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Cloutier RM, Dowd WN, Aldridge A, Walsh CA, Messman BA, Northcott JL, Talbert A, Manolis C, Campbell V, Pringle JL. Project Lifeline-II: Feasibility of Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Allegheny County, Pennsylvania. Public Health Rep 2024:333549241277416. [PMID: 39342449 DOI: 10.1177/00333549241277416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES US community pharmacies are a unique and underused health service setting for identifying and potentially intervening with patients at risk of opioid overdose or opioid use disorder with evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT). The aim of our study was to assess the feasibility of implementing SBIRT in community pharmacies in an urban county in terms of engagement, reach, and equity across the cascade of pharmacy screening and care. METHODS Patients aged 18 years or older receiving a schedule II or III opioid prescription at 1 of 17 participating community pharmacies in Allegheny County, Pennsylvania, were invited to engage in SBIRT as part of Project Lifeline-II from June 2020 through January 2023. Participants completed a prescreen and/or a full screen. We calculated the percentage of patients who participated across the cascade of pharmacy screening and care, overall and by sex (male and female) and race (Black and White). RESULTS During the study period, 1952 unique adults (79.6%) were screened at least once (52.1% female; 58.0% White, 30.7% Black). Patients who identified as male (vs female) and Black (vs White) were more likely to have a positive prescreen (14.7% male vs 9.8% female; 16.4% Black vs 9.5% White), receive and complete a full screen (82.7% male vs 80.0% female; 83.6% Black vs 78.4% White), and score positively on the full screen (26.6% male vs 20.4% female; 26.8% Black vs 21.9% White). CONCLUSION Although additional research is needed to characterize the full effect of Project Lifeline-II on patient outcomes, our findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the substance use disorder crisis in the United States.
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Affiliation(s)
- Renee M Cloutier
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Caitlin A Walsh
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Brett A Messman
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Jessica L Northcott
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Abigail Talbert
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Chronis Manolis
- University of Pittsburgh Medical Center Health Plan, Pittsburgh, PA, USA
| | - Vanessa Campbell
- University of Pittsburgh Medical Center Health Plan, Pittsburgh, PA, USA
| | - Janice L Pringle
- Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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Nawaratne SD, Vidanapathirana J. Psychometric properties of the modified Drug Abuse Screening Test Sinhala version (DAST-SL): evaluation of reliability and validity in Sri Lanka. BMC Public Health 2024; 24:1773. [PMID: 38961374 PMCID: PMC11223402 DOI: 10.1186/s12889-024-19288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Psychoactive drug use is an important public health issue in Sri Lanka as it causes substantial health, social and economic burden to the country. Screening for substance use disorders in people who use drugs is vital in preventive health care, as it can help to identify problematic use early. Screening can aid in referring those in need, for the most appropriate treatment and care. Thus, preventing them from developing severe substance use disorders with complications. The Drug Abuse Screening Test (DAST-10) is an evidence-based tool widely used to assess the severity of psychoactive drug use. This study aimed to culturally adapt and evaluate the validity and reliability of the Drug Abuse Screening Test (DAST-10) in Sri Lanka. METHODS The DAST-10 was culturally adapted, and the nine-item Sinhala version (DAST-SL) was validated using exploratory and confirmatory factor analysis. The validation study was conducted in the Kandy district among people who use drugs, recruited using respondent-driven sampling. Criterion validity of the questionnaire was assessed by taking the diagnosis by a psychiatrist as the gold standard. Cut-off values for the modified questionnaire were developed by constructing Receiver Operating Characteristic (ROC) curves. The reliability of the DAST-SL was assessed by measuring its internal consistency and test re-test reliability. RESULTS The validated DAST-SL demonstrated a one-factor model. A cut-off value of ≥ 2 demonstrated the presence of substance use disorder and had a sensitivity of 98.7%, specificity of 91.7%, a positive predictive value of 98.8% and a negative predictive value of 91.3%. The area under the curve of the ROC curve was 0.98. A cut-off score of ≤ 1 was considered a low level of problems associated with drug use. The DAST-SL score of 2-3 demonstrated a moderate level of problem severity, a score of 4-6 demonstrated a substantial level of problems, and a score of ≥ 7 demonstrated a severe level of drug-related problems. The questionnaire demonstrated high reliability with an internal consistency of 0.80 determined by Kuder-Richardson Formula-20 and an inter-class correlation coefficient of 0.97 for test re-test reliability. CONCLUSION The DAST-SL questionnaire is a valid and reliable tool to screen for drug use problem severity in people who use drugs in Sri Lanka.
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Affiliation(s)
- Sashiprabha Dulanjalee Nawaratne
- Directorate of Healthcare Quality and Safety, Ministry of Health, Premises of Castle Street Hospital for Women, Colombo, 08, Sri Lanka.
| | - Janaki Vidanapathirana
- Planning Unit, Ministry of Health, No. 385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo, 10, Sri Lanka
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Doss RA, Lowmaster SE. Validation of the DSM-5 Level 1 Cross-Cutting Symptom Measure in a Community Sample. Psychiatry Res 2022; 318:114935. [PMID: 36332507 DOI: 10.1016/j.psychres.2022.114935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
The shift toward transdiagnostic and dimensional approaches to diagnosing mental disorders has created a need for assessment tools that efficiently measure a range of mental health symptoms and their severity. The present study aimed to evaluate the psychometric properties and diagnostic utility of the DSM-5 Level 1 Cross-Cutting Symptom Measure (CCSM), developed by the American Psychiatric Association as a brief transdiagnostic measure of mental health symptoms, in community-dwelling adults. Participants (N = 482) completed symptom measures corresponding to CCSM domains and self-reported diagnostic criteria were used to establish DSM-5 diagnoses. The results showed CCSM domains had significant validity correlations with longer measures of the same or similar mental health constructs and overall symptom severity was associated with functional impairments and current treatment status. Several domains demonstrated moderate diagnostic efficiency for corresponding DSM-5 diagnoses. The recommended thresholds for depression, anxiety, and substance use domains showed strong sensitivity (≥ 0.83) but low specificity (range = 0.60-.73), whereas the personality functioning threshold showed low sensitivity (0.51) and excellent specificity (0.92). These results suggest CCSM domains are internally consistent and valid measures of psychopathology. Further, these findings indicate the CCSM shows promise as a screening tool for specific DSM-5 disorders in community samples.
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Affiliation(s)
- Robert A Doss
- Department of Psychology, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069, United States
| | - Sara E Lowmaster
- Department of Psychology, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069, United States.
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Severe J, Pfeiffer PN, Palm-Cruz K, Hoeft T, Sripada R, Hawrilenko M, Chen S, Fortney J. Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial. J Gen Intern Med 2022; 37:3361-3367. [PMID: 35106719 PMCID: PMC9550945 DOI: 10.1007/s11606-021-07343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Telepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations. OBJECTIVE Assess clinical predictors of treatment engagement for complex psychiatric conditions in TCC-in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy-and TER, in which remote specialists provide direct telehealth treatment. DESIGN A randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists. PARTICIPANTS A total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year. MAIN MEASURES Psychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ). KEY RESULTS Engagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group. CONCLUSIONS Both teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02738944.
