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Scopano MR, Jones HE, Stea SG, Freeman MZ, Grisel JE. Age, β-endorphin, and sex dependent effects of maternal separation on locomotor activity, anxiety-like behavior, and alcohol reward. Front Behav Neurosci 2023; 17:1155647. [PMID: 37091593 PMCID: PMC10113444 DOI: 10.3389/fnbeh.2023.1155647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionChildhood adversity is pervasive and linked to numerous disadvantages in adulthood, including physical health problems, mental illness, and substance use disorders. Initial sensitivity to the rewarding effects of alcohol predicts the risk of developing an alcohol use disorder, and may be linked to developmental stress. The opioid peptide β-endorphin (β-E) regulates the stress response and is also implicated in the risk for excessive alcohol consumption.MethodsWe explored the influence of β-E in an animal model of early life adversity using controlled maternal separation by evaluating changes in locomotor activity, anxiety-like behavior, and the initial rewarding effects of alcohol in a single exposure conditioned place preference paradigm in control C57BL/6J and β-E deficient β-E +/+ 0.129S2-Pomc tm1Low/J; β-E −/− mice. Maternal separation (MS) occurred for 3 h each day from post-natal days (PND) 5–18 in approximately half the subjects.ResultsMaternal interactions increased following the separation protocol equally in both genotypes. MS and control subjects were tested as adolescents (PND 26–32) or adults (PND 58–72); the effects of MS were generally more pronounced in older subjects. Adults were more active than adolescents in the open field, and MS decreased activity in adolescent mice but increased it in adults. The increase in adult activity as a result of early life stress depended on both β-E and sex. β-E also influenced the effect of maternal separation on anxiety-like behavior in the Elevated Plus Maze. MS promoted rewarding effects of alcohol in male β-E deficient mice of either age, but had no effect in other groups.DiscussionTaken together, these results suggest that the effects of MS develop over time and are β-E and sex dependent and may aid understanding of how individual differences influence the impact of adverse childhood experiences.
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Rabiee R, Sjöqvist H, Agardh E, Lundin A, Danielsson AK. Risk of readmission among individuals with cannabis use disorder during a 15-year cohort study: the impact of socio-economic factors and psychiatric comorbidity. Addiction 2023. [PMID: 36746781 DOI: 10.1111/add.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Cannabis use disorder (CUD) is one of the main reasons for seeking substance treatment in the Nordic countries, but there are few studies on readmission to care. We aimed to characterize CUD readmission and estimate the magnitude of how socio-economic factors and psychiatric comorbidity influence the risk of CUD readmission. DESIGN, SETTING AND PARTICIPANTS This was a nation-wide cohort study carried out between 2001 and 2016 in Sweden. The participants were individuals with CUD, aged 17 years and above (n = 12 143). MEASUREMENTS Information on predictors was obtained from registers and included education, income and psychiatric comorbidity assessed by six disease groups. The outcome measure was readmission, defined as a CUD visit to health-care at least 6 months after initial CUD diagnosis. Hazard ratios (HR) were estimated using Cox survival analyses and flexible parametric survival analyses to assess risk of readmission and how the risk varied with age. FINDINGS The vast majority of CUD visits took place in outpatient care (~80%). Approximately 23% of the included individuals were readmitted to care during follow-up. The fully adjusted model showed an increased risk of readmission among those with schizophrenia and other psychotic disorders [HR = 1.54, 95% confidence interval (CI) = 1.29-1.84], low education (HR = 1.40, 95% CI = 1.24-1.57), personality disorders (HR = 1.27, 95% CI = 1.05-1.54) or mood disorders (HR = 1.27, 95% CI = 1.12-1.45). Flexible parametric modeling revealed increased risk of readmission mainly in individuals aged 18-35 years. CONCLUSIONS The risk of readmission was highest among those with low education, schizophrenia and other psychotic disorders, mood-related disorders or personality disorders. Individuals aged 18-35 years showed the highest risk of readmission. Our findings highlight individuals with complex health-care needs.
