactive Drugs 2024:1-7. [PMID: 38860858 DOI: 10.1080/02791072.2024.2366192] [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: 11/22/2023] [Accepted: 04/12/2024] [Indexed: 06/12/2024]
Abstract
Cocaine-related mortality rates have risen sharply since 2013 and social vulnerability is a crucial indicator for drug-related mortality rates. Therefore, the purpose of this study was to investigate the relationship between social vulnerability and cocaine-related mortality rates in U.S. counties. The Data were collected from the CDC WONDER, CDC's Social Vulnerability Index (CDC's SVI), and American Community Survey (ACS). The Data were analyzed by spatial autoregression models. According to present results, first, counties with social vulnerability (socioeconomic) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.323, p < .05; spatial error: B = 0.513, p < .01). Second, counties with social vulnerability (minority status & language) were negatively related to higher rates of cocaine overdose death (spatial lag: B = -0.233, p < .05). Third, counties with social vulnerability (housing type & transportation) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.413, p < .001; spatial error: B = 0.378, p < .001). In conclusion, the spread of cocaine overdose on U.S. counties with social vulnerabilities demonstrated a disproportionate burden of cocaine-related mortality.
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Affiliation(s)
- Baksun Sung
- Department of Sociology and Anthropology, Utah State University, Logan, UT, USA
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Mars S, Ondocsin J, Holm N, Ciccarone D. The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States. Harm Reduct J 2024; 21:57. [PMID: 38443903 PMCID: PMC10913463 DOI: 10.1186/s12954-024-00976-1] [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: 05/22/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality. METHOD We recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant. RESULTS A clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand. CONCLUSION Transformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs' market dominance at this location and possible interventions.
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Affiliation(s)
- Sarah Mars
- University of California, San Francisco, USA.
| | | | - Nicole Holm
- University of California, San Francisco, USA
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5
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Drouard G, Wang Z, Heikkinen A, Foraster M, Julvez J, Kanninen KM, van Kamp I, Pirinen M, Ollikainen M, Kaprio J. Lifestyle differences between co-twins are associated with decreased similarity in their internal and external exposome profiles. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.12.23299868. [PMID: 38168348 PMCID: PMC10760270 DOI: 10.1101/2023.12.12.23299868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Whether differences in lifestyle between co-twins are reflected in differences in their internal or external exposome profiles remains largely underexplored. We therefore investigated whether within-pair differences in lifestyle were associated with within-pair differences in exposome profiles across four domains: the external exposome, proteome, metabolome and epigenetic age acceleration (EAA). For each domain, we assessed the similarity of co-twin profiles using Gaussian similarities in up to 257 young adult same-sex twin pairs (54% monozygotic). We additionally tested whether similarity in one domain translated into greater similarity in another. Results suggest that a lower degree of similarity in co-twins' exposome profiles was associated with greater differences in their behavior and substance use. The strongest association was identified between excessive drinking behavior and the external exposome. Overall, our study demonstrates how social behavior and especially substance use are connected to the internal and external exposomes, while controlling for familial confounders.
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Affiliation(s)
- Gabin Drouard
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Zhiyang Wang
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Aino Heikkinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Maria Foraster
- PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Llull (URL), Barcelona, Spain
| | - Jordi Julvez
- Clinical and epidemiological Neuroscience (NeuroÈpia), Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- ISGlobal, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Katja M. Kanninen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Irene van Kamp
- National Institute for Public Health and the Environment, centre for Sustainability, Environment and Health, Netherlands
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
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Lin B, Zheng Y, Roussos-Ross D, Gurka KK, Gurka MJ, Hu H. An external exposome-wide association study of opioid use disorder diagnosed during pregnancy in Florida. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 870:161842. [PMID: 36716893 PMCID: PMC9998369 DOI: 10.1016/j.scitotenv.2023.161842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled in recent years and widely varies geographically in the US. However, few studies have examined which environmental factors are associated with OUD during pregnancy. We conducted an external exposome-wide association study (ExWAS) to investigate the associations between external environmental factors and OUD diagnosed during pregnancy. Data were obtained from a unique, statewide database in Florida comprising linked individual-level birth and electronic health records. A total of 255,228 pregnancies with conception dates between 2012 and 2016 were included. We examined 82 exposome measures characterizing seven aspects of the built and social environment and spatiotemporally linked them to each individual record. A two-phase procedure was utilized for the external ExWAS. In Phase 1, we randomly divided the data into a discovery set (50 %) and a replication set (50 %). Associations between exposome measures (normalized and standardized) and OUD initially diagnosed during pregnancy were examined using logistic regression. A total of 15 variables were significant in both the discovery and replication sets. In Phase 2, multivariable logistic regression was used to fit all variables selected from Phase 1. Measures of walkability (the national walkability index, OR: 1.23, 95 % CI: 1.17, 1.29), vacant land (the percent vacant land for 36 months or longer, OR: 1.06, 95 % CI: 1.00, 1.12) and food access (the percentage of low food access population that are seniors at 1/2 mile, OR: 1.47, 95 % CI: 1.38, 1.57) were each associated with diagnosis of OUD during pregnancy. This is the first external ExWAS of OUD during pregnancy, and the results suggest that low food access, high walkability, and high vacant land in under-resourced neighborhoods are associated with diagnosis of OUD during pregnancy. These findings could help develop complementary tools for universal screening for substance use and provide direction for future studies.
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Affiliation(s)
- Boya Lin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yi Zheng
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Kelly K Gurka
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Hui Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Orme S, Zarkin GA, Luckey J, Dunlap LJ, Novak MD, Holtyn AF, Toegel F, Silverman K. Cost and cost-effectiveness of abstinence contingent wage supplements. Drug Alcohol Depend 2023; 244:109754. [PMID: 36638680 PMCID: PMC10207811 DOI: 10.1016/j.drugalcdep.2022.109754] [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: 06/01/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care. METHODS To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment. RESULTS ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915. CONCLUSIONS ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.
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Affiliation(s)
- Stephen Orme
- RTI International, Research Triangle Park, NC, United States.
| | - Gary A Zarkin
- RTI International, Research Triangle Park, NC, United States
| | - Jackson Luckey
- RTI International, Research Triangle Park, NC, United States
| | - Laura J Dunlap
- RTI International, Research Triangle Park, NC, United States
| | - Matthew D Novak
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - August F Holtyn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Dertadian GC, Caruana T, Maher L. Injection drug use in an affluent beachside community in Sydney: An exploratory qualitative study. Drug Alcohol Rev 2023; 42:544-554. [PMID: 36539306 PMCID: PMC10947120 DOI: 10.1111/dar.13592] [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: 04/19/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Social research on injection drug use has focussed on marginalised groups and communities, leaving a large gap in the field's understanding of how it is experienced in other settings, including in relatively affluent communities. METHODS This research is based on fieldwork and 18 in-depth qualitative interviews conducted in suburban beach-side communities in Sydney collectively known as the Northern Beaches. RESULTS Participants did not experience stigmatisation by local health services as the norm or as a deterrent to access. Drug acquisition on the Northern Beaches occurred among closed networks of friends and acquaintances, and injecting use rarely occurred in public settings. Police contact was minimal, resulting in lower levels of criminalisation. DISCUSSION AND CONCLUSIONS Unlike many of the participants featured in the literature, our study participants grew up in middle and upper middle-class households, typically experiencing comfortable childhoods with little to no exposure to injection drug use. In this setting injection drug use operates covertly within the normal rhythms of middle-class life, hidden in amongst the bustle of cafés and shopping centres, and through the friendliness of neighbourhood driveway and doorstep interactions. Drug use is described as common in the area, with injecting behaviours stigmatised in ways that set it against the 'good' families and neighbourhoods of this beach-side enclave. In contrast to much of the Australian qualitative literature which frames injection drug use as a means of psychological relief or a subcultural norm, our participants described injecting as motivated by the desire to enhance pleasure and social connection.
