Substance use disorder: abuse, dependence and dyscontrol

Is employment status in adults over 25 years old associated with nonmedical prescription opioid and stimulant use?

PURPOSE

Nonmedical use of prescription opioid and stimulants (NMUPO and NMUPS, respectively) has declined in recent years, but remains an important public health problem. Evidence regarding their relationships with employment status remains unclear. We determined the relationship between employment status and NMUPO and NMUPS.

METHODS

We analyzed a cross-sectional, nationally representative, weighted sample of 58,486 adults, ages 26 years and older, using combined 2011-2013 data from the National Survey on Drug Use and Health (NSDUH). We fit two crude and two adjusted multivariable logistic regression models to assess the relationship between our two different outcomes of interest: (1) past-year NMUPO and (2) past-year NMUPS, and our exposure of interest: employment status, categorized as (1) full time, (2) part time, (3) unemployed, and (4) not in the workforce. Our adjusted models featured the following covariates: sex, race, age, marital status, and psychological distress, and other nonmedical use.

RESULTS

Prevalence of NMUPO was higher than NMUPS (3.48 vs. 0.72%). Unemployed participants had the highest odds of NMUPO [aOR 1.45, 95% CI (1.15-1.82)], while those not in the workforce had the highest odds of NMUPS [aOR 1.71, 95% CI (1.22-2.37)]. Additionally, part-time and unemployed individuals had increased odds of NMUPS [aORs, 95% CI 1.59 (1.09-2.31) and 1.67 (1.11-2.37) respectively], while those not in the workforce had decreased odds of NMUPO [aOR 0.82, 95% CI (0.68-0.99)] relative to full-time participants.

CONCLUSIONS

There is a need for adult prevention and deterrence programs that target nonmedical prescription drug use, especially among those unemployed or not in the workforce.

How to think about your drink: Action-identification and the relation between mindfulness and dyscontrolled drinking

Cross-sectional and intervention research have shown that mindfulness is inversely associated with difficulties in controlling alcohol use. However, little is known regarding the mechanisms through which mindfulness is related to increased control over drinking. One potential mechanism consists of the way individuals represent their drinking behaviour. Action identification theory proposes that self-control of behaviour is improved by shifting from high-level representations regarding the meaning of a behaviour to lower-level representations regarding "how-to" aspects of a behaviour. Because mindfulness involves present-moment awareness, it may help to facilitate such shifts. We hypothesized that an inverse relation between mindfulness and dyscontrolled drinking would be partially accounted for by the way individuals mentally represent their drinking behaviour - i.e., reduced levels of high-level action identification and increased levels of low-level action identification. One hundred and twenty five undergraduate psychology students completed self-report measures of mindful awareness, action identification of alcohol use, and difficulty in controlling alcohol use. Results supported the hypothesis that high-level action identification partially mediates the relation between mindfulness and dyscontrolled drinking but did not support a mediating role for low-level action identification. These results suggest that mindfulness can improve self-control of alcohol by changing the way we think about our drinking behaviour.

Predicting dyscontrolled drinking with implicit and explicit measures of alcohol attitude

BACKGROUND

A defining feature of alcohol addiction is dyscontrol - drinking despite intentions to restrain use. Given that dyscontrolled drinking involves an automatic (nonvolitional) element and that implicit measures are designed to assess automatic processes, it follows that implicit measures may be particularly useful for predicting dyscontrolled alcohol use. Although there is accumulating evidence for the benefit of using implicit measures to predict nonvolitional behaviors, relatively little research has examined such predictive validity for alcohol dyscontrol. The current study was designed to examine whether an implicit measure of alcohol attitude would predict variance of dyscontrol above that explained by typical drinking behavior and an explicit measure of alcohol attitude.

METHODS

A sample of 62 undergraduate students completed implicit and explicit measures of alcohol-positive (relative to alcohol-negative) valence associations and retrospective self-report measures of typical drinking behavior and difficulty in controlling alcohol consumption.

RESULTS

Both the implicit and explicit measures predicted alcohol dyscontrol. The implicit measure continued to predict dyscontrol when controlling for the explicit measure and typical drinking behavior.

CONCLUSIONS

These findings indicate that assessing the automaticity of alcohol-positive associations may be beneficial for predicting clinically relevant behaviors such as post-treatment outcome.

Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample

Adults with attention-deficit/hyperactivity disorder (ADHD) are at higher risk to use substances than their nonclinical peers. Increased levels of impulsivity are generally thought to contribute to their increased levels of risk. Impulsivity is a multifaceted construct, however, and little research to date has attempted to identify which facets of impulsivity contribute to the increased rates of substance abuse among individuals with ADHD. The current study examined the relation among ADHD symptom clusters (i.e., hyperactivity/impulsivity and inattention), substance use rates (i.e., alcohol use, nicotine use, and marijuana use), and personality processes associated with impulsive behavior in a group of young adults. Participants were 361 undergraduate students. Both symptom clusters were positively associated with rates of substance use. Specifically, hyperactive/impulsive symptoms were associated with alcohol and nicotine use, and inattentive symptoms were associated with alcohol use. Several pathways from hyperactive/impulsive symptoms to alcohol, nicotine, and marijuana use via specific facets of impulsivity were identified. These findings have implications for understanding the relation between ADHD symptoms and substance use, as well as clinical implications for preventing and treating substance use problems in individuals with symptoms of ADHD.

When wanting to change is not enough: automatic appetitive processes moderate the effects of a brief alcohol intervention in hazardous-drinking college students

BACKGROUND

Research indicates that brief motivational interventions are efficacious treatments for hazardous drinking. Little is known, however, about the psychological processes that may moderate intervention success. Based on growing evidence that drinking behavior may be influenced by automatic (nonvolitional) mental processes, the current study examined whether automatic alcohol-approach associations moderated the effect of a brief motivational intervention. Specifically, we examined whether the efficacy of a single-session intervention designed to increase motivation to reduce alcohol consumption would be moderated by the strength of participants' automatic alcohol-approach associations.

METHODS

Eighty-seven undergraduate hazardous drinkers participated for course credit. Participants completed an Implicit Association Test to measure automatic alcohol-approach associations, a baseline measure of readiness to change drinking behavior, and measures of alcohol involvement. Participants were then randomly assigned to either a brief (15-minute) motivational intervention or a control condition. Participants completed a measure of readiness to change drinking at the end of the first session and returned for a follow-up session six weeks later in which they reported on their drinking over the previous month.

RESULTS

Compared with the control group, those in the intervention condition showed higher readiness to change drinking at the end of the baseline session but did not show decreased drinking quantity at follow-up. Automatic alcohol-approach associations moderated the effects of the intervention on change in drinking quantity. Among participants in the intervention group, those with weak automatic alcohol-approach associations showed greater reductions in the amount of alcohol consumed per occasion at follow-up compared with those with strong automatic alcohol-approach associations. Automatic appetitive associations with alcohol were not related with change in amount of alcohol consumed per occasion in control participants. Furthermore, among participants who showed higher readiness to change, those who exhibited weaker alcohol-approach associations showed greater reductions in drinking quantity compared with those who exhibited stronger alcohol-approach associations.

CONCLUSIONS

The results support the idea that automatic mental processes may moderate the influence of brief motivational interventions on quantity of alcohol consumed per drinking occasion. The findings suggest that intervention efficacy may be improved by utilizing implicit measures to identify those who may be responsive to brief interventions and by developing intervention elements to address the influence of automatic processes on drinking behavior.

Increased sensitivity to the disinhibiting effects of alcohol in adults with ADHD

The acute impairing effects of alcohol on inhibitory control have been well documented in healthy drinkers. By contrast, little is known about alcohol effects in individuals with disorders characterized by poor impulse control, such as those with attention-deficit/hyperactivity disorder (ADHD). Alcohol could produce greater inhibitory impairment in these individuals. The present study tested this hypothesis in adults with ADHD (n=10) and controls (n=12) using the cued go/no-go task. The task requires quick responses to go targets and suppression of responses to no-go targets following the presentation of cues. Prior research on healthy adults has shown that valid cues can protect against alcohol impairment (Marczinski & Fillmore, 2003). Performance was tested under 3 doses of alcohol: 0.65 g/kg, 0.45 g/kg, and 0.0 g/kg (placebo). Alcohol dose-dependently increased inhibitory failures in controls in the invalid, but not the valid, cue condition. By contrast, those with ADHD displayed significant alcohol impairment regardless of cue condition. Thus, unlike controls, valid cues offered little protection from the disinhibiting effects of alcohol in drinkers with ADHD, suggesting an increased sensitivity to alcohol impairment of inhibitory control.

Acute effects of alcohol on inhibitory control and information processing in high and low sensation-seekers

Sensation-seeking is a personality characteristic that has been associated with drug abuse. Some evidence suggests that sensation-seekers might experience increased rewarding effects from drugs of abuse, possibly contributing to the association between sensation-seeking and risk for drug abuse. The present study examined the effects of three doses of alcohol (0.0 g/kg, 0.45 g/kg, and 0.65 g/kg) on inhibitory control, information processing, and subjective ratings in a group of high sensation-seekers and a group of low sensation-seekers (N=20). Inhibitory control was measured by a cued go/no-go task and speed of information processing was assessed by the Rapid Information Processing (RIP) task. Alcohol impaired inhibitory control and information processing. Group differences were also observed. Compared with their low sensation-seeking counterparts, high sensation-seekers demonstrated increased sensitivity to the subjective rewarding effects of alcohol and a poorer degree of inhibitory control that was further impaired by alcohol. The findings highlight reward- and cognitive-based mechanisms by which sensation-seeking could operate to increase risk for alcohol abuse.

