Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems

Hard drugs use and tooth wear: a scoping review

OBJECTIVES

This study aims to map evidence on the relationship between hard drug use and dental wear. The scoping review is guided by the question: What is the relationship between hard drug consumption and dental wear?

MATERIALS AND METHODS

Adhering to PRISMA-ScR guidelines, searches were conducted across PubMed, Embase, and four databases in March 2024. Inclusion criteria included studies investigating the association between hard drug use and dental wear, regardless of publication date or language. Data were presented through narrative exposition, tables, and a conceptual framework.

RESULTS

Twenty-eight studies (four case-control, three cross-sectional, five case reports, and sixteen literature reviews) were included. Among case-control studies, 75% observed an association between drug use and dental erosion; however, no cross-sectional studies demonstrated this association. Despite questionable quality, reviews established connections between drug use and dental erosion. Studies aimed to elucidate potential causes for dental erosion.

CONCLUSIONS

Analysis suggests a potential link between hard drug use and dental wear, though indirect. Factors like bruxism and reduced salivary pH may contribute to dental wear among drug users. Further investigation through primary studies exploring this relationship is necessary.

CLINICAL RELEVANCE

Dentists should focus not only on clinical characteristics of dental wear but also on mediating factors such as bruxism and decreased salivary pH associated with drug use. This holistic approach allows for a deeper understanding of dental wear mechanisms, enabling targeted preventive and therapeutic interventions.

Exploring indicators of natural recovery from alcohol and drug use problems: findings from the life in recovery survey in Flanders

INTRODUCTION

Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates.

METHODS

A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis.

RESULTS

Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant (p < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver's license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so.

CONCLUSION

The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.

Levels of IL-6 are Associated with Lifetime Attempted Suicide in Alcohol Use Disorder Patients

Background

Patients with alcohol use disorder (AUD) have an increased risk of suicide. Neuroimmunological measures, such as cytokines, are shown to deviate in people with attempted suicide. Few studies have investigated this among AUD patients.

Patients and Methods

One-hundred and fourteen patients undergoing residential treatment for AUD were interviewed on lifetime suicide attempts (SA) along with several other background variables and clinical characteristics. Serum blood samples were drawn for analysis of cytokines.

Results

Thirty-one patients (27%) reported at least one SA. These patients had more symptoms of current affective disorders and more severe dependence. In bivariate analysis only IL-6 and IL-10 appeared to be associated with lifetime SA but without reaching statistical significance. In multivariate linear regression, adjusting for sex, nicotine use, somatic illness, and the use of anti-inflammatory drugs, IL-6 was associated to SA (p = 0.033).

Conclusion

The cytokine IL-6 has repeatedly been found to be associated with suicidality. The present study concurs with this role of IL-6 in a naturalistic observational study of AUD patients.

Coping and Co-Occurrence of Gaming Disorder and Substance Use in Recovering Substance Users

BACKGROUND

There are a wide range of negative effects associated with both substance use disorders and behavioural disorders and their co-occurrence. Understanding the way in which at-risk populations (e.g., substance-abstinent users) interact with potentially addictive behaviours (e.g., gaming) and substance use-while navigating life stressors through differing coping styles-can inform preventative strategies.

METHODS

Therefore, the present study investigated 64 clinical participants and 138 general population participants. Each cohort was required to complete a battery of psychometric scales exploring problematic behaviours, problematic substance use, co-occurrence, and coping styles. Additional exploratory direct comparisons of gamers in the clinical cohort and gamers in the general cohort were carried out.

RESULTS

The study's findings suggest that gamers from different populations (i.e., general and clinical) share similar at-risk behaviours. These problematic behaviours were more pronounced among abstinent substance use gamers, and more specifically among poly-substance use gamers.

CONCLUSIONS

The findings of the present study add to the literature and suggest that dysfunctional coping style and the co-occurrence of problematic behaviours may have an impact on the assessment and potential treatment of substance abstinent gamers. The findings offer support for an integrated treatment approach, wherein both substance use and the other problematic behaviours (e.g., gaming) are considered in tandem.

History of Delirium Tremens in AUD Patients in Treatment: Relationship to AUD Severity and Other Factors

Introduction

Delirium tremens (DT) occurs after stopping prolonged, high alcohol intake and may be life-threatening if untreated. We need to know about clinical correlates of DT in order to provide the best clinical care.

Methods

At admission to inpatient treatment a cohort of 114 alcohol use disorder (AUD) patients were interviewed and examined concerning psychiatric diagnosis and symptoms, trauma experiences and alcohol related measures and if they had experienced DT.

Results

Twenty-four percent of the patients reported a life-time experience of DT. These patients were predominantly males and had lower educational level. More of the patients in the DT than the non-DT group reported at least one suicide attempt, were diagnosed with PTSD, and dropped out of treatment. Also, having parents with alcohol problems was more common among these patients, and they reported a longer duration of problematic drinking and a higher number of drinks needed to feel an effect of drinking. In the multivariable adjusted analysis only a diagnosis of PTSD (OR=5.71; 95% confidence interval (CI): 1.34–24.31) and duration of problematic drinking with a 6% increase in risk for every year (OR=1.06; 95% CI: 1.01–1.11) remained significant risk factors for having DT experience.

Discussion and conclusion

Having experienced DT was more prevalent in the current investigation than in earlier studies. Patients that had experienced DT seemed to have more serious AUD, especially signified by a longer duration of drinking. These patients seemed to have many clinical disadvantages including more drop-out and higher suicide rate. PTSD could be a risk factor for DT but may also follow the DT experience.