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Affiliation(s)
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW SydneySydneyAustralia
| | - Lisa Maher
- Kirby Institute, Faculty of MedicineUNSW SydneySydneyAustralia
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Philbin MM, Greene ER, LaBossier NJ, Martins SS, McCrimmon T, Mauro PM. Age-related patterns of cocaine and methamphetamine use across the life course in the United States: Disparities by gender and sexual identity among adults. Addict Behav 2023; 137:107539. [PMID: 36343473 PMCID: PMC11018266 DOI: 10.1016/j.addbeh.2022.107539] [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: 05/03/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Research showing substance use decreases over the life course has focused primarily on heterosexual adults. We examined how age-related patterns of cocaine and methamphetamine use vary by sexual identity and gender among a national sample. METHODS We included 191,954 adults aged 18-64 from the 2015-2019 National Survey on Drug Use and Health. We described the weighted prevalence of past-year cocaine and methamphetamine use and used logistic regressions to estimate relative odds of past-year cocaine and methamphetamine use by age, stratified by gender and sexual identity (heterosexual, gay/lesbian, bisexual). RESULTS Cocaine and methamphetamine use was highest among lesbian, gay, and bisexual (LGB) adults compared to their heterosexual counterparts. Gay/lesbian men and women and bisexual men were also more likely to use cocaine at later ages. Heterosexual adults ages 26-34 (adjusted odds ratio [aOR] = 0.73; confidence interval [CI] = 0.65-0.83) were less likely than those 21-25 to report past-year cocaine use, but there were no differences between those ages 26-34 and 21-25 among any LGB sub-group. Heterosexual (aOR = 1.62; CI = 1.28-2.04) and gay (aOR = 2.93; CI = 1.26-6.80), men ages 26-34 were more likely to report past-year methamphetamine use than their counterparts ages 21-25. There were no age-related differences in past-year methamphetamine use between bisexual men and gay/lesbian women. CONCLUSIONS Patterns of cocaine and methamphetamine use across the life course for LGB individuals differ from those of heterosexuals. This has implications for targeted prevention efforts to address stimulant use among minoritized populations.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | | | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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10
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Lu Z, Xie C, Liu N, Xie Y, Lu H. 'Can we predict aggression?'-Determining the predictors of aggression among individuals with substance use disorder in China undergoing enforced detoxification through machine learning. J Affect Disord 2023; 320:628-637. [PMID: 36209778 DOI: 10.1016/j.jad.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The general aggression model has shown that both individual and situational factors can predict aggression. However, past research has tended to discuss these two factors separately, which might lead to inconsistency. This study addresses this gap by examining the importance of each predictor of aggression in a Chinese compulsory drug treatment population and further explores the predictors of aggression in various substance use disorder populations. METHOD Analyses were conducted using a sample of 894 male participants (mean = 38.30, SD = 8.38) in Chinese compulsory drug rehab. A machine learning model named LightGBM was employed to make predictions. We then used a game-theoretic explanatory technique, SHAP, to estimate the effect of predictors. RESULTS In the full-sample model, psychological security, parental conflict, and impulsivity were the top 3 predictors. Depression, childhood abuse, and alexithymia positively predicted aggression, whereas psychological security, family cohesion, and gratitude negatively predicted aggression. There were significant differences in the predictive effects of depressants and stimulants. Although the importance of predictors varied between drug-use groups, several individual and situational factors were consistently the most important predictors. LIMITATIONS All participants in this study were male, and the data were acquired through self-reports from the participants. Domestic and nondomestic aggression are not distinguished. Additionally, our findings cannot support causal conclusions. CONCLUSION This study tested a series of classical theories of the predictors of aggression in China's compulsory drug treatment context and extended the ideas of the GAM to various substance use disorder groups. The findings have important implications for aggression treatment.
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Affiliation(s)
- Zekai Lu
- Center for Brain and Cognitive Sciences, School of Education, Guangzhou University, Guangzhou, China; Experimental Center (Education) of National Intelligent Society Governance - Student Development Center under Intelligent Education, Guangzhou, China
| | - Chuyin Xie
- Center for Brain and Cognitive Sciences, School of Education, Guangzhou University, Guangzhou, China; Guangdong Women's Polytechnic College, Guangzhou, China
| | - Nian Liu
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Ying Xie
- School of Public Administration, Guangzhou University, Guangzhou, China.
| | - Hong Lu
- Center for Brain and Cognitive Sciences, School of Education, Guangzhou University, Guangzhou, China; Experimental Center (Education) of National Intelligent Society Governance - Student Development Center under Intelligent Education, Guangzhou, China.
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11
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Dash GF, Martin NG, Agrawal A, Lynskey MT, Slutske WS. Are prescription misuse and illicit drug use etiologically distinct? A genetically-informed analysis of opioids and stimulants. Psychol Med 2022; 52:3176-3183. [PMID: 33455586 PMCID: PMC8286273 DOI: 10.1017/s0033291720005267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Potential differences in genetic and environmental influences on the (mis)use of prescription and illicit drugs that are subsumed under the same class should be examined. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for addressing this etiological issue. METHODS A total of 2410 individual Australian twins [Mage = 31.77 (s.d. = 2.48); 67% women] were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types. RESULTS Variation in the propensity to misuse prescription opioids was attributable to genes (41%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was attributable to genes (79%) and unique environment (21%). Illicit stimulant use was attributable to genes (48%), shared environment (29%), and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Bivariate correlations suggested that prescription opioid use may be more genetically similar to prescription stimulant use than to illicit opioid use. CONCLUSIONS Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Nicholas G. Martin
- Queensland Institute of Medical Research- Berghofer, Brisbane, QLD, Australia
| | - Arpana Agrawal
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael T. Lynskey
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wendy S. Slutske
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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13
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Azimi V, Jackups R, Farnsworth CW, Budelier MM. Use of laboratory data for illicit drug use surveillance and identification of socioeconomic risk factors. Drug Alcohol Depend 2022; 236:109499. [PMID: 35605528 DOI: 10.1016/j.drugalcdep.2022.109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug overdose is the leading cause of death among people 25-44 years of age in the United States. Existing drug surveillance methods are important for prevention and directing treatment, but are limited by delayed reporting and lack of geographic granularity. METHODS Laboratory urine drug screen and complete metabolic panel data from patients presenting to the emergency department was used to observe long-term and short-term temporal and geospatial changes at the zip code-level in St. Louis. Multivariate linear regression was performed to investigate associations between zip code-level socioeconomic factors and drug screening positivity rates. RESULTS An increase in the fentanyl positive drug screens was seen during the initial COVID-19 shutdown period in the spring of 2020. A decrease in cocaine positivity was seen in the fall and winter of 2020, with a return to baseline coinciding with the second major COVID-19 shutdown in the summer of 2021. These changes appeared to be independent of changes in emergency department utilization as measured by complete metabolic panels ordered. Significant short-term changes in fentanyl and cocaine positivity rates between specific time periods were able to be localized to individual zip codes. Zip code-level multivariate analysis demonstrated independent associations between socioeconomic/demographic factors and fentanyl/cocaine positivity rates as determined by laboratory drug screening data. CONCLUSIONS Analyzing clinical laboratory drug screening data can enable a more temporally and geographically granular view of population-level drug use surveillance. Additionally, laboratory data can be utilized to find population-level socioeconomic associations with illicit drug use, presenting a potential avenue for the use of this data to guide public health and healthcare policy decisions.
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Affiliation(s)
- Vahid Azimi
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ronald Jackups
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Melissa M Budelier
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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14
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Pourfarzi F, Moghadam TZ, Zandian H. Decomposition socio-economic inequality in cardiovascular disease prevalence in adult population: A cohort based cross-sectional study in north-west of Iran. J Prev Med Public Health 2022; 55:297-306. [PMID: 35678004 PMCID: PMC9201090 DOI: 10.3961/jpmph.22.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil,
Iran
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15
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Kupka P, Petruželka B, Walach V. Illicit drug use and exposure in disadvantaged neighborhoods in Czechia: policy representations and evidence. J Ethn Subst Abuse 2022; 21:662-686. [PMID: 32701039 DOI: 10.1080/15332640.2020.1793866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines the lifetime prevalence of illicit drug use and illicit drug exposure in disadvantaged ("Roma") and more affluent neighborhoods in Czechia. The results of a survey among populations of both types of neighborhoods suggest no statistically significant difference between the two in terms of the overall lifetime prevalence of illicit drug use; however, lifetime prevalence of methamphetamine use proved higher in disadvantaged neighborhoods. The population of disadvantaged neighborhoods has also lower chances to use LSD during their lifetime. Further differences were identified in drug exposure, with the population of more affluent neighborhoods being more frequently exposed to illicit drugs than the population of disadvantaged neighborhoods. The predictors of drug use and drug exposure were partially different for both populations. In the disadvantaged population, drug use was revealed, among other predictors, to be associated with housing conditions.
