Violence among men and women in substance use disorder treatment: a multi-level event-based analysis

Social support networks of incarcerated women with opioid use disorder: Differences associated with jail-based substance use treatment

INTRODUCTION

Social support is a critical factor for women's engagement with substance use treatment and recovery, particularly for women with criminal-legal system involvement. However, less is known about the social support networks of incarcerated women, particularly as a function of service engagement. Thus, this paper aims to describe the structure, composition, and function of social support networks of women with opioid use disorder (OUD) incarcerated in jails; and compare network differences between women receiving jail-based substance use treatment and non-treatment participants.

METHODS

As part of a larger clinical trial under the NIDA-funded Justice Community Opioid Innovation Network (JCOIN), staff conducted an egocentric social network inventory with women who were randomly selected from eight jails in Kentucky, screened for OUD, and consented (N = 445). Women were asked to name people (alters) who provided them with support in the past 90 days and respond to questions about alters who were named. Bivariate comparisons examined differences in social networks among women who were currently receiving jail-based treatment (29.9 %, n = 133) and those who were incarcerated, but not receiving treatment (70.1 %, n = 312).

RESULTS

On average, women's social support networks consisted of 2.4 alters (range 1-9). Compared to women with OUD who were not receiving treatment, those in treatment were significantly more likely to name at least one alter who was in recovery (57.9 % vs. 43.9 %, p = .007) and less likely to name a partner (21.8 % vs. 37.8 %, p = .001) or someone who had recently used opioids (9.8 % vs. 24.7 %, p < .001). On average, women in treatment also felt significantly closer to their alters (4.70 vs. 4.55 out of 5, p = .021) and rated alters as fulfilling more types of social support functions (5.54 vs. 5.18 out of 6, p < .001) and recovery support functions (2.83 vs. 2.70 out of 3, p = .016).

CONCLUSION

Results suggest that women participating in jail-based substance use treatment reported more positive social support network attributes, including network function and composition. Future research should assess longitudinal changes in networks and associated differences in recovery outcomes as women are released to the community.

Dual-substance use disorder couples: An integrative review and proposed theoretical model

Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.

Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review

Introduction

Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV.

Methods

A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD).

Results

Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics.

Discussion

Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.

Variation by race/ethnicity-gender in the relationship between arrest history and alcohol use

BACKGROUND

Alcohol use contributes to the national burden of morbidity and mortality in the United States. Arrest, as a unique form of criminal justice system involvement, may be related to alcohol use from adolescence to adulthood. This study investigates the relationship between arrest and alcohol use across race/ethnicity-gender (R/E-G) status (e.g., Black, Latinx, and White men and women) as youth age.

METHODS

Data from 17 waves (1997-2015) of the National Longitudinal Survey of Youth, 1997 cohort (N = 8901) were used to explore how variation in R/E-G moderates the relationship between arrest history and alcohol use trajectories from 13 to 30 years old. Multilevel zero-inflated Poisson and Poisson regression were used to assess R/E-G variation in the relationship between arrest history and days of alcohol consumption, drinks per drinking occasion, and days of binge drinking after accounting for covariates, including incarceration.

RESULTS

The findings indicate that an arrest history is associated with alcohol use, and these results varied by R/E-G status, age, and alcohol use outcome. Those with an arrest history reported more days of drinking than their counterparts without an arrest; yet, the magnitude and direction of average drinks per occasion and binge drinking days varied by R/E-G status and age. Paradoxically, Black men, Black women, and Latinx men with an arrest history reported fewer days of binge drinking as they aged than their counterparts without an arrest.

CONCLUSIONS

A history of arrest is important for alcohol use from adolescence to adulthood and varies by R/E-G status, age, and alcohol use outcome. This work confirms previous scholarship showing that arrest and alcohol use are socially patterned and R/E-G status is an essential consideration in understanding the relationship. Future work should include additional identities and health behaviors and the consequences related to alcohol use outcomes.

A latent class analysis of mental disorders, substance use, and aggressive antisocial behavior among Swedish forensic psychiatric patients

BACKGROUND

Patients in the forensic mental health services (FMHS) with a mental disorder, a co-occurring substance use disorder (SUD), and high risk of aggressive antisocial behavior (AAB) are sometimes referred to as the 'triply troubled'. They suffer poor treatment outcomes, high rates of criminal recidivism, and increased risk of drug related mortality. To improve treatment for this heterogeneous patient group, more insight is needed concerning their co-occurring mental disorders, types of substances used, and the consequent risk of AAB.

METHODS

A three-step latent class analysis (LCA) was used to identify clinically relevant subgroups in a sample of patients (n = 98) from a high-security FMHS clinic in Sweden based on patterns in their history of mental disorders, SUD, types of substances used, and AAB.

RESULTS

A four-class model best fit our data: class 1 (42%) had a high probability of SUD, psychosis, and having used all substances; class 2 (26%) had a high probability of psychosis and cannabis use; class 3 (22%) had a high probability of autism and no substance use; and class 4 (10%) had a high probability of personality disorders and having used all substances. Both polysubstance classes (1 and 4) had a significantly more extensive history of AAB compared to classes 2 and 3. Class 3 and class 4 had extensive histories of self-directed aggression.

CONCLUSIONS

The present study helps disentangle the heterogeneity of the 'triply troubled' patient group in FMHS. The results provide an illustration of a more person-oriented perspective on patient comorbidity and types of substances used which could benefit clinical assessment, treatment planning, and risk-management among patients in forensic psychiatric care.