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Affiliation(s)
- Rynaz Rabiee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Agardh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Rabiee R, Lundin A, Agardh E, Allebeck P, Danielsson AK. Cannabis use disorder in relation to socioeconomic factors and psychiatric comorbidity: A cluster analysis of three million individuals born in 1970-2000. Scand J Public Health 2023; 51:82-89. [PMID: 36120841 PMCID: PMC9903242 DOI: 10.1177/14034948221122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is one of the main reasons for seeking substance use treatment. It is thus important to monitor and increase knowledge of individuals with CUD utilizing healthcare. We aimed to examine the number of CUD diagnoses over time, compare individuals with CUD with those without and identify subgroups based on CUD diagnosis, sex, birth year, socioeconomic factors and psychiatric comorbidity. METHODS A Swedish, population-based study with 3,307,759 individuals, born in 1970-2000, with register data extending to 2016. K-mode cluster analysis was used to identify potential subgroups. RESULTS The number of individuals with a CUD diagnosis was 14,046 (0.42%). CUD diagnoses increased over time (born 1990-1994: 61 per 100,000, born 1995-2000: 107 per 100,000, by 2016). A majority of those with a CUD had another psychiatric diagnosis (80%, compared with 19% for those without CUD). Four clusters were identified. Cluster 1 comprised mainly men with low income and substance use disorders, clusters 2, 3 and 4 comprised mainly women with higher proportions of mood-related, neurotic and stress-related and behavioural disorders. CONCLUSIONS
There was an increase in CUD diagnoses in Sweden over time, especially among younger birth cohorts. Individuals with CUD were more often male, from younger birth cohorts, with lower education and income than those without CUD. Men and women with CUD exhibited differences in education, income and psychiatric comorbidity. Our results demonstrate the importance of monitoring the impact of socioeconomic factors and psychiatric comorbidity in relation to CUD.
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Affiliation(s)
- Rynaz Rabiee
- Department of Global Public Health, Karolinska Institutet, Sweden,Rynaz Rabiee, Karolinska Institutet, Department of Global Public Health (GPH), Stockholm, SE-171 77, Sweden. E-mail:
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Sweden,Centre for Epidemiology and Community Medicine, Sweden
| | - Emilie Agardh
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Peter Allebeck
- Department of Global Public Health, Karolinska Institutet, Sweden
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Addictive and other mental disorders: a call for a standardized definition of dual disorders. Transl Psychiatry 2022; 12:446. [PMID: 36229453 PMCID: PMC9562408 DOI: 10.1038/s41398-022-02212-5] [Citation(s) in RCA: 5] [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: 05/06/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation.
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Livne O, Shmulewitz D, Sarvet AL, Wall MM, Hasin DS. Association of Cannabis Use-Related Predictor Variables and Self-Reported Psychotic Disorders: U.S. Adults, 2001-2002 and 2012-2013. Am J Psychiatry 2022; 179:36-45. [PMID: 34645275 PMCID: PMC8945254 DOI: 10.1176/appi.ajp.2021.21010073] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine the association of cannabis indicators with self-reported psychotic disorders in the U.S. general population. METHODS Participants were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309). Logistic regression was used to estimate standardized prevalences of past-year self-reported psychotic disorders within each survey and to evaluate the association of past-year self-reported psychotic disorders with indicators of nonmedical cannabis use (any use; frequent use [at least three times/week], daily/near-daily use, and DSM-IV cannabis use disorder) compared with those with no past-year nonmedical cannabis use. Whether the strength of associations differed between surveys was indicated by difference-in-difference tests (between-survey contrasts) and ratios of odds ratios between surveys. RESULTS Self-reported psychotic disorders were significantly more prevalent among participants with any nonmedical cannabis use than those without (2001-2002: 1.65% compared with 0.27%; 2012-2013: 1.89% compared with 0.68%). In 2001-2002, self-reported psychotic disorders were unrelated to either frequent use or daily/near-daily use. However, in 2012 - 2013, compared with nonusers, self-reported psychotic disorders were more common among participants with frequent use and those with daily/near-daily nonmedical cannabis use (2012-2013: 2.79% and 2.52%, respectively, compared with 0.68% among nonusers). Self-reported psychotic disorders were significantly more prevalent among participants with cannabis use disorder than nonusers in both surveys (2001-2002: 2.55% compared with 0.27%; 2012 - 2013: 3.38% compared with 0.68%). The strength of these associations did not change over time. CONCLUSIONS Data from the U.S. general population, especially more recent data, suggest associations between self-reported psychotic disorder and frequent nonmedical cannabis use and cannabis use disorder. Clinicians and policy makers should consider these relationships when monitoring patients and formulating programs.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Aaron L. Sarvet
