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de Aguiar ACL, Bloc LG. Transdiagnosis of alcohol use and psychopathologies: A systematic review. Addict Behav Rep 2024; 19:100543. [PMID: 38628974 PMCID: PMC11019097 DOI: 10.1016/j.abrep.2024.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/21/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Multiple diagnoses are the rule in Mental Health and alcohol use disorder (AUD) is a psychopathology with many comorbidities, requiring interventions that consider common factors, which means using a transdiagnostic perspective. This study aimed to identify in the scientific literature the main common transdiagnostic factors that link AUD to other psychopathologies in people over 18 years of age. A systematic review of the literature was carried out in the portals of the databases Pubmed, PsychINFO and CAPES. 37 articles were selected for analysis, which resulted in 25 transdiagnostic factors linked to AUD and to several other related disorders and health conditions. The results emphasize the variety of disorders and health conditions related to AUD, which highlights the importance of transdiagnostic factors for these conditions as targets for both scientific research and therapeutic interventions for this population.
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Affiliation(s)
- Ana Caroline Leite de Aguiar
- University of Fortaleza (Unifor), Washington Soares Avenue, 1321, Edson Queiroz, Fortaleza, Ceará 60811-905, Brazil
| | - Lucas Guimarães Bloc
- University of Fortaleza (Unifor), Washington Soares Avenue, 1321, Edson Queiroz, Fortaleza, Ceará 60811-905, Brazil
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Berlin J, Wallinius M, Nilsson T, Karlén MH, Delfin C. Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample. BMC Psychiatry 2023; 23:184. [PMID: 36944949 PMCID: PMC10031895 DOI: 10.1186/s12888-023-04609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings. METHODS Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximum-security forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses. RESULTS The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting α and ω values ≥ 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity. CONCLUSION Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.
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Affiliation(s)
- Johan Berlin
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden.
- Rättspsykiatriska regionkliniken, Box 1223, 351 12, Växjö, Sweden.
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Thomas Nilsson
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department for Forensic Psychiatry, The National Board of Forensic Medicine, Gothenburg, Sweden
- Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Malin Hildebrand Karlén
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department for Forensic Psychiatry, The National Board of Forensic Medicine, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Institute for Globally Distributed Open Research and Education (IGDORE), Gothenburg, Sweden
| | - Carl Delfin
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
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Yoon D, Yoon M, Wang X, Robinson-Perez AA. A developmental cascade model of adolescent peer relationships, substance use, and psychopathological symptoms from child maltreatment. CHILD ABUSE & NEGLECT 2023; 137:106054. [PMID: 36709732 DOI: 10.1016/j.chiabu.2023.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Although previous studies have demonstrated high intercorrelations among deviant peer affiliation, substance use, externalizing and internalizing symptoms in adolescence, these studies have been limited because they did not examine 1) the associations over time by assuming one particular sequence; and 2) child maltreatment effects. METHODS This study included 617 adolescents (54.3 % girls, 55.6 % Black) at-risk of maltreatment living in the U.S and primarily low-income. Deviant peer affiliation was assessed at ages 12, 14, and 16 using 13 items from the modified version of the Youth Risk Behavior and Monitoring the Future Survey. Externalizing and internalizing symptoms were measured at ages 12, 14, and 16 using the Child Behavior Checklist. The number of substances used (ages 12, 14, 16, and 18) were created by summing the self-reported alcohol, tobacco, and marijuana use. Each type of maltreatment (birth to age 12) was assessed using the self-report. RESULTS Autoregressive cross-lagged structural equation modeling explained the stability effects within each domain, as well as how different maltreatment types affect diverse developmental processes. Cross-lagged results showed the socialization effects of peers on substance use, whereas the peer selection effects on externalizing symptoms. Physical abuse was only associated with externalizing symptoms, while sexual abuse was associated with both externalizing and internalizing symptoms. Additionally, emotional abuse was associated with deviant peer affiliation and substance use. CONCLUSIONS Identifying the underlying reciprocal processes offers a deeper understanding of peer relationships in the substance use and externalizing symptoms among at-risk of maltreatment sample.
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Affiliation(s)
- Dalhee Yoon
- Department of Social Work, Binghamton University-State University of New York, USA.