Housing mobility protects against alcohol use for children with socioemotional health vulnerabilities: An experimental design

PURPOSE

Neighborhood context may influence alcohol use, but effects may be heterogeneous, and prior evidence is threatened by confounding. We leveraged a housing voucher experiment to test whether housing vouchers' effects on alcohol use differed for families of children with and without socioemotional health or socioeconomic vulnerabilities.

TRIAL DESIGN

In the Moving to Opportunity (MTO) study, low-income families in public housing in five US cities were randomized in 1994 to 1998 to receive one of three treatments: (1) a housing voucher redeemable in a low-poverty neighborhood plus housing counseling, (2) a housing voucher without locational restriction, or (3) no voucher (control). Alcohol use was assessed 10 to 15 years later (2008 to 2010) in youth ages 13 to 20, N = 4600, and their mothers, N = 3200.

METHODS

Using intention-to-treat covariate-adjusted regression models, we interacted MTO treatment with baseline socioemotional health vulnerabilities, testing modifiers of treatment on alcohol use.

RESULTS

We found treatment effect modification by socioemotional factors. For youth, MTO voucher treatment, compared with controls, reduced the odds of ever drinking alcohol if youth had behavior problems (OR = 0.26, 95% CI [0.09, 0.72]) or problems at school (OR = 0.46, [0.26, 0.82]). MTO low-poverty treatment (vs. controls) also reduced the number of drinks if their health required special medicine/equipment (OR = 0.50 [0.32, 0.80]). Yet treatment effects were nonsignificant among youth without socioemotional vulnerabilities. Among mothers of children with learning problems, MTO voucher treatment (vs. controls) reduced past-month drinking (OR = 0.69 [0.47, 0.99]), but was harmful otherwise (OR = 1.22 [0.99, 1.45]).

CONCLUSIONS

For low-income adolescents with special needs/socioemotional problems, housing vouchers protect against alcohol use.

Acute effects of Δ9-tetrahydrocannabinol and cannabidiol on auditory mismatch negativity

RATIONALE

Mismatch negativity (MMN) is a candidate endophenotype for schizophrenia subserved by N-methyl-D-aspartate receptor (NMDAR) function and there is increasing evidence that prolonged cannabis use adversely affects MMN generation. Few human studies have investigated the acute effects of cannabinoids on brain-based biomarkers of NMDAR function and synaptic plasticity.

OBJECTIVES

The current study investigated the acute effects of Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD) alone and in combination on the mismatch negativity (MMN).

METHODS

In a randomised, double-blind, crossover placebo-controlled study, 18 frequent and 18 less-frequent cannabis users underwent 5 randomised drug sessions administered via vaporiser: (1) placebo; (2) THC 8 mg; (3) CBD 400 mg; (4) THC 8 mg + CBD 4 mg [THC + CBD_low]; (5) THC 12 mg + CBD 400 mg [THC + CBD_high]. Participants completed a multifeature MMN auditory oddball paradigm with duration, frequency and intensity deviants (6% each).

RESULTS

Relative to placebo, both THC and CBD were observed to increase duration and intensity MMN amplitude in less-frequent users, and THC also increased frequency MMN in this group. The addition of low-dose CBD added to THC attenuated the effect of THC on duration and intensity MMN amplitude in less-frequent users. The same pattern of effects was observed following high-dose CBD added to THC on duration and frequency MMN in frequent users.

CONCLUSIONS

The pattern of effects following CBD combined with THC on MMN may be subserved by different underlying neurobiological interactions within the endocannabinoid system that vary as a function of prior cannabis exposure. These results highlight the complex interplay between the acute effects of exogenous cannabinoids and NMDAR function. Further research is needed to determine how this process normalises after the acute effects dissipate and following repeated acute exposure.

Psychosocial difficulties and treatment retention in inpatient detoxification programmes

Aims:

Treatment retention is associated with addiction treatment outcomes. Research regarding predictors of retention at inpatient detoxification treatment is limited. The aim of this study was to investigate whether psychosocial difficulties (PSDs) are associated with treatment retention among Finnish inpatients undergoing detoxification treatment.

Design:

This register-based study included real-life data on detoxification treatment episodes (n = 2,752) between February of 2016 and May of 2019 from several inpatient treatment units in Finland. The PARADISE24fin instrument was used to assess PSDs. Socio-demographic and substance use related variables, as well as PSDs, were analysed with regard to treatment retention. Multiple logistic regression models were used to identify predictors of treatment incompletion.

Results:

Of the 2,752 detoxification treatment episodes, 80.3% (n = 2,209) were completed. Men and women differed with regard to the variables associated with treatment retention. After adjusting for confounders, younger age (≤ 35 years), being less educated (≤ 9 years), being unemployed, using opioids, polysubstance use and more severe dependence were associated with treatment incompletion. Overall severity of PSDs (PARADISE24fin mean score) became non-significant after adjusting for confounders. However, having more severe cognitive difficulties was significantly associated with treatment incompletion, while more severe difficulties in daily activities was associated with treatment completion.

Conclusions:

Special attention should be paid to younger individuals with opioid and/or polysubstance use, as well as those with cognitive difficulties, in order to retain people in treatment.

A Personalized Approach Bias Modification Smartphone App ("SWiPE") to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study

Background

Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement.

Objective

We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use.

Methods

In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training.

Results

We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t₄₅₄=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t₄₅₄=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t₄₃₅=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t₄₃₅=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001).