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Affiliation(s)
- Jennifer Severe
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| | - Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Department of Veterans Affairs, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Katherine Palm-Cruz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Theresa Hoeft
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rebecca Sripada
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Department of Veterans Affairs, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Matthew Hawrilenko
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - John Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
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Brolin M, Reif S, Buell J, Whitcher H, Jaghoo S, McNeil P. Screening and Brief Intervention With Low-Income Youth in Community-Based Settings. J Adolesc Health 2022; 71:S65-S72. [PMID: 36122972 DOI: 10.1016/j.jadohealth.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 05/20/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE We described screening, brief intervention, and referral to treatment (SBIRT) results and assessed whether SBIRT is associated with positive changes in substance use, risky use, and educational/employment outcomes for youth in community-based settings that are not healthcare focused. METHODS YouthBuild USA serves youth of ages 16-24 who are neither in school nor employed. In an SBIRT intervention, youth completed substance use surveys and Alcohol Use Disorders Identification Test and Drug Abuse Screening Test screenings at entry and program completion. Staff reported on services provided in response to screening scores. Regression models compared changes in youth screening results and substance use from intake to follow-up and, with aggregate program-level data, youth outcomes across programs with and without the SBIRT intervention. RESULTS Youth significantly reduced Alcohol Use Disorders Identification Test (3.1 vs. 2.3, p < .001) and Drug Abuse Screening Test (1.9 vs. 1.4, p < .001) scores, positive screens (64% vs. 54%, p < .001), and need for referrals to treatment (48% vs. 37%, p < .001), indicating less risky substance use, although self-reports of substance use in the past 30 days did not decrease. Proportionately more youth in SBIRT programs attained a high school diploma or equivalent (49% vs. 42%, p = .01) and were still in educational/job placements 3 months after program completion (67% vs. 59%, p = .02), compared to youth in non-SBIRT programs. DISCUSSION These findings suggest that community-based SBIRT is associated with positive outcomes-both reduced risky substance use and improved education and employment-that relate to longer-term positive development for youth. SBIRT appears to be an evidence-based approach to intervene and help youth.
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Affiliation(s)
- Mary Brolin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jennifer Buell
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Chang WP, Stuart H, Chen SP. Alcohol Use, Drug Use, and Psychological Distress in University Students: Findings from a Canadian Campus Survey. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00519-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Korhonen CJ, Flaherty BP, Wahome E, Macharia P, Musyoki H, Battacharjee P, Kimani J, Doshi M, Mathenge J, Lorway RR, Sanders EJ, Graham SM. Validity and reliability of the Neilands sexual stigma scale among Kenyan gay, bisexual, and other men who have sex with men. BMC Public Health 2022; 22:754. [PMID: 35421967 PMCID: PMC9009048 DOI: 10.1186/s12889-022-13066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya.
Methods
Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset.
Results
EFA produced a two-factor scale of perceived and enacted stigma. The CFA model fit to the two-factor scale was improved after removing three cross-loaded items and adding correlated errors (chi-squared = 26.5, df 17, p = 0.07). Perceived stigma was associated with depressive symptoms (beta = 0.34, 95% CI 0.24, 0.45), alcohol use (beta = 0.14, 95% CI 0.03, 0.25) and other substance use (beta = 0.19, 95% CI 0.07, 0.31), while enacted stigma was associated with alcohol use (beta = 0.17, 95% CI 0.06, 0.27).
Conclusions
Our findings suggest enacted and perceived sexual stigma are distinct yet closely related constructs among GBMSM in Kenya and are associated with poor mental health and substance use.
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Mekawi Y, Kuzyk E, Dixon HD, McKenna B, Camacho L, de Andino AM, Stevens J, Michopolous V, Powers A. Characterizing Typologies of Polytraumatization: A Replication and Extension Study Examining Internalizing and Externalizing Psychopathology in an Urban Population. Clin Psychol Sci 2021; 9:1144-1163. [PMID: 35359798 PMCID: PMC8966626 DOI: 10.1177/21677026211000723] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
A person-centered approach to examining trauma has uncovered typologies of polytraumatization that are differentially associated with psychopathology. However, previous research is limited by narrow conceptualizations of trauma, limited distal outcomes, and underrepresentation of minorities. To address these gaps, we used latent profile analyses to uncover distinct polytraumatization typologies and examine four symptom-based (PTSD, depression, aggression, and substance abuse) and two behavior-based (self-harm, jail counts) outcomes in a sample of low-income adults (n = 7,426, 94% African American). The models were indicated by 19 traumatic experiences (e.g., accident, sexual assault, witnessing/experiencing violence). The best fitting model uncovered five classes: minimal trauma, physical abuse, violence exposure, sexual abuse, and polytrauma. Classes characterized by significant and varied trauma were higher on both internalizing and externalizing psychopathology, while those characterized by specific types of trauma were only higher on one type of psychopathology. Implications for the assessment and treatment of trauma-related disorders are discussed.
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Affiliation(s)
- Yara Mekawi
- Department of Psychiatry and Brain Science, Emory School of Medicine
| | - Eva Kuzyk
- Department of Psychiatry and Brain Science, Emory School of Medicine
| | - H. Drew Dixon
- Department of Psychiatry and Brain Science, Emory School of Medicine
| | | | - Luisa Camacho
- Department of Psychiatry and Brain Science, Emory School of Medicine
| | | | - Jennifer Stevens
- Department of Psychiatry and Brain Science, Emory School of Medicine
| | | | - Abigail Powers
- Department of Psychiatry and Brain Science, Emory School of Medicine
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Nasmith TE, Gadermann A, Jaworsky D, Norena M, To MJ, Hwang SW, Palepu A. Clinically significant substance use and residential stability among homeless or vulnerably housed persons in Canada: a longitudinal cohort study. J Public Health (Oxf) 2021; 43:532-540. [PMID: 32076717 DOI: 10.1093/pubmed/fdaa018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined clinically significant substance use among homeless or vulnerably housed persons in three Canadian cities and its association with residential stability over time using data from the Health and Housing in Transition study. METHODS In 2009, 1190 homeless or vulnerably housed individuals were recruited in three Canadian cities and followed for 4 years. We collected information on housing and incarceration history, drug and alcohol use, having a primary care provider at baseline and annually for 4 years. Participants who screened positive for substance use at baseline were included in the analyses. We used a generalized logistic mixed effect regression model to examine the association between clinically significant substance use and residential stability, adjusting for confounders. RESULTS Initially, 437 participants met the criteria for clinically significant substance use. The proportion of clinically significant substance use declined, while the proportion of participants who achieved residential stability increased over time. Clinically significant substance use was negatively associated with achieving residential stability over the 4-year period (AOR 0.7; 95% CI 0.57, 0.86). CONCLUSIONS In this cohort of homeless or vulnerably housed individuals, clinically significant substance use was negatively associated with achieving residential stability over time, highlighting the need to better address substance use in this population.
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Affiliation(s)
- Trudy E Nasmith
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Denise Jaworsky
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew J To
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.,Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
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Moges S, Belete T, Mekonen T, Menberu M. Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. Int J Ment Health Syst 2021; 15:42. [PMID: 33957944 PMCID: PMC8101248 DOI: 10.1186/s13033-021-00464-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapse in psychiatric disorders is highly distressing that posed a huge burden to the patients, family, and society. It interrupts the process of recovery and may increase the risk of resistance to treatment. Relapse detection and taking preventive measures against its possible factors are crucial for a better prognosis. OBJECTIVE To assess lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia. METHOD An institution-based cross-sectional study was conducted from July 13-August 13, at Comprehensive Specialized Hospitals in Amhara region, Ethiopia, 2020. Data were collected from 415 randomly selected participants using an interviewer administered questionnaire. Relapse was determined using participants' medical records and a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 25. Logistic regression analysis was done to identify the explanatory variables of relapse. Variables with P-value < 0.05 were considered significantly associated with relapse. RESULT The magnitude of lifetime relapse was 57.4% (95% CI = 53-62%). Relapse was significantly associated with comorbidity of another mental illness (AOR = 1.84, 95% CI = 1.06, 3.18), non-adherence to medication (AOR = 2.23, 95% CI = 1.22, 4.07), shorter duration on treatment (AOR = 1.71, 95% CI = 1.05, 2.81), and experiencing stressful life events (AOR = 2.42, CI = 1.2, 4.66). CONCLUSION In the current study, more than half of the participants had lifetime relapses. Comorbid mental illnesses, non-adherence, duration of treatment ≤ 5 years, and experiencing stressful life events were factors associated with relapse. This requires each stakeholder to give concern and work collaboratively on the respective factors that lead to relapse.
