Spontaneous remission from alcohol, tobacco, and other drug abuse: seeking quantitative answers to qualitative questions

Using the social cognitive theory to examine spontaneous attempts to quit illicit substance use

Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.

"Everybody needs to find the best path for them": Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder

BACKGROUND

Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment.

METHODS

We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants.

RESULTS

Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants.

CONCLUSIONS

Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD.

Developmental trajectories of illicit drug use, prescription drug misuse and cannabis practices among young adult cannabis users in Los Angeles

INTRODUCTION AND AIMS

Young adults have the highest rates of drug use and contribute significantly to the growing population of medical cannabis patients (MCP). This study examined relationships between longitudinal patterns of illicit/prescription drug use/misuse and cannabis practices among young adult cannabis users.

DESIGN AND METHODS

In 2014-2015, 210 young adult MCP and 156 nonpatient users were recruited in Los Angeles and surveyed annually over four waves. The analytical sample was limited to completers of all four waves (n = 301). Distinct developmental trajectories of illicit drug use and prescription drug misuse were identified. Fixed effects regression analysis evaluated changes in cannabis practices by trajectory groups.

RESULTS

Results supported two-trajectory solutions (high/low) for illicit drug use and prescription drug misuse. Decreases in use within all four trajectories occurred by wave 4. Low illicit drug use trajectory members were more likely to self-report medical cannabis use. Membership in both types of high-use trajectories was associated with use of concentrates and edibles. The prevalence of MCP, edibles use and cannabis days decreased significantly by wave 4.

DISCUSSION AND CONCLUSIONS

While alternative cannabis forms use was associated with membership in high drug use trajectories, self-reported medical cannabis use (not MCP) was negatively associated with high illicit drug use trajectory membership. Reductions in the prevalence of MCP, cannabis days, edibles use and other drug use by wave 4 alongside stable levels of self-reported medical cannabis use might reflect the changing legal status of cannabis in California, maturing out phenomenon and safer patterns of cannabis use.

Attitudes about medications for alcohol use disorder among individuals with serious mental illness: A health belief model analysis

BACKGROUND

Medications for alcohol use disorder (MAUD) are underutilized in mental health settings. Increasing use of MAUD requires increasing both the availability of these medications and the demand by individuals who could benefit. Few studies have explored the views of individuals with severe mental illness and alcohol use disorder about MAUD. We sought to examine, among individuals treated in publicly funded community mental health clinics, perceived need for and attitudes toward MAUD.

METHODS

We conducted 8 focus groups with 87 participants treated in public mental health clinics in Los Angeles County. We aimed to include individuals with a current or past AUD diagnosis and individuals helping others (e.g., a family member) who drink. We examined responses using domains associated with the Health Belief Model to identify factors that shape acceptance of MAUD.

RESULTS

Participants were 53% female; most were minorities. Average age was 47 years (SD = 11). Twenty-four reported never drinking, 13 of whom had a current or past diagnosis of AUD. Twenty-two reported drinking 4 or more times per week. Three-quarters had not heard of naltrexone. Participants understood that alcohol use has severe adverse consequences and perceived themselves to be highly susceptible to these consequences. Regarding attitudes toward MAUD, participants described an internal locus of control (e.g., their own desires, actions, and effort) as central to addressing problem drinking; this shaped their views that MAUD would have only modest benefits and potentially high burden. Those individuals who had tried MAUD expressed the most optimism about its effectiveness.

CONCLUSIONS

Participants worried MAUD would impede the development of self-control over drinking by fostering dependence on medication and undermining self-discipline. Client education and counseling that emphasizes MAUD as a tool to build clients' self-control may increase demand for these medications in mental health settings.

The Role of Life Events/Contextual Factors and Cannabis Use in Patterns of Other Drug Use Among Young Adult Cannabis Users in Los Angeles: A Qualitative Inquiry

This analysis examined the role of impactful life events/stressful contextual factors and cannabis use in the patterns of illicit drug use. It utilized semi-structured qualitative interviews with 40 young adult medical cannabis patients and 22 non-patient users collected in Los Angeles during 2014-2015. Three patterns of illicit drug use emerged based on participants' narratives: regular/problematic, recreational/occasional, and never users. Among regular/problematic users, a common theme was the lasting impact of traumatic life events or stressful contextual factors on transition to and away from problematic drug use, and using cannabis to cope with negative after effects of drug use. In contrast, most recreational/occasional and never users, who reported impactful life events or stressful contextual factors, used cannabis to cope with those experiences. Family history of addiction and acceptance of cannabis use within a family as protective factors against illicit drug use among some recreational/occasional and never users was an unexpected finding.

Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes

This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.

Alcohol use disorders

Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.

Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand

OBJECTIVE

Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners.

METHOD

A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date.

RESULTS

Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available.

CONCLUSIONS

Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

Measuring Unmet Demand for Alcohol and Other Drug Treatment: The Application of an Australian Population-Based Planning Model

OBJECTIVE

The estimation of demand for treatment is one of the important elements in planning for alcohol and other drug treatment services. This article reports on a demand-projection model used in Australia to estimate the extent of unmet treatment demand by drug type.

METHOD

The model incorporated the prevalence of substance use disorders (by drug type and age), with the application of a severity distribution, which distributed the substance abuse disorders into three disability categories: mild, moderate, and severe. The application of treatment rates derived from expert judgments reflecting the proportion of people within disability categories who would be suitable for, likely to seek, and benefit from treatment. Sensitivity analyses incorporating variations to the severity distributions and treatment rates were applied, along with adjustment for polydrug use.

RESULTS

The estimate for treatment demand for Australia varied between a low of 411,740 people and a high of 755,557 people. The most sensitive parameter is the expected treatment-seeking rate. Given that approximately 200,000 to 230,000 people are currently in treatment, this represents a met demand of between 26.8% and 56.4%.

CONCLUSIONS

There is insufficient alcohol and drug treatment available to meet the demand in Australia, despite Australia's relatively high met demand, when compared with other countries.

Is smartphone addiction really an addiction?

Aims In light of the rise in research on technological addictions and smartphone addiction in particular, the aim of this paper was to review the relevant literature on the topic of smartphone addiction and determine whether this disorder exists or if it does not adequately satisfy the criteria for addiction. Methods We reviewed quantitative and qualitative studies on smartphone addiction and analyzed their methods and conclusions to make a determination on the suitability of the diagnosis "addiction" to excessive and problematic smartphone use. Results Although the majority of research in the field declares that smartphones are addictive or takes the existence of smartphone addiction as granted, we did not find sufficient support from the addiction perspective to confirm the existence of smartphone addiction at this time. The behaviors observed in the research could be better labeled as problematic or maladaptive smartphone use and their consequences do not meet the severity levels of those caused by addiction. Discussion and conclusions Addiction is a disorder with severe effects on physical and psychological health. A behavior may have a similar presentation as addiction in terms of excessive use, impulse control problems, and negative consequences, but that does not mean that it should be considered an addiction. We propose moving away from the addiction framework when studying technological behaviors and using other terms such as "problematic use" to describe them. We recommend that problematic technology use is to be studied in its sociocultural context with an increased focus on its compensatory functions, motivations, and gratifications.

Social Work Contribution to Desistance Among At-Risk Youth

Desistance as a process to forgo delinquent habits is an important target for intervention into youth at risk of delinquency. The intervention through social work services, nevertheless, has not clearly demonstrated its effectiveness. For such a demonstration, the present study examines the contribution of social work services with reference to the voluntaristic theory of action. The theory suggests that promoting the youth's voluntarism underlying desistance, encompassing appreciation, facilitation, observation, and identification concerning desistance is essential. The suggestion leads to the hypothesis that social work services promote the youth's desistance through the promotion of voluntarism for desistance. This hypothesis gets support from this study of 586 at-risk youths in Hong Kong, with data collected from both the youths and their responsible social workers. The support implies the value of social work services for sustaining the youth's desistance.

Recovery Agency and Informal Recovery Pathways from Gambling Problems

This study applied a holistic, strength-based lens to better articulate the impetus for, and processes of, informal recovery from gambling problems. Two research objectives framed the parameters of the study: to explore (a) the process by which gamblers move from recognition of a gambling problem to action for recovery and (b) the experiences, perceptions and contextual factors that shape the features of this process. Narrative telephone interviews were conducted with adult residents of Victoria, Australia. Thirty-two adult participants (22 males and 10 females) were recruited from the general community. All participants were self-identified as recovering or recovered from gambling problems. Participants primarily used informal recovery strategies, rather than professional services or support groups. The impetus for informal recovery was identified broadly as either (a) dissonance between desired and actual self-image and goals, (b) an uncontrollable adverse event, or (c) confrontation and decisive action by others affected by the individual's gambling involvement. The impetus, process and goals of recovery were best described by pathways that were distinguished by agency in recovery: externally directed and self-directed. The application of a strength-based lens helped to illuminate the role of agency in informal recovery. A proposed pathways framework may inform strength-based informal recovery strategies for gamblers and affected others, and therapeutic approaches. The pathways, which have not been articulated in previous gambling recovery literature, generally cohere with pathways articulated in the alcohol and substance recovery literature.