Conclusions

The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p

International Registered Report Identifier (IRRID)

RR2-10.2196/21278

Risk of cancer in individuals with alcohol and drug use disorders: a registry-based study in Reggio Emilia, Italy

Aims of this population-based cohort study was to compare the overall and site-specific cancer incidence in individuals with alcohol or drug use disorders with incidence of the general population, and to estimate excess cancer risk in a subgroup of individuals who have hepatitis C virus or HIV infection. The study included 4373 residents of Reggio Emilia province diagnosed with alcohol or drug use disorders during the period from 1 January 1985 to 31 December 2014. All newly diagnosed cancers registered from 1 January 1996 to 31 December 2014 were taken into account to calculate the standardised incidence ratio (SIR) of cancers of any site and of site-specific cancers. SIR of cancer at any site was 1.6 (95% confidence interval [CI] 1.4-1.9). Anogenital cancers were associated with the highest excess risk (SIR=11.9; 95% CI 4.9-28.5), followed by oesophageal (SIR=9.5; 95% CI 3.6-25.3) and cervical cancer (SIR=8.6; 95% CI 2.8-26.7). Excess risk of all cancer sites, except for breast cancer, was observed among individuals with alcohol use disorders and of all cancer sites, except breast and kidney cancers, among individuals with drug use disorders. Among hepatitis C virus-positive individuals, cancer at any site risk was 1.9 (95% CI 1.2-3.1) and among HIV-infected individuals it was 3.3 (95% CI 1.8-5.7). Individuals with alcohol and drug use disorders face a higher risk of various cancers. Effective interventions to prevent or reduce the harm of substance abuse and risky behaviours in this population are warranted.

The Severity of Dependence Scale (SDS) for Codeine: Preliminary Investigation of the Psychometric Properties of the SDS in an Online Sample of Codeine Users From the UK

Objective: Investigate the psychometric properties of the Severity of Dependence Scale (SDS) for codeine and its association with aberrant codeine related behaviors. Design: A voluntary and uncompensated cross-sectional online survey. Setting: Online population (≥18 years). Respondents: Two hundred and eighty-six respondents (66% women) who had used codeine containing medicines in the last 3 months and were living in the UK. Results: Of the respondents (mean age = 35.4 years, SD = 12.5), more than half were employed. Only 3.5% respondents reported no income. The majority of respondents (45.1%) primarily obtained prescription-only codeine from a consultation with a health professional, whilst 40.9% mainly purchased "over-the-counter" codeine containing medicines in a pharmacy without a medical prescription. Principal component analysis indicated a single factor solution accounting for 75% of the variance. Factor loadings ranged from 0.83 to 0.89. Cronbach's Alpha was high (α = 0.92). Several behaviors relating to codeine use were found to significantly predict probable codeine dependence. These included: daily codeine use in the last 3 months (OR = 66.89, 95% CI = 15.8-283.18); tolerance to codeine (OR = 32.14, 95% CI = 13.82-74.75); problems with role responsibility due to intoxication (OR = 9.89, 95% CI = 4.95-19.78); having sought advice on the internet to manage codeine use (OR = 9.56, 95% CI = 4.5-20.31); history of alcohol or drug treatment (OR = 3.73, 95% CI = 1.88-7.43). Conclusions: The SDS was acceptable and feasible to use to assess probable psychological codeine dependence in an online sample of people using codeine containing medicines. SDS scores were associated with behaviors known to be indicators of codeine dependence. Studies are needed in well-defined populations of people who use codeine to test the different aspects of psychometry of the scale compared against "gold standard" criterion [a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)].

Personalized Approach Bias Modification Smartphone App ("SWIPE") to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study

Background

Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion.

Objective

We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness.

Methods

We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM.

Results

We expect to commence recruitment in August 2020 and complete data collection in March 2021.

Conclusions

This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p

International Registered Report Identifier (IRRID)

PRR1-10.2196/21278

Contribution of alcohol and drug co-use to substance use problems: Data from a nationally-representative sample of U.S. adults who have never been to treatment

Aims:

Combined use of alcohol with drugs elevates risk for problems including injury and driving while intoxicated. We assessed contributions of heavy drinking (5+ drinks for men/4+ for women), drug use (cannabis and other drugs) and simultaneous co-use to DSM-5 alcohol use disorder (AUD) and drug abuse (DA). We expected co-use to increase risk for AUD and DA.

Methods:

Using population-weighted data from adults in the 2014–2015 National Alcohol Survey who had never been to treatment (N = 3386 drinkers, 50% male, 13% Hispanic, 11% Black, mean age 45 years; N = 439 drug users, 56% male, 20% Hispanic, 15% Black, mean age 36), we tested hypotheses using logistic regression adjusting for demographics, family history of alcohol problems and impulsivity.

Results:

Ten percent of drinkers and 26% of drug users met criteria for mild AUD; <1% of drinkers and 4% of drug users met criteria for DA. Heavy drinking significantly increased risk for AUD, as did monthly or weekly use of cannabis. When simultaneous co-use was added, increased risk associated with cannabis use was reduced to non-significance. Weekly cannabis use, weekly use of other drugs and simultaneous drug and alcohol co-use were associated with significantly elevated risk of DA. In bivariate analyses, simultaneous co-use was associated with significantly greater endorsement of each of the separate AUD and DA symptom domains, including alcohol craving, tolerance and withdrawal, as well as drug and alcohol social and physical health problems.

Conclusion:

Healthcare providers should screen for simultaneous co-use of alcohol and drugs to help identify patients who may benefit from substance abuse treatment.