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Deborah S. Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY,New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
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Sun L, Zhang Y, Cui L, Li J, Li L, Sun X, Liu Y, Zhang L, Li K. Lifetime and 1-Month Prevalence of Mental Disorders in Hebei Province, China: A Community-Based Cross-Sectional Study. Front Public Health 2021; 9:759160. [PMID: 34722453 PMCID: PMC8551383 DOI: 10.3389/fpubh.2021.759160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of mental disorders is an important topic, which has been reported in different countries in the world. In China, some studies were also conducted to get the prevalence of mental disorders at the national level and in some metropolitan cities. However, the prevalence of mental disorders in Chinese underdeveloped provinces has not been reported internationally in recent decades. Due to the discrepancy in the social-economic development of different Chinese provinces, we also have reasons to believe the different prevalence of mental disorders between underdeveloped provinces and other provinces. Method: A community-based cross-sectional study was conducted among community residents aged 18 years and older in Hebei province, China. We screened 20,884 community residents in this study, and a Structured Clinical Interview for Diagnostic and Statistical Manual (DSM-IV) Axis I disorders was used to make the diagnoses of mental disorders. Results: The weighted lifetime prevalence of mental disorders was 15.87% (95% CI 15.38-16.38%), and the 1-month prevalence was 10.79% (95% CI 10.37-11.22%). Anxiety disorder ranked first in the classification of mental disorders for both lifetime (6.56%) and 1-month prevalence (6.25%). The weighted lifetime and 1-month region-gender-age-specific prevalence of mental disorders was also analyzed in this study. Conclusions: Mental disorders have been an important issue in Chinese economically underdeveloped regions, and the prevalence was at a high level compared with the results in the 2000s. There are several serious challenges in the work of Chinese mental disorders, which should be paid more attention to.
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Affiliation(s)
- Long Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yunshu Zhang
- Hebei Provincial Mental Health Center, Baoding, China
| | - Lijun Cui
- Hebei Provincial Mental Health Center, Baoding, China
| | - Jianfeng Li
- Hebei Provincial Mental Health Center, Baoding, China
| | - Lin Li
- Hebei Provincial Mental Health Center, Baoding, China
| | - Xiuli Sun
- Hebei Provincial Mental Health Center, Baoding, China
| | - Yongqiao Liu
- Hebei Provincial Mental Health Center, Baoding, China
| | - Lili Zhang
- Hebei Provincial Mental Health Center, Baoding, China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, China
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Jefsen OH, Speed M, Speed D, Østergaard SD. Bipolar disorder and cannabis use: A bidirectional two-sample Mendelian randomization study. Addict Biol 2021; 26:e13030. [PMID: 33733564 DOI: 10.1111/adb.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Cannabis use is associated with a number of psychiatric disorders; however, the causal nature of these associations has been difficult to establish. Mendelian randomization (MR) offers a way to infer causality between exposures with known genetic predictors (genome-wide significant single nucleotide polymorphisms [SNPs]) and outcomes of interest. MR has previously been applied to investigate the relationship between lifetime cannabis use (having ever used cannabis) and schizophrenia, depression, and attention deficit hyperactivity disorder (ADHD), but not bipolar disorder, representing a gap in the literature. We conducted a two-sample bidirectional MR study on the relationship between bipolar disorder and lifetime cannabis use. Genetic instruments (SNPs) were obtained from the summary statistics of recent large genome-wide association studies (GWAS). We conducted a two-sample bidirectional MR study on the relationship between bipolar disorder and lifetime cannabis use using inverse variance weighted regression, weighted median regression, and Egger regression. Genetic liability to bipolar disorder was significantly associated with an increased risk of lifetime cannabis use; however, genetic liability to lifetime cannabis use showed no association with the risk of bipolar disorder. The sensitivity analyses showed no evidence for pleiotropic effects. The present findings support a causal effect of liability to bipolar disorder on the risk of using cannabis at least once. No evidence was found for a causal effect of liability to cannabis use on the risk of bipolar disorder. These findings add important new knowledge to the understanding of the complex relationship between cannabis use and psychiatric disorders.