Combined use of cocaine and alcohol: A violent cocktail? A systematic review

It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents. In the current systematic review, available data from human studies on the relation between cocaine and violent behaviour is presented. In particular, we present scientific data on the acute induction of violence by cocaine alone, as well as, that by the combination of cocaine and alcohol known to be frequently used simultaneously. RESULTS: show that there is only weak scientific evidence for the acute induction of violent behaviour by cocaine, either when used alone or in combination with alcohol. Based on these data we were also able to refute misconceptions about the relation between cocaine and violence published in the popular press and governmental reports, because it appeared that there was hardly any empirical support for this widely shared opinion. Probably, contextual factors, including cocaine use disorder and personality disorder, may better explain the assumed association between cocaine and violence.

Prevalence, incidence, deaths, and disability-adjusted life-years of drug use disorders for 204 countries and territories during the past 30 years

Drug use disorders are increasingly recognized as the main cause of public health issues worldwide. The current analysis aims to provide the most comprehensive, updated estimates of the burden from drug use disorders at global, regional, and national levels during the past three decades. Prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were estimated from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 by age and sex for drug use disorder as well as its four main categories (opioid use disorders, cocaine use disorders, amphetamine use disorders, and cannabis use disorders) in 204 countries and territories between 1990 and 2019. DisMod-MR 2.1, and Bayesian meta-regression were used to analyze prevalence and incidence, while the Cause of Death Ensemble model (CODEm) was used to estimate death of diseases. Globally, the burden of drug use disorders, as measured by the average annual percentage change (AAPC) of deaths and DALYs, continues to increase. The patterns by regions of DALYs due to drug use disorders varied significantly, and it is mainly in developed countries and concentrated among young people and males. Programs for drug use disorders management should be improved, particularly in opioid use disorders. Governments will face increasing demand for treatment and support services, and effective prevention as well as control strategies are required to reduce the burden from these causes.

Association Between Cannabis and Violence in Community-Dwelling Patients With Severe Mental Disorders: A Cross-sectional Study Using Machine Learning

The objective of this cross-sectional study was to identify cannabis-related features and other characteristics predictive of violence using a data-driven approach in patients with severe mental disorders (SMDs). A Least Absolute Shrinkage and Selection Operator regularization regression model was used on the database consisting of 97 patients with SMD who completed questionnaires measuring substance use and violence. Cannabis use, particularly related to patients' decision to consume or time spent using, was a key predictor associated with violence. Other patterns of substance use and personality traits were identified as strong predictors. Regular patterns of cannabis use and interpersonal issues related to cannabis/stimulant abuse were inversely correlated to violence. This study identified the effect of several predictors correlated to violence in patients with SMD using a regularization regression model. Findings open the door to better identify the profiles of patients that may be more susceptible to perpetrate violent behaviors.

A randomized controlled trial examining the effects of intranasal oxytocin on alcohol craving and intimate partner aggression among couples

BACKGROUND

While alcohol use disorder (AUD) is a well-established risk factor for intimate partner aggression (IPA), effective treatments for co-occurring AUD and IPA (AUD/IPA) are lacking. Oxytocin is one promising pharmacological candidate for AUD/IPA given its potential to modulate social behavior and attenuate alcohol use. However, emerging data suggests that oxytocin's prosocial effects are inconsistent, and a small number of studies have also found that oxytocin might have the potential to be aggressogenic. No studies have directly examined the impact of oxytocin on alcohol- or IPA-related outcomes in a dyadic context.

METHODS

The goal of this double-blind, randomized, and placebo-controlled trial was to examine the effects of a single dose of intranasal oxytocin (40 international units) on cue-induced alcohol craving, subjective aggression, laboratory task-based IPA, and cortisol reactivity in a sample of 100 couples (N = 200 individuals) with AUD and physical IPA in their current relationship.

RESULTS

There were no statistically significant differences between the oxytocin and placebo conditions for any of the primary outcomes.

CONCLUSIONS

Findings suggest that a single dose of intranasal oxytocin was not efficacious in mitigating alcohol craving or aggression in this sample. Although hypotheses were not supported, the findings provide important evidence that oxytocin was not aggressogenic in this high-risk sample. Future research investigating dispositional and contextual moderators of oxytocin response in addition to the therapeutic effects of more intensive oxytocin dosing or administration strategies on alcohol craving and aggression is warranted.

The impact of social network dynamics on engagement in drug use reduction programs among men and women who use drugs

BACKGROUND

Cross-sectional studies have shown strong relationships between social network characteristics and substance use disorder (SUD) treatment engagement. The current study examined associations between longitudinal changes in egocentric social networks of male and female people who use drugs (PWUD) and engagement in drug use reduction programs, broadly defined as either formal SUD treatment or self-help groups.

METHOD

Using data from an HIV prevention and care study in Baltimore, MD, this study categorized PWUD into those who engaged and did not engage in any drug use reduction programs over two follow-ups during a one-year observation window. The study used multivariate logistic generalized estimating equations (GEE) to examine associations between network composition and stability measures and drug use reduction program engagement, stratified by gender.

RESULTS

Of the 176 subjects participating in drug use reduction programs at baseline, 56.3% remained engaged at one year. Among both male and female respondents, higher turnover into non-kin networks was associated with increased odds of engagement in drug use reduction programs (AOR 1.4; 95% CI: 1.1-1.9, AOR 1.3; 95% CI: 1.0-1.8, respectively). For males, retention of intimate partner networks was associated with increased odds of program engagement (AOR 2.9; 95% CI: 1.1-7.6); for females, higher turnover into kin networks was associated with decreased odds of engagement (AOR 0.8; 95% CI: 0.5-1.0).