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Affiliation(s)
- Solomon Moges
- College of Health Sciences, Department of Psychiatry, Woldia University, Woldia, Ethiopia.
| | - Tilahun Belete
- College of Medicine and Health Sciences, Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tesfa Mekonen
- College of Medicine and Health Sciences, Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melak Menberu
- College of Medicine and Health Sciences, Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
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Philogene-Khalid HL, Cunningham E, Yu D, Chambers JE, Brooks A, Lu X, Morrison MF. Depression and its association with adverse childhood experiences in people with substance use disorders and comorbid medical illness recruited during medical hospitalization. Addict Behav 2020; 110:106489. [PMID: 32563021 DOI: 10.1016/j.addbeh.2020.106489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
AIMS People who have experienced adverse childhood experiences (ACEs) are more susceptible to substance use disorder (SUD) and depression. The present study examined depression prevalence in hospitalized patients with SUD and examined the association of individual ACEs with major depression. Depression rates 3 months after discharge were also examined. METHODS Medical inpatients with SUD were recruited from Temple University Hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and 3 months post-discharge. Participants were also assessed using an ACE scale at baseline. RESULTS Of 79 baseline participants, 48% (38) had moderate to severe major depressive disorder (MDD) with PHQ-9 scores ≥15. Among those with baseline MDD, 38% (9/24) continued to have MDD 3 months post discharge, and 42.9% (12/28) of those without MDD at baseline met criteria at 3 months. Sixty-three percent (50/79) of the participants reported 4+ ACEs at baseline. Two ACEs, Household Incarceration and Household Mental Illness, were significantly associated with having MDD at baseline and 3 months (adjusted mean PHQ-9 total score increase (SE) and p-value: 2.97 (1.35), p < .05; 5.32 (1.37), p < .005, respectively). CONCLUSIONS In this exploratory study, nearly half of medical inpatients with substance use disorder had moderate to severe major depression, with a similar percentage of participants having MDD as outpatients at 3 months. Approximately two thirds of participants reported four or more adverse childhood experiences at baseline. Inpatient medical hospitalization should be utilized as an opportunity to engage people with SUD in multidisciplinary treatment including psychiatric, trauma informed care, and substance abuse treatment.
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12
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Factors associated with psychotic symptoms among a sample of male prisoners with substance use disorder: A cross-sectional study. J Subst Abuse Treat 2020; 118:108104. [DOI: 10.1016/j.jsat.2020.108104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/07/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
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13
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Rockne WY, Quinn KC, James G, Cochran A. Identification of substance use disorders in burn patients using simple diagnostic screening tools (AUDIT/DAST-10). Burns 2019; 45:1182-1188. [PMID: 30948281 DOI: 10.1016/j.burns.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/21/2019] [Accepted: 03/02/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Substance use is disproportionately high in burn patients and associated with adverse outcomes. Screening methods for substance use disorders may help predict or avoid adverse outcomes. The University of Utah Burn Center records self-reported Alcohol Use Disorders Identification Tests (AUDIT) and Drug Abuse Screening Tests (DAST-10) for all adult burn admissions. This study assessed for association between AUDIT/DAST-10 scores and burn patient outcomes. METHODS A retrospective chart review of adult burn patients admitted to the University of Utah from 05/01/2014-06/30/2017. Patient demographics, injury data, and substance use data were collected and analyzed. RESULTS 322 patients underwent AUDIT/DAST-10 screening (n = 322). 56 (17.4%) had positive AUDIT screens (score ≥ 8). 15/50 with alcohol use at time of injury (TOI) had negative AUDIT screens. Median AUDIT score with TOI alcohol use was 12, without TOI alcohol use was 1. 30/55 patients offered alcohol counseling accepted. 14 patients (4.3%) had positive DAST-10 screens (score ≥3). 9/25 with drug use at TOI had negative DAST-10 screens. No patients without TOI drug use had DAST-10 scores >2. 9/11 patients offered drug counseling accepted. Mean standardized length of stay (LOS) per TBSA burn injury was 1.7 days for positive AUDIT, 1.6 days for negative AUDIT. Median standardized LOS was 1.4 days for positive DAST-10, 1.7 days for negative DAST-10. CONCLUSIONS AUDIT and DAST-10 screens can identify burn patients with problematic substance use, allowing early intervention. Positive screening scores do not independently predict longer hospital stays, increased wound severity, or treatment noncompliance.
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Affiliation(s)
- Wendy Y Rockne
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, United States
| | - Kristen C Quinn
- University of Utah Health Burn Center, 50 N Medical Dr., Salt Lake City, UT, 84132, United States
| | - Gretchen James
- University of Utah Health Burn Center, 50 N Medical Dr., Salt Lake City, UT, 84132, United States
| | - Amalia Cochran
- University of Utah School of Medicine, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, United States; The Ohio State University, Department of Surgery, 395 W 12th Ave #670, Columbus, OH, 43210, United States.
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Ngo QM, Veliz PT, Kusunoki Y, Stein SF, Boyd CJ. Adolescent sexual violence: Prevalence, adolescent risks, and violence characteristics. Prev Med 2018; 116:68-74. [PMID: 30194960 PMCID: PMC6553641 DOI: 10.1016/j.ypmed.2018.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/05/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this research is to investigate peer-to-peer sexual violence victimization and perpetration among male and female adolescents in a large, racially and economically diverse, community-based sample. Using cross-sectional data over a four-year period (2009-2013) from a regional sample of middle school and high school students in southeastern Michigan, we examined the prevalence and correlates of peer-to-peer sexual violence victimization and perpetration among adolescents. 33.9% of males and 53.5% of females reported sexual violence victimization, while 22.8% of males and 12.6% of females reported sexual violence perpetration. The majority of peer-to-peer sexual victimization and perpetration occurred by someone of the opposite sex, however, same-sex victimization and perpetration were not uncommon. Substance use, depression, Attention Deficit Hyperactivity Disorder (ADHD), and conduct disorder were associated with peer-to-peer sexual violence (victimization or perpetration) for both males and females, with few differences in the patterns of associations by sex. These findings are an important step in better understanding the types of peer-to-peer sexual violence that adolescents experience and risk factors for both male and female youth.
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Affiliation(s)
- Quyen M Ngo
- Department of Emergency Medicine's Injury Prevention Center and the Institute for Research on Women and Gender at the University of Michigan, Ann Arbor, MI, United States of America.
| | - Philip T Veliz
- School of Nursing, University of Michigan, 1136 Lane Hall, 204 S. State St., Ann Arbor, MI 48109, United States of America.
| | - Yasamin Kusunoki
- Department of Systems, Populations and Leadership in the School of Nursing and the Institute for Social Research (ISR) at the University of Michigan, 426 Thompson St, Ann Arbor, MI 48104, United States of America.
| | - Sara F Stein
- School of Social Work, the Department of Psychology and the Injury Prevention Center at the University of Michigan, 1080 S. University Ave, Ann Arbor, MI, 48109, United States of America.
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences in the School of Nursing and the Institute for Research on Women and Gender (IRWG) at the University of Michigan, 400 North Ingalls St., Ann Arbor, MI 48104, United States of America.
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15
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Residential moves and its association with substance use, healthcare needs, and acute care use among homeless and vulnerably housed persons in Canada. Int J Public Health 2018; 64:399-409. [PMID: 30382287 DOI: 10.1007/s00038-018-1167-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/03/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization. METHODS A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders. RESULTS The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17-1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07-1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16-1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes. CONCLUSIONS Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.
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16
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Arevian AC, Springgate B, Jones F, Starks SL, Chung B, Wennerstrom A, Jones L, Kataoka SH, Griffith K, Sugarman OK, Williams P, Haywood C, Kirkland A, Meyers D, Pasternak R, Simmasalam R, Tang L, Castillo EG, Mahajan A, Stevens M, Wells KB. The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity. Ethn Dis 2018; 28:295-302. [PMID: 30202181 DOI: 10.18865/ed.28.s2.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We describe the rationale, development, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Setting A community-academic partnership across Los Angeles County and New Orleans. Methods Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Findings Patient and community stakeholders participated in all phases of development, including local and national activities. Key developments include partnered planning efforts, progress on aggregating a large, de-identified dataset across county agencies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakeholders.
