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Silva MA, Añez LM, Carroll KM, Jaramillo Y, Kiluk BD, Frankforter T, Ball SA, Gordon MA, Paris M. Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction. J Ethn Subst Abuse 2024; 23:251-271. [PMID: 35714996 PMCID: PMC10350903 DOI: 10.1080/15332640.2022.2086194] [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] [Indexed: 10/18/2022]
Abstract
There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.
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Affiliation(s)
- Michelle A Silva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis M Añez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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2
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Moskal D, Bennett ME, Marks RM, Roche DJO. Associations among Trauma Exposure, Post-Traumatic Stress Symptoms and Alcohol Use in Black/African American Treatment-Seeking Adults. J Dual Diagn 2024; 20:5-15. [PMID: 38113919 PMCID: PMC10842739 DOI: 10.1080/15504263.2023.2286025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Black/African American (AA) individuals are a group at risk for co-occurring posttraumatic stress disorder (PTSD) symptoms and alcohol use due to unique cultural and system-level barriers. Although associations between trauma exposure, PTSD symptoms, and alcohol use are well established across various populations, Black/AA individuals are underrepresented in this literature, and related findings in this population are inconclusive. Thus, the goal of this study was to examine the associations among trauma exposure, PTSD symptoms, and alcohol use in a sample of treatment-seeking, Black/AA adults. We hypothesized that trauma exposure and alcohol use would be positively associated and that this relationship would be mediated by PTSD symptoms. METHODS This study conducted secondary analysis of screening data from a PTSD and alcohol use disorder clinical trial. Participants were 96 Black/AA adults (57.3% male; 2.0% Hispanic; M age = 44.73, SD = 11.83) who were seeking treatment for alcohol use and endorsed trauma exposure. Associations between trauma exposure, PTSD symptom severity, and quantity and frequency of alcohol use were tested using bivariate correlations and linear regressions. Hypothesized indirect effects were tested using IBM SPSS Statistics Version 27 PROCESS model 4 with bootstrapping. RESULTS Findings illustrated a significant positive association between trauma exposure and PTSD symptoms and between PTSD symptoms and drinks per typical drinking day. PTSD symptoms were not significantly associated with number of drinking days. Tests of indirect effects were significant for trauma exposure on drinks per typical drinking day through PTSD symptoms. CONCLUSIONS Results from the test of indirect effects suggest that among Black/AA adults with heavy alcohol use and trauma exposure, trauma exposure is associated with PTSD symptoms, which in turn is associated with quantity of alcohol use. These findings are consistent with research conducted with White/mixed groups and align with tenets of the self-medication model of PTSD-AUD comorbidity. These findings support current practices that highlight the importance of screening for and addressing PTSD and alcohol use in individuals exposed to trauma. Findings from this paper provide initial data on understudied relationships in an underserved sample and several suggestions are made to generate future research and improve clinical care for Black/AA adults. CLINICAL TRIALS REGISTRY NAME Pharmacogenetic Treatment With Anti-Glutaminergic Agents for Comorbid PTSD & AUD; ClinicalTrials.gov Identifier: NCT02884908.
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Affiliation(s)
- Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Melanie E Bennett
- VA VISN 5 Mental Illness Research, Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, USA
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Russell M Marks
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, Maryland, USA
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Bauer AG, Bellot J, Bazan C, Gilmore A, Kideys K, Cameron A. Cultural considerations for substance use and substance use disorders among Black men. Bull Menninger Clin 2024; 88:108-127. [PMID: 38836848 DOI: 10.1521/bumc.2024.88.2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.
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Affiliation(s)
- Alexandria G Bauer
- Center of Alcohol & Substance Use Studies and the Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Jahnayah Bellot
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Carolyn Bazan
- School of Health Professions, Rutgers University, Piscataway, New Jersey
| | - Ayanna Gilmore
- New York State Psychiatric Institute, New York, New York
| | - Kaan Kideys
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, New Jersey
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Pars E, VanDerNagel JEL, Dijkstra BAG, Schellekens AFA. Using the Recovery Capital Model to Explore Barriers to and Facilitators of Recovery in Individuals with Substance Use Disorder, Psychiatric Comorbidity and Mild-to-Borderline Intellectual Disability: A Case Series. J Clin Med 2023; 12:5914. [PMID: 37762855 PMCID: PMC10531644 DOI: 10.3390/jcm12185914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Recovery capital (RC) encompasses the wide range of resources individuals can employ to recover from Substance Use Disorder (SUD). It consists of five subdomains: human, social, cultural, financial, and community RC. Negative recovery capital (NRC) represents the obstacles to recovery. Research on (N)RC in complex multimorbid populations is scarce. This study offers an initial exploration of the viability of (N)RC in three individuals with SUD, psychiatric comorbidities, and an intellectual disability (a triple diagnosis) in inpatient addiction treatment. We collected case file data, ranked recovery goals, and conducted follow-up interviews. The data were subjected to template analysis, using (N)RC domains as codes. All domains were prevalent and relevant, showing dynamic and reciprocal effects, influenced by critical life events acting as catalysts. Notably, during treatment, patients prioritized individual skill development despite challenges in other domains. RC emerges as a valuable concept for mapping recovery barriers and facilitators in individuals with a triple diagnosis, serving as an alternative to the medical model and complementing the biopsychosocial model. It provides a systematic framework to assess critical factors for recovery in complex cases and accordingly align interventions. Future studies should explore the intersections of NRC domains and the dynamic nature of (N)RC to enhance the understanding of the challenges faced by individuals with a triple diagnosis.