CONCLUSION

Evaluation of associations between social network characteristics and drug use reduction program engagement appears to benefit from longitudinal analyses that are stratified by gender. Efforts to improve retention in formal SUD treatment or self-help groups might consider intervening through social networks, perhaps by increasing overall levels of social support.

The Perceptions of Domestic Violence by a Family Member Who Uses Crack or Cocaine: A Secondary Retrospective Cross-Sectional Study

OBJECTIVE

To evaluate the relationship between crack/cocaine use and domestic violence perpetration from the perspective of substance users' families. A secondary retrospective cross-sectional study, with 3162 family members of crack/cocaine users seeking treatment in the Recomeço Família Programme in São Paulo/Brazil was undertaken. Family members of crack/cocaine users reported that their relatives were more involved in domestic violence such as stealing (money and objects) at home [Odds Ratio Adjusted ORA = 2.17 (CI 95% 1.87; 2.53)], the family gave money to the user to buy drugs [ORA = 1.27 (1.08; 1.48)], and having problems with the judiciary [ORA = 1.48 (CI 95% 1.28; 1.71)]. Relatives of snorted cocaine users reported that there was physical and interpersonal violence, such as fathers being assaulted [ORA = 2.50 (CI 95% 1.08; 5.82)], assaulted someone else [ORA = 1.86 (CI 95% 1.32; 2.60)], threats of violence fights, arguments when the family talk about problematic drug use [ORA = 1.50 (CI 95% 1.13; 1.96)] and threatened some family members [ORA = 1.52 (CI 95% 1.14; 2.04)]. In this sample, there was a connection between crack/cocaine use and the perpetuation of domestic violence, corroborating with important implications for public policies, substance use treatment and prevention of domestic violence interventions.

Psychological Interventions on Abstinence in Patients with Alcohol Use Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

PURPOSE

Accumulating research suggests that psychotherapy helps improve abstinence but the difference in the efficacy of multiple psychotherapies in alcohol use disorder (AUD) remains to be explored.

PATIENTS AND METHODS

A systematic search of databases (Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and EBSCO) for studies (published from inception to April 10th.) of adults diagnosed with AUD accepting psychotherapies was conducted. Studies covering 9 countries and regions. The qualitative analysis pooled 2646 individuals from 34 randomized controlled trials (RCTs) and the networks included 1928 participants (23 RCTs). The outcomes included percentage of days abstinent (PDA), change in drinks per drinking day (change in DDD), and change in craving compared among individuals accepting various psychotherapies. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered on the International Prospective Register of Systematic Reviews (PROSPERO).

RESULTS

For the network of PDA, motivational enhancement treatment (MET) (35.44, 11.78 to 59.09, high-certainty) and couple therapy (CT) (28.89, 13.42 to 44.36, moderate-certainty) were significantly different from treatment as usual (TAU) with the surface under the cumulative ranking curve (SUCRA) mean rank 1.9 and 1.9 respectively. TAU+supportive psychotherapy (SP) was better than TAU for the change in DDD in the high-quality direct comparison.

CONCLUSION

The motivational enhancement and the couple therapy show potential amelioration for alcohol abstinence. Additionally, the preferred interventions are different for improving PDA and change in DDD. The evidence network remains to be strengthened.

Schizophrenia and substance use disorder: Characteristics of coexisting issues in a forensic setting

BACKGROUND AND AIMS

Recent research has identified higher prevalence of offending behavior in patients with comorbid schizophrenia spectrum disorder (SSD) and substance use disorder (SUD) compared to patients with SSD only and to the general population. However, findings on the subgroup of patients with SUD, SSD and offending behavior in forensic psychiatric care are scarce and inconsistent. The present study used machine learning to uncover more detailed characteristics of offender patients in forensic psychiatric care with comorbid SSD and SUD.

METHODS

Using machine learning algorithms, 370 offender patients (91.6 % male, mean age of M = 34.1, SD = 10.2) and 558 variables were explored in order to build three models to differentiate between no substance use disorder, cannabis use disorder and any other substance use disorder. To counteract the risk of overfitting, the dataset was split, employing variable filtering, machine learning model building and selection embedded in a nested resampling approach on one subset. The best model was then selected and validated on the second data subset.

RESULTS

Distinguishing between SUD vs. no drug use disorder yielded models with an AUC of 70 and 78. Variables assignable to demographics, social disintegration, antisocial behavior and illness were identified as most influential for the distinction. The model comparing cannabis use disorder with other substance use disorders provided no significant differences.

CONCLUSIONS

From a clinical perspective, offender patients suffering from schizophrenia spectrum and comorbid substance use disorder seem particularly challenging to treat, but initial differences in psychopathology will dissipate over inpatient treatment. Our data suggest that offender patients may benefit from appropriate treatment that focuses on illicit drug abuse to reduce criminal behavior and improve social integration.

Addressing Key Gaps in Existing Longitudinal Research and Establishing a Pathway Forward for Firearm Violence Prevention Research

The main purpose of this article and this special section is to encourage greater attention to the key gaps that exist in our understanding of the epidemiology of adolescent firearm violence and to provide a pathway forward for future longitudinal research that will inform prevention efforts. This increased attention is especially salient given: (a) firearms are the leading cause of death for adolescents and emerging adults in the United States, with the majority of these deaths due to interpersonal violence; (b) significant health and social disparities with regards to the populations that are most affected by interpersonal firearm violence have been documented; and, (c) limitations in federal research funding during the past 30 years have created a deficit of knowledge about key risk and protective factors necessary to inform evidence-based prevention efforts. We discuss the implications of the articles in this special edition for existing and novel prevention programs. We also identify key considerations for future epidemiological research, including the need for a greater focus on collecting longitudinal data among nationally representative samples enriched with subgroups of at-risk youth, the need to examine the role of protective factors and mediating variables within existing and novel theoretical models of firearm risk behaviors, the need to examine key factors across all levels of the socio-ecological model, and the need to incorporate novel and innovative research designs, methods and analyses.