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Affiliation(s)
- Petr Kupka
- University of West Bohemia, Pilsen, Czechia
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16
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Marshall BDL, Alexander-Scott N, Yedinak JL, Hallowell BD, Goedel WC, Allen B, Schell RC, Li Y, Krieger MS, Pratty C, Ahern J, Neill DB, Cerdá M. Preventing Overdose Using Information and Data from the Environment (PROVIDENT): protocol for a randomized, population-based, community intervention trial. Addiction 2022; 117:1152-1162. [PMID: 34729851 PMCID: PMC8904285 DOI: 10.1111/add.15731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS In light of the accelerating drug overdose epidemic in North America, new strategies are needed to identify communities most at risk to prioritize geographically the existing public health resources (e.g. street outreach, naloxone distribution efforts). We aimed to develop PROVIDENT (Preventing Overdose using Information and Data from the Environment), a machine learning-based forecasting tool to predict future overdose deaths at the census block group (i.e. neighbourhood) level. DESIGN Randomized, population-based, community intervention trial. SETTING Rhode Island, USA. PARTICIPANTS All people who reside in Rhode Island during the study period may contribute data to either the model or the trial outcomes. INTERVENTION Each of the state's 39 municipalities will be randomized to the intervention (PROVIDENT) or comparator condition. An interactive, web-based tool will be developed to visualize the PROVIDENT model predictions. Municipalities assigned to the treatment arm will receive neighbourhood risk predictions from the PROVIDENT model, and state agencies and community-based organizations will direct resources to neighbourhoods identified as high risk. Municipalities assigned to the control arm will continue to receive surveillance information and overdose prevention resources, but they will not receive neighbourhood risk predictions. MEASUREMENTS The primary outcome is the municipal-level rate of fatal and non-fatal drug overdoses. Fatal overdoses will be defined as unintentional drug-related death; non-fatal overdoses will be defined as an emergency department visit for a suspected overdose reported through the state's syndromic surveillance system. Intervention efficacy will be assessed using Poisson or negative binomial regression to estimate incidence rate ratios comparing fatal and non-fatal overdose rates in treatment vs. control municipalities. COMMENTS The findings will inform the utility of predictive modelling as a tool to improve public health decision-making and inform resource allocation to communities that should be prioritized for prevention, treatment, recovery and overdose rescue services.
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Affiliation(s)
- Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C. Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Maxwell S. Krieger
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel B. Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA
- Courant Institute of Mathematical Sciences, Department of Computer Science, New York University, New York, NY, USA
- Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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17
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Brawner BM, Kerr J, Castle BF, Bannon JA, Bonett S, Stevens R, James R, Bowleg L. A Systematic Review of Neighborhood-Level Influences on HIV Vulnerability. AIDS Behav 2022; 26:874-934. [PMID: 34480256 PMCID: PMC8415438 DOI: 10.1007/s10461-021-03448-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/27/2022]
Abstract
A better understanding of the social-structural factors that influence HIV vulnerability is crucial to achieve the goal of ending the HIV epidemic by 2030. Given the role of neighborhoods in HIV outcomes, synthesis of findings from such research is key to inform efforts toward HIV eradication. We conducted a systematic review to examine the relationship between neighborhood-level factors (e.g., poverty) and HIV vulnerability (via sexual behaviors and substance use). We searched six electronic databases for studies published from January 1, 2007 through November 30, 2017 (PROSPERO CRD42018084384). We also mapped the studies' geographic distribution to determine whether they aligned with high HIV prevalence areas and/or the "Ending the HIV Epidemic: A Plan for the United States". Fifty-five articles met inclusion criteria. Neighborhood disadvantage, whether measured objectively or subjectively, is one of the most robust correlates of HIV vulnerability. Tests of associations more consistently documented a relationship between neighborhood-level factors and drug use than sexual risk behaviors. There was limited geographic distribution of the studies, with a paucity of research in several counties and states where HIV incidence/prevalence is a concern. Neighborhood influences on HIV vulnerability are the consequence of centuries-old laws, policies and practices that maintain racialized inequities (e.g., racial residential segregation, inequitable urban housing policies). We will not eradicate HIV without multi-level, neighborhood-based approaches to undo these injustices. Our findings inform future research, interventions and policies.
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Affiliation(s)
- Bridgette M Brawner
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 E. Lancaster Avenue, Office 212, Villanova, PA, 19085, USA.
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
| | - Billie F Castle
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Jaqueline A Bannon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen Bonett
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Robin Stevens
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, USA
| | - Richard James
- Biomedical Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
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18
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Novak MD, Holtyn AF, Toegel F, Leoutsakos JM, Silverman K. Abstinence-contingent wage supplements to promote drug abstinence and employment: Post-intervention outcomes. Drug Alcohol Depend 2022; 232:109322. [PMID: 35077956 PMCID: PMC8885832 DOI: 10.1016/j.drugalcdep.2022.109322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Substance use disorder, unemployment, and poverty are interrelated problems that have not been addressed adequately by existing interventions. This study evaluated post-intervention effects of abstinence-contingent wage supplements on drug abstinence and employment. METHODS Unemployed adults enrolled in opioid agonist treatment were randomly assigned to an abstinence-contingent wage supplement group (n = 44) or a usual care control group (n = 47). All participants could work with an employment specialist throughout a 12-month intervention period. Those in the abstinence-contingent wage supplement group earned stipends for working with the employment specialist and, after gaining employment, abstinence-contingent wage supplements for working in their community job but had to provide opiate- and cocaine-negative urine samples to maximize pay. To assess post-intervention effects of abstinence-contingent wage supplements and compare those effects to during-intervention effects, we analyzed urine samples and self-reports every 3 months during the 12-month intervention and the 12-month post-intervention period. RESULTS During the intervention, abstinence-contingent wage supplement participants provided significantly more opiate- and cocaine-negative urine samples than usual care control participants; abstinence-contingent wage supplement participants were also significantly more likely to become employed and live out of poverty than usual care participants during intervention. During the post-intervention period, the abstinence-contingent wage supplement and usual care control groups had similar rates of drug abstinence, similar levels of employment, and similar proportions living out of poverty. CONCLUSIONS Long-term delivery of abstinence-contingent wage supplements can promote drug abstinence and employment, but many patients relapse to drug use and cease employment when wage supplements are discontinued.
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Affiliation(s)
- Matthew D Novak
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - August F Holtyn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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19
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Bernhardt C, King C. Neighborhood disadvantage and prescription drug misuse in low-income urban mothers. Drug Alcohol Depend 2022; 231:109245. [PMID: 34998251 DOI: 10.1016/j.drugalcdep.2021.109245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prescription drug misuse remains a persistent problem in the United States. Residents living in disadvantaged neighborhoods are at greater risk of substance abuse such as alcohol, tobacco, or drugs. However, whether neighborhood disadvantage affects prescription drug misuse remains underexplored. METHODS This study uses data on 3444 mothers from the Fragile Families and Child Wellbeing Study to examine the role of neighborhood disadvantage in prescription drug misuse. In addition, we examine whether social support and neighborhood collective efficacy (social cohesion and social control) explain this relationship. The analysis uses multivariate logistic regression and delineated between the following neighborhoods: affluent (3% poverty), low poverty (3-10%), moderate poverty (10-20%), and high poverty neighborhoods (20% or more). RESULTS Mothers living in moderately poor neighborhoods were more than twice as likely (odds = 2.17, 95% CI: 1.43-3.27) to misuse prescription drugs than mothers living in neighborhoods with high poverty. Mothers living in neighborhoods with high poverty did not have a statistically significant difference in prescription drug misuse than those living in affluent or low poverty neighborhoods. Social support and neighborhood collective efficacy did not explain these associations. The association between moderate poverty and prescription drug misuse was mostly direct and there was no indirect association. CONCLUSION The study highlights the higher risk of prescription drug misuse among mothers living in neighborhoods with moderate poverty. Interventions aimed at reducing opioid misuse should focus on demographic groups that are more vulnerable such as low-income mothers living in disadvantaged neighborhoods.
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Affiliation(s)
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA.
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20
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Lotfipour S, Au C, Saadat S, Bruckner T, Singh P, Chakravarthy B. Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors. West J Emerg Med 2021; 22:1139-1145. [PMID: 34546890 PMCID: PMC8463049 DOI: 10.5811/westjem.2021.3.50452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning. METHODS This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis. RESULTS The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI]: 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI: 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. CONCLUSION Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.