Perceived role of motivation and self-efficacy in smoking cessation: A secondary data analysis

BACKGROUND

This secondary analysis tested whether smokers' perceived importance of willpower, ability to quit (i.e., self-efficacy), and use of treatment would prospectively predict occurrence of a quit attempt, duration of abstinence, or use of cessation aids.

METHODS

Smokers (n=143) who planned to quit sometime in the next 3months were asked whether, for most smokers, a) willpower is necessary for quitting, b) willpower is sufficient for quitting, c) they could quit anytime, d) they were too addicted to quit, and e) they thought use of aids indicated weakness of character. Smokers then reported quit attempts and abstinence daily for 3months. No treatment was provided.

RESULTS

The two willpower beliefs were often endorsed (78% and 60% each); the can quit any time and being too addicted beliefs were endorsed less consistently (12% and 35% each); and the belief that use of aids indicates a weakness was rarely endorsed (8%). The beliefs were only modestly correlated. Those who more strongly endorsed the two willpower beliefs or use of aids as a weakness were less likely to make a quit attempt. None of the constructs predicted duration of quit attempt. Seeing treatment as a weakness predicted less use of treatment.

CONCLUSIONS

The large majority of smokers believe willpower is necessary and sufficient for quitting and this belief appears to impede quit attempts. Given this is a post-hoc finding, replication tests are needed. If replicated, clinical and media interventions to combat willpower beliefs may increase quit attempts.

The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Sobriety and alcohol use among rural Alaska Native elders

BACKGROUND

Although notable health disparities related to alcohol use persist among Alaska Native people living in rural communities, there is a paucity of research examining drinking behaviour in particular segments of this population, including elders. One explanation for this is the distrust of behavioural health research in general and alcohol research in particular following the legacy of the Barrow Alcohol Study, still regarded as a notable example of ethics violations in cross-cultural research.

OBJECTIVE

The present study reports findings from one of the first research studies asking directly about alcohol abuse among rural Alaska Natives (AN) since the study in Barrow took place in 1979.

DESIGN

We report findings regarding self-reported alcohol use included in an elder needs assessment conducted with 134 Alaska Native elders from 5 rural villages off the road system in Alaska. Data were collected in partnership between academic researchers and community members in accordance with the principles of Community-Based Participatory Research.

RESULTS

Findings showed very high rates of sobriety and low rates of alcohol use, contradicting stereotypes of widespread alcohol abuse among AN. Possible explanations and future research directions are discussed.

CONCLUSIONS

This research represents one step forward in mending academic-community relationships in rural Alaska to further research on alcohol use and related health disparities.

Cannabis withdrawal in patients with and without opioid dependence

BACKGROUND

Cannabis use is common among opioid-dependent individuals, but little is known about cannabis withdrawal in this population.

METHODS

Thirty inpatients (57% men) completed the Marijuana Quit Questionnaire (MJQQ) after completing acute heroin detoxification treatment in Saint Petersburg, Russia. The MJQQ collected data on motivations for quitting, withdrawal symptoms, and coping strategies used to help maintain abstinence during their most "serious" (self-defined) quit attempt made without formal treatment outside a controlled environment.

RESULTS

At the start of their quit attempt, 70% of participants smoked cannabis at least weekly (40% daily), averaging [SD] 2.73 [1.95] joints daily; 60% were heroin dependent. Subjects with heroin dependence were significantly older at the start of their quit attempt (22.9 [3.6] vs. 19.1 [2.9] years), were significantly less likely to report withdrawal irritability/anger/aggression (22% vs. 58%), restlessness (0% vs. 25%), or physical symptoms (6% vs. 33%), or to meet diagnostic criteria for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) cannabis withdrawal syndrome (6% vs. 33%), and had shorter duration of abstinence (29.6 [28.7] vs 73.7 [44.1] months) than those without heroin dependence.