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Affiliation(s)
- Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Sarah L Starks
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services; Harbor-UCLA Medical Center; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Sheryl H Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Krystal Griffith
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Olivia K Sugarman
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Pluscedia Williams
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | | | | | | | - Ryan Pasternak
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Rubinee Simmasalam
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G Castillo
- UCLA David Geffen School of Medicine; Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Max Stevens
- Los Angeles County Chief Executive Office, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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17
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Fikreyesus M, Soboka M, Feyissa GT. Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study. BMC Psychiatry 2016; 16:354. [PMID: 27765033 PMCID: PMC5072324 DOI: 10.1186/s12888-016-1076-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Psychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH). METHODS Data were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable. RESULTS The prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31). CONCLUSIONS The high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.
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Affiliation(s)
| | - Matiwos Soboka
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Garumma Tolu Feyissa
- Department of Health Education and Behavioral Science, Jimma University, Jimma, Ethiopia. .,The Joanna Briggs Institute, University of Adelaide, Adelaide, Australia.
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18
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To MJ, Palepu A, Aubry T, Nisenbaum R, Gogosis E, Gadermann A, Cherner R, Farrell S, Misir V, Hwang SW. Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study. BMC Public Health 2016; 16:1041. [PMID: 27716129 PMCID: PMC5048475 DOI: 10.1186/s12889-016-3711-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Background Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Methods Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Results Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14–2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22–3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33–0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97–1.00) were protective against homelessness. Conclusions Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
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Affiliation(s)
- Matthew J To
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim Aubry
- University of Ottawa, Ottawa, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Evie Gogosis
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Vachan Misir
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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19
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Dugosh KL, Festinger DS, Lipkin JL. Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients. J Subst Abuse Treat 2016; 71:30-35. [PMID: 27776674 DOI: 10.1016/j.jsat.2016.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
Abstract
Drug courts address issues such as employment and housing but largely miss the opportunity to address important health care issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9 months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey, with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest that clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.
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Affiliation(s)
- Karen L Dugosh
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States.
| | - David S Festinger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
| | - Jessica L Lipkin
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
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20
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Jaworsky D, Gadermann A, Duhoux A, Naismith TE, Norena M, To MJ, Hwang SW, Palepu A. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada. J Urban Health 2016; 93:666-81. [PMID: 27457795 PMCID: PMC4987593 DOI: 10.1007/s11524-016-0065-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Trudy E Naismith
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Matthew J To
- Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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21
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Rodgers MA, Grisso JA, Crits-Christoph P, Rhodes KV. No Quick Fixes: A Mixed Methods Feasibility Study of an Urban Community Health Worker Outreach Program for Intimate Partner Violence. Violence Against Women 2016; 23:287-308. [PMID: 27075666 DOI: 10.1177/1077801216640383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community health workers (CHWs) provide peer support in diverse health care settings, but few studies have evaluated CHW interventions for intimate partner violence (IPV). We assessed the feasibility, acceptability, and safety of CHW outreach in four urban community health clinics and characterized the experiences and barriers to providing safe and effective services for women experiencing IPV. CHWs successfully enrolled and engaged IPV victims, who indicated satisfaction and increased safety with program participation. However, complex psychosocial barriers prevented many from achieving safety and security. More work is needed to assess the impact of well-integrated IPV-trained CHWs in primary care medical homes.
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Affiliation(s)
| | | | | | - Karin V Rhodes
- 3 Northwell Health System at the Hofstra School of Medicine, Hempstead, NY, USA
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22
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McCabe SE, Veliz P, Boyd CJ. Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts. Drug Alcohol Depend 2016; 163:55-63. [PMID: 27129621 PMCID: PMC4921894 DOI: 10.1016/j.drugalcdep.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents. METHODS A Web-based survey was self-administered by Detroit-area secondary school students (N=4755) between the 2009-10 and 2012-13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories. RESULTS During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n=322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n=124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation. CONCLUSIONS More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA; Substance Abuse Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Phil Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 204 S. State St., Ann Arbor, MI, USA 48109-1290
| | - Carol J. Boyd
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 204 S. State St., Ann Arbor, MI, USA 48109-1290,School of Nursing, University of Michigan, Ann Arbor, MI,Addiction Research Center, University of Michigan, Ann Arbor, MI
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23
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Epstein-Ngo QM, McCabe SE, Veliz PT, Stoddard SA, Austic EA, Boyd CJ. Diversion of ADHD Stimulants and Victimization Among Adolescents. J Pediatr Psychol 2015; 41:786-98. [PMID: 26590265 DOI: 10.1093/jpepsy/jsv105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 10/11/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). METHODS Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. RESULTS Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. CONCLUSIONS Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.
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Affiliation(s)
- Quyen M Epstein-Ngo
- Institute for Research on Women and Gender, University of Michigan Institute for Clinical and Health Research, University of Michigan Injury Center, University of Michigan
| | | | - Philip T Veliz
- Institute for Research on Women and Gender, University of Michigan
| | - Sarah A Stoddard
- School of Nursing, University of Michigan School of Public Health, University of Michigan
| | - Elizabeth A Austic
- Institute for Clinical and Health Research, University of Michigan Injury Center, University of Michigan Department of Emergency Medicine, University of Michigan
| | - Carol J Boyd
- Institute for Research on Women and Gender, University of Michigan School of Nursing, University of Michigan Department of Psychiatry, Addiction Research Center, University of Michigan
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24
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Healthcare Utilization, Legal Incidents, and Victimization Following Traumatic Brain Injury in Homeless and Vulnerably Housed Individuals. J Head Trauma Rehabil 2015; 30:270-6. [DOI: 10.1097/htr.0000000000000044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Veliz P, McCabe SE. Examining Potential Substance Use Disorders Among Former Interscholastic Athletes. Subst Abus 2015; 36:400-6. [PMID: 25551424 DOI: 10.1080/08897077.2014.988324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite numerous studies examining the association between competitive sports participation and substance use behaviors among adolescents and young adults, the use of standardized measures to assess potential substance use disorders has been largely neglected. The objective of this study was to examine if past involvement in interscholastic sports (competitive school-sponsored sports) was associated with potential substance use disorders in young adulthood. METHODS Data for this study were taken from the Student Life Survey (SLS). A total of 3442 young adults participated in the SLS during the spring semester in 2013, with 74% of males and 71% of females indicating participation in interscholastic sport during high school. RESULTS Respondents who participated in interscholastic sports during high school had higher odds of positive screens for potential alcohol use disorders when compared with their peers who did not participate in interscholastic sports. No association was detected between interscholastic sports participation and potential drug abuse disorders. Moreover, previous involvement in certain types of sports was found to be associated with positive screens for potential alcohol use disorders (i.e., crew and football) and positive screens for potential drug abuse disorders (i.e., lacrosse) among the sample of young adults. CONCLUSIONS School and community sport organizations should be aware of the potential link between sports participation and potential substance use disorders, and may consider brief substance use screeners during yearly physicals to monitor potential substance use problems among athletes.
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Affiliation(s)
- Philip Veliz
- a Institute for Research on Women & Gender (IRWG) , University of Michigan , Ann Arbor , Michigan , USA
| | - Sean Esteban McCabe
- a Institute for Research on Women & Gender (IRWG) , University of Michigan , Ann Arbor , Michigan , USA
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26
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Nicholls J, Staiger PK, Williams JS, Richardson B, Kambouropoulos N. When social anxiety co-occurs with substance use: does an impulsive social anxiety subtype explain this unexpected relationship? Psychiatry Res 2014; 220:909-14. [PMID: 25261335 DOI: 10.1016/j.psychres.2014.08.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
Abstract
Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.