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Affiliation(s)
- Esther Pars
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Department of Human Media Interaction (HMI), University of Twente, 7500 AE Enschede, The Netherlands
| | - Joanne E. L. VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Department of Human Media Interaction (HMI), University of Twente, 7500 AE Enschede, The Netherlands
- Tactus, Centre for Addiction and Intellectual Disability, 7400 AD Deventer, The Netherlands
- Aveleijn, 7622 GW Borne, The Netherlands
| | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Behavioral Science Institute, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands
- Novadic-Kentron, Addiction Care Centre, 5261 LX Vught, The Netherlands
| | - Arnt F. A. Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
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Hong S, Walton B, Kim HW, Kaboi M, Moynihan S, Rhee TG. Exploring Disparities in Behavioral Health Service Use in the Early Stages of the COVID-19 Pandemic. Int J Behav Med 2023:10.1007/s12529-023-10192-z. [PMID: 37349603 DOI: 10.1007/s12529-023-10192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Previous studies examined the impact of the COVID-19 pandemic on mental health, but few studies looked at associations between the pandemic and state-funded behavioral health service utilization. We aimed to examine behavioral health service utilization during the early phase of COVID-19 among individuals with psychiatric disorders (PD), substance use disorders (SUD), and co-occurring disorders (COD). METHODS Using the last Adult Needs and Strengths Assessment (ANSA) completed in 2019 and 2020 in a Midwestern state, a column proportion test and Poisson regression model examined the associations of the pandemic year, age, gender, race/ethnicity, diagnostic type, and behavioral health needs. RESULTS Between 2019 and 2020, the number of adults newly involved in behavioral health services increased from 11,882 to 17,385. The number of total actionable items (TAI) differed by gender and age group. Adults who were Black or American Indian were more likely to have a significantly higher number of needs that interfered with functioning (β = 0.08; CI [0.06, 0.09]), (β = 0.16; CI [0.08, 0.23]), respectively, than White peers. Individuals with COD showed the highest number of needs (β = 0.27; CI [0.26, 0.28]) when compared to the needs of individuals with psychiatric disorders, after controlling for year, age, gender, and race/ethnicity. CONCLUSIONS Additional research is needed to better understand the intersections of age, gender identity, race/ethnicity, the complexity of needs, and useful strengths. The involvement of practitioners, service organizations, researchers, and policymakers will be required to provide accessible, effective behavioral health services with cultural and developmental adaptations to support recovery.
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Affiliation(s)
- Saahoon Hong
- School of Social Work, Indiana University, Indianapolis, IN, USA.
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, IN, USA.
| | - Betty Walton
- School of Social Work, Indiana University, Indianapolis, IN, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, IN, USA
| | - Hea-Won Kim
- School of Social Work, Indiana University, Indianapolis, IN, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, IN, USA
| | - Maryanne Kaboi
- School of Social Work, Indiana University, Indianapolis, IN, USA
| | - Stephanie Moynihan
- School of Social Work, Indiana University, Indianapolis, IN, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, IN, USA
| | - Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Grigsby TJ, Lopez A, Albers L, Rogers CJ, Forster M. A Scoping Review of Risk and Protective Factors for Negative Cannabis Use Consequences. Subst Abuse 2023; 17:11782218231166622. [PMID: 37056398 PMCID: PMC10087658 DOI: 10.1177/11782218231166622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 04/15/2023]
Abstract
Objective Numerous reviews have examined risk and protective factors for alcohol-related negative consequences, but no equivalent review of risk and protective factors exists for cannabis-related negative consequences (CRNCs)-a gap filled by the present study. This scoping review examined survey-based research of risk and protective factors for CRNCs such as neglecting responsibilities, blacking out, or needing more cannabis. Methods Three databases (PubMed, PsycINFO, and Google Scholar) were searched for peer-reviewed manuscripts published between January 1, 1990, and December 31, 2021. A qualitative synthesis was performed using the matrix method and the results were organized using the socioecological model as a framework. Results Eighty-three studies were included in the review. There was considerable variation in measures and operationalizations of CRNCs across studies. Risk factors were identified in the intrapersonal (depression, social anxiety, PTSD, impulsivity, sensation seeking, motives, expectancies), interpersonal/community (trauma, victimization, family and peer substance use, social norms), and social/policy (education, employment, community attachment, legalization, availability of substances) domains of influence. Protective behavioral strategies were a robust protective factor for CRNCs. Males consistently reported more CRNCs than females, but there were no differences observed across race. Conclusions Future research should identify person- and product-specific patterns of CRNCs to refine theoretical models of cannabis misuse and addiction. Public health interventions to reduce the risk of negative consequences from cannabis should consider utilizing multilevel interventions to attenuate the cumulative risk from a combination of psychological, contextual, and social influences.
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Affiliation(s)
- Timothy J. Grigsby
- Department of Social and Behavioral
Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Timothy J. Grigsby, Department of Social
and Behavioral Health, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy,
Las Vegas, NV 89154, USA.
| | - Andrea Lopez
- Department of Social and Behavioral
Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Larisa Albers
- Department of Population and Public
Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Christopher J. Rogers
- Department of Health Sciences,
California State University, Northridge, Northridge, CA, USA
| | - Myriam Forster
- Department of Health Sciences,
California State University, Northridge, Northridge, CA, USA
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Racial/Ethnic Differences in Psychometric Properties of Alcohol-Related Behaviors in the USA. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01379-3. [PMID: 35917062 DOI: 10.1007/s40615-022-01379-3] [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: 04/27/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Alcohol-related behaviors are often examined using surveys assessing participants' self-report of attitudes/actions. However, racial/ethnic differences exist in scale construction and evaluation, and surveys evaluating alcohol behaviors lack invariance across ethnic groups. These dissimilarities may be due to deep-rooted differences in ethnic classification of unhealthy substance use behaviors. METHODS We examined factor structure of "Number of days per month drank alcohol in past 12 months," "Number of days had one or more drinks in past 30 days," and "Number of days had four/five or more drinks in past 30 days," administered during the 2017 National Survey on Drug Use and Health. Factorial invariance was examined across 12- to 17-year-old White, Black/African American, Asian American, and Hispanic/Latinx boys and girls endorsing alcohol use. A multigroup confirmatory factor analysis statistically determined whether the factor structure was invariant across groups. RESULTS The alcohol scale lacked invariance across all groups, indicating racial/ethnic group identification is related to alcohol-related cognitions. CONCLUSIONS Psychometric properties of scales assessing alcohol-related behaviors generalized across racial/ethnic groups require evaluation.
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Wahab S, Baharom MA, Abd Rahman FN, A. Wahab K, Zulkifly MA, Azmi AD, Ahmad N. The relationship of lifetime substance-use disorder with family functioning, childhood victimisation, and depression, among juvenile offenders in Malaysia. Addict Behav Rep 2021; 14:100359. [PMID: 34136633 PMCID: PMC8181857 DOI: 10.1016/j.abrep.2021.100359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adolescent substance use is a multifactorial social issue that leads to detrimental outcomes. The aim of this study is to understand the association of a lifetime history of substance abuse or dependence with family functioning, childhood victimisation, and depression, among adolescent male inmates in a juvenile detention centre in Malaysia. METHODS This study was cross-sectional involving 230 inmates and was conducted in a juvenile detention centre in Malaysia. The mean age of the participants was 16.65 years, with the highest percentage from the Malay ethnicity (87.8% where n = 202). The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), Adolescent Alcohol and Drug Involvement Scale (AADIS), Family Adaptability and Cohesion Evaluation Scale (FACES) IV and Juvenile Victimization Questionnaire Second Revision (JVQ-R2) were used as instruments. RESULTS The prevalence of a lifetime history of substance abuse and substance dependence is 72.6% and 58.3%, respectively. A lifetime history of substance abuse and dependence had a significant association with age, race, religion, and peer/sibling victimisation. Further analysis reveals that an increase in age can be a predictor of both lifetime history of substance abuse and dependence while peer/sibling victimisation may predict lifetime history of substance abuse. There was no significant association of lifetime substance-use disorder with family functioning and depression in the juvenile offenders. CONCLUSIONS Adolescents exposed to peer/sibling victimisation might be at a higher risk of developing a substance-use disorder. At-risk groups need to be identified, assessed, and have intervention early to prevent adverse outcomes.