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Affiliation(s)
- Shahram Lotfipour
- University of California, Irvine, Department of Emergency Medicine, Irvine, California
- Eisenhower Health, Department of Emergency Medicine, Rancho Mirage, California
| | - Connie Au
- University of California, Irvine, School of Medicine, Irvine, California
| | - Soheil Saadat
- University of California, Irvine, Department of Emergency Medicine, Irvine, California
| | - Tim Bruckner
- University of California, Irvine, Program in Public Health, Irvine, California
| | - Parvati Singh
- University of California, Irvine, Program in Public Health, Irvine, California
| | - Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Irvine, California
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21
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Sauer J, Stewart K, Dezman ZDW. A spatio-temporal Bayesian model to estimate risk and evaluate factors related to drug-involved emergency department visits in the greater Baltimore metropolitan area. J Subst Abuse Treat 2021; 131:108534. [PMID: 34172342 DOI: 10.1016/j.jsat.2021.108534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
The ongoing opioid overdose epidemic in the United States presents a major public health challenge. Opioid-involved morbidity, especially nonfatal emergency department (ED) visits, are a key opportunity to prevent mortality and measure the extent of the problem in the local substance use landscape. Data on the rate of ED visits is normally distributed by federal agencies. However, state- and substate-level rates of ED visit demonstrate significant geographic variation. This study uses an ongoing sample of ED visits from four hospitals in the University of Maryland Medical System from January 2016 to December 2019 to provide locally sensitive information on ED visit rates and risk for drug-related health outcomes. Using exploratory spatial data analysis and spatio-temporal Bayesian models, this study analyzes both the frequency and risk of heroin-, methadone-, and cocaine-involved ED visits across the greater Baltimore Maryland area at the Zip Code Tabulation Area-level (ZCTA). The Global Moran's I for total heroin-, methadone-, and cocaine-involved ED visits in 2019 was 0.44, 0.56, and 0.53, demonstrating strong positive spatial autocorrelation. Spatio-temporal Bayesian models indicated that ZCTA with a higher score in a deprivation index, with a higher share of Centers for Medicare Services claims, and adjacent to a sampled UMMS hospital had an increased risk of ED visits, with variation in the magnitude of this increased risk depending on the drug-demographic strata. Modeled disease risk surfaces - including posterior median risk and posterior exceedance probabilities - showed distinctly different risk surfaces between the substances of interest, probabilistically identifying ZCTA with a lower or higher risk of ED visits. The modeling approach used a sample of ED visits from a larger health system to estimate recent, locally sensitive drug-related morbidity across a large metropolitan area.
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Affiliation(s)
- Jeffery Sauer
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, USA.
| | - Kathleen Stewart
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, USA
| | - Zachary D W Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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22
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"Todo se trata de a quién conoces": Social Networks and Drug Use Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2021; 25:1276-1289. [PMID: 33201429 DOI: 10.1007/s10461-020-03094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 12/30/2022]
Abstract
The purpose of this study was to characterize the social networks of female sex workers (FSWs) living with HIV in the Dominican Republic (DR) and to examine the association between daily drug use and network risk profile. The study employed a micro-longitudinal observational design using a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors and social network data was collected at study enrollment. A series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations (GEE), clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings revealed that FSWs with more network members who were drug users (≥ 3) and more network members who were sexual partners and also drugs users (≥ 2) were 8.89 (95% CI 2.62, 30.22) and 6.08 (95% CI 1.20, 30.92) times more likely to engage in daily drug use compared to women with small drug and sex and drug networks. Study findings demonstrate the role high risk networks have on risk behaviors. Results may be used to inform interventions that focus on modifying negative social ties, creating and/or improving existing positive support relationships, and integrating drug use harm reduction promotion within HIV treatment programs.
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23
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Felker-Kantor E, Polanco C, Perez M, Donastorg Y, Andrinopoulos K, Kendall C, Kerrigan D, Theall K. Daily activity spaces and drug use among female sex workers living with HIV in the Dominican Republic. Health Place 2021; 68:102527. [PMID: 33588303 PMCID: PMC10768855 DOI: 10.1016/j.healthplace.2021.102527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to explore the daily activity spaces of female sex workers living with HIV in the Dominican Republic and assess the relationship between activity path and location-based risk exposure measures and daily drug use. The study employed a micro-longitudinal observational study design using an innovative 7-day travel diary to capture daily activity routes and a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors among 51 female sex workers. To estimate between-subject variability, a series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations, clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings showed that female sex workers exposed to a higher number of risk outlets (e.g., liquor stores, bars, hotels, nightclubs, brothels, etc.) within 200 and 100-meters of sex work locations were at an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.01, 1.05, RRadj: 1.05, 95%CI: 1.01, 1.09). No association was detected between activity path exposure and daily drug use. These findings illustrate the importance of moving beyond static residential neighborhood boundaries for measuring risk exposures and highlight the significant role that daily work environments have on drug harms among a highly stigmatized and vulnerable population.
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Affiliation(s)
| | - Caluz Polanco
- La Universidad Autónoma de Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico Dominicano y Cirugía de Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Instituto Dermatológico Dominicano y Cirugía de Piel, Santo Domingo, Dominican Republic
| | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Deanna Kerrigan
- George Washington University, Departments of Prevention and Community Health, Washington, DC, USA
| | - Katherine Theall
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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24
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Holtyn AF, Toegel F, Arellano M, Subramaniam S, Silverman K. Employment outcomes of substance use disorder patients enrolled in a therapeutic workplace intervention for drug abstinence and employment. J Subst Abuse Treat 2021; 120:108160. [PMID: 33298300 PMCID: PMC7733028 DOI: 10.1016/j.jsat.2020.108160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 10/04/2020] [Indexed: 11/20/2022]
Abstract
Poverty is common among people who have substance use disorder. The therapeutic workplace addresses some of the interrelated and chronic problems of poverty, such as unemployment, lack of education and job skills, and drug use. A prior controlled trial showed that the therapeutic workplace was effective in promoting drug abstinence and self-reported community employment in unemployed adults in medication-assisted treatment for opioid use disorder. The current study extends this research by providing a detailed and objective analysis of employment outcomes using objective data abstracted from participants' pay stubs. Secondary analyses examined the types and patterns of employment that participants (N = 44) obtained during the trial, and the extent to which participants gained and maintained financially sufficient employment. Although most participants had relatively long histories of unemployment and underemployment, many participants (n = 26; 59%) obtained employment at some point during the intervention. Most participants worked part time and were employed in low-wage jobs, however. The mean number of hours worked per week was 20.6 h (range 5.5 to 41.3 h per week) and the mean hourly pay was $11.00 per hour (range $9.00 to $15.50 per hour). The most common type of employment was in food preparation and serving-related occupations (e.g., waiters and waitresses, restaurant cooks, and fast food counter workers). Many participants (n = 17; 65%) maintained employment in these jobs over several weeks, while others (n = 9; 35%) were employed sporadically for short durations. Additional supports may be needed for some chronically unemployed adults with substance use disorder to promote consistent employment in well-paying jobs.
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Affiliation(s)
- August F Holtyn
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA.
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
| | - Meghan Arellano
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
| | - Shrinidhi Subramaniam
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
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Webb EK, Weis CN, Huggins AA, Parisi EA, Bennett KP, Miskovich T, Krukowski J, deRoon-Cassini TA, Larson CL. Neighborhood disadvantage is associated with stable deficits in neurocognitive functioning in traumatically-injured adults. Health Place 2021; 67:102493. [PMID: 33321457 PMCID: PMC7854519 DOI: 10.1016/j.healthplace.2020.102493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In trauma-exposed adults, the relationship between an individual's socioeconomic position (SEP) and post-traumatic stress disorder (PTSD) has been well demonstrated. One potential mechanism by which the stress associated with lower SEPs may impact trauma outcomes is through changes in neurocognition. In both healthy and clinical samples, area-level factors also appear to be independently related to neurocognition. Far less is known about how neighborhood socioeconomic disadvantage, may impact cognition in traumatically-injured adults. The current study employed hierarchical linear modeling to longitudinally investigate whether neighborhood disadvantage was associated with neurocognitive functioning in five domains: processing speed, sustained attention, controlled attention, cognitive flexibility, and response inhibition. METHODS One-hundred and ninety-five socioeconomically diverse traumatically-injured subjects (mean age = 32.8, 52.8% female) were recruited from an Emergency Department. Two-weeks, three-months, and six-months post-trauma, participants completed self-report measures and a computerized test battery to evaluate neurocognition. An Area Deprivation Index (ADI) score, a measure of a neighborhood's socioeconomic disadvantage, was derived from each participants' home address. RESULTS Greater neighborhood disadvantage was significantly related to lower scores in all domains. Results of hierarchical linear models revealed neighborhood disadvantage was significantly associated with processing speed, controlled attention, cognitive flexibility, and response inhibition across time, even after adjusting for individual annual household income, baseline PTSD symptoms, and previous adverse life experiences. This relationship was stable for all domains except sustained attention, which varied across time. CONCLUSION These findings indicate neighborhood disadvantage contributes uniquely to neurocognitive functioning and, for the majority of domains, these contributions are stable across time. The relationship between area-level variables and cognitive function may underlie individual vulnerability to developing psychiatric disorders. Future work should continue to examine the interaction between socioenvironmental stressors and PTSD symptoms longitudinally.