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Affiliation(s)
- Oskar Hougaard Jefsen
- Department of Affective Disorders Aarhus University Hospital – Psychiatry Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Maria Speed
- Department of Affective Disorders Aarhus University Hospital – Psychiatry Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Doug Speed
- Bioinformatics Research Centre Aarhus University Aarhus Denmark
- Aarhus Institute of Advanced Studies Aarhus University Aarhus Denmark
- Center for Quantitative Genetics and Genomics Aarhus University Aarhus Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders Aarhus University Hospital – Psychiatry Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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Peris L, Szerman N. Partial Agonists and Dual Disorders: Focus on Dual Schizophrenia. Front Psychiatry 2021; 12:769623. [PMID: 34975572 PMCID: PMC8716462 DOI: 10.3389/fpsyt.2021.769623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022] Open
Abstract
Dual disorder is a term applied to patients with an addictive disorder and other mental disorder. Epidemiological studies have established that dual disorders are an expectation rather than an exception. They are difficult to diagnose and treat and constitute a huge burden for both patients and their relatives and society. Current treatments are a combination of those needed to treat the addictive disorder with those focused on the co-occurring psychiatric disorder. Focusing specifically on schizophrenia, growing scientific evidence supports the existence of a shared vulnerability for substance use in these patients and those at risk. Various antipsychotics have been found to be useful in the treatment of psychotic symptoms and disorders; however, few effective treatments have been identified until now for substance use disorders in patients with dual schizophrenia. Partial agonism stands as a new pharmacological option available in recent years. Molecules with this kind of action may act as functional agonists or as antagonists, depending on the surrounding levels of the neurotransmitter. Studies have found their efficacy in schizophrenia, addiction, anxiety and depression. Certain partial agonist antipsychotics seem to have a role in the treatment of dual schizophrenia. That could be the case with cariprazine. Because of its higher affinity for dopaminergic D3 receptors compared to D2, a potential to prevent relapse to addiction, added to its antipsychotic efficacy, has been suggested. Here we briefly review current advances and future directions and introduce some personal insights into the role of partial agonists in co-occurring schizophrenia and substance use.
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Affiliation(s)
- Lola Peris
- Centre Neuchâtelois De Psychiatrie, Marin-Epagnier, Switzerland
| | - Nestor Szerman
- Hospital Universitario Gregorio Marañon, Madrid, Spain.,Fundación Patología Dual, WPA Section on Dual Disorders, WADD, Madrid, Spain
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Acceptabilité du questionnaire Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) pour repérer les consommations de substances psychoactives en pratique courante de psychiatrie. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lee JY, Pahl K, Kim W. Correlates of Cannabis Use Disorders among urban women of color: childhood abuse, relationship with spouse/partner, and media exposure. JOURNAL OF SUBSTANCE USE 2020; 26:132-137. [DOI: 10.1080/14659891.2020.1784301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jung Yeon Lee
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Kerstin Pahl
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
- Nathan Kline Institute, Research Foundation for Mental Hygiene, Orangeburg, New York, USA
| | - Wonkuk Kim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
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11
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Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity. Med Care 2020; 58:101-107. [PMID: 31688556 DOI: 10.1097/mlr.0000000000001242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. OBJECTIVES To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). RESEARCH DESIGN Observational study using an interrupted time series design. SUBJECTS 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics. MEASURES Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance. RESULTS Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs. CONCLUSIONS After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.
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12
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[The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:126-140. [PMID: 32114950 DOI: 10.13109/prkk.2020.69.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents Risk-taking behavior is a common phenomenon in adolescence. Even prevalence rates for illicit drug use are considerably high in youth and associated with a range of psychiatric disorders, especially depression and Borderline Personality Disorder (BPD). However, there is a lack of data investigating differences in psychopathology between different substance user groups. Therefore, aim of the study was to investigate occurrence of depression and BPD symptoms in different drug risk groups (no use vs. occasional use vs. frequent use). Further aim of the study was to examine risk profiles regarding single BPD criteria. Data of n = 347 adolescents (81.7 % female, mean age 14.95, SD = 1.50) presenting at the specialized outpatient clinic for risk-taking and self-harming behavior (AtR!Sk) in Heidelberg were analyzed. Results show that BPD is clearly associated with illicit drug use in adolescence. There is no difference between occasional and frequent users in terms of mean number of BPD criteria. However, frequent users differ from occasional users regarding greater number of impulsivity and anger criteria. After adjusting for sociodemographic variables there was no association between drug use and depression. Since even single events of illicit drug use are associated with higher levels of BPD, clinicians should rapidly target to stop consumption. Further, psychotherapeutic interventions for BPD in high-risk consumers should especially focus on facilitating adaptive emotion regulation skills in regards to impulsivity and anger.