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Affiliation(s)
- Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | | | - Fairuz Nazri Abd Rahman
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | | | - Muhamad Afiq Zulkifly
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | - Amirul Danial Azmi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
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Jahn ZW, Lopez J, de la Salle S, Faber S, Williams MT. Racial/ethnic differences in prevalence of hallucinogen use by age cohort: Findings from the 2018 National Survey on Drug Use and Health. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2021.00166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Few studies have assessed the epidemiology of hallucinogenic substance use among racial and ethnic groups of varying age cohorts. Use of psychedelic substances may differ among people of color (POC), due to factors such as stigma and discriminatory drug enforcement practices against POC. The lack of inclusion of POC in psychedelic research further underscores the importance of identifying differences in use among racial/ethnic groups and age cohorts.
Methods
Data from the 2018 National Survey on Drug Use and Health (NSDUH) was used for this analysis (N = 56,313, unweighted), representative of the non-institutionalized U.S. population. Proportions of lifetime hallucinogen use by race/ethnicity were compared. Proportions of past year rates of use were compared to examine differences by race/ethnicity and age cohort.
Results
Approximately 15.9% of the U.S. population over 12 had used a hallucinogen at some point in their lifetime and 2.0% had used in the past year. Lifetime hallucinogen use was most prevalent among non-Hispanic White and multi-racial individuals, while Black/African Americans reported the lowest rates of use. White and multi-racial groups also reported the highest proportions of past year use among 12–34 year olds, and White individuals reported the highest proportions among 35–49 year olds. Hispanic individuals reported higher proportions of use among the 12–17 cohort, but lower proportions among the 26–49 year old cohorts. Black/African Americans reported the lowest rates of past year use among the 12–25 year old cohorts. 50+ and older cohorts reported the lowest rates of hallucinogen use in the past year.
Limitations
Data is cross-sectional and self-reported. “Race” is a social construction is subject to change over time, and NSDUH ethnoracial categories are limited. Institutionalized populations are not included in the study.
Conclusions
Significant differences in hallucinogen use among ethnoracial groups by substance and age cohorts were observed. Findings from this work may inform education, interventions, and therapeutic psychedelic research.
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Affiliation(s)
- Zoe W. Jahn
- 1 Department of Physiology and Neurobiology, University of Connecticut, USA
| | - Joel Lopez
- 2 Department of Psychological Sciences, University of Connecticut, USA
| | | | | | - Monnica T. Williams
- 3 School of Psychology, University of Ottawa, Ontario, Canada
- 5 Department of Cellular and Molecular Medicine, University of Ottawa, Ontario, Canada
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10
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May AC, Burrows K, Figueroa-Hall LK, Kirlic N, White EJ, Smith R, Ekhtiari H, Paulus MP, Savitz J, Stewart JL. Sex differences in circulating inflammatory mediators as a function of substance use disorder. Drug Alcohol Depend 2021; 221:108610. [PMID: 33631550 PMCID: PMC8026624 DOI: 10.1016/j.drugalcdep.2021.108610] [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: 10/07/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substance use disorders (SUD) with comorbid depression and anxiety are linked to poor treatment outcome and relapse. Although some depressed individuals exhibit elevated blood-based inflammation (interleukin-6 [IL-6] and C reactive protein [CRP]), few studies have examined whether the presence of SUD exacerbates inflammation. METHODS Treatment-seeking individuals with major depressive disorder (MDD), anxiety disorders, and/or SUD (N = 160; 80 % with MDD) recruited into the Tulsa 1000 study provided blood samples, participated in clinical interviews, and completed a questionnaire battery querying symptoms of current psychopathology and emotional processing. Analyses followed a multistep process. First, groups were created on the presence versus absence of 1+ lifetime SUD diagnoses: SUD+ (37 F, 43 M) and SUD- (60 F, 20 M). Second, a principal component analysis (PCA) of questionnaire data resulted in two factors, one indexing negative emotionality/withdrawal motivation and one measuring positive emotionality/approach motivation. Third, SUD groups, extracted PCA factors, and nuisance covariates (age, body mass index [BMI], nicotine use, psychotropic medication [and hormone/contraception use in females]) were entered as simultaneous predictors of blood-based inflammation (IL-6, IL-8, IL-10, tumor necrosis factor-α, and CRP). RESULTS Within females, SUD + exhibited higher IL-8 and IL-10 but lower CRP levels than SUD-. In contrast, SUD was not associated with biomarker levels in males. Across sexes, higher BMI was linked to higher IL-6 and CRP levels, and within the five biomarkers, IL-6 and CRP shared the most variance. CONCLUSION These findings point to sex-specific inflammatory profiles as a function of SUD that may provide new targets for intervention.
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Affiliation(s)
- April C May
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
| | | | | | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
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Warfield SC, Pack RP, Degenhardt L, Larney S, Bharat C, Ashrafioun L, Marshall BDL, Bossarte RM. The next wave? Mental health comorbidities and patients with substance use disorders in under-resourced and rural areas. J Subst Abuse Treat 2020; 121:108189. [PMID: 33162261 DOI: 10.1016/j.jsat.2020.108189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/10/2020] [Accepted: 10/22/2020] [Indexed: 01/30/2023]
Abstract
The rapid spread of the coronavirus disease (COVID-19) has impacted the lives of millions around the globe. The COVID-19 pandemic has caused increasing concern among treatment professionals about mental health and risky substance use, especially among those who are struggling with a substance use disorder (SUD). The pandemic's impact on those with an SUD may be heightened in vulnerable communities, such as those living in under-resourced and rural areas. Despite policies loosening restrictions on treatment requirements, unintended mental health consequences may arise among this population. We discuss challenges that under-resourced areas face and propose strategies that may improve outcomes for those seeking treatment for SUDs in these areas.