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Affiliation(s)
- E Kate Webb
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA.
| | - Carissa N Weis
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Ashley A Huggins
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Elizabeth A Parisi
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | | | - Tara Miskovich
- VA Northern California Healthcare System, Martinez, CA, USA
| | | | - Terri A deRoon-Cassini
- Medical College of Wisconsin, Department of Surgery, Division of Trauma & Acute Care Surgery, Milwaukee, WI, USA
| | - Christine L Larson
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
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26
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Breedon JR, Ziauddeen H, Stochl J, Ersche KD. Feeding the addiction: Narrowing of goals to habits. Eur Neuropsychopharmacol 2021; 42:110-114. [PMID: 33246848 DOI: 10.1016/j.euroneuro.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/25/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Whilst the initiation of cocaine use is typically goal-directed and motivated by the rewarding effects of the drug, drug-taking can become habitual over time, rendering the user less sensitive to cocaine's hedonic value. Experimental studies suggest that patients with cocaine use disorder (CUD) are particularly prone to develop habits, even in non-drug related contexts. CUD patients have previously been shown to consume higher levels of high-calorie foods and report more uncontrolled eating, suggesting a tendency towards habitual or dysregulated food-related behaviours. We investigated this in CUD patients compared with healthy controls. Participants were presented with a series of food images and asked to rate their willingness to pay for, and their motivation to consume the foods. Self-reported motivations for food choices were collected using a validated questionnaire. Our data suggests CUD patients display goal-narrowing towards cocaine, as well as habitual tendencies towards both cocaine and food. These findings stress the importance of addressing non-drug related behaviours when treating CUD patients. Further, they suggest that habits may provide a novel and additional target for psychological interventions, for example, through the retraining of maladaptive habits. Whilst research into the feasibility and efficacy of habit retraining is certainly required, the potential for a new avenue of treatment should not be ignored.
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Affiliation(s)
- J R Breedon
- University of Cambridge, Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK
| | - H Ziauddeen
- University of Cambridge, Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - J Stochl
- University of Cambridge, Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK; Department of Kinanthropology and Humanities, Charles University, 16252 Prague, Czech Republic
| | - K D Ersche
- University of Cambridge, Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK.
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Schneider S, Richter C, Niethammer R, Beisel L. Fatal and Non-Fatal Heroin-Related Overdoses: Circumstances and Patterns. Subst Use Misuse 2021; 56:1997-2006. [PMID: 34470589 DOI: 10.1080/10826084.2021.1963986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis. METHODS Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases. RESULTS The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome. CONCLUSION Future prevention and intervention measures should aim to consider the context, i.e. typical constellations of risk, and attempt to inhibit this through appropriate counter measures.
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Affiliation(s)
- Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Christian Richter
- Drug Counselling Centre "Abrigado", Drug Consumption Room, Hamburg, Germany
| | - Rainer Niethammer
- Clinic for Psychiatry and Psychotherapy, Hospital "Zum Guten Hirten", Ludwigshafen, Germany
| | - Larissa Beisel
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
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28
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Bland AR, Ersche KD. Deficits in recognizing female facial expressions related to social network in cocaine-addicted men. Drug Alcohol Depend 2020; 216:108247. [PMID: 32896724 DOI: 10.1016/j.drugalcdep.2020.108247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/23/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The ability to accurately recognise facial expressions of emotion is crucial for social functioning and maintaining healthy relationships. Recognising the emotional state of others allows us to respond to their needs and adjust our behaviour appropriately. Impairments in facial affect recognition have been reported in chronic cocaine users but little is known whether these contribute to their difficulties in social situations. METHODS We assessed facial emotional expression recognition in forty-five men with cocaine use disorder (CUD) and forty-four healthy control participants. Using standardised questionnaires, we also collected information on perceived social support, social provision and community integration. RESULTS Our results found that male cocaine users had greater difficulty in recognising female emotional facial expressions than male controls. This effect was not explained by demographic variables but it was associated with their social network; including social support, social provisions and community integration. CONCLUSION Our findings suggest that men with CUD have greater difficulty in identifying emotional expression in female faces, which is linked with their social support networks. This may play an important role in misunderstanding non-verbal communications that contribute to destabilising friendship and family ties typically seen in drug addiction. Addressing deficits in recognising female emotional expressions may be an important piece of information for counselling and other interventions.
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Affiliation(s)
- Amy R Bland
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0SZ, UK; Department of Psychology, Brooks Building, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Karen D Ersche
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0SZ, UK.
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Mella-Raipán J, Romero-Parra J, Recabarren-Gajardo G. DARK Classics in Chemical Neuroscience: Heroin and Desomorphine. ACS Chem Neurosci 2020; 11:3905-3927. [PMID: 32568519 DOI: 10.1021/acschemneuro.0c00262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Opioids are arguably one of the most important pharmacologic classes, mainly due to their rich history, their useful and potent analgesic effects, and also, just as importantly, their "Dark Side", constituted by their reinforcing properties that have led countless of users to a spiral of addiction, biological dependence, tolerance, withdrawal syndromes, and death. Among the most significant abused and addictive known opioids are heroin and desomorphine, both synthetic derivatives of morphine that belong to the 4,5-epoxymorphinan structural chemical group of the opioid family drugs. These agents share not only structural, pharmacological, and epidemiological features but also a common geographical distribution. A drop in Afghan heroin production and its "exports" to Russia gave rise to widespread consumption of desomorphine in ex-Soviet republics during the first decade of the 21st century, representing an economical and accessible alternative for misusers to this sort of derivative. Herein we review the state of the art of history, chemistry and synthesis, pharmacology, and impact on society of these "cursed cousins".
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Affiliation(s)
- Jaime Mella-Raipán
- Instituto de Quı́mica y Bioquı́mica, Facultad de Ciencias, Universidad de Valparaı́so, Av. Gran Bretaña 1111, Valparaı́so 2360102, Chile
- Facultad de Farmacia, Centro de Investigación Farmacopea Chilena, Universidad de Valparaı́so,, Av. Gran Bretaña 1093, Valparaı́so 2360102, Chile
| | - Javier Romero-Parra
- Departamento de Quı́mica Orgánica y Fisicoquı́mica, Facultad de Ciencias Quı́micas y Farmacéuticas, Universidad de Chile, Sergio Livingstone 1007, Casilla
233, 8380492 Santiago, Chile
| | - Gonzalo Recabarren-Gajardo
- Bioactive Heterocycles Synthesis Laboratory, BHSL, Departamento de Farmacia, Facultad de Quı́mica y de Farmacia, Pontificia Universidad Católica de Chile, Casilla 306, Avda. Vicuña Mackenna 4860, Macul, 7820436 Santiago, Chile
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile,, Marcoleta 391, 8330024 Santiago, Chile
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30
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Cao Y, Stewart K, Factor J, Billing A, Massey E, Artigiani E, Wagner M, Dezman Z, Wish E. Using socially-sensed data to infer ZIP level characteristics for the spatiotemporal analysis of drug-related health problems in Maryland. Health Place 2020; 63:102345. [PMID: 32543431 DOI: 10.1016/j.healthplace.2020.102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
This research investigated how socially sensed data can be used to detect ZIP level characteristics that are associated with spatial and temporal patterns of Emergency Department patients with a chief complaint and/or diagnosis of overdose or drug-related health problems for four hospitals in Baltimore and Anne Arundel County, MD during 2016-2018. Dynamic characteristics were identified using socially-sensed data (i.e., geo-tagged Twitter data) at ZIP code level over varying temporal resolutions. Data about three place-based variables including comments and concerns about crime, drug use, and negative or depressed sentiments, were extracted from tweets, along with data from four socio-environmental variables from the American Community Survey were collected to explore socio-environmental characteristics during the same period. Our study showed a statistically significant increase in adjusted rates of Emergency Department (ED) visits occurred between June and November 2017 for patients residing in ZIP codes in western Baltimore and northeastern Anne Arundel County. During this period, the three topics extracted from Twitter data were highly correlated with the ZIP codes where the patients were residing. Exploring the dynamic spatial associations between socio-environmental variables and ED visits for acute overdose assists local health officials in optimizing interventions for vulnerable locations.