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13
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Coping Strategies in Male Patients under Treatment for Substance Use Disorders and/or Severe Mental Illness: Influence in Clinical Course at One-Year Follow-Up. J Clin Med 2019; 8:jcm8111972. [PMID: 31739487 PMCID: PMC6912473 DOI: 10.3390/jcm8111972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/27/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Coping strategies have an impact on substance use disorders (SUD), relapses, and clinical variables, but knowledge on this area is scarce. We explored the coping strategies used during treatment in patients with dual diagnosis (DD), SUD, and severe mental illness (SMI), and the relation with clinical course and relapses at one-year follow-up. A sample of 223 patients was divided into three groups depending on diagnosis: DD (N = 80; SUD with comorbid schizophrenia or major depressive disorder), SUD only (N = 80), and SMI only (N = 63; schizophrenia or major depressive disorder). MANCOVA analyses reflected differences in self-criticism and problem avoidance, with a higher use of these in the DD and SUD groups. The coping strategies used differed depending on the presence/absence of a SUD, but not depending on psychiatric diagnosis. At one-year follow-up, social support was the only strategy that predicted the presence of relapses in DD patients with schizophrenia (positively), and in SMI patients with major depressive disorder (negatively). Thus, social support was associated with relapses, but the relationship was different depending on psychiatric diagnosis. Further studies should analyze the implications of social support as a coping strategy in different mental disorders, as well as its usefulness in individualized interventions.
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14
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Bianco CL. Rates of electronic cigarette use among adults with a chronic mental illness. Addict Behav 2019; 89:1-4. [PMID: 30237110 DOI: 10.1016/j.addbeh.2018.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Electronic cigarette (e-cig) use has increased dramatically over the past decade, rates of e-cig use among those with a chronic mental illness has largely been unexplored. Exploring this relationship for adults with a mental illness is necessary when examining the health needs of this population. METHODS Data from the 2016 National Health Interview Survey (NHIS) was used to explore associations between e-cig use and chronic mental illness. E-cig use was explored in two different contexts, having tried an e-cig at least once and current e-cig use. Chronic mental illness was categorized as depression, anxiety, emotional disorder, or ADD, bipolar, schizophrenia, other disorder. RESULTS Rates of ever trying an e-cig and current e-cig use were higher among those with a chronic mental illness. Complex logistic regressions suggested having a chronic mental illness significantly increases the likelihood of both trying an e-cig and being an e-cig user. CONCLUSIONS Increased likelihood of e-cig use in chronic mental illness supports previous findings. This may be due to perceptions that e-cigs are less harmful and they provide ways of socially connecting with others. IMPLICATIONS Current knowledge surrounding e-cig use in this population is lacking. The 2016 NHIS allows for a nationally representative prediction of e-cig use in this population. This data is relevant in monitoring potential harm caused by e-cigs, in addition it may be helpful when assessing the value of e-cigs as a smoking cessation tool for those with a mental illness.
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Scalzo F, Hulbert CA, Betts JK, Cotton SM, Chanen AM. Substance Use in Youth With Borderline Personality Disorder. J Pers Disord 2018; 32:603-617. [PMID: 28926304 DOI: 10.1521/pedi_2017_31_315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Co-occurring substance misuse and borderline personality disorder (BPD) in adults is associated with more severe dysfunction and poorer prognosis than BPD alone. However, it is unknown to what extent substance use in youth with BPD is normative for this age group or pathological. This study compared substance use in 117 help-seeking youth (aged 15-25 years) with their first presentation for treatment of BPD, with an epidemiological general population sample and with healthy, age- and gender-matched controls. Established instruments were used to diagnose BPD and assess substance use. Alcohol dependence, daily tobacco use, and use of illicit substances in the past month were between four and nine times more prevalent in the BPD group than in the general population. Similarly, the prevalence of substance use was disproportionately higher in youth with BPD than in matched controls. The findings indicate a non-normative, alarmingly high rate of substance use among youth with BPD.
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Affiliation(s)
- Franco Scalzo
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Carol A Hulbert
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Jennifer K Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne
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Abstract
The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.
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Affiliation(s)
- Jacob T. Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States,The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St. Hanover, NH 03755, United States
| | - Alan J. Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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17
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Amutah-Onukagha N, Mahadevan M, Opara I, Rodriguez M, Trusdell M, Kelly J. Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective. AIDS Patient Care STDS 2018; 32:119-128. [PMID: 29630851 PMCID: PMC5972771 DOI: 10.1089/apc.2017.0215] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.