Within- and between-person associations with drug use disorder among adolescents and emerging adults presenting to an urban emergency department

BACKGROUND

The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use.

METHODS

Research staff recruited youth age 14-24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects.

RESULTS

Among 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects.

CONCLUSIONS

DUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.

Relationships between insomnia and alcohol and cocaine use frequency with aggression among veterans engaged in substance use treatment

BACKGROUND

Veterans with substance use problems have rates of partner and non-partner violence that typically exceed the general population. Sleep problems may exacerbate violence and maintain addictive behaviors in non-veterans, but requires study in veterans. Therefore, we examine the interrelationships between substance use, insomnia, and violence in veterans.

METHODS

Veterans (N = 762) screened for a randomized controlled trial at veterans affairs mental health and substance use clinics. Participants completed modified Conflict Tactics Scales to quantify past-year violence and the Insomnia Symptom Questionnaire to assess sleep disturbance. We evaluated associations between substance use and sleep in predicting the target of aggression (partner or non-partner) and degree of violence (aggression or injury) using binomial logistic regressions.

RESULTS

Half of participants endorsed symptoms suggestive of insomnia, 23.2% endorsed physical aggression toward partners (PA-P) and 33.9% non-partners (PA-NP), and 9.7% endorsed physical injury of partners (PI-P) and 17.6% of non-partners (PI-NP). Regressions revealed significant models for PA-P, PA-NP, and PI-NP, whereas the PI-P model was not significant. PA-P was higher among non-Caucasian race and older veterans. PA-NP was more common in those with insomnia and increased with frequency of cocaine use. Insomnia moderated the relationship between cocaine use and PA-NP; there was a weaker relationship between cocaine use and PA-NP in those with insomnia. PI-NP was more common with higher frequency of alcohol and cocaine use, and in those with insomnia.

CONCLUSIONS

This study finds sleep disturbances are meaningful predictors of violence among veterans with differential relationships with aggression severity, victims, and substance use concurrence.

Effects of couple conflict on alcohol craving: Does intimate partner violence play a role?

OBJECTIVE

Social stress in the form of maladaptive relationship conflict is a common precipitant to alcohol misuse and problems. Research has also established a clear causal association between alcohol misuse and relationship conflict in the form of intimate partner violence (IPV). Despite the robust literature linking relationship conflict and problematic drinking using survey methodology, no laboratory studies have examined the proximal association between relationship conflict and alcohol craving among couples, or the influence of IPV perpetration and victimization on this association.

METHOD

As part of a larger randomized controlled trial, 30 different-sex community couples with substance misuse completed a laboratory conflict resolution task. Participants reported subjective alcohol craving on a Likert-type scale immediately, before, and after the task. Conflict behaviors were coded by trained observers. Analyses were conducted using a multilevel modeling framework to account for the dyadic nature of the data.

RESULTS

Findings indicate that psychological and physical IPV perpetration and victimization strengthened the associations between negative and positive conflict behaviors and alcohol craving among men only. Contrary to our hypotheses, no main or moderating effects of conflict behaviors, IPV perpetration, or IPV victimization were found for women.

CONCLUSIONS

Findings from this exploratory study suggest that in this sample, relationship conflict and IPV in one's current relationship played a more impactful role on acute alcohol craving among men compared to women. Future studies should examine the role of specific conflict behaviors on alcohol craving and relapse risk, and patterns of communication that might increase or reduce risk for exacerbated alcohol craving.

Association of Cannabis Use With Intimate Partner Violence Among Couples With Substance Misuse

BACKGROUND AND OBJECTIVES

There is a well-established causal link between substance use and intimate partner violence (IPV) perpetration and victimization. However, little is known about the complex emerging relationship between cannabis use and IPV. Because cannabis is the most commonly used drug in the United States and is associated with numerous IPV risk factors such as alcohol use, it is important to examine this relationship in greater detail.

METHOD

The current exploratory study examined the association between (a) self-reported cannabis use during the past 90 days and (b) Δ9-tetrahydrocannabinol (THC) urine drug screens and IPV perpetration and victimization in a sample of 30 alcohol or drug-misusing community couples (N = 60 individual participants).

RESULTS

The majority of participants (n = 50 individuals, 83.3%) had concordant cannabis self-reported and urine drug screen results. After accounting for demographic variables and quantity and frequency of alcohol and stimulant use, greater quantity and frequency of cannabis use as well as positive THC urine drug screen results were associated with greater physical IPV victimization, and greater quantity and frequency of cannabis were associated with greater IPV psychological victimization and perpetration, and physical IPV victimization. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Findings emphasize the unique and important role that cannabis plays in the occurrence of IPV among intact couples. Findings also underscore the feasibility and utility of integrating confirmatory biological samples into future studies on this topic in order to advance the science in this area. (Am J Addict 2020;00:00-00).

Daily patterns of substance use and violence among a high-risk urban emerging adult sample: Results from the Flint Youth Injury Study

OBJECTIVE

Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples.

METHODS

Within an RCT comparing ILM assessment/schedule methods, 162-participants completed daily IVR (n = 81) or SMS (n = 81) assessments measuring 19 substance use and violence (partner/non-partner) behaviors daily for 90-days. GLMMs characterized between- and within-person predictors of daily violence.