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Affiliation(s)
- Yanjia Cao
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Kathleen Stewart
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, USA
| | - Julie Factor
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Amy Billing
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Ebonie Massey
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Michael Wagner
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Zachary Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric Wish
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
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31
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Haile K, Umer H, Ayano G, Fejo E, Fanta T. A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia. BMC Psychiatry 2020; 20:204. [PMID: 32375717 PMCID: PMC7203867 DOI: 10.1186/s12888-020-02626-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia. METHODS A qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis. RESULTS Four major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances. CONCLUSION Factors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.
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Affiliation(s)
- Kibrom Haile
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Halima Umer
- Clinical Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Edao Fejo
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tolesa Fanta
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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32
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Holtyn AF, Toegel F, Subramaniam S, Jarvis BP, Leoutsakos JM, Fingerhood M, Silverman K. Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial. J Epidemiol Community Health 2020; 74:445-452. [PMID: 32086373 PMCID: PMC7259020 DOI: 10.1136/jech-2020-213761] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Poverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder. METHODS A randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay. RESULTS Abstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants. CONCLUSION Abstinence-contingent wage supplements can promote drug abstinence and employment. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02487745.
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Affiliation(s)
- August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shrinidhi Subramaniam
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brantley P Jarvis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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33
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Satinsky EN, Doran K, Felton JW, Kleinman M, Dean D, Magidson JF. Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City. PLoS One 2020; 15:e0228084. [PMID: 32004328 PMCID: PMC6993963 DOI: 10.1371/journal.pone.0228084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023] Open
Abstract
Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.
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Affiliation(s)
- Emily N. Satinsky
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Kelly Doran
- Department of Nursing, University of Maryland, Baltimore, Maryland, United States of America
| | - Julia W. Felton
- Department of Public Health, Michigan State University, Flint, Michigan, United States of America
| | - Mary Kleinman
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Dwayne Dean
- Department of Nursing, University of Maryland, Baltimore, Maryland, United States of America
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
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Lung Y, Chang SS, Hsu CY, Wu SC, Chen CY, Chen WJ. Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis. Subst Use Misuse 2020; 55:2025-2034. [PMID: 32654584 DOI: 10.1080/10826084.2020.1788089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While the association between residential socioeconomic environments and the use of globally common substances such as alcohol and tobacco has been well documented in Western countries, it remains little known about regionally important substances, such as areca nut in Asia. Objective: This study was aimed to develop residential environmental indicators in the context of Taiwan and examine their associations with areca nut use, in comparison to alcohol and tobacco use. Methods: Data were drawn from 13,392 adults across 168 townships in the 2014 National Survey on Substance Use in Taiwan. Residential socioeconomic environment variables were derived from the census and analyzed using factor analysis. Multilevel logistic regression models were used to examine the association of individual- and residential-level factors with the use of areca nut (use/nonuse), alcohol (harmful use, low-risk use, or nonuse), and tobacco (nicotine dependence, regular active use, or nonuse). Results: A three-factor structure of socioeconomic environments derived from 16 residential-level variables consisted of Rural Disadvantage, Affluence, and Family Fragmentation. Multilevel analyses showed that areca nut use was associated with both individual-level (male sex, age group 35-44 years, being divorced/widowed/separated, low educational attainment, and the occupational group of labors) and residential-level (Rural Disadvantaged and Family Fragmented) variables; such a profile was most similar to that of nicotine dependence. Conclusions: A three-factor structure could be derived for the residential-level socioeconomic environments in the Taiwanese context. Rural Disadvantaged and Family Fragmented were associated with areca nut use, which have implications for interventions targeted at the community level.
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Affiliation(s)
- Yu Lung
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chia-Yueh Hsu
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shang-Chi Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
| | - Wei J Chen
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan.,Department of Psychiatry, College of Medicine, and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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35
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The Role of Individual and Social Mediators in the Association Between Drug Consumption and Mental Health Among Adolescents in Barcelona. Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-018-9879-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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36
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Sadler RC, Furr-Holden D. The epidemiology of opioid overdose in Flint and Genesee County, Michigan: Implications for public health practice and intervention. Drug Alcohol Depend 2019; 204:107560. [PMID: 31586805 PMCID: PMC6884144 DOI: 10.1016/j.drugalcdep.2019.107560] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022]
Abstract
As the opioid epidemic continues to worsen throughout the United States, researchers and practitioners require additional tools to help in efforts to address use and prevent overdose. Although opioids are increasingly of concern to all racial and socioeconomic groups, specific geographic regions and sub-populations remain more burdened by overdoses than others. The example of Flint, Michigan, is used to contextualize the landscape of opioid overdose death and understand geographic and demographic variation in risk. Kernel density analysis and spatial joins in ArcGIS were used to map opioid overdose death clusters, treatment availability, and neighborhood-level conditions to uncover factors related to overdose death. Spatial analysis revealed three geographic clusters in opioid overdose death in Flint. These neighborhoods tended to be somewhat poorer but also significantly Whiter than the average Flint neighborhood. Alternatively, opioid overdose death clusters did not occur in predominately African-American neighborhoods. As well, treatment sites were not coincident with the location of overdose death clusters, suggesting a potential need for geographically-targeted interventions. Of the 47 treatment sites, only 29 offered medication-assisted treatment, and expansion of these programs may therefore be warranted. This work is of great importance to ongoing prevention and treatment efforts in Flint, but also to other communities with a need for better tools to monitor and intervene in the opioid epidemic.
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Affiliation(s)
- Richard C. Sadler
- Michigan State University, College of Human Medicine, Division of Public Health,Michigan State University, College of Human Medicine, Department of Family Medicine,Michigan State University, College of Social Science; Department of Geography, Environment, and Spatial Sciences
| | - Debra Furr-Holden
- Michigan State University, College of Human Medicine, Division of Public Health,Michigan State University, College of Human Medicine, Department of Family Medicine,Michigan State University, College of Human Medicine, Department of Epidemiology and Biostatistics
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37
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Silverman K, Holtyn AF, Toegel F. The Utility of Operant Conditioning to Address Poverty and Drug Addiction. Perspect Behav Sci 2019; 42:525-546. [PMID: 31976448 PMCID: PMC6768936 DOI: 10.1007/s40614-019-00203-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Poverty is associated with poor health. This article reviews research on proximal and distal operant interventions to address drug addiction and poverty. Proximal interventions promote health behaviors directly. Abstinence reinforcement, a common proximal intervention for the treatment of drug addiction, can be effective. Manipulating familiar parameters of operant conditioning can improve the effectiveness of abstinence reinforcement. Increasing reinforcement magnitude can increase the proportion of individuals that respond to abstinence reinforcement, arranging long-term exposure to abstinence reinforcement can prevent relapse, and arranging abstinence reinforcement sequentially across drugs can promote abstinence from multiple drugs. Distal interventions reduce risk factors that underlie poor health and may have an indirect beneficial effect on health. In the case of poverty, distal interventions seek to move people out of poverty. The therapeutic workplace includes both proximal and distal interventions to treat drug addiction and poverty. In the therapeutic workplace, participants earn stipends or wages to work. The therapeutic workplace uses employment-based reinforcement in which participants are required to provide drug-free urine samples or take scheduled doses of addiction medications to work and/or maintain maximum pay. The therapeutic workplace has two phases, a training and an employment phase. Special contingencies appear required to promote skill development during the training phase, employment-based reinforcement can promote abstinence from heroin and cocaine and adherence to naltrexone, and the therapeutic workplace can increase employment. Behavior analysts are well-suited to address both poverty and drug addiction using operant interventions like the therapeutic workplace.
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Affiliation(s)
- Kenneth Silverman
- Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD 21224 USA
| | - August F. Holtyn
- Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD 21224 USA
| | - Forrest Toegel
- Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD 21224 USA
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38
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Ivsins A, Vancouver Area Network Of Drug Users, Benoit C, Kobayashi K, Boyd S. From risky places to safe spaces: Re-assembling spaces and places in Vancouver's Downtown Eastside. Health Place 2019; 59:102164. [PMID: 31382220 DOI: 10.1016/j.healthplace.2019.102164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023]
Abstract
Vancouver's Downtown Eastside (DTES) neighbourhood is commonly associated with stigmatized and criminalized activities and attendant risks and harms. Many spaces/places in this urban neighbourhood are customarily portrayed and experienced as risky and harmful, and are implicated in experiences of structural (and physical) violence and marginalization. Drawing on 50 qualitative interviews, this paper explores how spaces/places frequently used by structurally vulnerable people who use drugs (PWUD) in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as enabling safety and wellbeing. Study participants recounted both negative and positive experiences with particular spaces/places, suggesting the possibility of making these locations less risky and safer. Our findings demonstrate how spaces/places used by PWUD in this particular geographical context can be understood as assemblages, a variety of human and nonhuman forces - such as material objects, actors, processes, affect, temporal elements, policies and practices - drawn together in unique ways that produce certain effects (risk/harm or safety/wellbeing). Conceptualizing these spaces/places as assemblages provides a means to better understand how experiences of harm, or conversely wellbeing, unfold, and sheds light on how risky spaces/places can be re-assembled as spaces/places that enable safety and wellbeing.