CONCLUSION

Cannabis users with opioid dependence are less likely to experience cannabis withdrawal, suggesting that opiate use may prevent or mask the experience of cannabis withdrawal. RESULTS should be considered preliminary due to small convenience sample and retrospective data.

Life experiences in active addiction and in recovery among treated and untreated persons: a national study

Addiction treatment can be effective but fewer than 50% of addiction affected persons are ever treated. Little is known about the addiction and recovery experience of this large subgroup. A national sample of persons in recovery (N = 3,176, 29.5% untreated) was used to begin addressing these questions to inform strategies to encourage help-seeking and to contribute to the small knowledge base on untreated individuals. Study domains were finances, family, social and civic functioning, health, criminal justice involvement, and employment. Treated persons reported significantly greater levels of negative-and fewer positive-experiences in all areas during active addiction than did the untreated group. This gap was significantly narrowed in recovery.

Pretreatment assessment-related reductions in drinking among women with alcohol use disorders

BACKGROUND

Preliminary studies have suggested that patients entering research trials for alcohol use disorders (AUDs) may show substantial reductions in drinking prior to beginning treatment.

OBJECTIVES

Determine whether significant pretreatment reductions in drinking are present in a sample of alcohol-dependent women entering a psychotherapy trial for AUDs, and whether such pretreatment drinking reductions predict lower levels of drinking during and posttreatment.

METHOD

The study included 136 women with DSM-IV alcohol dependence who participated in a trial of individual or couples-based cognitive behavioral therapy for AUDs. Repeated-measures ANOVAs were used to examine changes in drinking across the pretreatment assessment period, and hierarchical multiple regression was used to test whether pretreatment reductions in drinking predicted continued reduced drinking during treatment and follow-up at 12 months posttreatment.

RESULTS

Patients had significant reductions in drinking quantity and frequency throughout the pretreatment period, with one-third of the sample becoming abstinent prior to treatment. Controlling for baseline quantity and frequency of drinking, reductions in pretreatment drinking were predictive of reduced frequency of drinking within- and posttreatment, and lower quantity of drinking per drinking occasion in the within-treatment period but not the posttreatment period. Motivational level and treatment arm did not predict the level of change in drinking across the pretreatment period.

CONCLUSIONS

The overall reductions in drinking are consistent with previous findings suggesting that female participants in AUD treatment trials can show a substantial amount of reduction in drinking during the pretreatment assessment phase, before therapy skills are imparted.

The Interactive Effects of Effort to Regulate Alcohol Use, Anxiety Disorders, and Affective Disorders on Long-Term Remission from Alcohol Dependence

OBJECTIVE

The present study examined how effort to regulate alcohol use may interact with anxiety and affective disorders to influence long-term remission from alcohol dependence.

METHOD

Using participants (n= 96; 73% male; 66% children of alcoholics; 71% non-Hispanic Caucasian; 26% Hispanic) from a high-risk community study who showed evidence of recovered alcohol dependence at baseline, the present study examined whether effort to regulate alcohol use at the baseline assessment significantly influenced the likelihood of maintaining remission from alcohol dependence at the 10 year follow-up. This study also examined whether having an anxiety or affective disorder interacted with effort to regulate alcohol use. All analyses controlled for treatment history, baseline alcohol use, parent alcoholism, age, and gender.

RESULTS

Results from logistic regressions showed that effort to regulate alcohol use had a significant unique main effect on maintenance of remission from alcohol dependence. Having an affective and/or anxiety disorder did not have a significant main effect on the maintenance of remission. However, having an anxiety/affective disorder significantly moderated the influence of effort to regulate alcohol use such that the protective effect of effort to regulate use on remission from alcohol dependence was only significant for those without an affective or anxiety disorder.

CONCLUSIONS

Individuals who try harder to limit their drinking are more likely to maintain long-term remission from alcohol dependence. However, affective and anxiety disorders may undermine the protective effect of effort to regulate alcohol use on long-term remission.

Predictors of change in cocaine use in a street-recruited cohort of young cocaine users

AIM

To determine predictors of changes in amount of cocaine use among regular users outside treatment services.

DESIGN

Longitudinal study-we estimated the proportion of subjects who increased or decreased cocaine use and assessed possible predictors related to these changes among a street-recruited cohort of young regular cocaine users (RCU).