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Affiliation(s)
- Sara C Warfield
- Injury Control Research Center, West Virginia University, United States of America; Center of Excellence for Suicide Prevention, Department of Veterans Affairs, United States of America; Department of Behavioral Medicine and Psychiatry, West Virginia University, United States of America.
| | - Robert P Pack
- Department of Community & Behavioral Health, College of Public Health, East Tennessee State University, United States of America; Addiction Science Center, East Tennessee State University, United States of America
| | | | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Australia; Department of Family Medicine and Emergency Medicine, Université de Montréal, Canada; Université de Montréal Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Australia
| | - Lisham Ashrafioun
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, United States of America; Department of Psychiatry, University of Rochester, United States of America
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, United States of America
| | - Robert M Bossarte
- Injury Control Research Center, West Virginia University, United States of America; Center of Excellence for Suicide Prevention, Department of Veterans Affairs, United States of America; Department of Behavioral Medicine and Psychiatry, West Virginia University, United States of America
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O'Reilly H, Hagerty A, O'Donnell S, Farrell A, Hartnett D, Murphy E, Kehoe E, Agyapong V, McLoughlin DM, Farren C. Alcohol Use Disorder and Comorbid Depression: A Randomized Controlled Trial Investigating the Effectiveness of Supportive Text Messages in Aiding Recovery. Alcohol Alcohol 2020; 54:551-558. [PMID: 31361815 DOI: 10.1093/alcalc/agz060] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/29/2019] [Accepted: 07/15/2019] [Indexed: 11/14/2022] Open
Abstract
AIM The aim of this randomized controlled trial was to examine the impact of daily supportive text messages over a 6-month treatment period on mood and alcohol consumption in individuals with a dual diagnosis of alcohol use disorder (AUD) and depression following completion of an inpatient treatment programme. METHOD Ninety-five adult participants with AUD and comorbid depression were recruited into this randomized control trial, which took place after completing a 30-day rehabilitation programme. The intervention group (n = 47) received twice-daily supportive text messages over 6-months while control participants (n = 48) had treatment as usual for a 6-month period, with an added 6-month post-treatment follow-up for both groups. Drinking history in the previous 90 days as well as symptoms of depression, anxiety and stress were measured at baseline, 3- and 6-month treatment points and 6-month post treatment follow up. RESULTS Depression scores (P = 0.02) and perceived stress scores (P < 0.01) were significantly reduced at 3-month treatment point in the intervention group relative to control participants with small to medium effect. The intervention group also showed a significantly greater reduction in units per drinking day from baseline to 6-month treatment point compared to the control group with a medium effect size (P = 0.03). There were no differences in drinking or mood measures at 6-month post treatment follow-up. CONCLUSIONS Supportive text messages provide an early initial benefit in decreasing symptoms of depression and stress, with a further positive impact on alcohol consumption following a longer treatment period. Benefits did not persist six months after the intervention ended.
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Affiliation(s)
- Helen O'Reilly
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.,Department of Psychology, University College Dublin, Ireland
| | - Aisling Hagerty
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Seamus O'Donnell
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Aoife Farrell
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Dan Hartnett
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Edel Murphy
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Elizabeth Kehoe
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Vincent Agyapong
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.,Department of Psychiatry, University of Alberta, Alberta, Canada
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Conor Farren
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
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Cano M, Takeuchi DT. Recent/Childhood Adversities and Mental Disorders Among US Immigrants. Front Psychiatry 2020; 11:573410. [PMID: 33312137 PMCID: PMC7703683 DOI: 10.3389/fpsyt.2020.573410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Past research documents the heterogeneity in US immigrants, particularly in terms of racial and ethnic categories and specific ethnic subgroups. The present study builds on this research foundation by investigating heterogeneity in immigrants' experiences of adversity, both recent and during childhood, and associations with mental disorders. Data are drawn from 6,131 adult immigrants in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Prevalence estimates for mental disorders and adversities were calculated overall and by gender. Latent class analysis was utilized to characterize patterns of self-reported experiences of childhood and recent adversities, and multinomial logistic regression established the statistical association between latent class membership and past-year mental disorder outcomes (substance use disorder only, mood/anxiety/trauma disorder only, co-occurring disorder, or no mental disorder). Neglect was the most commonly-reported childhood adversity among immigrant men and women. Prevalence of meeting criteria for a substance use disorder only, or a mood/anxiety/trauma disorder only, varied between men and women, yet no gender differences were observed in prevalence of co-occurring disorders. For latent class analyses, a five-class solution was selected based on fit indices and parsimony. Approximately 10.0% of the sample was categorized in the latent class characterized by severe childhood adversities, while 57.5% was classified in the latent class with low probabilities of reported adversities. The relative risk of meeting criteria for a past-year substance use disorder only (compared to no substance use or mood/anxiety/trauma disorder) was more than three times as high for members of the class with severe childhood adversities (RRR, 3.26; 95% CI, 2.08-5.10), as well as the class with recent employment/financial adversities (RRR, 3.82; 95% CI, 2.36-6.19), compared to the class with low adversities. The relative risk of past-year co-occurring disorders (compared to no disorder) was more than 12 times as high for those in the severe childhood adversities class (RRR, 12.21; 95% CI, 7.06-21.10), compared to the class with low adversities. Findings underscore the importance of considering both recent and childhood adversities when assessing and providing services for US immigrant groups.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX, United States
| | - David T Takeuchi
- School of Social Work, University of Washington, Seattle, WA, United States.,Department of Sociology, University of Washington, Seattle, WA, United States
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Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences. Brain Sci 2019; 9:brainsci9040086. [PMID: 31003459 PMCID: PMC6523251 DOI: 10.3390/brainsci9040086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.
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15
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Assari S, Mistry R, Caldwell CH, Zimmerman MA. Marijuana Use and Depressive Symptoms; Gender Differences in African American Adolescents. Front Psychol 2018; 9:2135. [PMID: 30505287 PMCID: PMC6250838 DOI: 10.3389/fpsyg.2018.02135] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study aimed to examine gender differences in the bidirectional associations between marijuana use and depressive symptoms among African American adolescents. The study also tested gender differences in the effects of socioeconomic status, maternal support, and friends' drug use on adolescents' depressive symptoms and marijuana use. Methods: This is a secondary analysis of the Flint Adolescent Study (FAS). Six hundred and eighty one African American adolescents (335 males and 346 females) were followed for 3 years, from 1995 (mean age 16) to 1997 (mean age 19). Depressive symptoms (Brief Symptom Inventory) and marijuana use were measured annually during the follow up. We used multi-group latent growth curve modeling to explore the reciprocal associations between depressive symptoms and marijuana use over time based on gender. Results: Baseline marijuana use was predictive of an increase in depressive symptoms over time among male but not female African American adolescents. Baseline depressive symptoms were not predictive of an increase in marijuana use among male or female adolescents. Conclusion: Study findings suggest that male African American adolescents who use marijuana are at an increased risk of subsequent depressive symptoms. Interventions that combine screening and treatment for marijuana use and depression may be indicated for African American male adolescents.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Cleopatra Howard Caldwell
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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16
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Explaining socioeconomic inequalities in illicit drug use disorders in Iran. Med J Islam Repub Iran 2018; 31:108. [PMID: 29951409 PMCID: PMC6014806 DOI: 10.14196/mjiri.31.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social
damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining
the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran.