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Affiliation(s)
- Andrew Ivsins
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada.
| | | | - Cecilia Benoit
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada
| | - Karen Kobayashi
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada
| | - Susan Boyd
- Faculty of Human and Social Development, University of Victoria, HSD Building, Room A102, Victoria, BC, V8P 5C2, Canada
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Carrà G, Bartoli F, Riboldi I, Trotta G, Crocamo C. Poverty matters: Cannabis use among people with serious mental illness: Findings from the United States survey on drug use and health, 2015. Int J Soc Psychiatry 2018; 64:656-659. [PMID: 30132359 DOI: 10.1177/0020764018795213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Little is known about the influence of contextual characteristics on comorbid substance use and serious mental illness (SMI). AIMS: To explore the role of poverty on comorbid SMI and cannabis use. METHODS: We used data from the 2015 National Survey on Drug Use and Health, considering those in poverty, with income under 100% of the US poverty threshold. RESULTS: People in poverty were more likely to suffer from concurrent SMI and cannabis use (3.07%, 95% confidence interval (CI):1.84%; 5.07%), even controlling for gender, age, tobacco and alcohol use (odds ratio (OR) = 2.77, 95% CI: 1.27; 6.03, p = .010). CONCLUSION: The magnitude of the association between SMI and cannabis use is influenced by poverty status. More research on potential mediators like income inequality and impoverished social capital is needed.
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Affiliation(s)
- Giuseppe Carrà
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,2 Division of Psychiatry, University College London, London, UK
| | - Francesco Bartoli
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giulia Trotta
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Cristina Crocamo
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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40
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Mahaffey CC, Stevens-Watkins D, Leukefeld C. Life After: Examining the Relationship Between Sociobehavioral Factors and Mental Health Among African American Ex-Offenders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3873-3889. [PMID: 29295666 PMCID: PMC6026572 DOI: 10.1177/0306624x17750327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mental health problems are 3 times higher among prisoners than the general population. After release, reentry barriers and other factors can exacerbate mental problems. This study of 250 African American ex-offenders examines the relationship between sociobehavioral factors and mental health. Independent variables included self-reported health, alcohol use, employment, and history of mental problems before prison. Covariates included the number of immediate family with mental problems and the number of serious conflicts with family members or friends. Analyses revealed that men who had serious conflicts, used alcohol more often, reported less than excellent health, and not employed were more likely to report being troubled by mental problems. Family mental health history was not statistically significant. The current study adds to the literature by identifying selected factors associated with the mental health of African American male, ex-offenders. Findings from this study can inform interventions to address mental health issues and reduce recidivism.
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41
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Vannan A, Powell GL, Scott SN, Pagni BA, Neisewander JL. Animal Models of the Impact of Social Stress on Cocaine Use Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 140:131-169. [PMID: 30193703 DOI: 10.1016/bs.irn.2018.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cocaine use disorders are strongly influenced by the social conditions prior, during, and after exposure to cocaine. In this chapter, we discuss how social factors such as early life stress, social rank stress, and environmental stress impact vulnerability and resilience to cocaine. The discussion of each animal model begins with a brief review of examples from the human literature, which provide the psychosocial background these models attempt to capture. We then discuss preclinical findings from use of each model, with emphasis on how social factors influence cocaine-related behaviors and how sex and age influence the behaviors and neurobiology. Models discussed include (1) early life social stress, such as maternal separation and neonatal isolation, (2) social defeat stress, (3) social hierarchies, and (4) social isolation and environmental enrichment. The cocaine-related behaviors reviewed for each of these animal models include cocaine-induced conditioned place preference, behavioral sensitization, and self-administration. Together, our review suggests that the degree of psychosocial stress experienced yields robust effects on cocaine-related behaviors and neurobiology, and these preclinical findings have translational impact for the future of cocaine use disorder treatment.
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Affiliation(s)
- Annika Vannan
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Gregory L Powell
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Samantha N Scott
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Broc A Pagni
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Janet L Neisewander
- School of Life Sciences, Arizona State University, Tempe, AZ, United States.
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42
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Tomek SE, Olive MF. Social Influences in Animal Models of Opiate Addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 140:81-107. [PMID: 30193710 DOI: 10.1016/bs.irn.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Opiate addiction has reached an epidemic prevalence in recent years, yet social influences on the use and abuse of opiates has been widely understudied. In particular, the neurobiological substrates of opiate addiction and their modulation by social influences are largely unknown, perhaps due to the lack of widespread incorporation of social variables into animal models of opiate addiction. As reviewed here, animal models such as oral and intravenous drug self-administration, conditioned place preference, behavioral sensitization, and the effects of various stressors, have been useful in identifying some of the neurochemical circuitry that mediate social influences on opiate addiction. However, it is clear from our review that newer paradigms that incorporate various social elements are greatly needed to provide more translational insights into the neurobiological basis of opiate addiction. These elements include social and environmental enrichment, presence of conspecifics, and procedures that require subjects to exert effort to engage in prosocial behavior. A wider implementation of social variables into animal models of opiate addiction will help inform neurobehavioral strategies to increase the efficacy of treatment.
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Affiliation(s)
- Seven E Tomek
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - M Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ, United States.
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43
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Gunja A, Stanislawski MA, Barón AE, Maddox TM, Bradley SM, Vidovich MI. The implications of cocaine use and associated behaviors on adverse cardiovascular outcomes among veterans: Insights from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Clin Cardiol 2018; 41:809-816. [PMID: 29652077 DOI: 10.1002/clc.22961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cocaine use has been associated with adverse cardiovascular outcomes in patients with coronary artery disease (CAD). It is unclear whether this is due to direct effects of cocaine or other factors. HYPOTHESIS Cocaine use is associated with worse outcomes in patients undergoing cardiac catheterization METHODS: We used the Veterans Affairs database to identify veterans undergoing coronary catheterization between 2007 and 2014. We analyzed association between cocaine use and 1-year all-cause mortality, myocardial infarction (MI), and cerebrovascular accident (CVA) among veterans with obstructive CAD (N = 122 035). To explore factors contributing to these associations, we sequentially adjusted for cardiac risk factors, risky behaviors, and clinical conditions directly affected by cocaine. RESULTS 3082 (2.5%) veterans were cocaine users. Cocaine users were younger (median 58.2 vs 65.3 years; P < 0.001), more likely to be African American (58.9% vs 10.6%; P < 0.001), and had fewer traditional cardiac risk factors. After adjustment for cardiac risk factors, cocaine was associated with increased risk of mortality (HR: 1.23, 95% CI: 1.08-1.39), MI (HR: 1.40, 95% CI: 1.07-1.83), and CVA (HR: 1.88, 95% CI: 1.38-2.57). With continued adjustment, increased CVA risk remained significantly associated with cocaine use, whereas MI risk was mediated by risky behaviors and mortality was fully explained by conditions directly affected by cocaine. CONCLUSIONS Cocaine use is associated with adverse cardiac events in veterans with CAD. Contributors to this association are multifaceted and specific to individual cardiovascular outcomes, including associated risky behaviors and direct effects of cocaine. Effective intervention programs to reduce cardiac events in this population will require multiple components addressing these factors.
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Affiliation(s)
- Ateka Gunja
- Division of Cardiology, University of Illinois at Chicago.,Division of Cardiology, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | | | - Anna E Barón
- University of Colorado School of Medicine, Aurora.,Colorado CV Health Care System, Denver, Colorado.,Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Bradley
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,Minneapolis Heart Institute, Center for Healthcare Delivery Innovation, and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota (work completed while at VA Eastern Colorado Health Care System)
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago.,Division of Cardiology, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
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Manning RM, Greenwood RM. Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users' Recovery Experiences. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:88-103. [PMID: 29323412 DOI: 10.1002/ajcp.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.