RESULTS

Participants [48.7%-female; age = 24.4; 62.3%-African-American; 66.7%-public assistance] completed an average of 46.5 daily reports [SD = 26.7]. Across 90-days, alcohol was characterized by episodic weekend use (average = 10 days-of-use, 34.4% drinking-days involved binge-drinking), while marijuana use was continuous (average = 27 days-of-use; 1.7 times/day), with no weekend differences. Among 118-violent conflicts, 52.5% occurred on weekends; 57.6% were with non-partners/peers; 61.0% involved perpetration/57.6% victimization; and 52.5% involved severe violence. For violence conflicts, 27.1% were preceded by alcohol/22.9% preceded by drug use. Between-person predictors of daily violence included retaliatory attitudes (AOR = 3.2) and anxiety (AOR = 1.1). Within-person predictors included weekends (AOR = 1.6), binge drinking (AOR = 1.9), non-medical prescription opioid use (AOR = 3.5) and illicit drug use (AOR = 8.1).

CONCLUSION

Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.

Drug Use Disorders and Violence: Associations With Individual Drug Categories

We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990–2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio =  2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.

Rates and correlates of risky firearm behaviors among adolescents and young adults treated in an urban emergency department

Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury related care (7/2017-6/2018) at a Level-1 urban Emergency Department (ED). In total, 1312 A/YAs completed the survey (mean-age 23.2; 29.6%-male; 50.5%-Black; 56.3%-public assistance), with 102 (7.8%) engaging in RFBs. Among those engaging in RFBs, 42% reported firearm ownership, 68.6% firearm carriage in high-risk situations, 39.2% firearm discharge in risky situations, and 41.2% reported partner/non-partner firearm aggression. Regression identified RFBs correlates, including older age (AOR = 1.09), male sex (AOR = 1.63), Black race/ethnicity (AOR = 2.01), substance misuse (AOR = 2.75), attitudes favoring firearm use/retaliation (AOR = 1.38), peer firearm ownership/carriage (AOR = 3.26), higher levels of community violence exposure (AOR = 1.05), and active parole/probation (AOR 2.38). Higher coping skills were protective for RFBs (AOR = 0.83). Overall, we found that A/YAs seeking urban ED treatment reported elevated RFB rates, emphasizing the need for novel prevention initiatives, especially those incorporating tailored content addressing substance use, retaliatory violence, and peer delinquency/norms, while enhancing self-efficacy for avoiding RFBs and providing access to external resources within a resiliency-based framework. Such prevention approaches may be a critical step towards addressing the public health problem of firearm violence. Primary Funding Sources: NIH/NIDA K23DA039341; NIH/NCATS UL1TR000433.

Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy

Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.

Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review

This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner's drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.

Tracking Assault-injured, Drug-using Youth in Longitudinal Research: Follow-up Methods

OBJECTIVES

Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants.

METHODS

The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months.

RESULTS

A total of 599 patients (ages 14-24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per follow-up time frame to complete a follow-up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts.

CONCLUSIONS

The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.

Coping and violence perpetration in a residential substance use disorder treatment sample

Background: Individuals in substance use disorder treatment report high rates of violence against partners and non-partners. There is growing interest in integrated coping-oriented treatment approaches for violence and substance use concerns, yet little is known about the relationship between specific coping responses and perpetration of partner and non-partner violence. Objective: This cross-sectional study evaluated relationships between coping responses and partner and non-partner physical assault perpetration in a substance use disorder treatment sample. Methods: Participants included 343 men (76%) and women (24%) who completed self-report survey measures of coping responses, violence perpetration, and substance use as part of screening for a randomized trial. Negative binomial regression was used to examine relationships between coping strategies and partner and non-partner violence perpetration, when accounting for substance use and demographic factors. Results: About one-third of participants reported partner violence perpetration (30%) and non-partner violence perpetration (34%). Frequency of partner violence and non-partner violence were both associated with more use of avoidant and emotion-focused strategies and less use of problem-focused coping in adjusted models. Discussion: Continued research is warranted to determine whether coping-oriented interventions decrease violence among people in substance use disorder treatment.

Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis

Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.

Integrating intimate partner violence and parenting intervention into residential substance use disorder treatment for fathers

Despite positive outcomes for the incorporation of gender- and motherhood-focused programing within substance use disorder treatment programs for women, a focus on gender and fatherhood has not been the focus of intervention or evaluation research for men in substance use disorder treatment. This was a mixed method study to examine the initial feasibility of incorporating a fatherhood-focused intervention within a substance use disorder treatment program for men. Forty-four fathers enrolled in a coordinated intervention for intimate partner violence and parenting. Interviews were conducted at baseline and follow-up to assess the impact of the intervention on anger, hostile thinking and emotion regulation problems. Focus groups were also conducted with the participants to gain further insight into their needs as fathers and their recommendations for interventions that they would find helpful. Results indicated a high prevalence of anger related thoughts at baseline that significantly decreased at follow up; there were also significant reductions in affect regulation problems. Importantly, 84.1% of participants completed the program in its entirety and were highly satisfied with the content. These findings suggest that Fathers for Change can be implemented, successfully, in a men's residential treatment program.

A Latent Profile Analysis of Aggression and Victimization Across Relationship Types Among Veterans Who Use Substances

OBJECTIVE

This study examined patterns of violence victimization and aggression in both intimate partner and nonpartner relationships among U.S. military veterans using latent profile analysis to identify subtypes of violence involvement.

METHOD

Participants were 839 substance use treatment-seeking veterans (93% male) from a large Veterans Affairs Medical Center who completed screening measures for a randomized controlled trial.