Methods: Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the
socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured
using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified
using the Oaxaca-Blinder Decomposition.
Results: The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique
revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders,
respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital
status, and gender accounted for the highest contribution to inequality, respectively.
Conclusion: There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic
group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for
males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.
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17
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Assari S. Socioeconomic Status and Self-Rated Oral Health; Diminished Return among Hispanic Whites. Dent J (Basel) 2018; 6:E11. [PMID: 29695074 PMCID: PMC6023433 DOI: 10.3390/dj6020011] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background. An extensive body of knowledge has documented weaker health effects of socio-economic status (SES) for Blacks compared to Whites, a phenomenon also known as Blacks’ diminished return. It is, however, unknown whether the same diminished return also holds for other ethnic minorities such as Hispanics or not. Aim. Using a nationally representative sample, the current study aimed to compare Non-Hispanic and Hispanic Whites for the effects of SES on self-rated oral health. Methods. For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001⁻2003. With a nationally representative sampling, CPES included 11,207 adults who were either non-Hispanic Whites (n = 7587) or Hispanic Whites (n = 3620. The dependent variable was self-rated oral health, treated as dichotomous measure. Independent variables were education, income, employment, and marital status. Ethnicity was the focal moderator. Age and gender were covariates. Logistic regressions were used for data analysis. Results. Education, income, employment, and marital status were associated with oral health in the pooled sample. Although education, income, employment, and marital status were associated with oral health in non-Hispanic Whites, none of these associations were found for Hispanic Whites. Conclusion. In a similar pattern to Blacks’ diminished return, differential gain of SES indicators exists between Hispanic and non-Hispanic Whites, with a disadvantage for Hispanic Whites. Diminished return of SES should be regarded as a systemically neglected contributing mechanism behind ethnic oral health disparities in the United States. Replication of Blacks’ diminished return for Hispanics suggests that these processes are not specific to ethnic minority groups, and non-White groups gain less because they are not enjoying the privilege and advantage of Whites.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor 48109-2700, MI, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor 48109-2700, MI, USA 4250 Plymouth Rd., Ann Arbor, MI 48109-2700, USA.
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18
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Chavez LM, Shrout PE, Wang Y, Collazos F, Carmona R, Alegría M. Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants. Drug Alcohol Depend 2017; 180:121-128. [PMID: 28888151 PMCID: PMC5648606 DOI: 10.1016/j.drugalcdep.2017.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early detection and intervention in primary care is integral to behavioral health. Valid, practical screening assessments are scarce, particularly for non-English speaking populations. We address this need by evaluating the psychometric properties of the Spanish version of the AC-OK Screen for Co-occurring Disorders for first and second generation immigrant Latinos in Massachusetts, USA, and Madrid and Barcelona, Spain. METHODS 567 Latino participants were recruited in waiting areas of clinics or by referral from Primary Care, Mental Health, Substance Use, and HIV Treatment Clinics, as well as Community Agencies. We use confirmatory factor analyses to evaluate the factor structure, correlation analysis to examine concurrent and discriminant validity, and receiver operating curves (ROC) to determine the ability of the AC-OK to approximate a composite of established instruments designed to measure depression, generalized anxiety, post-traumatic stress disorder symptoms, alcohol, and drugs (including benzodiazepines) as external criteria. RESULTS The original two factor structure was replicated in samples of Latino respondents in the US and Spain. Correlations with other measures followed the expected pattern. In both the US and Spain, ROC analyses suggested that the AC-OK scale was an adequate approximation to other specific measures of mental health (ROC=0.90) and substance abuse problems (ROC=0.83). CONCLUSIONS The Spanish version of the AC-OK Screen has good to excellent psychometric properties in both its subscales. These findings are robust across sites, gender, and type of clinic. We recommend its use for clinical research and for routine screening at treatment centers.
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Affiliation(s)
- Ligia M. Chavez
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus Río Piedras, PR 00935
| | - Patrick E. Shrout
- Department of Psychology, New York University 6 Washington Place, Room 455 New York, NY 10003
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School,50 Staniford St. Suite 830 Boston, MA 02114, USA.
| | - Francisco Collazos
- Hospital Universitari Vall d'Hebron, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Rodrigo Carmona
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain.
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School,50 Staniford St. Suite 830 Boston, MA 02114, USA.
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Davis AK, Rosenberg H, Rosansky JA. American counselors' acceptance of non-abstinence outcome goals for clients diagnosed with co-occurring substance use and other psychiatric disorders. J Subst Abuse Treat 2017; 82:29-33. [PMID: 29021112 DOI: 10.1016/j.jsat.2017.08.006] [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: 04/27/2017] [Revised: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 12/11/2022]
Abstract
Previous research has examined clinicians' acceptance of non-abstinence for clients who have a substance use disorder (SUD), but many SUD clients also present with a psychiatric disorder. To evaluate the acceptability of non-abstinence as a final outcome goal for clients with co-occurring diagnoses, we recruited a nationwide sample of 751 American substance abuse counselors to complete a web-based questionnaire. Respondents rated the acceptability of limited/moderate consumption by clients diagnosed with each of 18 co-occurring disorders: three psychiatric disorders (Major Depressive Disorder, Post-Traumatic Stress Disorder, Social Phobia) x three substances (alcohol, cannabis, opioids) x two levels of severity (DSM-5 Moderate SUD, DSM-5 Severe SUD). On average, non-abstinence was rated as unacceptable for clients with any of the 18 diagnostic pairs, although one-fourth to almost one-third rated limited/moderate use of cannabis somewhat or completely acceptable for clients diagnosed with a Moderate Cannabis Use Disorder when paired with any of the three psychiatric disorders. Furthermore, small proportions of respondents (13% to 20%) rated non-abstinence at least somewhat acceptable even when clients were diagnosed with a Severe SUD for any of the three substances and any co-occurring psychiatric disorder. Based on our findings, clients with co-occurring disorders who want to moderate their substance use will typically find their counselor does not accept that outcome goal. Because supporting non-abstinence respects client autonomy, could attract and retain clients in counseling, and is consistent with a recovery-oriented treatment model, we encourage continuing education about the benefits of non-abstinence as a treatment goal for clients with co-occurring disorders.