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Affiliation(s)
- Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, New Jersey
| | - Ijeoma Opara
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey
| | - Monica Rodriguez
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Megan Trusdell
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Jessica Kelly
- Department of Public Health, Montclair State University, Montclair, New Jersey
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18
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Bone CW, Goodfellow AM, Vahidi M, Gelberg L. Prevalence of Sexual Violence and its Association with Depression among Male and Female Patients with Risky Drug Use in Urban Federally Qualified Health Centers. J Urban Health 2018; 95:111-115. [PMID: 29340911 PMCID: PMC5862699 DOI: 10.1007/s11524-017-0213-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual violence (SV) is common; however, the prevalence of SV and its long term sequela vary geographically and among subpopulations within the USA. As such, the aims of this study are the following: (1) to determine the prevalence of SV, (2) to identify correlates of SV, and (3) to determine if SV is associated with depression among male and female risky drug users in urban Federally Qualified Health Centers (FQHCs) in Los Angeles. This study includes adult patients of five urban FQHCs who self-reported risky drug use. We identified survivors of SV and those experiencing depression through survey questions that queried, before or after age 18, "Were you ever sexually assaulted, molested or raped?" and with the RAND Mental Health Index (MHI-5). We utilized Pearson's chi-square tests to assess predictors of SV and logistic regression to assess for an association between SV and depression. Data collection took place from February 2011 to November 2012. Of the 334 study patients, 49% of females and 25% of males reported surviving SV. Exposure to SV, (both before 18 years of age and after 18 years of age) was the strongest predictor of depression among men and women in this study (OR 4.7, p < 0.05). These data demonstrate that sexual violence is prevalent in this urban FQHC population and is strongly associated with depression. Providers should consider screening both men and women with risky drug use for SV while health systems should continue to align mental health and primary care services to appropriately care for these extremely vulnerable patients. Trial Registration Clinical Trials. gov ID NCT01942876, Protocol ID DESPR DA022445, http://www.clinicaltrials.gov.
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Affiliation(s)
- Curtis W Bone
- Yale University School of Medicine, New Haven, CT, 06511, USA.
| | - Amelia M Goodfellow
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mani Vahidi
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Lillian Gelberg
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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19
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Roncero C, de Miguel A, Fumero A, Abad AC, Martín R, Bethencourt JM, Grau-López L, Rodríguez-Cintas L, Daigre C. Anxiety and Depression in Drug-Dependent Patients with Cluster C Personality Disorders. Front Psychiatry 2018; 9:19. [PMID: 29472875 PMCID: PMC5810269 DOI: 10.3389/fpsyt.2018.00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Comorbidity between personality disorders (PD) and substance-use disorders (SUD) is one of the most common findings in the psychiatric field. The patients with Cluster C disorders present maladjustment traits often characterized by high levels of anxiety. The main aim of this study was to find evidences about higher anxiety and depression prevalence on Cluster C than others Clusters, analyzing similarities and differences within, with other Cluster A and B PD patients and patients without PD. METHOD A total of 822 substance dependent patients (ages18-78; Mean = 38.35, SD = 10.14) completed the structured clinical interview for DSM-IV Axis I and Axis II disorders, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS Results supported poly-consumption in Cluster C patients, being greater alcohol consumption as well as abuse of both stimulants and depressants. Anxiety and depression did not show just one pattern for all patients with SUD-Cluster C PD. There was a relation between anxiety and depression for all the groups except for the Dependent-PD. CONCLUSION Interventions should focus on aspects like depression and anxiety more than on the substance consumed.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain.,Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adelia de Miguel
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Ascensión Fumero
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Alfonso C Abad
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Rita Martín
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | | | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
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20
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Madrid Study (Spain) on the Prevalence and Characteristics of Outpatients With Dual Disorders. ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Scalzo F, Hulbert CA, Betts JK, Cotton SM, Chanen AM. Substance Use in Youth With Borderline Personality Disorder. J Pers Disord 2017:1-16. [PMID: 29120279 DOI: 10.1521/pedi_2017_31_330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Co-occurring substance misuse and borderline personality disorder (BPD) in adults is associated with more severe dysfunction and poorer prognosis than BPD alone. However, it is unknown to what extent substance use in youth with BPD is normative for this age group or pathological. This study compared substance use in 117 help-seeking youth (aged 15-25 years) with their first presentation for treatment of BPD, with an epidemiological general population sample and with healthy age- and gender-matched controls. Established instruments were used to diagnose BPD and assess substance use. Alcohol dependence, daily tobacco use, and use of illicit substances in the past month were between four and nine times more prevalent in the BPD group than in the general population. Similarly, the prevalence of substance use was disproportionately higher in youth with BPD than in matched controls. The findings indicate a non-normative, alarmingly high rate of substance use among youth with BPD.