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Affiliation(s)
- Julia Nicholls
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Petra Karin Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia.
| | - James Stephen Williams
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Ben Richardson
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Nicolas Kambouropoulos
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
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Hunter CE, Palepu A, Farrell S, Gogosis E, O’Brien K, Hwang SW. Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities. J Prim Care Community Health 2014; 6:154-61. [DOI: 10.1177/2150131914560610] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Methods: Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Results: Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Conclusion: Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
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Affiliation(s)
- Charlotte E. Hunter
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Farrell
- University of Ottawa, Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Evie Gogosis
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kristen O’Brien
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Jason LA, Olson BD, Harvey R. Evaluating Alternative Aftercare Models for Ex-Offenders. JOURNAL OF DRUG ISSUES 2014; 45:53-68. [PMID: 25641984 DOI: 10.1177/0022042614552019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the role played by aftercare following (mainly) inpatient community-based treatment in the outcomes of criminal ex-offenders with substance use disorders. Two hundred and seventy individuals who had been released from the criminal justice system were randomly assigned to either a Therapeutic Community (TC), recovery homes called Oxford Houses (OHs), or usual care settings (UA). The OHs and TCs are residential settings that emphasized socialization and abstinence from drugs and alcohol, but OHs do not include the formal therapeutic change interventions common to TCs, nor did they include any on-site access to drug abuse or health care professionals. UA involved what occurred naturally after completing treatment, which included staying with friends or family members, their own house or apartment, homeless shelters, or other settings. Longer lengths of stay in either the TCs or OHs were associated with increased employment, and reduced alcohol and drug use. Those assigned to the OH condition received more money from employment, worked more days, achieved higher continuous alcohol sobriety rates, and had more favorable cost-benefit ratios.
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Veliz P, Epstein-Ngo QM, Meier E, Ross-Durow PL, McCabe SE, Boyd CJ. Painfully obvious: a longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants. J Adolesc Health 2014; 54:333-40. [PMID: 24225446 PMCID: PMC3943832 DOI: 10.1016/j.jadohealth.2013.09.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE The objective of this longitudinal study was to assess the prevalence of medical use, medical misuse, and non-medical use of opioid medication among adolescents who participate in organized sports. METHODS Data for this study were taken from the Secondary Student Life Survey. A total of 1,540 adolescents participated in three waves of data collection occurring between the 2009-2010 and 2011-2012 school years, with 82% of the baseline sample completing all three waves. RESULTS Using generalized estimating equation models to analyze the longitudinal data, it was found that male adolescents who participated in organized sports during each wave of the Secondary Student Life Survey had higher odds of being prescribed an opioid medication (i.e., medical use) during the past year (adjusted odds ratio [AOR], 1.86; 95% confidence interval [CI], 1.23-2.82), higher odds of past-year medical misuse of opioid medication as a result of taking too much (AOR, 10.5; 95% CI, 2.42-45.5), and higher odds of past-year medical misuse of opioid medication to get high (AOR, 4.01; 95% CI, 1.13-14.2) compared with males who did not participate in organized sports during the study period. Among females, no association was found between participation in organized sports and medical use, medical misuse, and non-medical use of opioid medication. CONCLUSIONS The results of this study indicate that adolescent males who participate in sports may have greater access to opioid medication, which puts them at greater risk to misuse these controlled substances.
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Affiliation(s)
- Philip Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan.
| | - Quyen M Epstein-Ngo
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth Meier
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Paula Lynn Ross-Durow
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Carol J Boyd
- School of Nursing, University of Michigan, Ann Arbor, Michigan
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Gallucci AR, Wynveen C, Hackman C, Meyer A, Usdan S. An Examination of the Situational Factors Associated With the Misuse of Prescription Analgesics Among College Students. JOURNAL OF DRUG EDUCATION 2014; 44:116-136. [PMID: 26150110 DOI: 10.1177/0047237915585523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The current study examined the effect that students' educational environment has on the prevalence and motivations associated with the misuse of prescription analgesics (MPA). A sample of 893 undergraduate students was recruited from one religiously affiliated private university and one public university in the Southern United States. Participants completed an in-class survey assessing MPA-related behavior and their associated motivations. Results indicated that students attending the religiously affiliated university displayed lower rates of MPA. Multivariate analyses revealed that a positive drug abuse screening, prescription status, and grade point average are the strongest predictors of past-year MPA for both schools. Some motivations for medical misuse differed significantly between campuses. Implications as to how these differences can inform programs aimed at the reduction of prescription analgesic abuse are discussed.
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Giordano GN, Ohlsson H, Kendler KS, Winkleby MA, Sundquist K, Sundquist J. Age, period and cohort trends in drug abuse hospitalizations within the total Swedish population (1975-2010). Drug Alcohol Depend 2014; 134:355-361. [PMID: 24300899 PMCID: PMC3909834 DOI: 10.1016/j.drugalcdep.2013.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The societal consequences of drug abuse (DA) are severe and well documented, the World Health Organization recommending tracking of population trends for effective policy responses in treatment of DA and delivery of health care services. However, to correctly identify possible sources of DA change, one must first disentangle three different time-related influences on the need for treatment due to DA: age effects, period effects and cohort effects. METHODS We constructed our main Swedish national DA database (spanning four decades) by linking healthcare data from the Swedish Hospital Discharge Register to individuals, which included hospitalisations in Sweden for 1975-2010. All hospitalized DA cases were identified by ICD codes. Our Swedish national sample consisted of 3078,129 men and 2921,816 women. We employed a cross-classified multilevel logistic regression model to disentangle any net age, period and cohort effects on DA hospitalization rates. RESULTS We found distinct net age, period and cohort effects, each influencing the predicted probability of hospitalisation for DA in men and women. Peak age for DA in both sexes was 33-35 years; net period effects showed an increase in hospitalisation for DA from 1996 to 2001; and in birth cohorts 1968-1974, we saw a considerable reduction (around 75%) in predicted probability of hospitalisation for DA. CONCLUSIONS The use of hospital admissions could be regarded as a proxy of the population's health service use for DA. Our results may thus constitute a basis for effective prevention planning, treatment and other appropriate policy responses.
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Affiliation(s)
- Giuseppe N Giordano
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden
| | - Kenneth S Kendler
- Virginia Commonwealth University School of Medicine, PO Box 980126 Richmond, VA 23298, USA
| | | | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden; Stanford Prevention Research Center, MSOB, Stanford, CA 94305, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden; Stanford Prevention Research Center, MSOB, Stanford, CA 94305, USA
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Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, Hwang SW. Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities. PLoS One 2013; 8:e75133. [PMID: 24124470 PMCID: PMC3790780 DOI: 10.1371/journal.pone.0075133] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/07/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction We examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study. Methods In 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment. Results Substance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54). Conclusions Problematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anita M. Hubley
- Department of Education and Counseling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Susan Farrell
- Department of Psychiatry, Royal Ottawa Health Care Group, University of Ottawa, Ottawa, ON, Canada
| | - Evie Gogosis
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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McCabe SE, West BT, Boyd CJ. Medical use, medical misuse, and nonmedical use of prescription opioids: results from a longitudinal study. Pain 2013; 154:708-713. [PMID: 23433943 DOI: 10.1016/j.pain.2013.01.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/24/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
The objective of this study was to examine the prevalence and patterns associated with past-year medical use, medical misuse, and nonmedical use of prescription opioids (NMUPO) among adolescents over a 2-year time period and to examine substance abuse, sleeping problems, and physical pain symptoms associated with these patterns of medical use, medical misuse, and NMUPO. A Web-based survey was self-administered by a longitudinal sample of 2050 middle and high school students in 2009-2010 (Year 1) and again in 2010-2011 (Year 2). The study was set in 2 southeastern Michigan school districts. The longitudinal sample consisted of 50% females, 67% Whites, 28% African-Americans, and 5% from other racial/ethnic categories. Main outcome measures were past-year medical use, medical misuse, and NMUPO. Of those reporting appropriate medical use of prescription opioids in Year 1, approximately 34% continued medical use in Year 2. Of those reporting past-year NMUPO in Year 1, approximately 25% continued NMUPO in Year 2. Appropriate medical use and NMUPO for pain relief was more prevalent among girls than boys. Multiple logistic regression analyses indicated that the odds of a positive screen for substance abuse in Year 2 were greater for adolescents who reported medical misuse or NMUPO for non-pain-relief motives in Year 1 compared with those who did not use prescription opioids. The findings indicate an increased risk for substance abuse among adolescents who report medical misuse or NMUPO for non-pain-relief motives over time. The findings have important clinical implications for interventions to reduce medical misuse and NMUPO among adolescents.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109-1290, USA Substance Abuse Research Center, University of Michigan, Ann Arbor, MI 48109-2054, USA Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI 48109-1070, USA Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48016-1248, USA School of Nursing, University of Michigan, Ann Arbor, MI 48109-5482, USA
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Matthews LR, Harris LM, Jaworski A, Alam A, Bozdag G. Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services. Disabil Rehabil 2012; 35:460-7. [PMID: 22889352 DOI: 10.3109/09638288.2012.699583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lynda R Matthews
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Resnick HS, Walsh K, McCauley JL, Schumacher JA, Kilpatrick DG, Acierno RE. Assault related substance use as a predictor of substance use over time within a sample of recent victims of sexual assault. Addict Behav 2012; 37:914-21. [PMID: 22521363 DOI: 10.1016/j.addbeh.2012.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/21/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022]
Abstract
Substance use at time of assault is reported by a significant subgroup of rape victims. This study examined: (1) prevalence of assault related marijuana or alcohol use among women seeking post-rape medical care; (2) sensitivity, specificity, positive and negative predictive power associated with reported use at time of assault in association with use in 6 weeks pre-assault, post-assault use, and post-assault abuse; and (3) trajectories of use and abuse over time as a function of use in 6 weeks pre-assault/assault time frame use, exposure to brief intervention, and interaction of pre-assault/assault time frame use with intervention. Participants were 268 women seeking post-sexual assault medical services completing one or more follow-up assessment at: (1) <3 months post-assault; (2) 3 to 6 months post-assault; and (3) 6 months or longer post-assault. Use of alcohol or marijuana at time of assault was a fairly sensitive and specific indicator respectively, of reported use of specific substance in the 6 weeks preceding assault and use or abuse at follow-up. Growth modeling revealed that use of alcohol or marijuana at the time of the assault or in the 6 weeks prior to assault predicted higher Time 1 follow-up alcohol and marijuana use and abuse. Although there was relatively little change in use or abuse over time, alcohol use at time of the assault or in the 6 weeks prior also predicted a steeper decline in alcohol use over the course of follow-up. Interestingly, women who reported using marijuana at the time of the assault or in the 6 weeks prior who also received a video intervention actually had lower initial marijuana use, a pattern that remained stable over time. Implications for evaluating screening, brief intervention and referral to treatment services among sexual assault victims seeking post-assault medical care are discussed.