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Affiliation(s)
- Alan K Davis
- University of Michigan, United States; Bowling Green State University, United States.
| | - Harold Rosenberg
- University of Michigan, United States; Bowling Green State University, United States
| | - Joseph A Rosansky
- University of Michigan, United States; Bowling Green State University, United States
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20
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Racial and ethnic differences in associations between psychological distress and the presence of binge drinking: Results from the California health interview survey. Addict Behav 2017; 65:1-6. [PMID: 27697600 DOI: 10.1016/j.addbeh.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Racial and ethnic minorities often suffer from poorer health than Whites given their exposure to more stressors and fewer resources that buffer the effects of stress. Given that alcohol is often consumed to alleviate the negative moods, the present study hypothesized that psychological distress may impact the involvement in binge drinking differently across racial and ethnic groups. METHODS We used data from the California Health Interview Survey (CHIS) from 2007 to 2012. The sample consisted of 130,556 adults including African Americans (N=6541), Asians (N=13,508), Latinos (N=18,128), and Whites (N=92,379). Binary logistic regression analysis was used with consideration for complex survey design. RESULTS The results indicated that psychological distress was significantly associated with binge drinking across all racial and ethnic groups. However, this association differed by race and ethnicity adjusting for age, gender, marital status, education, poverty, and employment status. The results revealed that psychological distress had the largest effect on binge drinking for Asian Americans, particularly Filipinos and South Asians, compared to Whites. CONCLUSIONS This study highlights the importance of examining racial and ethnic differences in the impacts of psychological distress on alcohol consumption. Future research is needed to better understand the potential factors that mediate the effects of psychological distress on binge drinking specific to each racial and ethnic group in order to develop culturally sensitive interventions and hence decrease the alcohol-related racial health disparities.
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21
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Asian American and Pacific Islander substance use treatment admission trends. Drug Alcohol Depend 2017; 171:1-8. [PMID: 27988403 DOI: 10.1016/j.drugalcdep.2016.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/14/2016] [Accepted: 11/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND A national analysis of Asian Americans and Pacific Islanders (AAPI) substance use treatment admissions has yet to be studied. We sought to explore admission trends for AAPI, demographic and treatment variable change, and individual state admission change over time. METHODS We used retrospective time-series logistic regression treating year as a predictor of yearly treatment admission trends, between-state test for heterogeneity of treatment effects among states' AAPI admissions, and percent-changes of AAPI demographic and treatment characteristics. Participants included AAPI (n=135,356) and comparison non-AAPI (n=8,938,982) treatment groups' first-time admissions (N=9,074,338) in United States treatment centers receiving public funding from 2000 to 2012. RESULTS AAPI demonstrated a greater increase in admissions than non-AAPI from 2000 to 2012 (p<0.0001; OR=1.02, 95% CI=1.019-1.022). Large percent increases were demonstrated in multiple demographic and treatment characteristic, most notably in prescription opioids as a problem substance, age of first use for the oldest and youngest groups, and homelessness. In addition, trends are provided for individual states to help prioritize resource need. CONCLUSIONS The present demographic and treatment characteristics revealed specific variables that may help to improve a culturally competent understanding of increasing risk factors among AAPI clients. The present findings may help to demonstrate which states may need to increase AAPI-specific resources and interventions.
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22
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Luczak SE, Khoddam R, Yu S, Wall TL, Schwartz A, Sussman S. Review: Prevalence and co-occurrence of addictions in US ethnic/racial groups: Implications for genetic research. Am J Addict 2016; 26:424-436. [PMID: 27759944 DOI: 10.1111/ajad.12464] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/16/2016] [Accepted: 10/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We conducted a review of the prevalence and co-occurrence of 12 types of addictions in US ethnic/racial groups and discuss the implications of the results for genetic research on addictions. METHODS We utilized MEDLINE and PsycINFO databases to review the literature on alcohol, tobacco, marijuana, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We present results for each addiction based on total US prevalence, prevalence within ethnic groups, and co-occurrence of addictions among ethnic groups when available. RESULTS This review indicates very little research has examined the interrelationships of addictive behaviors among US ethnic groups. The studies that exist have focused nearly exclusively on comorbidity of substances and gambling behaviors. Overall findings suggest differences among US ethnic groups in prevalence of addictions and in prevalence of addiction among those who use substances or engage in gambling. Almost no ethnic group comparisons of other addictive behaviors including eating/food, internet, love, sex, exercise, work, and shopping were identified in the literature. CONCLUSIONS Despite large-scale research efforts to examine alcohol and substance use disorders in the United States, few studies have been published that examine these addictive behaviors among ethnic groups, and even fewer examine co-occurrence and comorbidity with other addictions. SCIENTIFIC SIGNIFICANCE Even with the limited studies, these findings have implications for genetic research on addictive behaviors. We include a discussion of these implications, including issues of population stratification, disaggregation, admixture, and the interplay between genetic and environmental factors in understanding the etiology and treatment of addictions. (Am J Addict 2017;26:424-436).
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Affiliation(s)
- Susan E Luczak
- University of Southern California, Los Angeles, California
| | - Rubin Khoddam
- University of Southern California, Los Angeles, California
| | - Sheila Yu
- University of Southern California, Los Angeles, California
| | - Tamara L Wall
- University of California, San Diego, San Diego, California.,Veterans Affairs San Diego Healthcare System, San Diego, California.,Veterans Medical Research Foundation, San Diego, California
| | - Anna Schwartz
- University of Southern California, Los Angeles, California
| | - Steve Sussman
- University of Southern California, Los Angeles, California
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Lacey KK, Mouzon DM, Govia IO, Matusko N, Forsythe-Brown I, Abelson JM, Jackson JS. Substance Abuse Among Blacks Across the Diaspora. Subst Use Misuse 2016; 51:1147-58. [PMID: 27191862 PMCID: PMC4912398 DOI: 10.3109/10826084.2016.1160124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Lower rates of substance abuse are found among Black Americans compared to Whites, but little is known about differences in substance abuse across ethnic groups within the black population. OBJECTIVES We examined prevalence rates of substance abuse among Blacks across three geographic regions (US, Jamaica, Guyana). The study also sought to ascertain whether length of time, national context and major depressive episodes (MDE) were associated with substance abuse. METHODS We utilized three different data sources based upon probability samples collected in three different countries. The samples included 3,570 African Americans and 1,621 US Caribbean Black adults from the 2001-2003 National Survey of American Life (NSAL). An additional 1,142 Guyanese Blacks and 1,176 Jamaican Blacks living in the Caribbean region were included from the 2005 NSAL replication extension study, Family Connections Across Generations and Nations (FCGN). Mental disorders were based upon DSM-IV criteria. For the analysis, we used descriptive statistics, chi-square, and multivariate logistic regression analytic procedures. RESULTS Prevalence of substance abuse varied by national context, with higher rates among Blacks within the United States compared to the Caribbean region. Rates of substance abuse were lower overall for women, but differ across cohorts by nativity and length of time in the United States, and in association with major depressive episode. CONCLUSIONS The study highlights the need for further examination of how substance abuse disparities between US-based and Caribbean-based populations may become manifested.