Multiple substance use among patients attending treatment for substance-related problems in Switzerland

Purpose

The purpose of this paper is to estimate the share of multiple substance disorders among clients entering treatment for substance-related problems, to identify the most frequent combinations of the substances involved and to investigate the profiles of the clients involved.

Design/methodology/approach

Data were taken from the Swiss treatment monitoring system act-info applied among inpatient and outpatient facilities (reporting years 2013–2015). All cases with information on multiple substance disorders, according to a definition close to the diagnosis F19 from the ICD-10 classification of disease were included. The measurements comprised designated primary substance, existing multiple substance use disorder, substances involved and basic socio-demographics.

Findings

From 10,009 clients included in the study, 1,653 (16.5 per cent) were reported as having multiple substance use disorders. A great variety of substance combinations was identified and alcohol was found in the majority of them.

Practical implications

Treatment strategies targeting accurately substance-related disorders as a whole complex should be promoted. In particular the alcohol-related aspect of the disorder should not be neglected when the focus is on illegal drugs.

Originality/value

Multiple substance use was until recently not sufficiently documented in treatment monitoring systems. A recent version of the European treatment demand indicator (TDI) has introduced the notion of “polydrug use problem” as complementary information to the primary substance, which remains the key variable for reporting treatment demand. This study represents a first attempt to explore systematically this new data.

A virtual academy of polydrug use: Masters, novices and the art of combinations

Aims

Information technology has become an essential part of drug culture, providing a platform for lay knowledge concerning drug use. Due to the co-effects of different substances, making substance "combos" requires advanced skills to enhance pleasures and manage risks. In this study, we focussed on Finnish and Swedish online discussions as a context for learning and sharing experiences of combining substances.

Methods

Taking influences from positioning theory, we used qualitative methods to map what kinds of mutual interactive positions related to the expertise in polydrug use online discussants take and how these positions are negotiated and reformulated in the online setting. We reflect these results through Howard S. Becker's theory of social learning, according to which becoming a drug user is a process that occurs in interaction with other users, as the beginners need a model and advice from experienced users in order to claim their place in the users' community.

Results

In online forums, users discuss the risks and pleasures of combining drugs - on the one hand, in relation to different situations and, on the other hand, in relation to different competence positions. This occurs by asking for advice, presenting one's knowledge, challenging others, repositioning oneself, defending one's position or proving one's competence.

Conclusion

Online discussion forums constitute a kind of virtual academy where knowledge of the pleasures and risks of combining substances is produced and circulated, and where experienced masters mediate their expertise to less experienced novices.

Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses

BACKGROUND

Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist.

METHODS

A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486).

RESULTS

Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate.

CONCLUSIONS

Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.

Comorbidity of Internet gaming disorder and alcohol use disorder: A focus on clinical characteristics and gaming patterns

BACKGROUND AND OBJECTIVES

Although Internet gaming disorder (IGD), which has been considered as a behavioral addiction in DSM-5, shares core features with alcohol use disorder (AUD), there has been minimal research on the clinical implications of the comorbidity between IGD and AUD. The purpose of this study is to investigate clinical psychopathologies and Internet game usage patterns of IGD, AUD, and their comorbid status.

METHODS

Participants (n = 1819) completed a cross-sectional web-based survey. The survey questionnaire included socio-demographic data, the IGD scale according to DSM-5 criteria, the Korean version of Alcohol Use Disorders Identification Test for AUD, the Dickman Impulsivity Inventory (DII)-short version for impulsivity, the Brief Self-Control Scale (BSCS) for self-control, the subscales of the Symptom Check-List 90 Items-Revised (SCL-90-R) for depression and anxiety, and the Behavioral Inhibition System/Behavioral Approach System Scale, and the Internet game usage patterns.

RESULTS

The comorbidity group had substantially more severe clinical features such as impulsivity, impaired self-control, and mood symptoms than either IGD or AUD only. Especially the depression scale for the comorbidity group (26.0) is considerably higher than 13.0 for IGD and 16.0 for AUD alone. Furthermore, the comorbidity group spent twice as much money on Internet gaming as IGD alone (all p < .05).

CONCLUSIONS AND SIGNIFICANCE

The findings of this study indicate that the comorbidity between IGD with AUD showed more severe psychopathological impairments, and the respective persons spent more money on gaming than either IGD or AUD alone. These particular characteristics may serve as feasible therapeutic targets in clinical settings. (Am J Addict 2017;26:326-334).

[Out of addictions: Alcohol, or alcohol to alcohol]

Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.

METHODS

Three hundred and forty-one people (34% women) in the Paris area were questioned on their trajectories with a biographical questionnaire. Some open questions were aimed to understand the connection they made between events in their lives, how recovered they felt and what they considered strengths or obstacles. All the participants had stopped at least one product. Their mean age was 43, and 26% were over 50.

STUDY OBJECTIVES

How can the differences between one substance addicts and dual abusers be explained? Can we hypothesize a better result for the patients with a single dependence to alcohol in their lives for the following two reasons? (1) They could really be taken in charge for their alcoholism whereas the dual abusers mostly receive cared for their illicit drug problems with an under estimation of their problem with alcohol. In this case, they turn to alcohol after weaning themselves from their drug dependence so as to return to a social consumption, especially when they are given an opiate treatment. (2) Conversely could we suggest that the dual substance abusers had different trajectories from their childhood (more adverse events, more social difficulties, mental health problems), and that this accumulation explains their skipping from one substance or behaviour to another without any real recovery for decades?