SETTING

Three Spanish cities: Barcelona, Madrid and Seville

PARTICIPANTS

A total of 720 RCU aged 18-30 years not regularly using heroin were recruited in the community during 2004-06 (Itinere Project). Follow-up interviews (n = 501) were carried out at 12-24 months.

MEASUREMENTS

The average amount of cocaine used weekly was calculated taking into account the number of days of use and the usual quantity (g/day). A multinomial logistic regression approach was used to investigate the association between changes in amount of cocaine use (i.e. difference exceeded 33.3% of baseline level) after 12-24 months, and baseline socio-demographic characteristics, nightlife, patterns of cocaine use and use of alcohol and other psychoactive drugs.

FINDINGS

Cocaine use baseline average level was 2.14 g/week [95% confidence interval (CI) = 2.02-2.42]. It decreased in 71.5% of subjects and increased in 14.1%. In multinomial analysis, negative associations were found between decreasing cocaine use and high levels of alcohol consumption and using an increasing number of psychoactive drugs. Moreover, low education level, having used cocaine frequently in houses and reporting cocaine binges were associated with increasing cocaine use.

CONCLUSIONS

A street-recruited cohort of cocaine users in Spain showed a significant reduction in cocaine use over a period of 12-24 months. High consumption of alcohol and increasing use of other psychoactive drugs decreased the probability of reducing cocaine use.

Talking about friends, drugs, and change: meanings of friendship in substance abusers' change talk

This article explores the meanings of substance-abusing clients attach to friendships during motivational treatment sessions in Probation Service. Sessions (98) were videotaped in 12 probation service offices in Finland in 2007 to 2009. By using semiotic framework, this qualitative study examines client's change talk utterance about friendships as a symbolic sign. The findings indicate that the friendships play an important role in the substance-abusing clients' motivation to change and in their treatment outcome. The study suggests that the personal meanings of clients' utterances in motivational treatment sessions could be seen as potential predictors of their future behavior.

Reasons behind Greek problem drug users’ decisions to quit using drugs and engage in treatment of their own volition: sense of self and the Greek filotimo

AIMS

The aim of this study was to explore Greek problem drug users’ perceptions of the reasons that led them to quit using drugs and engage in treatment of their own volition.

DESIGN

Qualitative semi-structured in-depth interviews.

SETTING

Two state drug agencies in Thessaloniki, Greece.

PARTICIPANTS

A total of 40 adult problem drug-using men and women participated in the study.

MEASUREMENTS

Participants were asked to reflect on their decisions to wean themselves from drugs and enter treatment. Findings Participants reported that their decisions centred on the re-conceptualization of the drug-using community and their membership in it, the desire to restore aspects of identities thatwere deemed to be spoiled, and finally memories of their drug-free selves. The importance of the distinctively Greek notion of filotimo in this discussion is highlighted.

CONCLUSIONS

Primarily in relation to filotimo (a concept that represents a complex array of virtues that regulates behaviour towards one’s family), the desire to restore one’s spoiled identity plays a pivotal role in Greek problem drug users’ decisions to cease drug use and engage in treatment.

Relief of cannabis withdrawal symptoms and cannabis quitting strategies in people with schizophrenia

This study examined the response to cannabis withdrawal symptoms and use of quitting strategies to maintain abstinence in people with schizophrenia. A convenience sample of 120 participants with schizophrenia who had at least weekly cannabis use and a previous quit attempt without formal treatment were administered the 176-item Marijuana Quit Questionnaire to characterize their "most serious" (self-defined) quit attempt. One hundred thirteen participants had withdrawal symptoms, of whom 104 (92.0%) took some action to relieve a symptom, most commonly nicotine use (75%). 90% of withdrawal symptoms evoked an action for relief in a majority of participants experiencing them, most frequently anxiety (95.2% of participants) and cannabis craving (94.4%). 96% of participants used one or more quitting strategies to maintain abstinence during their quit attempt, most commonly getting rid of cannabis (72%) and cannabis paraphernalia (67%). Religious support or prayer was the quitting strategy most often deemed "most helpful" (15%). Use of a self-identified most helpful quitting strategy was associated with significantly higher one-month (80.8% vs. 73.6%) and one-year (54.9% vs. 41.3%) abstinence rates. Actions to relieve cannabis withdrawal symptoms in people with schizophrenia are common. Promotion of effective quitting strategies may aid relapse prevention.

Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations

BACKGROUND

Narrative therapies, especially narrative exposure therapy, are used to treat the effects of trauma in refugees and to prevent psychiatric illness. These methods involve helping the person to tell the story of what happened to them until it no longer elicits anxiety.

METHODS

We reviewed all quantitative studies related to narrative exposure methods for treating trauma or posttraumatic stress disorder in refugees. We focused on studies with sufficient information to calculate effect sizes and statistical power.

RESULTS

We found 7 quantitative studies for which effect size and power could be calculated. The total average effect size for all interventions was 0.63 (medium). The average effect size for studies in which interventions were administered by physicians, adequately trained graduate students, or both was 0.53. The effect size for studies in which the counselors were themselves refugees was 1.02. The 95% confidence intervals for the effect sizes of narrative exposure therapy did not reach below 0.

CONCLUSION

Studies demonstrating the effectiveness of narrative methods have adequate effect sizes and statistical power. Empowering lay counselors to treat their fellow refugees in future studies is warranted.

The Religious and Spiritual Dimensions of Cutting Down and Stopping Cocaine Use: A Qualitative Exploration Among African Americans in the South

This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God's will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.

Cannabis withdrawal in chronic cannabis users with schizophrenia

BACKGROUND

Chronic users of cannabis often report withdrawal symptoms after abstinence from use, but little is known about cannabis withdrawal in people with schizophrenia.

METHODS

Cannabis use patterns and withdrawal symptoms in adults with schizophrenia who had at least weekly cannabis use before attempting to quit without formal treatment were assessed with the Marijuana Quit Questionnaire (MJQQ), a 176-item, semi-structured questionnaire.

RESULTS

120 participants, predominantly African-American (62.5%) and male (76.7%), met inclusion criteria. 20.1% reported that their first regular cannabis use (median age 15 years [range 8-48]) preceded their age at first psychotic symptoms (20 [4-50] years). Twenty (16.7%) participants met lifetime criteria for cannabis abuse; 98 (81.7%) met surrogate criteria for lifetime cannabis dependence. Withdrawal symptoms were reported by 113 (94.2%) participants, with 74.2% reporting ≥4 symptoms. The most frequently reported withdrawal symptoms were craving for cannabis (59.2%), feeling anxious (52.57%), feeling bored (47.5%), feeling sad or depressed (45.8%), feeling irritable or jumpy (45.0%), feeling restless (43.3%), and trouble failing asleep (33.3%). One hundred-and-four (92.0%) participants took some action to relieve at least one of their withdrawal symptoms during their index-quit attempt, including 26 (23.0%) participants who reported resuming cannabis use.

CONCLUSION

Cannabis withdrawal is a clinically significant feature of cannabis use among people with schizophrenia, may serve as a negative reinforcer for relapse, and deserves greater attention in treatment and research. Clinical Trials registration NCT00679016.

An interview study investigating experiences of psychological change without psychotherapy

OBJECTIVES

Given that most people who experience psychological distress resolve this distress without the assistance of psychotherapy, the study sought to increase our understanding of naturally occurring change including the facilitators of this change.

DESIGN

The study sought to replicate and extend earlier work in this area. The design involved recruiting participants who had experienced some form of psychological distress and had resolved this distress without accessing psychotherapy services.

METHODS

Qualitative methods were used for this study because the lived experience of the participants was of interest. Semi-structured interviews were used following a pro forma developed in earlier work. Interpretive Phenomenological Analysis was the analytical method adopted for this study to identify themes and patterns in the transcripts of the interviews of the participants.

RESULTS

Data analysis identified the themes of identity, connection, threshold, desire to change, change as a sudden and gradual process, and thinking process. An unexpected finding was the subjectivity associated with deciding whether or not a problem had actually resolved.

CONCLUSIONS

The results are discussed in terms of their implications for clinical practice including the apparent importance of people reaching an emotional threshold prior to change. A sense of identity also appears to be important in change experiences.

Rural drug users: factors associated with substance abuse treatment utilization

The purpose of this study is to use a modified version of Andersen's Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users' substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users.

Do premorbid predictors of alcohol dependence also predict the failure to recover from alcoholism?

OBJECTIVE

In a search for viable endophenotypes of alcoholism, this longitudinal study attempted to identify premorbid predictors of alcohol dependence that also predicted the course of alcoholism.

