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Snowdon N, Allan J, Shakeshaft A, Rickwood D, Stockings E, Boland VC, Courtney RJ. Outpatient psychosocial substance use treatments for young people: An overview of reviews. Drug Alcohol Depend 2019; 205:107582. [PMID: 31778903 DOI: 10.1016/j.drugalcdep.2019.107582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings. METHODS Reviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included. FORTY-THREE REVIEWS MET ALL INCLUSION CRITERIA To appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84). RESULTS All high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy. CONCLUSIONS Methodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.
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Affiliation(s)
- Nicole Snowdon
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia; National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia.
| | - Julaine Allan
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Debra Rickwood
- Research and Evaluation, headspace, The National Youth Mental Health Foundation, South Tower, Level 2, 485 La Trobe St, Melbourne VIC 3000, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Veronica C Boland
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
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Hammond CJ, Gray KM. Pharmacotherapy for Substance Use Disorders in Youths. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016; 25:292-316. [PMID: 28082828 DOI: 10.1080/1067828x.2015.1037517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite recent advances in psychosocial treatments targeting adolescent substance use disorders (SUD), effect sizes generally remain small to modest, and few treatment-enrolled youth achieve sustained abstinence. Among adults, SUD-targeted pharmacotherapies have emerged as viable options to complement psychosocial treatments and enhance outcomes. Developmental differences exist in pharmacodynamics and treatment-response, and comparatively little research has focused on SUD-targeted pharmacotherapies for youth. This article provides a review and synthesis of relevant published clinical trials focusing on youth SUDs and co-occurring/comorbid psychiatric and substance use disorders. It offers recommendations for clinical practice and further research based on the limited findings to date.
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Affiliation(s)
| | - Kevin M Gray
- Medical University of South Carolina, Charleston, SC, USA
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3
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Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions. CURRENT ADDICTION REPORTS 2016; 3:145-156. [PMID: 27570728 DOI: 10.1007/s40429-016-0098-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adolescence is a key period in the development of substance use and misuse. Substance use typically begins during adolescence and prevalence rates for many substance use disorders peak before age 21 years. Yet, despite clinical demand, treatments for youth rely almost entirely on psychosocial interventions that yield only modest benefit. One potential way to improve treatment effects is to augment the best available psychosocial interventions with pharmacotherapy. Although pharmacotherapy research has advanced care for adults with substance use disorders, no medication is indicated for adolescents and controlled trials with teenagers are scant. Optimizing treatments for youth will require closing this important gap in medication development research. In this paper we review the paucity of pharmacotherapy research for adolescent substance misuse, and we discuss how we can leverage human laboratory paradigms and technology to advance our understanding regarding if and how medications may improve treatment options for youths.
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4
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Minozzi S, Amato L, Vecchi S, Davoli M. Psychosocial treatments for drugs and alcohol abusing adolescents. Hippokratia 2015. [DOI: 10.1002/14651858.cd008283.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Silvia Minozzi
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
| | - Laura Amato
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
| | - Simona Vecchi
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
| | - Marina Davoli
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
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5
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Is there more to psychosocial treatments in addiction than brief interventions? Ir J Psychol Med 2014; 31:61-68. [PMID: 30189469 DOI: 10.1017/ipm.2013.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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6
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Sibley MH, Kuriyan AB, Evans SW, Waxmonsky JG, Smith BH. Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature. Clin Psychol Rev 2014; 34:218-32. [PMID: 24632046 DOI: 10.1016/j.cpr.2014.02.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/08/2014] [Accepted: 02/13/2014] [Indexed: 01/19/2023]
Abstract
Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.
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Affiliation(s)
| | | | | | - James G Waxmonsky
- Pennsylvania State University Milton Hershey Medical Center, Hershey, PA, USA
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7
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Lopes GM, Nóbrega BA, Del Prette G, Scivoletto S. Use of psychoactive substances by adolescents: current panorama. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S51-61. [PMID: 24142128 DOI: 10.1590/1516-4446-2013-s105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adolescence is a period of vulnerability to substance use disorders (SUDs). Epidemiological studies indicate that about 23% of Brazilian adolescents use drugs, with alcohol being the most widely consumed substance. The etiology of SUDs is complex, influenced by an interaction of genetic risk, individual development, environmental factors, context of use, and substance used. Clinicians should consider diagnostic criteria and be aware of behavioral changes that may indicate drug use and its consequences in various aspects of adolescent life. Identification and treatment of comorbid conditions is critical to the management of SUDs in this age group. Interventions should restrict access to drugs and facilitate prompt recognition of initial use, preventing progression to serious patterns of abuse or dependence. Intervention should be broad, including academic and occupational activities as well as social relationships and leisure, which are critical to the reestablishment of normal adolescent development.