RESULTS

All respondents were polydrug users. Eighty-two had been dependent mainly on alcohol. One hundred and twenty-one people had been drug addicts (mostly heroin), which they had stopped on average ten years before the survey. The last group included 138 persons who had been heroin or cocaine addicts and alcoholics in their lives, a third of whom had been dependent on alcohol before their drug addiction (35%), a tenth on both at the same time (10%) and more than half of the users (55%) had turned from drug addiction to alcoholism. The group concerning alcohol dependence includes the oldest participants, on average 49.7, and 55% of them were abstinent at the survey. Conversely, the group "with no alcohol dependence" had mainly turned to opiate treatments. Their histories in dependence and in various social statuses also showed a longer duration out of employment, in sickness or invalidity, or in prison, for the drug dependents as opposed to the "mainly" alcoholics. The population with dual substance abuse experienced twice as many adverse childhood events as the others (P<0.005): it was the case for 19.5% in "mainly alcohol" dependence compared to 38.4% in dual abuse. The recovery capital gave a mean score of 7.56±2.35 (median 7). A score below 6 was considered low. The score was significantly different according to the dependence groups: while 7.3% of "mainly alcohol" dependents had a score below 6, this was the case for 30.4% of the dual group (with alcohol and drugs), and 19% for the "mainly drug dependence" group. Controlling ages, sexes and groups of dependence in a logistic regression, the risk of having a recovery capital below six was more than four times higher for the dual dependents as opposed to the "mainly alcohol" dependents.

CONCLUSION

Some people stay for decades in drug addiction centers switching from one dependence to another. Their alcohol drinking should be addressed earlier to prevent them from turning to drinking excessively in order to wean themselves from their drug addiction.

Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs

INTRODUCTION AND AIMS

Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs.

DESIGN AND METHODS

Respondent-driven sampling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community sample of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, methamphetamine-dependent only, opioid-dependent only, dependent on methamphetamine and opioids).

RESULTS

Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both methamphetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only.

DISCUSSION AND CONCLUSIONS

The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both methamphetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs. Drug Alcohol Rev 2016;35:611-619].

Mismatch Negativity and P50 Sensory Gating in Abstinent Former Cannabis Users

Prolonged heavy exposure to cannabis is associated with impaired cognition and brain functional and structural alterations. We recently reported attenuated mismatch negativity (MMN) and altered P50 sensory gating in chronic cannabis users. This study investigated the extent of brain functional recovery (indexed by MMN and P50) in chronic users after cessation of use. Eighteen ex-users (median 13.5 years prior regular use; median 3.5 years abstinence) and 18 nonusers completed (1) a multifeature oddball task with duration, frequency, and intensity deviants and (2) a P50 paired-click paradigm. Trend level smaller duration MMN amplitude and larger P50 ratios (indicative of poorer sensory gating) were observed in ex-users compared to controls. Poorer P50 gating correlated with prior duration of cannabis use. Duration of abstinence was positively correlated with duration MMN amplitude, even after controlling for age and duration of cannabis use. Impaired sensory gating and attenuated MMN amplitude tended to persist in ex-users after prolonged cessation of use, suggesting a lack of full recovery. An association with prolonged duration of prior cannabis use may indicate persistent cannabis-related alterations to P50 sensory gating. Greater reductions in MMN amplitude with increasing abstinence (positive correlation) may be related to either self-medication or an accelerated aging process.

Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program

Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.

The National Treatment Outcomes Research Study (NTORS) and its influence on addiction treatment policy in the United Kingdom

This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment.

Assessing Drug Consumption Behavior With the Heidelberger Drogenbogen (Heidelberg Drug Scales): Reliabilities, Validities, and Cut-Off Criteria

BACKGROUND

The Heidelberger Drogenbogen (HDB) is a German language assessment of substance-specific knowledge and consumption patterns of the illicit psychoactive substances cannabis, MDMA (ecstasy), amphetamines, cocaine, and hallucinogens. The behavior modules for each of these five drugs/drug groups allow for a diagnostic evaluation of the extent of harmful consumption behavior. Each of the five modules represents a single standardized test.

OBJECTIVES

This paper outlines several statistical parameters, Cronbach's alpha, retest reliabilities, as well as numerous validity and cut-off-criteria of the behavioral modules.

METHODS

Participants (N = 4,794) were recruited at schools, universities, in subcultural contexts, and in institutions of substance abuse treatment.

RESULTS

Internal consistencies range from = .68 to .79 while test-retest reliabilities between .87 and .94 were found. The behavior modules of the HDB can discriminate between populations with and without clinical levels of substance use. Furthermore, this measure has incremental validity and higher diagnostic accuracy over competing measures.

CONCLUSIONS

The behavior modules of the HDB are reliable and valid measures of substance use and misuse.

Affective temperaments in alcohol and opiate addictions

Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.05-1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95% CI 1.36-7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95% CI 0.42-0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.

Problem alcohol use among problem drug users: development and content of clinical guidelines for general practice

BACKGROUND

Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment.

AIMS

This paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among this population.

METHODS

The guidelines were developed in three stages: (1) identification of key stakeholders, (2) development of evidence-based draft guidelines, and (3) determination of a modified 'Delphi-facilitated' consensus among the group members.

RESULTS

The guidelines incorporate advice for physicians on all aspects of care, including (1) definition of problem alcohol use among problem drug users, (2) alcohol screening, (3) brief intervention, and (4) subsequent management of patients with alcohol dependence.

CONCLUSIONS

Primary care has an important role to play in the care of problem alcohol use among problem drug users, especially opiate substitution patients. Further research on strategies to inform the implementation of these guidelines is a priority.