METHOD

The 202 male subjects who completed a 40-year follow-up were originally selected from a Danish birth cohort (N = 9,182). Two thirds of the subjects were high-risk biological sons of treated alcoholics. A large number of measures (361) were obtained at different periods before any subject had developed an alcohol-use disorder. At age 40, a psychiatrist provided mutually exclusive lifetime diagnoses of alcohol abuse or alcohol dependence that were characterized as currently active or currently in remission according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, course specifiers.

RESULTS

The majority of subjects with a diagnosis of alcohol abuse were in remission at age 40 compared with those with a diagnosis of alcohol dependence (88% vs. 58%). Treatment did not predict remission. Fourteen of the 18 predictors of remission that also predicted dependence were submitted to an exploratory factor analysis (varimax). Two premorbid dimensions were identified: cognitive efficiency and early behavioral dyscontrol in childhood. Both factors predicted the failure to remit (low cognitive efficiency and high behavioral dyscontrol) even when lifetime alcoholism severity was controlled.

CONCLUSIONS

This 4-decade study found a striking disconnect between measures that predicted alcohol dependence and measures that predicted remission from alcohol dependence. Reduced cognitive efficiency and increased behavioral dyscontrol may be basic to gaining a fuller understanding of the etiology of alcoholism.

Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers

BACKGROUND

Cannabis withdrawal is not recognized in DSM-IV because of doubts about its clinical significance.

OBJECTIVES

Assess the phenomenon of cannabis withdrawal and its relationship to relapse in non-treatment-seeking adults.

SUBJECTS

Convenience sample of 469 adult cannabis smokers who had made a quit attempt while not in a controlled environment.

METHODS

Subjects completed a 176-item Marijuana Quit Questionnaire collecting information on sociodemographic characteristics, cannabis use history, and their "most difficult" cannabis quit attempt.

RESULTS

42.4% of subjects had experienced a lifetime withdrawal syndrome, of whom 70.4% reported using cannabis in response to withdrawal. During the index quit attempt, 95.5% of subjects reported > or =1 individual withdrawal symptom (mean [SD] 9.5 [6.1], median 9.0); 43.1% reported > or =10. Number of withdrawal symptoms was significantly associated with greater frequency and amount of cannabis use, but symptoms occurred even in those using less than weekly. Symptoms were usually of > or = moderate intensity and often prompted actions to relieve them. Alcohol (41.5%) and tobacco (48.2%) were used more often than cannabis (33.3%) for this purpose. There was little change during withdrawal in use of other legal or illegal substances.

CONCLUSIONS

Cannabis withdrawal is a common syndrome among adults not seeking treatment. The intention to relieve withdrawal symptoms can drive relapse during quit attempts, giving cannabis withdrawal clinical significance as a target of treatment.

What is the mechanism of psychological change? A qualitative analysis of six individuals who experienced personal change and recovery

OBJECTIVE

The mechanism of psychological change, whether this occurs as a result of psychotherapeutic intervention or during natural recovery, remains unknown. The aim of this study was to explore and understand how and why psychological change occurs.

DESIGN

This study presents the accounts of six individuals who experienced psychological change and recovery following a significant problem in their lives using the qualitative method of interpretative phenomenological analysis (IPA).

METHOD

A semi-structured interview covered several aspects of their experience which included details of the problem they faced, how the problem affected their lives, how they were able to overcome the problem, and how they felt about their problem looking back.

RESULTS

Four superordinate themes emerged from the analysis: hopelessness and issues of control; the change process; new self versus old self; and putting the problem into perspective.

CONCLUSIONS

Findings are discussed in relation to existing literature on hopelessness and locus of control, experiential avoidance, acceptance and mindfulness, insight, and adversarial growth. The findings are also discussed in relation to a theory of self-regulation known as perceptual control theory (PCT). It is proposed that this theory may provide a valid account of the mechanism of psychological change.

Factors influencing the course of opiate addiction

AIMS

To describe important non-biological factors which influence the course of opiate addiction.

METHOD

Studies were reviewed that present empirical results on the long-term course of opiate addiction, progress of opiate addicts during and after treatment, variables that predict remission and abstinence, comparisons of treated and untreated samples, and recovery from opiate addiction without formal help.