RESULTS

Past-year violence involvement, including both intimate partner violence (IPV) and nonpartner violence (NPV), was common in the sample, although NPV occurred at somewhat higher rates. When we included either IPV or NPV aggression or victimization, more than 40% reported involvement with physical violence, 30% with violence involving injury, and 86% with psychological aggression. Latent profile analysis including both aggression and victimization in partner and nonpartner relationships indicated a four-profile solution: no/low violence (NLV; n = 377), predominantly IPV (n = 219), predominantly NPV (n = 134), and high general violence (HGV; n = 109). Multinomial logistic regression analyses revealed that, compared with the NLV group, the remaining three groups differed in age, cocaine use, posttraumatic stress disorder (PTSD) symptoms, and legal involvement. Legal issues appeared to differentiate the profiles most, with the predominantly NPV and HGV profiles reporting more instances of driving under the influence and the HGV profile reporting legal problems related to aggression.

CONCLUSIONS

IPV and NPV are fairly common among veterans seeking substance use treatment. The clinical characteristics of violence profiles indicate that cocaine use, PTSD symptoms, and legal involvement are treatment needs that vary with violence profile and may be useful for clinical decision making.

Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences

AIMS

This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development.

METHODS

Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups.

RESULTS

Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group).

CONCLUSIONS

Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.

Developing an Integrated Violence Prevention for Men and Women in Treatment for Substance Use Disorders

Rates of past-year partner and non-partner violence perpetration (VP) in substance use disorder (SUD) treatment samples exceed 50%, with studies showing rates of past-year VP exceeding 70% when considering violence occurring with either intimate partners or non-partners. However, SUD treatment programs typically do not include VP prevention interventions, and the few studies examining the impact of SUD interventions on VP have focused exclusively on partner VP. This study summarizes results of a randomized controlled pilot study of an Integrated Violence Prevention Treatment (IVPT) designed to address VP across partner and non-partner relationships as well as predictors of post-treatment VP. Participants were men (70%) and women (30%) in SUD treatment reporting past-year VP who were randomized to either IVPT or a control condition. The IVPT involved a Motivational Interviewing session targeting interpersonal conflicts, followed by five cognitive-behavioral therapy sessions focusing on VP prevention skills. The control condition included a session including a videotape and discussion of anger management, followed by five psycho-educational sessions common for SUD settings. Results showed that VP (total, partner, and non-partner) and cocaine use significantly decreased between baseline and 3-month follow-up for both conditions, and the IVPT group showed a significant decline in alcohol use. Analyses focusing on VP during follow-up revealed that baseline cocaine use and drinking during the follow-up predicted post-treatment VP. Together, these findings suggest that IVPT is a promising intervention (feasible, appears to impact drinking, an important factor related to violence) but that additional continuing care approaches may be indicated to sustain positive outcomes.

Persistency of Cannabis Use Predicts Violence following Acute Psychiatric Discharge

BACKGROUND

Violence is a major concern and is prevalent across several mental disorders. The use of substances has been associated with an exacerbation of psychiatric symptoms as well as with violence. Compared to other substances such as alcohol and cocaine, existing literature on the cannabis-violence relationship has been more limited, with most studies being conducted in the general population, and has shown controversial results. Evidence has suggested a stronger relationship when examining the effects of the persistency of cannabis use on future violent behaviors. Though, while cannabis use is highly prevalent amid psychiatric patients, far less literature on the subject has been conducted in this population. Hence, the present prospective study aims to investigate the persistency of cannabis use in psychiatric patients.

METHOD

The sample comprised of 1,136 recently discharged psychiatric patients provided by the MacArthur Risk Assessment Study. A multi-wave (five-assessment) follow-up design was employed to allow temporal sequencing between substance use and violent behaviors. Generalized estimating equations (GEE) were used to examine the effect of persistency of cannabis use on violence, while controlling for potential confounding factors. Potential bidirectional association was also investigated using the same statistical approach.

RESULTS

Our results suggest a unidirectional association between cannabis use and violence. GEE model revealed that the continuity of cannabis use across more than one time wave was associated with increased risks of future violent behavior. Patients who reported having used cannabis at each follow-up periods were 2.44 times more likely to display violent behaviors (OR = 2.44, 95% CI: 1.06-5.63, p < 0.05).

CONCLUSION

These findings are particularly relevant as they suggest that the longer individuals report having used cannabis after a psychiatric discharge, the more likely they are of being violent in the following time waves. These results add to our understanding of the negative consequences of chronic cannabis use amid psychiatric patients.

Associations between PTSD and intimate partner and non-partner aggression among substance using veterans in specialty mental health

BACKGROUND

Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration.

METHODS

Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM), probable PTSD (PCL-C), and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment.

RESULTS

In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ²=11.46, p=0.001, φ=0.12; non-partner physical, χ²=50.64, p<0.001, φ=0.25; partner injury, χ²=6.41, p=0.011, φ=0.09; non-partner injury, χ²=42.71, p<0.001, φ=0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics, probable PTSD was independently associated with non-partner physical (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.97-4.05) and injury aggression (OR, 3.96; CI, 2.56-6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively.

CONCLUSIONS

The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.

Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviors Among People Who Inject Drugs

BACKGROUND

Alcohol is associated with a multitude of severe health consequences. While risk behaviors related to illicit drug use are commonly studied among people who inject drugs (PWID), the role of alcohol use has received substantially less attention in this population. We explored whether drug and sexual risk behaviors as well as experiences of violence were associated with hazardous alcohol use in a cohort of PWID.