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Affiliation(s)
- Krim K Lacey
- a Program for Research on Black Americans , University of Michigan , Ann Arbor , Michigan , USA
| | - Dawne M Mouzon
- b Edward J. Bloustein School of Planning and Public Policy, Rutgers , The State University of New Jersey , New Brunswick , New Jersey , USA
| | - Ishtar O Govia
- a Program for Research on Black Americans , University of Michigan , Ann Arbor , Michigan , USA.,c Tropical Medicine Research Institute , University of the West Indies , Kingston , Jamaica
| | - Niki Matusko
- a Program for Research on Black Americans , University of Michigan , Ann Arbor , Michigan , USA
| | - Ivy Forsythe-Brown
- d Department of Behavioral Sciences , University of Michigan-Dearborn , Dearborn , Michigan , USA
| | - Jamie M Abelson
- a Program for Research on Black Americans , University of Michigan , Ann Arbor , Michigan , USA
| | - James S Jackson
- a Program for Research on Black Americans , University of Michigan , Ann Arbor , Michigan , USA
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Cacchione PZ, Eible L, Gill LL, Huege SF. Person-Centered Care for Older Adults With Serious Mental Illness and Substance Misuse Within a Program of All-Inclusive Care for the Elderly. J Gerontol Nurs 2016; 42:11-7. [PMID: 27110737 DOI: 10.3928/00989134-20160413-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Providing person-centered care (PCC) to older adults with dual diagnosis, co-occurring serious mental illness (SMI), and substance misuse is complex and requires an interprofessional team. Older adults, who qualify for both Medicaid and Medicare (i.e., dual-eligibles) are overrepresented in the population of older adults with SMI and substance misuse. Programs of All-Inclusive Care for the Elderly (PACE) exist to support community living needs of nursing home-eligible older adults and are increasingly in a position to serve older adults with SMI and substance misuse issues. PACE programs provide integrated person-centered mental health care to address the serious medical, social, and emotional complications posed by having SMI and substance misuse disorders. The case study presented illustrates PCC provided to a dual-diagnosis PACE participant, illustrating the impact of recent and past trauma on current psychopathology and substance misuse. Finally, recommendations for addressing PCC of dual diagnosis within the PACE model are provided. [Journal of Gerontological Nursing, 42(5), 11-17.].
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Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. J Womens Health (Larchmt) 2016; 25:729-37. [PMID: 27387193 DOI: 10.1089/jwh.2015.5328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.
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Affiliation(s)
- Sarah Meshberg-Cohen
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Candice Presseau
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut
| | - Leroy R Thacker
- 3 Department of Family and Community Health Nursing, Virginia Commonwealth University , Richmond, Virginia
| | - Kathryn Hefner
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Dace Svikis
- 4 Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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Lai HMX, Cleary M, Sitharthan T, Hunt GE. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug Alcohol Depend 2015; 154:1-13. [PMID: 26072219 DOI: 10.1016/j.drugalcdep.2015.05.031] [Citation(s) in RCA: 497] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. METHODS A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. RESULTS There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. CONCLUSIONS This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.
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Affiliation(s)
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, NSW, Australia.
| | | | - Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
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Leadership and Licensure for Drug Treatment and the Implementation of Co-Occurring Disorder Treatment in Community Mental Health Centers. Community Ment Health J 2015; 51:554-66. [PMID: 25982830 PMCID: PMC4476917 DOI: 10.1007/s10597-015-9886-0] [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: 11/01/2013] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Using a random sample of 48 outpatient mental health programs in low-income and racial and ethnic minority communities, this study examined directorial leadership, drug treatment licensure, and implementation of evidence-based protocols and practices to address co-occurring mental health and substance abuse disorders (COD). Understanding of findings was enhanced with focus groups at six clinics. Most programs (81 %) offered COD treatment. Directorial leadership was positively associated with COD treatment (β = 0.253, p = 0.047, 95 % CI 0.003, 0.502) and COD supervision and training (β = 0.358, p = 0.002, 95 % CI 0.142, 0.575). Licensure was negatively associated with COD treatment (β = -0.235, p = 0.041, 95 % CI -0.460, -0.010) and COD supervision and training (β = -0.195, p = 0.049, 95 % CI -0.389, -0.001). Although lack of financial integration may limit the effect of licensing on COD treatment implementation, the response of leaders to regulation, funding, and human resources issues may encourage COD treatment practices. Implications for leadership interventions and policy are discussed in the context of health care reform.
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Cross D, Crow T, Powers A, Bradley B. Childhood trauma, PTSD, and problematic alcohol and substance use in low-income, African-American men and women. CHILD ABUSE & NEGLECT 2015; 44:26-35. [PMID: 25680654 PMCID: PMC4461539 DOI: 10.1016/j.chiabu.2015.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 05/07/2023]
Abstract
Previous studies demonstrate that PTSD mediates the relationship between childhood trauma and alcohol and substance use disorders and that PTSD and alcohol/substance use comorbidity is greater in men than in women. We sought to replicate and extend these findings in a predominantly low-income, African-American sample recruited from a public hospital. We administered measures of childhood trauma, PTSD symptoms, problematic alcohol use, and problematic substance use to 803 men and 2084 women. We examined rates of comorbidity in men and women. Next, two bootstrap analyses were used to test whether PTSD is a mediator between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. Finally, two bootstrap analyses were used to test whether gender would moderate the indirect effect of PTSD in both the alcohol and substance use models. Results showed that although men and women reported similar overall PTSD symptom frequency, men were more likely than women to report PTSD comorbid with alcohol and/or substance use problems. In addition, PTSD partially mediated the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. The indirect effects of PTSD on the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use were greater in men. This study demonstrates the important interplay of gender, childhood trauma, PTSD, and alcohol and substance use. Mental health providers should consider childhood trauma histories and diagnostic comorbidities when treatment planning.