| | - Miyoung Yoon
- Department of Social Welfare, Pusan National University, South Korea
| | - Xiafei Wang
- School of Social Work, Syracuse University, USA
| | - Ada A Robinson-Perez
- Division of Diversity, Equity and Inclusion, Binghamton University-State University of New York, USA
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Papp LM, Kouros CD, Witt HK, Curtin JJ, Blumenstock SM, Barringer A. Real-time momentary mood as a predictor of college students' prescription drug misuse in daily life: Direct links and the moderating role of background mental health. Exp Clin Psychopharmacol 2022; 30:787-796. [PMID: 34110882 PMCID: PMC8660934 DOI: 10.1037/pha0000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study addressed calls for research to identify real-time predictors of prescription drug misuse (Schepis et al., 2020) by testing young adults' momentary reports of their negative mood and positive mood as predictors of event-level misuse in daily life. We implemented a 28-day ecological momentary assessment (EMA) procedure that collected individuals' mood and other contextual experiences in moments preceding prescription drug misuse. Consistent with models of problematic substance use as a means to reduce negativity (Khantzian, 1997), results from hierarchical generalized linear modeling (HGLM) indicated within-person links between higher than usual negative mood and greater likelihood of prescription misuse in daily life. Contrary to the hypothesis, misuse was also more likely when preceded by elevated positive mood. We found consistent support for the hypothesized between-person effects, with prescription misuse in daily life associated with higher average levels of negative mood, and lower average levels of positive mood, across the reporting period. We further predicted that individuals reporting greater levels of social anxiety, depression, and externalizing symptoms would evidence stronger links between their momentary negative mood and prescription misuse. Partial support for this moderation hypothesis was found, with the positive within-person link between negative mood and prescription misuse significantly stronger among individuals higher (vs. lower) on social anxiety and depression. Results provide support for intricate connections between young adults' momentary mood, mental health symptoms, and prescription drug misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Elliott JC, Greene AL, Thompson RG, Eaton NR, Hasin DS. Substance use in a sexual context: The association of sex-related substance use motives with substance choice and use behaviors. JOURNAL OF SUBSTANCE USE 2021; 26:212-217. [PMID: 33732094 DOI: 10.1080/14659891.2020.1807633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance use before sex is associated with riskier behaviors. Sex-related substance use motives may explain pre-sex substance use. We explored what sex-related motives are associated with alcohol versus drug use, and which motives underlie heavier use. METHODS A sample of 936 participants (50% male, 80% White) completed an Internet survey about sexuality. Those who drank before sex (n=657) reported on six sex-related drinking motives; those who used drugs before sex (n=271) reported on six (parallel) sex-related drug use motives. The frequency of endorsement of each motive between drinkers and drug users was compared with z-distributions. Logistic regressions assessed whether motives were associated with substance use frequency and intoxication before sex. RESULTS Substance use to relax and to get a sex partner to use were more commonly endorsed for alcohol than drugs; substance use to improve performance and enhance experience were more commonly endorsed for drugs. Most motives were associated with alcohol frequency and intoxication before sex. None were associated with drug frequency; some were associated with drug intoxication. CONCLUSIONS Alcohol was generally used to facilitate sex, and drugs to enhance sex. Sex-related drinking motives were associated with drinking before sex; sex-related drug use motives were less predictive.
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Affiliation(s)
- Jennifer C Elliott
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Ashley L Greene
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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The structure of psychopathology and association with poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem in a population sample of adolescents. Dev Psychopathol 2020; 33:1208-1219. [PMID: 32468983 DOI: 10.1017/s0954579420000437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.
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Solano I, Eaton NR, O'Leary KD. Pornography Consumption, Modality and Function in a Large Internet Sample. JOURNAL OF SEX RESEARCH 2020; 57:92-103. [PMID: 30358432 DOI: 10.1080/00224499.2018.1532488] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Pornography consumption research often contains measurement inconsistencies that make the literature difficult to integrate. We investigated measurement issues relating to four key areas of pornography research simultaneously in a single data set: (a) differential endorsement across commonly used pornography consumption measures; (b) common modalities of pornography use (e.g., pictures, videos); (c) function of pornography use; and (d) association of age and gender with the above. The sample (n = 1,392) of adults in the United States was collected using Amazon Mechanical Turk and included a much wider age range (ages 18-73) than in typical pornography research. Using all modalities of pornography, 91.5% of men and 60.2% of women herein reported having consumed pornography in the past month. The three primary modalities of pornography consumed were written pornography, pictures, and videos. Videos were consumed most often, but women were much more likely to consume written pornography than men. The primary function of viewing pornography was to enhance masturbation, but notably there was endorsement of many other uses. Cross-sectional age trends and gender differences are discussed with suggestions for future research. Empirical concerns for research in pornography are addressed, with special attention to considerations for estimates of pornography consumption rates and research definitions of pornography.
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Affiliation(s)
- Ingrid Solano
- Department of Psychology, Stony Brook University, Stony Brook
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Taggart TC, Rodriguez-Seijas C, Dyar C, Elliott JC, Thompson RG, Hasin DS, Eaton NR. Sexual orientation and sex-related substance use: The unexplored role of bisexuality. Behav Res Ther 2019; 115:55-63. [PMID: 30594299 PMCID: PMC6409130 DOI: 10.1016/j.brat.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023]
Abstract
Using alcohol and drugs in sexual contexts is associated with negative health consequences, including increased risk for HIV/STIs, sexual victimization, unplanned pregnancies, and overdose. Evidence suggests millions of adults regularly use alcohol in sexual contexts, thus increasing their risk for these consequences. However, no nationally representative estimates exist for rates of regular alcohol and/or drug use in sexual contexts. Additionally, previous studies suggest sexual minority individuals are more likely to use substances in sexual contexts than heterosexuals; however, none of these studies examined for multiple dimensions or subgroups of sexual orientation. Thus, using two distinct datasets-one large, nationally representative sample (N = 17,491) and an Internet-collected convenience sample (N = 1001)-we explored the associations between sexual orientation (dimensions and subgroups) and rates of regular sex-related alcohol and/or drug use in American adults. Results showed that sexual minority individuals were significantly more likely to report regularly using substances in sexual contexts compared to heterosexuals; however, results varied based on dimension of sexual orientation and by sex. Across both samples, bisexual individuals exhibited the highest rates of regular sex-related substance use. Findings suggest that sexual minorities, and bisexual individuals in particular, may be at increased risk for regular sex-related substance use and its associated negative health consequences. Future research should include nuanced and multidimensional assessments of sexual orientation to investigate sex-related alcohol and/or drug use and its associated risks, as well as examine the potential direct and indirect pathways by which these disparities may be conferred.