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Affiliation(s)
- Gabriel M Lopes
- Department of Psychiatry and Institute of Psychiatry, Universidade de São Paulo (USP), São PauloSP, Brazil
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8
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Thomas CP, Garnick DW, Horgan CM, Miller K, Harris AHS, Rosen MM. Establishing the feasibility of measuring performance in use of addiction pharmacotherapy. J Subst Abuse Treat 2013; 45:11-8. [PMID: 23490233 PMCID: PMC3954716 DOI: 10.1016/j.jsat.2013.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 11/17/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022]
Abstract
This paper presents the rationale and feasibility of standardized performance measures for use of pharmacotherapy in the treatment of substance use disorders (SUD), an evidence-based practice and critical component of treatment that is often underused. These measures have been developed and specified by the Washington Circle, to measure treatment of alcohol and opioid dependence with FDA-approved prescription medications for use in office-based general health and addiction specialty care. Measures were pilot tested in private health plans, the Veterans Health Administration (VHA), and Medicaid. Testing revealed that use of standardized measures using administrative data for overall use and initiation of SUD pharmacotherapy is feasible and practical. Prevalence of diagnoses and use of pharmacotherapy vary widely across health systems. Pharmacotherapy is generally used in a limited portion of those for whom it might be indicated. An important methodological point is that results are sensitive to specifications, so that standardization is critical to measuring performance across systems.
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Affiliation(s)
- Cindy Parks Thomas
- Schneider Institutes for Health Policy, Brandeis University, Waltham, MA 02454, USA.
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9
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Tanner-Smith EE, Wilson SJ, Lipsey MW. The comparative effectiveness of outpatient treatment for adolescent substance abuse: a meta-analysis. J Subst Abuse Treat 2012; 44:145-58. [PMID: 22763198 DOI: 10.1016/j.jsat.2012.05.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 05/02/2012] [Accepted: 05/30/2012] [Indexed: 11/19/2022]
Abstract
Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment-comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre-post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre-post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use.
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10
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Wu LT, Gersing K, Burchett B, Woody GE, Blazer DG. Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: findings from a large electronic health records database. J Psychiatr Res 2011; 45:1453-62. [PMID: 21742345 PMCID: PMC3196279 DOI: 10.1016/j.jpsychires.2011.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/12/2011] [Accepted: 06/17/2011] [Indexed: 11/18/2022]
Abstract
This study examined the prevalence of substance use disorders (SUDs) among psychiatric patients aged 2-17 years in an electronic health records database (N=11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large university-based hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2-12-year age group (n=6210) was 1.6% and increased to 25% in the 13-17-year age group (n=5247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n=1423), children aged 2-12 years (95%) and females (75-100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Box 3419, Durham, NC 27710, USA.
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11
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Minozzi S, Amato L, Vecchi S, Davoli M. Psychosocial treatments for drugs and alcohol abusing adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd008283.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Abstract
There is a paucity of research on pharmacotherapies in adolescents with substance use disorders. This paucity is partly because of the fact that most people with substance dependence do not get diagnosed until early adulthood, that is, after 18 years of age. This article reviews pharmacotherapies used for aversion, substitution, anti-craving, and detoxification of alcohol, nicotine, cocaine, and opioids dependence. Adult research is referenced when applicable and generalized to adolescents with caution. Continued evaluation and development of pharmacotherapy for youth in controlled studies are needed to examine medication effectiveness, safety, potential for abuse, compliance, and potential interactions with other medications or substances of abuse.
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13
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Bukstein OG, Horner MS. Management of the adolescent with substance use disorders and comorbid psychopathology. Child Adolesc Psychiatr Clin N Am 2010; 19:609-23. [PMID: 20682224 DOI: 10.1016/j.chc.2010.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Substance use disorders are common in youth, and co-occurring psychiatric disorders are present in the majority of cases. This article reviews clinical considerations unique to the population, including intricacies of assessment and special treatment considerations. Several psychotherapeutic intervention models are discussed, including cognitive-behavioral therapy, dialectic behavior therapy, motivational enhancement therapy/motivational interviewing, family behavior therapy, multidimensional family therapy, and multisystemic therapy. Research on psychopharmacologic treatment is limited, and primarily focuses on mood disorders and attention deficit/hyperactivity disorder. To maximize outcome, recommendations based on practice parameters promote integration of treatment modalities versus serial or concurrent treatment of co-occurring substance use and psychiatric disorders.