METHODS

Analyses were conducted using observational data from a prospective cohort of community-recruited HIV-negative PWID in Vancouver, Canada. We used the U.S. National Institute on Alcohol Abuse and Alcoholism definition of hazardous alcohol use (i.e., >14 drinks/wk or >4 drinks on 1 occasion for men, and >7 drinks/wk or >3 drinks on 1 occasion for women). We used multivariable generalized estimating equations (GEE) to identify the factors associated with hazardous alcohol use.

RESULTS

Between 2006 and 2012, 1,114 HIV-negative individuals were recruited, and 186 (16.7%) reported hazardous alcohol use in the previous 6 months at baseline. In multivariable GEE analyses, having multiple sex partners (adjusted odds ratio [AOR] = 1.25), history of sexually transmitted infection (AOR = 1.50), experiencing violence (AOR = 1.36), and incarceration (AOR = 1.29) were each independently associated with hazardous alcohol use. Caucasian ethnicity (AOR = 0.56), ≥ daily heroin injection (AOR = 0.81), and engagement in addiction treatment (AOR = 0.84) were negatively associated with hazardous alcohol use (all p < 0.05).

CONCLUSIONS

A considerable proportion of PWID reported hazardous alcohol use, which was independently associated with reporting sexual, but not drug-related, HIV risk behaviors and experiencing recent violence. Findings suggest a need to integrate regular screening and evidence-based alcohol interventions into treatment efforts for PWID.

The couple that smokes together: Dyadic marijuana use and relationship functioning during conflict

Self-reported marijuana use has been associated with poor relationship functioning and decreased stability over time. The present study examined the behavioral interactions of couples with concordant and discordant patterns of marijuana use during conflict, using individual self-reports and observation by independent coders. Heavy drinking community couples (N = 149) participated in a conflict resolution paradigm. Interactions were recorded and coded by naïve coders. Approximately 30% of the sample reported past year marijuana use. Actor-Partner Interdependence Models and analysis of covariance (ANCOVA) were used to evaluate the individual and interactive effects of dyadic marijuana use on maladaptive relationship functioning. A Robust Actor × Partner Marijuana Use interaction was detected for a range of behavioral outcomes, assessed by both self-report and direct observation, including relationship satisfaction, anger experience, patterns of demand and withdrawal during conflict, constructive behaviors, and overall relationship quality. Specifically, couples in which both partners used or abstained from marijuana displayed more adaptive relationship functioning across indicators relative to couples in which only 1 partner identified as a marijuana user. This pattern was particularly strong for couples in which the female partner used marijuana and the male partner did not. Couples with discordant, rather than concordant, marijuana use displayed distinct conflict resolution behaviors that were consistent with the long-term negative relationship outcomes that have been observed in previous studies. (PsycINFO Database Record

Does Marijuana Use Contribute to Intimate Partner Aggression? A Brief Review and Directions for Future Research

Marijuana users are more likely to perpetrate intimate partner aggression (IPA) than non-users, yet the mechanism responsible for this association is unknown. Recent studies considering the association between episodes of marijuana use and episodes of IPA have failed to find evidence consistent with an acute effect of marijuana. Research gaps are highlighted and a heuristic model of marijuana's potential effects on IPA is presented. Research priorities include consideration of mediating mechanisms, moderating variables at the individual and couple level, and examination of acute effects of marijuana using daily report and EMA designs.

Alcohol-Adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol Dependence

A randomized controlled trial for an innovative alcohol-adapted anger management treatment (AM) for outpatient alcohol dependent individuals scoring moderate or above on anger is described. AM treatment outcomes were compared to those of an empirically-supported intervention, Alcoholics Anonymous Facilitation treatment (AAF). Clients in AM, relative to clients in AAF, were hypothesized to have greater improvement in anger and anger-related cognitions and lesser AA involvement during the 6-month follow-up. Anger-related variables were hypothesized to be stronger predictors of improved alcohol outcomes in the AM treatment condition and AA involvement was hypothesized to be a stronger predictor of alcohol outcomes in the AAF treatment group. Seventy-six alcohol dependent men and women were randomly assigned to treatment condition and followed for 6 months after treatment end. Both AM and AAF treatments were followed by significant reductions in heavy drinking days, alcohol consequences, anger, and maladaptive anger-related thoughts and increases in abstinence and self-confidence regarding not drinking to anger-related triggers. Treatment with AAF was associated with greater AA involvement relative to treatment with AM. Changes in anger and AA involvement were predictive of posttreatment alcohol outcomes for both treatments. Change in trait anger was a stronger predictor of posttreatment alcohol consequences for AM than for AAF clients; during-treatment AA meeting attendance was a stronger predictor of posttreatment heavy drinking and alcohol consequences for AAF than for AM clients. Anger-related constructs and drinking triggers should be foci in treatment of alcohol dependence for anger-involved clients.

Impulsive versus premeditated aggression in the prediction of violent criminal recidivism

Past aggression is a potent predictor of future aggression and informs the prediction of violent criminal recidivism. However, aggression is a heterogeneous construct and different types of aggression may confer different levels of risk for future violence. In this prospective study of 91 adults in a pretrial diversion program, we examined (a) premeditated versus impulsive aggression in the prediction of violent recidivism during a one-year follow-up period, and (b) whether either type of aggression would have incremental validity in the prediction of violent recidivism after taking into account frequency of past general aggression. Findings indicate that premeditated, but not impulsive, aggression predicts violent recidivism. Moreover, premeditated aggression remained a predictor of recidivism even with general aggression frequency in the model. Results provide preliminary evidence that the assessment of premeditated aggression provides relevant information for the management of violent offenders.