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Affiliation(s)
- Heidi S Resnick
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, United States.
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McCabe SE, West BT, Teter CJ, Ross-Durow P, Young A, Boyd CJ. Characteristics associated with the diversion of controlled medications among adolescents. Drug Alcohol Depend 2011; 118:452-8. [PMID: 21665384 PMCID: PMC3190027 DOI: 10.1016/j.drugalcdep.2011.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/30/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this study was to estimate the lifetime prevalence of diversion (i.e., trading, selling, giving away or loaning) of four classes of controlled medications (pain, stimulant, anti-anxiety, and sleeping) among adolescents, and to identify demographic and behavioral characteristics of adolescents who divert their own controlled medications. METHODS A web-based survey was self-administered by 2744 secondary school students from two southeastern Michigan school districts in 2009-2010. The sample consisted of 51% females, 65% Whites, 29% African-Americans, 4% Asians, 1% Hispanics and 1% from other racial categories. RESULTS Thirty-three percent of the students had ever been prescribed at least one controlled pain, stimulant, anti-anxiety, or sleeping medication. Approximately 13.8% (n=117) of lifetime prescribed users of controlled medications (n=848) had ever traded, sold, given away or loaned their medications. Multiple logistic regression analyses indicated that being approached to divert medications, nonmedical use of prescription medications, externalizing behaviors, and being non-White were significantly associated with the diversion of controlled medications. Multiple logistic regression analysis indicated that the odds of substance use and abuse for lifetime prescribed users who diverted their controlled medications were significantly greater than prescribed users who never diverted. CONCLUSIONS The findings indicate that approximately one in seven prescribed users had diverted their controlled medications in their lifetimes. Being approached to divert medications and substance use are more prevalent among adolescents who diverted their controlled medications. Careful assessments, diligent prescribing and monitoring of controlled medications, and continual patient education could be useful in reducing medication diversion.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA.
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McCabe SE, West BT, Cranford JA, Ross-Durow P, Young A, Teter CJ, Boyd CJ. Medical misuse of controlled medications among adolescents. ACTA ACUST UNITED AC 2011; 165:729-35. [PMID: 21810634 DOI: 10.1001/archpediatrics.2011.114] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine the past-year medical misuse prevalence for 4 controlled medication classes (pain, stimulant, sleeping, and antianxiety) among adolescents, and to assess substance use outcomes among adolescents who report medical misuse. DESIGN A Web-based survey was self-administered by 2744 secondary school students in 2009-2010. SETTING Two southeastern Michigan school districts. PARTICIPANTS The sample had a mean age of 14.8 years and was 51.1% female. The racial/ethnic distribution was 65.0% white, 29.5% African American, 3.7% Asian, 1.3% Hispanic, and 0.5% other. MAIN OUTCOME MEASURES Past-year medical use and misuse of 4 controlled medication classes. RESULTS Eighteen percent of the sample reported past-year medical use of at least 1 prescribed controlled medication. Among past-year medical users, 22.0% reported misuse of their controlled medications, including taking too much, intentionally getting high, or using to increase alcohol or other drug effects. Medical misusers were more likely than nonmisusers to divert their controlled medications and to abuse other substances. The odds of a positive screening result for drug abuse were substantially higher among medical misusers (adjusted odds ratio, 7.8; 95% confidence interval, 4.3-14.2) compared with medical users who used their controlled medications appropriately. The odds of drug abuse did not differ between medical users who used their controlled medications appropriately and nonusers. CONCLUSIONS Most adolescents who used controlled medications took their medications appropriately. Substance use and diversion of controlled medications were more prevalent among adolescents who misused their controlled medications. Careful therapeutic monitoring could reduce medical misuse and diversion of controlled medications among adolescents.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, 204 S State Street, Ann Arbor, MI 48109-1290, USA.
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Bradley B, DeFife JA, Guarnaccia C, Phifer J, Fani N, Ressler KJ, Westen D. Emotion dysregulation and negative affect: association with psychiatric symptoms. J Clin Psychiatry 2011; 72:685-91. [PMID: 21658350 PMCID: PMC4605672 DOI: 10.4088/jcp.10m06409blu] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/20/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A growing body of research focuses on the development and correlates of emotion dysregulation, or deficits in the ability to regulate intense and shifting emotional states. Current models of psychopathology have incorporated the construct of emotion dysregulation, suggesting its unique and interactive contributions, along with childhood disruptive experiences and negative affect, in producing symptomatic distress. Some researchers have suggested that emotion dysregulation is simply a variant of high negative affect. The aim of this study was to assess the construct and incremental validity of self-reported emotion dysregulation over and above childhood trauma and negative affect in predicting a range of psychopathology. METHOD Five hundred thirty individuals aged 18 to 77 years (62% female) were recruited from the waiting areas of the general medical and obstetric/gynecologic clinics in an urban public hospital in Atlanta, Georgia. Participants completed a battery of self-report measures obtained by interview, including the Childhood Trauma Questionnaire, the Positive and Negative Affect Schedule, and the Emotion Dysregulation Scale. Regression analyses examined the unique and incremental associations of these self-report measurements of childhood traumatic experiences, negative affect, and emotion dysregulation with concurrent structured interview-based measurements of psychiatric distress and history of self-destructive behaviors. These measures included the Clinician-Administered PTSD Scale, the Alcohol Use Disorders Identification Test, the Short Drug Abuse Screening Test, the Beck Depression Inventory, and the Global Adaptive Functioning Scale from the Longitudinal Interval Follow-Up Evaluation. The presented data were collected between 2005 and 2009. RESULTS Regression models including age, gender, childhood trauma, negative affect, and emotion dysregulation were significantly (P ≤ .001) associated with each of the study's criterion variables, accounting for large portions of the variance in posttraumatic stress symptoms (R² = 0.21), alcohol and drug abuse (R² = 0.28 and 0.21, respectively), depression (R² = 0.55), adaptive functioning (R² = 0.14), and suicide history (omnibus χ² = 74.80, P < .001). Emotion dysregulation added statistically significant (P < .01) incremental validity to each regression model (β = 0.25, 0.34, 0.35, 0.34, and -0.18, and Wald = 24.43, respectively). CONCLUSIONS Results support the conceptualization of emotion dysregulation as a distinct and clinically meaningful construct associated with psychiatric distress that is not reducible to negative affect. Emotion dysregulation is a key component in a range of psychiatric symptoms and disorders and a core target for psychopharmacologic and psychosocial treatment interventions.