Alcohol consumption and marijuana use in young adult Czechs

OBJECTIVES

The main objective of the study is to explore associations between alcohol consumption and marijuana use in young adults and to discuss the opportunities for brief intervention.

METHODS

Face to face structured interviews were carried out with 2,221 young adult Czechs (mean age 29.9, sd. 5.8 years). 51.4% were males. Alcohol consumption was calculated using beverage specific quantity frequency method. Alcohol-related problems were assessed using the Czech version of the AUDIT. Frequency of marijuana use in the last twelve months was asked as well.

RESULTS

The overall alcohol consumption was 9.2 litres of pure alcohol per person and year. The last year prevalence of marijuana use was 21.8%. The use of marijuana positively correlated with the frequency of beer drinking (r = 0.27), frequency of heavy episodic drinking [HED] (r = 0.32) and with the summary score in AUDIT (r = 0.39). Harmful or problem drinkers (AUDIT score > or = 16) reported marijuana use more frequently than moderate drinkers (60% compared to 18.8%; OR = 6.54; 95% CI = 4.7; 9.1). OR for marihuana use in heavy episodic drinkers was 4.3 (95% CI = 3.3; 5.6).

DISCUSSION

The results suggest that frequent HED and harmful drinking are closely associated with marijuana use in younger adults. Since marijuana use (including heavy use) is rather common in the Czech Republic, it would be recommendable to also extend screening and brief intervention to reduce the use of cannabis. The existing guidelines for brief intervention should be modified in order to cover marijuana consumption as well.

Impact of addiction severity and psychiatric comorbidity on the quality of life of alcohol-, drug- and dual-dependent persons in residential treatment

BACKGROUND

Substance users' quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL.

METHODS

Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire.

RESULTS

Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health.

CONCLUSION

Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

Prevalence and determinants of personality disorders in a clinical sample of alcohol-, drug-, and dual-dependent patients

The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses. Data were gathered in 2007-2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview). The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients. The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.

Understanding subtypes of inner-city drug users with a latent class approach

AIMS

We empirically identified subtypes of inner-city users of heroin and cocaine based on type of drug used and route of administration.

METHOD

The sample was recruited from the communities in Baltimore, MD (SHIELD study) and consisted of 1061 participants who used heroin and or cocaine in the past 6 months on a weekly basis or more. Latent class analysis (LCA) was used to identify subtypes of drug users based on type of drug and route of administration. Logistic regression was used to compare the subtypes on depressive symptoms, injection risk and drug network compositions.

FINDINGS

Inner-city drug users were classified into five subtypes: three subtypes of injection drug users (IDUs) [heroin injecting (n=134; 13%), polydrug and polyroute (n=88, 8%), and heroin and cocaine injecting (n=404, 38%)], and two subtypes with low proportions of IDUs (LIDUs) [heroin snorting (n=275, 26%) and crack smoking (n=160; 14%)]. The polydrug and polyroute subtype had the highest depressive symptoms risk among all subtypes. Injection risk was lowest in the heroin injecting subtype and significantly differed from heroin and cocaine injecting subtype. The IDU subtypes also varied in the drug network compositions. The LIDU subtypes had similar depressive symptoms risk but vastly differed in the drug network compositions.

CONCLUSIONS

Subgroups of inner-city cocaine and heroin users based on type and route of administration differed in their depressive symptoms, injection risk and drug network compositions. Future studies should longitudinally examine factors associated with transitioning across these subtypes to better inform prevention and treatment efforts.

Discounting of delayed rewards and executive dysfunction in individuals infected with hepatitis C

OBJECTIVE

Determine whether adults with hepatitis C (HCV), regardless of substance use disorder, are more likely to discount delayed rewards than adults without hepatitis C, and explore the relationship between delay discounting and neuropsychological functioning.

METHODS

Procedures included clinical interviews, neuropsychological testing, and a delay discounting task.

RESULTS

Regardless of substance abuse history, adults with hepatitis C were significantly more likely to choose smaller immediate rewards over larger delayed rewards. Delay discounting correlated with performance on executive functioning tasks.

CONCLUSIONS

Increased discounting is associated with broad executive dysfunction, suggesting that HCV-associated executive dysfunction may lead to altered decision-making style.

The cognitive effects of hepatitis C in the presence and absence of a history of substance use disorder

The aim of the study was to determine whether infection with the hepatitis C virus (HCV) is associated with cognitive impairment beyond the effects of prevalent comorbidities and a history of substance use disorder (SUD). Adult veterans were recruited from the Portland Veterans Affairs Medical Center into three groups: (1) HCV+/SUD+ (n = 39), (2) HCV+/SUD- (n = 24), and (3) HCV-/SUD- (n = 56). SUD+ participants were in remission for > or =90 days, while SUD- participants had no history of SUD. Groups did not significantly differ in terms of rates of psychiatric or medical comorbidities. Procedures included clinical interviews, medical record reviews, and neuropsychological testing. Significant group differences were found in the domains of Verbal Memory, Auditory Attention, Speeded Visual Information Processing, and Reasoning/Mental Flexibility (p <or = .05). Post hoc comparisons indicated that HCV+/SUD- patients performed significantly worse than HCV-/SUD- controls on tests measuring verbal learning, auditory attention, and reasoning/mental flexibility, but only HCV+/SUD+ patients did worse than HCV-/SUD- controls on tests of speeded visual information processing. Results indicate that chronic HCV is associated with cognitive impairment in the absence of a history of SUD. The most robust deficits appear to be in verbal learning and reasoning/mental flexibility. (JINS, 2009, 15, 69-82.).