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Affiliation(s)
- Rachel M Manning
- Department of Psychology, University of Limerick, Limerick, Ireland
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45
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Reid HH, Lundahl LH, Lister JJ, Woodcock EA, Greenwald MK. Mediational Pathways Among Trait Impulsivity, Heroin-use Consequences, and Current Mood State. ADDICTION RESEARCH & THEORY 2018; 26:421-429. [PMID: 30150910 PMCID: PMC6108588 DOI: 10.1080/16066359.2018.1434513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study examined whether lifetime heroin-use consequences mediate the relationship between trait impulsivity and three current mood outcomes: depression symptoms, stress levels, and perception of life events. METHOD Regular heroin users (N = 163) were assessed using the Barratt Impulsiveness Scale (BIS-11) to measure trait impulsivity; a standardized Drug History and Use Questionnaire to measure lifetime adverse consequences of heroin use; Beck Depression Inventory II to measure current depression symptoms; Stress subscale of the Depression Anxiety Stress scale; and Hassles and Uplifts scale to measure perception of life events. RESULTS BIS-11 Attentional and Motor impulsivity were positively related to number of adverse heroin-use consequences, depression symptoms, and stress level, and negatively associated with positive perception of events. A greater number of heroin-use consequences was related to more depression symptoms, higher stress, more negative perception of events, injection heroin use, and earlier ages of first and regular heroin use. In six mediation models, lifetime heroin-use consequences partially mediated relationships between two trait impulsivity domains (Attentional, Motor) and current mood measures (depression symptoms, stress, perception of events). CONCLUSIONS The present findings suggest that current negative mood can be a response to the accumulated burden of heroin-use consequences, particularly in the presence of high trait impulsivity.
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Affiliation(s)
- Holly H. Reid
- Beaumont Health System, Wayne, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Leslie H. Lundahl
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Jamey J. Lister
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Eric A. Woodcock
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
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46
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Dennison CR. Intergenerational Mobility and Changes in Drug Use Across the Life Course. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617746974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The consequences of “falling from grace”—or experiencing downward intergenerational mobility—are indeed becoming an abrupt reality for many entering the labor force. Scholars of social mobility speculate that such life course trajectories can result in antisocial behavior, but few have examined whether these trajectories lead to drug use. Thus, with the United States in the midst of a drug epidemic, as well as recovering from an economic recession, the study of social mobility may contribute to a better understanding of what causes individuals to turn to drugs. Using data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) and a series of logistic diagonal reference models, this study examines the association between intergenerational social mobility and drug use. Overall, I find evidence that downward mobility is associated with increases in drug use, with the relationship strongest among those experiencing the greatest loss in status.
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47
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Rudolph AE, Young AM, Havens JR. A rural/urban comparison of privacy and confidentiality concerns associated with providing sensitive location information in epidemiologic research involving persons who use drugs. Addict Behav 2017; 74:106-111. [PMID: 28609723 DOI: 10.1016/j.addbeh.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Analyses that link contextual factors with individual-level data can improve our understanding of the "risk environment"; however, the accuracy of information provided by participants about locations where illegal/stigmatized behaviors occur may be influenced by privacy/confidentiality concerns that may vary by setting and/or data collection approach. METHODS We recruited thirty-five persons who use drugs from a rural Appalachian town and a Mid-Atlantic city to participate in in-depth interviews. Through thematic analyses, we identified and compared privacy/confidentiality concerns associated with two survey methods that (1) collect self-reported addresses/cross-streets and (2) use an interactive web-based map to find/confirm locations in rural and urban settings. RESULTS Concerns differed more by setting than between methods. For example, (1) rural participants valued interviewer rapport and protections provided by the Certificate of Confidentiality more; (2) locations considered to be sensitive differed in rural (i.e., others' homes) and urban (i.e., where drugs were used) settings; and (3) urban participants were more likely to view providing cross-streets as an acceptable alternative to providing exact addresses for sensitive locations and to prefer the web-based map approach. CONCLUSION Rural-urban differences in privacy/confidentiality concerns reflect contextual differences (i.e., where drugs are used/purchased, population density, and prior drug-related arrests). Strategies to alleviate concerns include: (1) obtain a Certificate of Confidentiality, (2) collect geographic data at the scale necessary for proposed analyses, and (3) permit participants to provide intersections/landmarks in close proximity to actual locations rather than exact addresses or to skip questions where providing an intersection/landmark would not obfuscate the actual address.
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Linton SL, Haley DF, Hunter-Jones J, Ross Z, Cooper HLF. Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Soc Sci Med 2017; 185:81-90. [PMID: 28554162 DOI: 10.1016/j.socscimed.2017.04.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 12/20/2022]
Abstract
Theories of social causation and social influence, which posit that neighborhood and social network characteristics are distal causes of substance use, are frequently used to interpret associations among neighborhood characteristics, social network characteristics and substance use. These associations are also hypothesized to result from selection processes, in which substance use determines where people live and who they interact with. The potential for these competing selection mechanisms to co-occur has been underexplored among adults. This study utilizes path analysis to determine the paths that relate census tract characteristics (e.g., economic deprivation), social network characteristics (i.e., having ≥ 1 illicit drug-using network member) and illicit drug use, among 172 African American adults relocated from public housing in Atlanta, Georgia and followed from 2009 to 2014 (7 waves). Individual and network-level characteristics were captured using surveys. Census tract characteristics were created using administrative data. Waves 1 (pre-relocation), 2 (1st wave post-relocation), and 7 were analyzed. When controlling for individual-level sociodemographic factors, residing in census tracts with prior economic disadvantage was significantly associated with illicit drug use at wave 1; illicit drug use at wave 1 was significantly associated with living in economically-disadvantaged census tracts at wave 2; and violent crime at wave 2 was associated with illicit drug-using social network members at wave 7. Findings from this study support theories that describe social causation and neighborhood selection processes as explaining relationships of neighborhood characteristics with illicit drug use and illicit drug-using social networks. Policies that improve local economic and social conditions of neighborhoods may discourage substance use. Future studies should further identify the barriers that prevent substance users from obtaining housing in less disadvantaged neighborhoods.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Danielle F Haley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd CB#7030, Chapel Hill, NC 27599, USA
| | - Josalin Hunter-Jones
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, 120 N Aurora Street, Suite 3A, Ithaca, NY 14850, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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49
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Chang JS. Health in the Tenderloin: A resident-guided study of substance use, treatment, and housing. Soc Sci Med 2017; 176:166-174. [PMID: 28157570 DOI: 10.1016/j.socscimed.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
Substance use researchers recognize that environments - our homes, streets, communities, and neighborhoods - set the stage for substance use and treatment experiences by framing interactions, health options, and decision-making. The role of environment is particularly salient in places deemed disadvantaged or risky, such as parts of the Tenderloin neighborhood of San Francisco. Since risk is historically, socially, and structurally situated, an individual's social position in a neighborhood shapes how risk environments are experienced. The purpose of this study was to explore how the environment shapes substance use and treatment experiences, described from the perspective of Tenderloin residents. I conducted docent method interviews with formerly homeless women living in supportive housing in San Francisco (N = 20). The docent method is a three-stage, participant-led, audiotaped, and photographed walking interview. As they guided me through target "sites of interest" (homes, streets, treatment programs, and safe spaces), participants discussed their experiences with substance use and treatment in the environment. First, they described that the risks of a broader drug market are concentrated in the Tenderloin, exposing residents to elevated and disproportionate risk. Second, for structural, economic, social, and physical reasons, participants described a sense of geographic or neighborhood stratification. Third, multiple levels of policing and surveillance were persistent, even in participants' homes. Fourth, despite all the challenges, participants found security and support in the Tenderloin, and considered it their home. In the discussion, I offer that the Tenderloin environment provided residents many advantages, but forms of structural and everyday violence largely defined their experiences in the neighborhood.
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Affiliation(s)
- Jamie Suki Chang
- University of California, San Francisco, Department of Social and Behavioral Sciences, 3333 California Street, Suite 455, San Francisco, CA 94143-0612, United States.
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Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-adherence Among Black Americans Living with HIV: a Longitudinal Assessment. Ann Behav Med 2016; 49:865-72. [PMID: 26296702 DOI: 10.1007/s12160-015-9724-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stigma may contribute to HIV-related disparities among HIV-positive Black Americans. PURPOSE We examined whether social network characteristics moderate stigma's effects. METHODS At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically. RESULTS In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time. CONCLUSIONS Well-connected social networks have the potential to buffer the effects of stigma.
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