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Affiliation(s)
- Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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de Wit M, Jones DG, Sessler CN, Zilberberg MD, Weaver MF. Alcohol-use disorders in the critically ill patient. Chest 2010; 138:994-1003. [PMID: 20923804 DOI: 10.1378/chest.09-1425] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Alcohol abuse and dependence, referred to as alcohol-use disorders (AUDs), affect 76.3 million people worldwide and account for 1.8 million deaths per year. AUDs affect 18.3 million Americans (7.3% of the population), and up to 40% of hospitalized patients have AUDs. This review discusses the development and progression of critical illness in patients with AUDs. In contrast to acute intoxication, AUDs have been linked to increased severity of illness in a number of studies. In particular, surgical patients with AUDs experience higher rates of postoperative hemorrhage, cardiac complications, sepsis, and need for repeat surgery. Outcomes from trauma are worse for patients with chronic alcohol abuse, whereas burn patients who are acutely intoxicated may not have worse outcomes. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs. Despite studies showing that up to 40% of hospitalized patients have AUDs, relatively few guidelines exist on the specific management of the critically ill patient with AUDs. AUDs are underdiagnosed, and a first step to improving patient outcomes may lie in systematically and accurately identifying AUDs.
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Affiliation(s)
- Marjolein de Wit
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298-0050, USA.
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Brookman-Frazee L, Haine RA, Baker-Ericzén M, Zoffness R, Garland AF. Factors associated with use of evidence-based practice strategies in usual care youth psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:254-69. [PMID: 19795204 PMCID: PMC2877313 DOI: 10.1007/s10488-009-0244-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to gain an understanding of how therapists providing usual care (UC) psychotherapy are using elements of treatment common to evidence-based practices (EBPs) for children with disruptive behavior disorders (DBPs) and to identify client and therapist characteristics that may be associated with EBP strategies directed toward children and those directed to their caregivers. Results indicate that certain child, family, and therapist characteristics are associated with use of EBP strategies; however, much of the variability in practice was not explained by the variables examined. These findings highlight the complexity of UC psychotherapy and provide directions for future research on implementation of EBPs in UC.
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Weinreb L, Rog DJ, Henderson KA. Exiting shelter: an epidemiological analysis of barriers and facilitators for families. THE SOCIAL SERVICE REVIEW 2010; 84:597-614. [PMID: 21488321 DOI: 10.1086/657108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study examines the role of individual- and family-level factors in predicting the length of shelter stays for homeless families. Interviews were conducted with all families exiting one of six emergency family shelters in Worcester, Massachusetts, between November 2006, and November 2007. Analyses, using an ordinary least squares regression model, find that families with a positive alcohol or drug screen in the year prior stay 85 days longer than those without a positive screen; families leaving shelter with a housing subsidy stay 66 days longer than those leaving without a subsidy. Demographic factors, education, employment, health, and mental health are not found to predict shelter stay duration. Consistent with prior research, housing resources relate to families' time in shelter; with the exception of a positive substance abuse screen, individual-level problems are not related to their time in shelter. Efforts to expand these resources at the local, state, and national levels are a high priority.
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McCabe SE, Boyd CJ, Teter CJ. Subtypes of nonmedical prescription drug misuse. Drug Alcohol Depend 2009; 102:63-70. [PMID: 19278795 PMCID: PMC2975029 DOI: 10.1016/j.drugalcdep.2009.01.007] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 12/18/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping, and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3639 undergraduate students attending a large midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan Substance Abuse Research Center, 2025 Traverwood Dr., Suite C, Ann Arbor, MI 48105-2194, USA.
| | - Carol J. Boyd
- University of Michigan Substance Abuse Research Center, 2025 Traverwood Dr., Suite C, Ann Arbor, MI, USA 48105-2194,University of Michigan Institute for Research on Women and Gender, 1136 Lane Hall, Ann Arbor, MI 48109-1290
| | - Christian J. Teter
- University of Michigan Substance Abuse Research Center, 2025 Traverwood Dr., Suite C, Ann Arbor, MI, USA 48105-2194,Northeastern University School of Pharmacy, 245 Mugar Life Sciences Building, Boston, MA 02115-5000,McLean Hospital, Alcohol and Drug Abuse Treatment Program, Proctor House III, 115 Mill St., Belmont, MA 02478
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Zacny JP, Lichtor SA. Nonmedical use of prescription opioids: motive and ubiquity issues. THE JOURNAL OF PAIN 2008; 9:473-86. [PMID: 18342577 PMCID: PMC2409193 DOI: 10.1016/j.jpain.2007.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 12/09/2007] [Accepted: 12/17/2008] [Indexed: 11/19/2022]
Abstract
UNLABELLED Two issues relating to prescription opioid nonmedical use that to our knowledge have not been comprehensively addressed in the peer-reviewed literature are discussed: Motives for nonmedical use and the extent of nonmedical use of prescription opioids in other countries. The United States' national annual survey on illicit drug use in the general population (National Survey on Drug Use and Health) asks respondents whether they have used prescription opioids for nonmedical purposes but does not assess motives for such use. By not assessing motives, nonmedical users who use only for pain relief and nonmedical users who have other motives for use are grouped together, but 2 recent epidemiological studies suggest that these 2 groups may differ in a propensity to have substance use-related problems. We suggest that the survey add a question that assesses motives for nonmedical use. Regarding whether countries besides the United States have problems associated with nonmedical use of prescription opioids, after searching for epidemiological surveys and other materials potentially relevant to this issue, we were unable to determine the extent of nonmedical use of prescription opioids in other countries or draw cross-national comparisons. We suggest that more countries include specific questions about nonmedical use of prescription opioids in their national epidemiological surveys. PERSPECTIVE We believe that critical information surrounding the nonmedical use of prescription opioids is not being gathered. Such information would allow for a better understanding of the problem. We invite discussion and commentaries regarding the issues we raise to more effectively address this public health issue.
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Affiliation(s)
- James P Zacny
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois 60637, USA.
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McCabe SE. Screening for drug abuse among medical and nonmedical users of prescription drugs in a probability sample of college students. ACTA ACUST UNITED AC 2008; 162:225-31. [PMID: 18316659 DOI: 10.1001/archpediatrics.2007.41] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the prevalence of medical and nonmedical use of 4 classes of prescription drugs (opioid, stimulant, sleeping, and sedative or anxiety) and to assess probable drug abuse among 4 mutually exclusive groups of medical and nonmedical use of prescription drugs. DESIGN In 2005, a Web survey was self-administered by a probability sample of 3639 college students (68% response rate). SETTING A large, midwestern 4-year university. PARTICIPANTS The sample had a mean age of 19.9 years, and respondents were 53.6% female, 67.4% white, 12.1% Asian, 6.0% African American, 4.2% Hispanic, and 10.2% other racial categories. MAIN OUTCOME MEASURES Medical and nonmedical use of prescription drugs was measured. Probable drug abuse was assessed using a modified version of the Drug Abuse Screening Test, Short Form. RESULTS A total of 40.1% of respondents reported no lifetime use of at least 1 of 4 classes of prescription drugs, 39.7% reported medical use only, 15.8% reported both medical and nonmedical use, and 4.4% reported nonmedical use only. The odds of a positive screening result for drug abuse were greater among medical and nonmedical users (adjusted odds ratio, 5.5; 95% confidence interval, 3.4-7.3) and nonmedical users only (adjusted odds ratio, 6.5; 95% confidence interval, 4.0-10.6) compared with nonusers. The odds of a positive screening result for drug abuse did not differ between medical users only and nonusers. CONCLUSIONS Nonmedical users of prescription drugs are at heightened risk for drug abuse, whereas medical users without a history of nonmedical use are generally not at increased risk. Drug abuse screening should be routine for college students, especially among individuals with any history of nonmedical use of prescription drugs.