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Affiliation(s)
- Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | | | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Well-being, Northwestern University, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Villalobos-Gallegos L, Medina-Mora ME, Benjet C, Ruiz-Velasco S, Magis-Rodriguez C, Marín-Navarrete R. Multidimensional Patterns of Sexual Risk Behavior and Psychiatric Disorders in Men with Substance Use Disorders. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:599-607. [PMID: 29845445 DOI: 10.1007/s10508-018-1227-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
Previous evidence links substance use disorders (SUD) to STI/HIV risk and suggests that comorbid psychiatric disorders increase the probability to engage in sexual risk behaviors. This study had two aims: (1) to identify subgroups based on sexual risk behavior using a person-centered approach in a sample of substance users and (2) to measure the association of psychiatric and SUD with subgroup membership. We assessed 402 male adults with SUD, reporting sexual intercourse in the previous 12 months using the HIV-Risk Behavior Scale and the Mini International Neuropsychiatric Interview. Latent class analysis was performed to determine multidimensional patterns of sexual risk behaviors and multinomial logistic regression was utilized to associate classes with disorders. The three-class model showed the best fit, and the classes were labeled: Relationship-Based (31.34% of the sample), Condom-Based (39.55%), and Multiple Risks (29.10%). Controlling for age and marital status, major depressive disorders, antisocial personality disorder, and any psychiatric disorder were associated with the Multiple Risks class. Results stress the importance of developing a personalized assessment and counseling for sexual risk behaviors in individuals with SUD, particularly when they endorse criteria for comorbid psychiatric disorders. Future studies should focus on evaluating differential response to preventive interventions.
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Affiliation(s)
- Luis Villalobos-Gallegos
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
- Facultad de Medicina, UNAM, Mexico City, Mexico
| | - María Elena Medina-Mora
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
| | - Corina Benjet
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
| | - Silvia Ruiz-Velasco
- Instituto de Investigaciones en Matemáticas Aplicadas y Sistemas, UNAM, Mexico City, Mexico
| | | | - Rodrigo Marín-Navarrete
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico.
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Bosma-Bleeker MH, Blaauw E. Substance use disorders and sexual behavior; the effects of alcohol and drugs on patients' sexual thoughts, feelings and behavior. Addict Behav 2018; 87:231-237. [PMID: 30077915 DOI: 10.1016/j.addbeh.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/28/2018] [Accepted: 07/05/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hardly any research exists on the relationship between substance use and sexual behaviors in patients with a substance use disorder. This study aimed to examine this relation by looking into perceived positive effects on sexual behavior, perceived negative effects and risky sexual behavior due to substance use in patient groups of users of alcohol, stimulants, sedatives and Gamma hydroxybutyrate (GHB). In addition, the current study aimed to address the question whether sexual behavior (e.g. number of sexual partners, sexual activity) differs between these patient groups. METHOD A total of 180 patients with a substance use disorder (i.e. alcohol, amphetamine, cannabis, cocaine, GHB and opiates) participated. A self-report questionnaire was administered with questions on substance use, sexual behaviors (e.g. sexual activity, masturbation, use of pornography) and statements about the perceived changes in sexual functioning and behavior under influence of the primary substance of abuse. RESULTS All four groups reported changes in sexual thoughts, feelings and behavior due to the use of their primary substance. More than half of the patients reported enhancements in sexual domains (i.e. sexual pleasure, sexual arousal, sexual behavior), but also decrements or risky behaviors and about a quarter stated that their sexual thoughts, feelings and behaviors were often associated with the use of their primary substance of abuse. Patients with a GHB use disorder reported the strongest relation between drug use and sexual behavior. Users of GHB not only reported more enhancement in several sexual domains, but also less decline in sexual domains compared to the other patient groups and more risky behavior or more sexual activity than some of the other groups of patients. CONCLUSIONS The results underline the importance of addressing the relationship between substance use and sexual behavior in treatment programs, as patients may be hesitant to stop their use of substances when they experience many positive effects in their sexual behavior. Future research directions are suggested.
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Affiliation(s)
| | - Eric Blaauw
- Verslavingszorg Noord Nederland, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen, the Netherlands
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