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Affiliation(s)
- Oscar G Bukstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Allen DN, Donohue B, Sutton G, Haderlie M, Lapota H. Application of a standardized assessment methodology within the context of an evidence-based treatment for substance abuse and its associated problems. Behav Modif 2009; 33:618-54. [PMID: 19864319 PMCID: PMC3486630 DOI: 10.1177/0145445509343284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Administrators of community-based treatment programs are increasingly being required to utilize psychometrically validated instruments to measure the effectiveness of their interventions. However, developers of psychometric measures have often failed to report strategies relevant to the administration of these measures in nontraditional settings outside the therapy office. Moreover, with few exceptions, developers of evidence-based treatments (EBTs) have insufficiently disseminated methods for integrating assessment measures into treatment planning. Therefore, the purpose of this article is to review an assessment methodology that may be utilized to support EBT for individuals who are identified for substance abuse or related problem behaviors. The application of this methodology is demonstrated utilizing Family Behavior Therapy to exemplify "real world" scenarios involving adolescents and adults. Although many of these strategies are evidence supported, most are based on clinical experiences occurring in clinical trials and dissemination efforts within community settings.
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Affiliation(s)
- Daniel N Allen
- Department of Psychology, University of Nevada LasVegas, 4505 Maryland Parkway, Las Vegas NV, USA.
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Harvey AG, Talbot LS, Gershon A. Sleep Disturbance in Bipolar Disorder Across the Lifespan. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:256-277. [PMID: 22493520 PMCID: PMC3321357 DOI: 10.1111/j.1468-2850.2009.01164.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this article is to highlight the importance of the sleep-wake cycle in children, adolescents, and adults with bipolar disorder. After reviewing the evidence that has accrued to date on the nature and severity of the sleep disturbance experienced, we document the importance of sleep for quality of life, risk for relapse, affective functioning, cognitive functioning, health (sleep disturbance is implicated in obesity, poor diet, and inadequate exercise), impulsivity, and risk taking. We argue that sleep may be critically important in the complex multifactorial cause of interepisode dysfunction, adverse health outcomes, and relapse. An agenda for future research is presented that includes improving the quality of sleep measures and controlling for the impact of bipolar medications.
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Riggs P, Levin F, Green AI, Vocci F. Comorbid psychiatric and substance abuse disorders: recent treatment research. Subst Abus 2008; 29:51-63. [PMID: 19042206 DOI: 10.1080/08897070802218794] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Psychiatric comorbidity is defined as the co-occurrence of a psychiatric disorder in a patient with a substance use disorder. Psychiatric disorders in substance abuse patients can antedate the substance use disorder or be a consequence of the substance abuse. There is emerging evidence that drug use in adolescence may alter the onset of certain psychiatric disorders in vulnerable individuals. Patients with concurrent comorbid disorders present special challenges for the substance abuse treatment system in terms of diagnosis and management because each disorder has the capability of exacerbating the other. This manuscript is a summary of an ISAM symposium that featured three speakers who discussed the following topics: 1. Etiology and treatment of comorbid psychiatric and substance use disorders in adolescents; 2. Treatment of ADHD and substance use disorders in adults; 3. Effects of substance abuse on the onset, severity, and treatment of schizophrenia. Recommendations for further research will be presented.
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Affiliation(s)
- Paula Riggs
- Department of Psychiatry, University of Colorado Health Science Cneter, Denver, CO 80224, USA
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Eme RF. Attention-Deficit/Hyperactivity Disorder and the Juvenile Justice System. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2008. [DOI: 10.1080/15228930801963994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Patients with co-occurring disorders (CODs) have a substance use disorder (SUD) and at least one other mental health diagnosis. Many patients with a non-SUD mental health diagnosis also have an SUD, whereas most patients with SUDs have other co-occurring psychiatric disorders. Recognition is growing regarding the importance of identifying and treating CODs. This article reviews the magnitude of CODs, theories by which CODs develop, treatment options for CODs (including psychotherapeutic and psychopharmacologic interventions), current treatment initiatives for CODs, and ways to prevent CODs. Although research on CODs is providing direction and hope for treatment, many more questions than answers remain regarding these challenging conditions.