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Affiliation(s)
- Sean Esteban McCabe
- Substance Abuse Research Center, University of Michigan, 2025 Traverwood Dr, Ste C, Ann Arbor, MI 48105-2194, USA.
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Race/ethnicity and gender differences in drug use and abuse among college students. J Ethn Subst Abuse 2008; 6:75-95. [PMID: 18192205 DOI: 10.1300/j233v06n02_06] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts.
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McCabe SE, Teter CJ. Drug use related problems among nonmedical users of prescription stimulants: a web-based survey of college students from a Midwestern university. Drug Alcohol Depend 2007; 91:69-76. [PMID: 17624690 PMCID: PMC2637564 DOI: 10.1016/j.drugalcdep.2007.05.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 05/04/2007] [Accepted: 05/14/2007] [Indexed: 11/26/2022]
Abstract
This college-based study compared nonmedical users of prescription stimulants to other types of drug users regarding drug use related problems. A Web survey was self-administered in 2005 by a probability sample of 3639 full-time undergraduate students (68% response rate) at a large public Midwestern 4-year university in the United States. The survey consisted of measures to assess substance use and misuse, including a modified version of the Drug Abuse Screening Test (DAST-10). Nonmedical users of prescription stimulants were more likely than other drug users to report polydrug use. Nonmedical users of prescription stimulants had over four times greater odds than other drug users to experience three or more DAST-10 items in the past 12 months (AOR=4.61, 95% CI=3.28-6.48). Among nonmedical users of prescription stimulants, those who used prescription stimulants via intranasal and other non-oral routes of administration had greater odds than oral only users to experience three or more DAST-10 items in the past 12 months. The findings of the present study suggest that the majority of nonmedical users of prescription stimulants are polydrug users and should be screened for potential drug abuse or dependence, especially those who report non-oral routes of administration.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan Substance Abuse Research Center, 2025 Traverwood Dr., Suite C, Ann Arbor, MI 48105-2194, USA.
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McCABE SEANESTEBAN, CRANFORD JAMESA, MORALES MICHELE, YOUNG AMY. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences. ACTA ACUST UNITED AC 2007; 67:529-37. [PMID: 16736072 PMCID: PMC1761923 DOI: 10.15288/jsa.2006.67.529] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this study, we sought to examine the prevalence, correlates, and consequences associated with simultaneous polydrug use and concurrent polydrug use of alcohol and prescription drugs. For purposes of this investigation, simultaneous polydrug use referred to the co-ingestion of different drugs at the same time, and concurrent polydrug use referred to the use of different drugs on separate occasions within the past 12 months. METHOD Undergraduate students attending a large public midwestern university in the United States were randomly selected to self-administer a Web survey. The sample consisted of 4,580 undergraduate students, with a mean (SD) age of 19.9 (2.0) years; the sample consisted of 50% women, and the racial breakdown was 65% white, 13% Asian, 7% black, 5% Hispanic, and 10% other race/ethnicity. The survey assessed simultaneous polydrug use and concurrent polydrug use of alcohol and four classes of prescription drugs: (1) pain medication, (2) stimulant medication, (3) sedative medication, and (4) sleeping medication. RESULTS The 12-month prevalence for polydrug use involving alcohol and abusable prescription drugs was 12.1% (including 6.9% simultaneous polydrug use). The majority of polydrug use involving alcohol and each class of prescription drugs was simultaneous polydrug use, with the exception of sleeping medication. Simultaneous polydrug use was more prevalent among undergraduate students who were male, were white, and reported early initiation of alcohol use. Simultaneous polydrug use was associated with more alcohol-related and other drug use-related problems than concurrent polydrug use. CONCLUSIONS Based on the high prevalence and increased risk for consequences associated with simultaneous polydrug use of alcohol and prescription drugs, collegiate prevention efforts aimed at reducing substance abuse should clearly focus on co-ingestion of alcohol and prescription drugs.
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Affiliation(s)
- SEAN ESTEBAN McCABE
- Correspondence may be sent to Sean Esteban McCabe at the above address or via email at: . Amy Young is with the Department of Psychology, Eastern Michigan University, Ypsilanti, MI
| | | | | | - AMY YOUNG
- Correspondence may be sent to Sean Esteban McCabe at the above address or via email at: . Amy Young is with the Department of Psychology, Eastern Michigan University, Ypsilanti, MI
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McCabe SE, Cranford JA, Boyd CJ, Teter CJ. Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav 2007; 32:562-75. [PMID: 16843611 PMCID: PMC1766373 DOI: 10.1016/j.addbeh.2006.05.022] [Citation(s) in RCA: 271] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 04/13/2006] [Accepted: 05/24/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The main objectives of this study were to assess the motives, diversion sources and routes of administration associated with the nonmedical use of prescription opioids as well as to examine substance use related problems associated with the nonmedical use of prescription opioids. METHOD A self-administered, cross-sectional Web survey was conducted in 2005 at a large public Midwestern 4-year university in the U.S. using a probability-based sampling approach. The final sample included 4580 full-time undergraduate students. RESULTS The three most common motives associated with the nonmedical use of prescription opioids were to relieve pain, get high, and experiment. The leading sources of prescription opioids were friends and parents although there were gender differences in reports of primary sources. More than 1 in every 10 nonmedical users reported intranasal administration. Multivariate analyses indicated nonmedical users of prescription opioids who used for motives other than to relieve pain, obtained these drugs from non-parental sources, or used these drugs via non-oral routes of administration were significantly more likely to experience substance use related problems. CONCLUSIONS These results indicate that nonmedical use of prescription opioids represents a considerable problem for particular subgroups of college students. While additional research is needed, the present study offers important new directions for policy and research regarding prescription opioid misuse.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan Substance Abuse Research Center, 2025 Traverwood Dr., Suite C, Ann Arbor, MI 48105-2194, USA.
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McCabe SE, Boyd CJ, Young A. Medical and nonmedical use of prescription drugs among secondary school students. J Adolesc Health 2007; 40:76-83. [PMID: 17185209 PMCID: PMC1764616 DOI: 10.1016/j.jadohealth.2006.07.016] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 07/20/2006] [Accepted: 07/20/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE The main objective of this study was to assess the prevalence of medical and nonmedical use of four categories of prescription drugs (opioid, stimulant, sleeping, and sedative/anxiety medication) in a racially diverse sample of secondary public school students in the Detroit metropolitan area. A secondary objective was to examine the association between the use of four categories of prescription medications and illicit drug use and probable drug abuse. METHODS In 2005, a Web-based survey was self-administered by 1086 secondary school students in grades seven through 12. RESULTS The sample consisted of 54% female, 52% White, 45% African American, and 3% from other racial categories. Forty-eight percent of the sample reported no lifetime use of four categories of prescription drugs (nonusers), 31.5% reported medically prescribed use only (medical users), 17.5% reported both medical and nonmedical use (medical/nonmedical users) and 3.3% reported nonmedical use only (nonmedical users). Multivariate analyses indicated that medical/nonmedical users and nonmedical users were significantly more likely than nonusers to report illicit drug use and probable drug abuse. Medical users generally reported similar or increased odds of illicit drug use and probable drug abuse than non-users. CONCLUSIONS These findings provide evidence that nonmedical use of prescription drugs represents a problem behavior among secondary school students.
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Affiliation(s)
- Sean Esteban McCabe
- Substance Abuse Research Center, The University of Michigan, Ann Arbor, Michigan 48105-2194, USA.
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D'Onofrio G, Becker B, Woolard RH. The impact of alcohol, tobacco, and other drug use and abuse in the emergency department. Emerg Med Clin North Am 2006; 24:925-67. [PMID: 16982347 DOI: 10.1016/j.emc.2006.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alcohol, tobacco, and other drug use is a significant societal problem. Individuals who use these substances are frequently seen in emergency departments at rates disproportionately greater than their population prevalence. This article highlights the impact of these drugs on patients and on emergency departments, including common presenting problems of individuals on these substances. Also discussed is how to help and to refer individuals with substance abuse problems through brief motivational interventions.
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Affiliation(s)
- Gail D'Onofrio
- Section of Emergency Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
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