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Affiliation(s)
- Dorthie Cross
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Thomas Crow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Atlanta VA Medical Center
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Wu LT, Blazer DG. Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders. Psychol Med 2015; 45:481-494. [PMID: 25066115 PMCID: PMC4272661 DOI: 10.1017/s0033291714001330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. METHOD We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. RESULTS NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. CONCLUSIONS Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.
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Affiliation(s)
- L.-T. Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - D. G. Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
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Sepehrmanesh Z, Ahmadvand A, Moraveji A. Comorbidity and pattern of substance use in hospitalized psychiatric patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e19282. [PMID: 25389488 PMCID: PMC4222014 DOI: 10.5812/ircmj.19282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/15/2014] [Accepted: 06/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Substance use in patients with psychiatric disorder is an every-day seen. Detection of this comorbidity can significantly affect the treatment of these disorders, as well as substance use. OBJECTIVES This study has been conducted to determine the prevalence and pattern of substance use in hospitalized psychiatric patients. PATIENTS AND METHODS In this cross-sectional study, 210 hospitalized psychiatric patients were selected by simple randomization from all records of hospitalized patients. The instrument of gathering data was a demographic checklist including age, gender, marital status, education, type of disorder and substance abuse and duration of psychiatric disorder. Data were analyzed by SPSS version 16 using Fisher exact and Chi square tests. RESULTS The mean age of patients was 37.9 years. Most of the patients were male, married and unemployed. The Prevalence of substance use was 36.7%. The most prevalent pattern of substance use was opium, opioid, methamphetamines and other substances (poly substance). The prevalence of substance use in patients with mood disorders was more than the other disorders and the most prevalent substance use in these patients was opium and opioid. Poly substance use was the most prevalent pattern of use (80 %) in psychotic and mood disorders due to substance. Significant difference was seen between genders, marital status, occupation, duration of illness and frequency of substance use (P < 0.05 ), however no significant difference was seen between educational levels, age and substance use. CONCLUSIONS The patients with mood disorders had the highest comorbidity with substance use and concurrent use of poly substance was the most prevalent pattern of use in these patients. Therefore, successful treatment of psychiatric disorders and substance use needs multimodal and more serious interventions. Regarding to the pattern of poly substance use in these patients, careful screening should be performed at admission.
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Affiliation(s)
- Zahra Sepehrmanesh
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Afshin Ahmadvand
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Afshin Ahmadvand, Department of Psychiatry, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9131625987, E-mail:
| | - Alireza Moraveji
- Department of Epidemiology, Kashan University of Medical Sciences, Kashan, IR Iran
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Brook JS, Lee JY, Rubenstone E, Brook DW, Finch SJ. Triple comorbid trajectories of tobacco, alcohol, and marijuana use as predictors of antisocial personality disorder and generalized anxiety disorder among urban adults. Am J Public Health 2014; 104:1413-20. [PMID: 24922120 DOI: 10.2105/ajph.2014.301880] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD). METHODS We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses. RESULTS A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions. CONCLUSIONS Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology.
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Affiliation(s)
- Judith S Brook
- Judith S. Brook, Jung Yeon Lee, Elizabeth Rubenstone, and David W. Brook are with the Department of Psychiatry, New York University School of Medicine, New York, NY. Stephen J. Finch is with the Department of Applied Mathematics & Statistics, Stony Brook University, Stony Brook, NY
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Alzahrani H, Barton P, Brijnath B. Self-reported depression and its associated factors among male inpatients admitted for substance use disorders in Saudi Arabia. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.923054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guerrero EG, Kao D. Racial/ethnic minority and low-income hotspots and their geographic proximity to integrated care providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:34. [PMID: 24059252 PMCID: PMC3848872 DOI: 10.1186/1747-597x-8-34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
Abstract
Background The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. However, access to integrated care is limited to certain communities. Racial and ethnic minority and low-income communities may not have access to needed integrated care in large urban areas. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities. Methods National Survey of Substance Abuse Treatment Services data from 2010 were used to examine geographic availability of facilities offering integration of mental health services in SAT programs in Los Angeles County, California. Using geographic information systems (GIS), service areas were constructed for each facility (N = 402 facilities; 104 offering integrated services) representing the surrounding area within a 10-minute drive. Spatial autocorrelation analyses were used to derive hot spots (or clusters) of census tracts with high concentrations of African American, Asian, Latino, and low-income households. Access to integrated care was reflected by the hot spot coverage of each facility, i.e., the proportion of its service area that overlapped with each type of hot spot. Results GIS analysis suggested that ethnic and low-income communities have limited access to facilities offering integrated care; only one fourth of SAT providers offered integrated care. Regression analysis showed facilities whose service areas overlapped more with Latino hot spots were less likely to offer integrated care, as well as a potential interaction effect between Latino and high-poverty hot spots. Conclusion Despite significant pressure to enhance access to integrated services, ethnic and racial minority communities are disadvantaged in terms of proximity to this type of care. These findings can inform health care policy to increase geographic access to integrated care for the increasing number of clients with public health insurance.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
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Qureshi A, Garcia Campayo J, Eiroa-Orosa FJ, Sobradiel N, Collazos F, Febrel Bordejé M, Roncero C, Andrés E, Casas M. Epidemiology of substance abuse among migrants compared to native born population in primary care. Am J Addict 2013; 23:337-42. [DOI: 10.1111/j.1521-0391.2013.12103.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/12/2013] [Accepted: 07/14/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Adil Qureshi
- Department of Psychiatry; University Hospital Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Javier Garcia Campayo
- Department of Psychiatry; University Hospital Miguel Servet, Zaragoza University; Barcelona Spain
| | | | - Natalia Sobradiel
- Department of Psychiatry; University Hospital Miguel Servet, Zaragoza University; Barcelona Spain
| | - Francisco Collazos
- Department of Psychiatry; University Hospital Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Psychiatry and Legal Medicine; Universitat Autónoma de Barcelona; Barcelona Spain
| | - Mercedes Febrel Bordejé
- Department of Psychiatry; University Hospital Miguel Servet, Zaragoza University; Barcelona Spain
| | - Carlos Roncero
- Department of Psychiatry; University Hospital Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Psychiatry and Legal Medicine; Universitat Autónoma de Barcelona; Barcelona Spain
| | - Eva Andrés
- Department of Psychiatry; University Hospital Miguel Servet, Zaragoza University; Barcelona Spain
| | - Miguel Casas
- Department of Psychiatry; University Hospital Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Psychiatry and Legal Medicine; Universitat Autónoma de Barcelona; Barcelona Spain
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