Alcohol consumption primes automatic alcohol-approach associations

OBJECTIVE

There is increasing evidence that automatic mental processes play a role in problematic alcohol use. Although previous research has shown that alcohol consumption can prime alcohol-seeking behavior in animals and humans, little research has examined whether alcohol consumption activates automatic alcohol-related cognitions. The current study was designed to examine the effects of alcohol consumption on the activation of automatic alcohol motivation as measured by a reaction time task.

METHOD

Eighty-five at-risk drinkers participated in the study, which began with a baseline measure of automatic alcohol motivation, after which participants completed a taste-test in which they could consume as much beer as they liked for 10 minutes. Following an absorption period, participants completed the measure of automatic alcohol motivation for a second time.

RESULTS

A partial correlation analysis indicated that amount of alcohol consumed predicted stronger automatic alcohol motivation when controlling for the baseline level of automatic alcohol motivation.

CONCLUSION

The findings suggest that alcohol consumption may prime the automatic mental processes that have been shown to contribute to problematic alcohol use.

Individual differences in acute alcohol impairment of inhibitory control predict ad libitum alcohol consumption

RATIONALE

Research has begun to examine how acute cognitive impairment from alcohol could contribute to alcohol abuse. Specifically, alcohol-induced impairment of inhibitory control could compromise the drinker's ability to stop the self-administration of alcohol, increasing the risk of binge drinking.

OBJECTIVE

The present study was designed to test this hypothesis by examining the relation between acute alcohol impairment of inhibitory control and alcohol consumption during a single drinking episode.

MATERIALS AND METHODS

Twenty-six healthy adults performed a cued go/no-go task that measured inhibitory control. The study tested the degree to which their inhibitory control was impaired by a moderate dose of alcohol (0.65 g/kg) versus a placebo and the extent to which individual differences in this impairment predicted levels of alcohol consumption as assessed by ad lib drinking in the laboratory.

RESULTS

In accord with the hypothesis, greater impairment of inhibitory control from alcohol was associated with increased ad lib consumption.

CONCLUSION

Acute impairment of inhibitory control might be an important cognitive effect that contributes to abuse in addition to the positive rewarding effects of the drug.

Predictive factors of persisting illicit drug use in hospitalized heroin addicts

The efficacy of methadone treatment in reducing the rate of positive urinalyses for opiates has been repeatedly assessed in outpatient intravenous heroin users (IHUs), but not in IHUs hospitalized for coexisting diseases. The aim of the present study, performed on 83 IHUs, was to assess the rate of drug-free urinalyses for addictive drugs over a 13-day period of hospitalization. The rate of drug-free urinalyses was then related to the intensity of withdrawal symptoms, the level of dependence (as measured by the severity of dependence scale (SDS)) and of heroin craving (as measured by a visual analogical scale, (VAS)), assessed on admission and on days 4, 7, 10, and 13. All but nine patients received methadone upon hospitalization. The results show that positive urinalyses for morphine and/or cocaine dropped over the period of observation from 67 to 7%. On admission, patients who persisted in the illicit use of heroin did not differ significantly from the rest in terms of abstinence scores or daily methadone dose, but scored higher at the SDS and yielded urinalyses which all tested positive for morphine and/or cocaine. In conclusion, in the hospital setting low methadone doses (32.5 mg per die on average) induce a drug-free condition in the majority of patients and high SDS scores associated with positive urinalysis for morphine and/or cocaine are predictive of persistent drug abuse during hospitalization.

Whose territory is it anyway? Should psychiatry own alcohol and drugs in Australia?

Surely alcohol and drug matters in Australia should be regarded as the province of psychiatry? Decades before any other branch of medicine displayed any interest in the subject and long before alcohol and drugs were considered even remotely respectable, numerous Australian psychiatrists provided inspiration and leadership in this Cinderella field. Drs Bartholomew, Bell, Buchanan, Chegwidden, Dalton, Drew, Ellard, Lennane, Milner, Milton, Waddy and Pols are some of the best known among the many Australian psychiatrists who pioneered efforts to improve treatment for patients with alcohol and drug problems. The NHMRC Committee on Alcohol and Drug Dependence, which has a considerable potential for influencing the field in Australia, has always been dominated by psychiatrists. In the United Kingdom and the United States, countries which often serve as models for much of Australian medical and other practice, alcohol and drug matters are determined almost exclusively by psychiatrists. Is there any evidence that they have been held back by a psychiatric hegemony on alcohol and drug's? For many decades (and until quite recently), alcohol and drug matters were handled for the World Health Organisation by its Mental Health Division. Did we suffer globally because WHO placed alcohol and drugs under the control of psychiatry?