Opioid maintenance therapy suppresses alcohol intake in heroin addicts with alcohol dependence: preliminary results of an open randomized study

An open randomized study lasting 12 months was performed to evaluate the efficacy of methadone or buprenorphine to suppress alcohol use in two hundred and eighteen heroin addicts with alcohol dependence. Daily maintenance doses of methadone were 80, 120, 160, and 200 mg/day, while doses of buprenorphine were 8, 16, 24, and 32 mg/day. As expected, both treatments were able to reduce both heroin use and addiction severity (measured with ASI interview). However, although both medications were able to suppress alcohol use, the highest dose of buprenorphine was better than the highest dose of methadone, in reducing alcohol craving, ethanol intake (measured as daily number of drinks), and the ASI subscale of alcohol use. The mechanism underlying the effects of the opioid maintenance therapy on the reduction of alcohol intake is still unclear. The results of the present study may represent the first clinical evidence of the potential effective use of the highest doses of buprenorphine for the suppression of ethanol intake in heroin addicts with alcohol dependence.

Comparative psychometric study of a range of hazardous drinking measures administered online in a youth population

AIMS

To compare the psychometric performance of a range of existing alcohol measures when data are collected online with young people, and thereby to gain insights into the reliability and validity of this mode of data collection.

METHOD

One hundred and sixty-seven U.K. resident young people aged 16-24 who had drunk alcohol within the past week participated in a cross-sectional psychometric study with a test-retest reliability component. Eight hazardous drinking measures were used: the alcohol use disorders identification test (AUDIT) summary instrument and dedicated assessments of consumption (timeline follow-back and diary-format recall of alcohol drunk in the last 7 days), dependence (Leeds dependence questionnaire and severity of dependence scale) and problems (Rutgers alcohol problem index, alcohol problems scale and academic role expectations and alcohol scale).

RESULTS

Internal consistency and test-retest correlation statistics were generally satisfactory, providing evidence of reliability. Validation data obtained in principal components analyses, investigation of the correlation matrix and in a multiple regression model of total AUDIT score were also supportive of the online use of these measures. Evidence was weakest for the alcohol problems scale.

CONCLUSIONS

A range of hazardous drinking measures exhibit sound psychometric properties when administered online. Further comparative study of the relationships between different measures is needed.

Dual Substance Abusers Seeking Treatment: Demographic, Substance-Related, and Treatment Utilization Characteristics

High comorbidity exists between alcohol and drug-related disorders. However, little information is available on characteristics of clients abusing both alcohol and illicit drugs (so-called dual substance abusers). The proportion of dual substance abusers and their characteristics are examined in a sample of 1,626 clients seeking treatment in one of the 16 participating centers in the province of Antwerp (Belgium). More than a quarter of all clients were identified as dual substance abusers. Their characteristics correspond better to those of drug abusers than to those of alcohol abusers, but compared to the former, they are younger, more often male, use more types of illicit substances and more often use stimulating substances. Alcohol is often underestimated in substance use patterns. Thorough alcohol assessment, early intervention, and preventive actions are needed within the drug treatment system, and closer collaboration with the alcohol treatment system is absolutely essential.

Mortality related to pharmacotherapies for opioid dependence: a comparative analysis of coronial records

INTRODUCTION AND AIMS

The aim of this study was to compare the mortality associated with oral naltrexone, methadone and buprenorphine in opioid dependence treatment, employing a retrospective data analysis using coronial and prescription data.

DESIGN AND METHODS

The number of deaths were identified through national coronial data and number of treatment recipients were estimated from 2000 to 2003 prescriptions and restricted medications data. Mortality rates were expressed as deaths per number of treatment episodes and per person-years at high and low risk of fatal opioid overdose.

RESULTS

Thirty-two oral naltrexone, one buprenorphine and 282 methadone-related deaths were identified. Mortality rates in the highest risk period in deaths per 100 person-years were 22.1 (14.6 - 32.2) for oral naltrexone following treatment cessation and 3.0 (2.3 - 3.9) for methadone during treatment induction. Rates in the lowest risk period in deaths per 100 person-years were 1.0 (0.3 - 2.2) during oral naltrexone treatment and 0.34 (0.3 - 0.4) during post-induction methadone treatment. The relative risk of death for oral naltrexone subjects was 7.4 times (high-risk period, p < 0.0001) or 2.8 times (low-risk period, p = 0.055) that of methadone subjects.

DISCUSSION AND CONCLUSIONS

This is the first comparison of mortality associated with these three pharmacotherapies for opioid dependence. The risk of death related to oral naltrexone appears higher than that related to methadone treatment.

Concurrent and simultaneous drug and alcohol use: results of the 2000 National Alcohol Survey

This study estimates the prevalence, assesses predictors and evaluates factors associated with concurrent and simultaneous use of drugs and alcohol in the United States population. Using data from the 2000 National Alcohol Survey (n=7612), respondents were asked if they used specific drugs in the last 12 months. Current drinkers who reported using each type of drug were asked if they used alcohol and the drug at the same time. Approximately 10% reported using marijuana in the last 12 months (concurrent use); 7% reported drinking alcohol and using marijuana at the same time (simultaneous use). Approximately 5% of current drinkers reported using drugs other than marijuana in the last 12 months; 1.7% reported drinking alcohol and using drugs other than marijuana at the same time. Being younger, having less than a high school education, not having a regular partner and having heavier drinking patterns were associated with using alcohol and marijuana simultaneously. Simultaneous use of marijuana and alcohol as well as other drugs and alcohol were significantly related to social consequences, alcohol dependence, and depression. These results mirror clinical populations in which increasingly younger clients report use of alcohol and drugs and need treatment for both.

Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence

Optimal cut-off points on the Severity of Dependence Scale (SDS) indicative of clinically significant dependence have been determined for a range of substance types. This study aims to determine a cut-off point on SDS that discriminates between the presence and absence of a DSM-IV diagnosis of alcohol dependence. A structured interview was administered to 90 alcohol users in Sydney, Australia. Receiver Operating Characteristic curve analysis confirmed the utility of the SDS-alcohol for characterising and diagnosing persons with respect to their alcohol-dependent status to an accuracy of 85%. A SDS score of 3 or above was determined as optimal for characterising alcohol dependence. Evidence is also provided confirming that the SDS-alcohol is a valid, reliable uni-dimensional scale for measuring alcohol dependence. It has been demonstrated that the SDS-alcohol can be used to characterise an individual's alcohol-dependent status. A cut-off value for SDS-alcohol provides additional meaning and value to the scale for clients and clinicians and will enable researchers to characterise the prevalence of alcohol dependence in their target populations.

Changes over time among homeless young people in drug dependency, mental illness and their co-morbidity

A cross-national survey was conducted among 358 recently homeless young people in Melbourne and Los Angeles. Drug dependence and mental illness were assessed at baseline, 6 and 12 months. At each time point, participants were classified as no condition, drug dependent, having a mental illness or dual condition. Low levels of drug dependence or mental illness or both were reported at each data point. Most young people were classified as neither drug dependent nor having mental illness at baseline and remained so for the 12-month period and few remained drug dependent, or had continuing mental illness or both. Half to two-thirds of young people classified as having one or both conditions were subsequently reclassified as "no condition". There was no evidence of a consistent pathway from either drug dependence or mental illness to co-morbidity. Most young people reported an absence of mental illness and/or drug dependence at each time point. Improvement from one or both conditions at each transition suggests it may be more effective to provide interventions to address drug dependence and mental health problems to young people early in their experience of homelessness.

Comparison of buprenorphine and methadone in the treatment of opiate withdrawal: possible advantages of buprenorphine for the treatment of opiate-benzodiazepine codependent patients?

The study is a preliminary investigation to compare the effectiveness of buprenorphine and methadone as opiate detoxification treatments. The sample comprised 123 drug misusers who were dependent upon opiates only or who were codependent upon opiates and benzodiazepines. Drug misusers dependent upon methadone doses up to 70 mg were eligible for the study. Detoxification took place within a specialist inpatient drug-dependence unit. Withdrawal symptom severity was assessed on a daily basis by means of the Short Opiate Withdrawal Scale. Outcome was assessed for reductions in severity of withdrawal symptoms, treatment retention, and treatment completion. Buprenorphine detoxification was associated with less severe opiate withdrawal symptoms than methadone. Opiate/Benzodiazepine codependent patients reported less severe withdrawal symptoms during treatment with buprenorphine than with methadone and were also more likely to complete detoxification when treated with buprenorphine.

Excessive alcohol consumption is associated with reduced quality of life among methadone patients

AIM

To evaluate the impact of excessive alcohol consumption on the health-related quality of life of patients receiving methadone treatment for opioid dependence.

DESIGN

A cross-sectional survey.

PARTICIPANTS

One hundred and ninety-two patients attending out-patient methadone clinics in the south-east of England, United Kingdom.

MEASUREMENTS

Quality of life (QoL) was assessed using the Medical Outcomes Study: General Health Survey, Short Form (SF-12). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).

FINDINGS

Approximately one-third of the sample (57/192) were AUDIT-positive (score > or = 8) and 20 of the 135 AUDIT-negative patients reported past history of alcohol problems. AUDIT-positive patients were less satisfied with their methadone dose than AUDIT-negative patients (P = 0.002), despite having a higher dose. AUDIT-positive patients reported more physical (P = 0.020) and psychological (P = 0.034) health problems and poorer QoL (P = 0.008) with an estimated effect size of 0.46. Lower QoL scores for AUDIT-positive patients affected both 'physical' (P = 0.009) and 'psychological' (P = 0.012) health domains with poor role functioning ('role limitation' due to physical health, P < 0.001 and to emotional health, P = 0.009), social functioning (P = 0.015) and self-perceived general health (P = 0.029).

CONCLUSION

Excessive alcohol consumption may be associated with a distinctive pattern of QoL impairment in methadone patients. In addition to advising methadone patients regarding their alcohol consumption, comprehensive care plans should seek to restore normal personal, family and social role functioning through the provision of appropriate health and social care.

Comparison of single and multiple agency clients in substance abuse treatment services

BACKGROUND

Frequent and multiple service utilization among substance abusers is a well-known problem. However, little statistical evidence exists about overlapping agency populations.

METHODS

This phenomenon was studied in a clear-cut region in Belgium, based on intake information concerning all clients who addressed a drug treatment center within a 6-month period (n=1,139).

RESULTS

Multiple service utilization was rather common but not omnipresent during this particular registration period. Almost 15% of the clients were registered in more than one substance abuse treatment agency. Compared to single agency attendees, multiple agency clients appeared to be more often poly-substance abusers with a longer previous treatment history and greater problem severity.

CONCLUSION

A continuous care perspective, interagency collaboration and a common tracking and documentation system are recommended to better address the needs of this specific subgroup of substance abusers. More research is needed to clarify whether these multiple service utilization patterns are caused by client-related, agency-related or other factors.