RESULTS

Opiate addiction is a chronic disorder with high mortality risk. The course of opiate addiction often consists of recurring sequences of addictive opiate use and abstinence. Treatment for opiate addiction, especially maintenance treatment, reduces opiate use; however, it is unclear how long after treatment the effects last. In treated samples, long-term opiate use can be moderately predicted from psychosocial factors, such as peer-group relationships, family problems, employment, and social support. Little is known about addicts who do not participate in treatment or who recover without treatment. Common factors that both treated and untreated addicts view as most important to their success are the social environment and their social life and daily activities.

CONCLUSIONS

In view of the chronic course of opiate addiction and the phenomenon of spontaneous recovery without treatment, the role of drug-abuse treatment as an influencing factor would seem to require further clarification. Current treatment programmes may leave unaddressed important factors that contribute to the recovery of drug addicts.

"Heavy users," "controlled users," and "quitters": understanding patterns of crack use among women in a midwestern city

Over the past two decades, the use of crack cocaine has become an enduring part of the social ecology of many cities across the United States. The purpose of this exploratory study is to describe patterns of crack use drawing on life history interviews conducted with 18 women in Dayton, Ohio, between 1998 and 2000. Ten of the women were African American, and eight were white. Age ranged between 23 and 47. The women were at very different stages of their crack-cocaine careers. We focus on understanding the social factors, life history, and everyday circumstances that participants related to their current patterns and levels of crack use. Implications for intervention are discussed.

Quitting Among Non-Treatment-Seeking Marijuana Users: Reasons and Changes in Other Substance Use

This study examines the self-reported reasons for quitting marijuana use, changes in other substance use during the quit attempt, and reasons for the resumption of use in 104 non-treatment-seeking adult marijuana smokers. Reasons for quitting were shown to be primarily motivated by concerns about the negative impact of marijuana on health and on self- and social image. The spontaneous quitting of marijuana use is often associated with an increase in the use of legal substances such as alcohol, tobacco, and sleeping aids, but not with the initiation of new substance use. These findings suggest areas for further research on spontaneous recovery from marijuana use.

The Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction Among Individuals in Recovery from Alcohol and Drug Problems

Many recovering substance users report quitting drugs because they wanted a better life. The road of recovery is the path to a better life but a challenging and stressful path for most. There has been little research among recovering persons in spite of the numbers involved, and most research has focused on substance use outcomes. This study examines stress and quality of life as a function of time in recovery, and uses structural equation modeling to test the hypothesis that social supports, spirituality, religiousness, life meaning, and 12-step affiliation buffer stress toward enhanced life satisfaction. Recovering persons (N = 353) recruited in New York City were mostly inner-city ethnic minority members whose primary substance had been crack or heroin. Longer recovery time was significantly associated with lower stress and with higher quality of life. Findings supported the study hypothesis; the 'buffer' constructs accounted for 22% of the variance in life satisfaction. Implications for research and clinical practice are discussed.

Unmet need for Substance Abuse Treatment of Adults in Massachusetts

This article presents a methodology to estimate the size and cost of eliminating unmet need for substance abuse treatment services among adults who have clinically significant substance use disorders, and applies the approach to Massachusetts' information. Unmet treatment needs were derived using a statewide household telephone survey of 7,251 Massachusetts residents aged 19 and older conducted in 1996-1997, and an index of treatment mix and cost information from state and Medicaid financial data. The study estimates that 39,450 adult state residents (0.81% of the total sample) had a clinically significant past-year substance use disorder, but had not received treatment in the past year. Providing substance abuse treatment and outreach services to them would have required an additional cost of approximately 109 million dollars (17 dollars per capita), of which the state's payer of last resort, the Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS), would need to fund 31 million dollars (5 dollars per capita). The share paid by BSAS (28%) would represent an increase of 42% over its current spending. This paper quantifies an important but sometimes overlooked objective of managed care: to improve access for substance abusers who need but do not seek treatment.

Social context and "natural recovery": the role of social capital in the resolution of drug-associated problems

This paper explores the social context of "natural recovery" from problems associated with the misuse of intoxicants. Using data collected from in-depth interviews with 46 former alcohol- and drug-dependent persons, this paper examines how the social capital that these respondents had accumulated prior to their addiction and maintained during it aided in their recovery without treatment. We specifically explore how the relations within their lives and the actual and virtual resources available to subjects through their social capital aided in our respondents' "natural recovery" from drug-use related problems. We conclude with a discussion of the implications an analysis of social capital has for the treatment of drug-associated problems as well as for drug policy.