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Affiliation(s)
- Christopher A Lamps
- Medical College of Virginia at Virginia Commonwealth University, 515 North 10th Street, Richmond, VA 23298, USA
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Leslie K. Youth substance use and abuse: challenges and strategies for identification and intervention. CMAJ 2008; 178:145-8. [PMID: 18195284 DOI: 10.1503/cmaj.071410] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Karen Leslie
- Division of Adolescent Medicine and Department of Paediatrics, Hospital for Sick Children, Toronto, Ont
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Abstract
The purpose of this review is to summarize the neurobiological factors involved in the etiology of adolescent addiction and present evidence implicating various mechanisms in its development. Adolescents are at heightened risk for experimentation with substances, and early experimentation is associated with higher rates of SUD in adulthood. Both normative (e.g., immature frontal-limbic connections, immature frontal lobe development) and non-normative (e.g., lowered serotonergic function, abnormal hypothalamic-pituitary-adrenal axis function) neurobiological developmental factors can predispose adolescents to a heightened risk for SUD. In addition, a normative imbalance in the adolescent neurobiological motivational system may be caused by the relative underdevelopment of suppressive mechanisms when compared to stimulatory systems. These neurobiological liabilities may correspond to neurobehavioral impairments in decision-making, affiliation with deviant peers and externalizing behavior; these and other cognitive and behavioral traits converge with neurobiological factors to increase SUD risk. The progression to SUD acts as an amplifying feedback loop, where the development of SUD results in reciprocal impairments in neurobehavioral and neurobiological processes. A clearer understanding of adolescent neurobiology is a necessary step in the development of prevention and treatment interventions for adolescent SUD.
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Affiliation(s)
- Ty S Schepis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Warner LA, Fontanella CA, Pottick KJ. Initiation and change of psychotropic medication regimens among adolescents in inpatient care. J Child Adolesc Psychopharmacol 2007; 17:701-12. [PMID: 17979589 DOI: 10.1089/cap.2007.0120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this study was to compare clinical and service utilization profiles of adolescents admitted to inpatient treatment with and without a psychotropic medication regimen, and estimate correlates of medication use separately for the two groups. METHOD Comprehensive data on clinical characteristics and service utilization of 517 adolescents enrolled in Medicaid who were admitted to three inpatient hospitals (one for-profit and two nonprofit) in a mid-Atlantic state were used. Medication correlates were examined with bivariate statistics (chi-square and t-test) and multivariate logistic regressions. RESULTS Psychotropic medication was prescribed for the majority (90.5%) of adolescents at discharge. During their inpatient stay, 76.3% of the youths who were not on medication at admission (n = 190) initiated medication use, and 45% admitted with prior medication (n = 327) had a medication change. Adolescents admitted with and without medication differed on all sociodemographic and clinical characteristics except age, suicidality, and hospital. Controlling on demographic, clinical, and service history characteristics, hospital setting was the only correlate significantly associated with both initiation and change. CONCLUSIONS Institutional factors may be more important than clinical factors in appraising medication patterns in inpatient settings. Interventions to ensure the development and implementation of medication management guidelines may need to be tailored to the climate and culture of the provider organization as well as directly to individual practitioners, parents or adolescents themselves.
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Affiliation(s)
- Lynn A Warner
- School of Social Welfare, University at Albany-SUNY, 135 Washington Avenue, Albany, NY 12222, USA.
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Toumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduce harm associated with adolescent substance use. Lancet 2007; 369:1391-1401. [PMID: 17448826 DOI: 10.1016/s0140-6736(07)60369-9] [Citation(s) in RCA: 278] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated findings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are effective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.
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Affiliation(s)
- J W Toumbourou
- Centre for Adolescent Health, Murdoch Childrens Research Institute and School of Psychology, Deakin University, Victoria, Australia
| | - T Stockwell
- Centre for Addictions Research of British Colombia, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada; National Drug Research Institute, Curtin University, Perth, Australia.
| | - C Neighbors
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, USA
| | - G A Marlatt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, USA
| | - J Sturge
- Centre for Addictions Research of British Colombia, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - J Rehm
- Centre for Addictions and Mental Health, Toronto, Ontario, Canada
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