Aggressive behavior among military veterans in substance use disorder treatment: the roles of posttraumatic stress and impulsivity

This study examined posttraumatic stress disorder (PTSD) symptom severity and impulsivity as predictors of aggressive behavior among 133 male military veterans entering substance abuse treatment who endorsed difficulty controlling anger in the past year. At treatment intake, participants completed measures assessing PTSD symptom severity, impulsivity and aggressive behavior. Perpetration of aggressive behavior was reassessed 4 months later. Results from multivariate models indicated that PTSD symptom severity and impulsivity explained unique variance in aggressive behavior at intake but not follow-up. Mediation models indicated that the association between PTSD symptom severity and aggressive behavior was accounted for by impulsivity. The identification of impulsivity as a key mediator between trauma symptoms and aggressive behavior has significant clinical and research implications. Based on these findings, clinicians are encouraged to consider a standard assessment of impulsivity and the selection of interventions that target impulsivity as a trans-diagnostic process among at-risk client populations.

Substance use and violence among youth: a daily calendar analysis

BACKGROUND

While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs.

OBJECTIVE

This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth.

METHODS

Data were collected from Emergency Department (ED) patients (ages 14-24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe).

RESULTS

Conflict over 'personal belongings' was a common reason for violence among males; 'jealousy'/'rumors' were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use.

CONCLUSIONS

RESULTS suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.

Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department

BACKGROUND

Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs.

METHODS

At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI.

RESULTS

Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG.

CONCLUSIONS

AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.

Nonmedical prescription stimulant use among youth in the emergency department: prevalence, severity and correlates

This study examined the prevalence, severity and correlates of nonmedical prescription stimulant use (NPSU) among youth in the emergency department (ED). Participants 14-20 years old presenting to the ED completed a survey. A multinomial logistic regression was used to compare those without NPSU, with mild NPSU and with moderate/severe NPSU on demographics, risk factors and ED utilization. There were 4389 participants; 8.3% reported past-year NPSU and 44% of those with past 3-month NPSU reported at least monthly use. After controlling for demographics, participants with mild NPSU or moderate/severe NPSU had higher odds of all substance use risk factors compared to those with no NPSU. Also, those with moderate/severe NPSU were more likely to report dating violence and nonmedical use of opioids or sedatives and less likely to use marijuana compared to those with mild NPSU. Healthcare setting screening and intervention efforts should consider NPSU concomitant with other substance use and explore the association of dating violence with NPSU.

Acute influence of alcohol, THC or central stimulants on violent suicide: A Swedish population study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

Associations between substance use, post-traumatic stress disorder and the perpetration of violence: A longitudinal investigation

AIM

Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) commonly co-occur. This is of significant concern, given the increased risk for violence perpetration among individuals with this comorbidity. Limited research, however, has examined relationships between SUD, PTSD and violence among individuals longitudinally. Such an investigation is warranted given that substance use and PTSD symptoms can fluctuate over time. This study therefore aims to examine how changes in substance use and PTSD symptom severity are associated with the perpetration of violent crime over time among individuals with comorbid SUD and PTSD.

METHOD

One-hundred and two men and women who met criteria for SUD and PTSD were interviewed four times over a 9-month period. These interviews included measures of past-month violent crime perpetration, substance use and dependence, PTSD symptom severity, and depression and state anxiety symptoms. Generalised estimating equations (GEE) modelled associations between substance use, PTSD and violence.

RESULTS

Increased substance use, more severe substance dependence and more severe PTSD symptomology were consistently associated with violent crime over time. Multivariate GEE analyses, however, revealed that the PTSD hyperarousal symptoms, specifically, were independently associated with violence over time.

CONCLUSIONS

This longitudinal study found that PTSD hyperarousal symptoms were consistently associated with the perpetration of violent crime, further highlighting the potentiating role of PTSD hyperarousal in relation to violence among individuals with SUD. These findings indicate that interventions addressing hyperarousal symptoms have the potential to reduce the susceptibility for violence among individuals with this common comorbidity.

Event-level analysis of antecedents for youth violence: comparison of dating violence with non-dating violence

BACKGROUND

Dating violence (DV) has emerged as a major concern among youth with links to substance use, injuries, and death. The emergency department (ED) provides an opportunity for violence screening and prevention interventions. Additional data are needed regarding antecedents of DV versus non-dating violence (NDV; e.g., acquaintance, stranger) to develop ED-based violence interventions for youth.

METHODS

Participants were 575 patients screening positive for past 6-month drug use in an urban ED who completed timeline follow-back aggression modules at baseline and 6- and 12-months, indicating event-specific antecedents of violence. Multi-level logistic regressions using event-level data, nested by individual and time (i.e. baseline, 6- and 12-month assessment intervals), were used to examine antecedents of DV vs. NDV. Post-hoc analyses examined substance use×reasons and gender interactions.

RESULTS

Prescription sedative/opioid misuse was more likely to be reported prior to DV whereas alcohol only, and co-ingested alcohol and marijuana only, were more likely to be reported prior to NDV. Reasons for DV included: "personal belongings", "angry/bad mood," "jealousy," "drunk/high on drugs" and "arguing about sex". Reasons for NDV included: "rumors," "retaliation," "personal space" and "aid (someone) due to physical attack". Substance use before/during conflicts and reasons for conflicts were both uniquely associated with DV versus NDV. Two gender interactions were found.

CONCLUSIONS

ED based interventions for urban youth need to be tailored by gender, substance use (alcohol, cocaine, sedatives), reasons for violence, and type of violence (DV vs. NDV).

Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study

The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.