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Affiliation(s)
| | | | - Jennifer K Betts
- University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sue M Cotton
- University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Andrew M Chanen
- University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
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22
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Adan A, Marquez-Arrico JE, Gilchrist G. Comparison of health-related quality of life among men with different co-existing severe mental disorders in treatment for substance use. Health Qual Life Outcomes 2017; 15:209. [PMID: 29061151 PMCID: PMC5654090 DOI: 10.1186/s12955-017-0781-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient-perceived health-related quality of life has become an important outcome in health care as an indicator of treatment effectiveness and recovery for patients with substance use disorder. As no study has assessed health-related quality of life among male patients with substance use disorder and co-existing severe mental illness, we compared health-related quality of life among patients with substance use disorder and the following severe mental illness diagnosis in Barcelona, Spain: schizophrenia, bipolar disorder, major depressive disorder, and examined the associations with clinically related variables. Additionally, we compared results for health-related quality of life in patients with substance use disorder and severe mental illness, with Spanish population norms. METHODS We assessed 107 substance use disorder male patients using the 36-Item Short Form Health Survey comparing results across three groups with: comorbid schizophrenia (n = 37), comorbid bipolar disorder (n = 34), and comorbid major depressive disorder (n = 36). Multiple analyses of variance were performed to explore health-related quality of life by the type of co-existing SMI and linear regression analyses examined clinical correlates for the 36-Item Short Form Health Survey dimensions for each group. RESULTS There were differences in Physical Functioning, Vitality and the Physical Composite Scale among groups. Poorer Physical Functioning was observed for patients with comorbid schizophrenia (80.13±3.27) and major depressive disorder (81.97±3.11) compared with comorbid bipolar disorder patients (94.26±1.93). Patients with substance use disorder and schizophrenia presented lower scores in Vitality (41.6±2.80) than those with co-existing bipolar disorder (55.68±3.66) and major depressive disorder (53.63±2.92). Finally, results in the Physical Composite Scale showed lower scores for patients with comorbid schizophrenia (51.06±1.41) and major depressive disorder (51.99±1.87) than for those with bipolar disorder (60.40±2.17). Moreover, all groups had poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms. Different clinical variables (e.g. medical disease comorbidity, severity of addiction, psychiatric symptomatology, suicide attempts, drug relapses) were related to different health-related quality of life dimensions depending on the co-existing severe mental illness. CONCLUSIONS Among male patients with substance use disorder, co-existing severe mental illness may influence some health-related quality of life dimensions and clinically related variables. Such differences may require tailored therapeutic interventions.
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Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Institute of Neuroscience, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
| | - Julia E. Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK
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23
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Gimeno C, Dorado ML, Roncero C, Szerman N, Vega P, Balanzá-Martínez V, Alvarez FJ. Treatment of Comorbid Alcohol Dependence and Anxiety Disorder: Review of the Scientific Evidence and Recommendations for Treatment. Front Psychiatry 2017; 8:173. [PMID: 29018367 PMCID: PMC5614930 DOI: 10.3389/fpsyt.2017.00173] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/04/2017] [Indexed: 01/11/2023] Open
Abstract
Patients with alcohol-use disorders (AUDs) have a high prevalence of anxiety disorders (AnxDs). "Co-occurring disorders" refers to the coexistence of an AUD and/or drug related disorders with another non-addictive psychiatric disorder. The aim of this study was to assess the effectiveness of psychopharmacological treatments and psychotherapy in patients with AUD and AnxD and to propose recommendations for the treatment of patients with comorbid AnxDs and AUDs. Randomized clinical trials, meta-analyses, and clinical guidelines were retrieved from PubMed, Embase, and Cochrane databases. Paroxetine was found to be effective in social anxiety patients with alcohol dependence. Selective serotonin reuptake inhibitors (SSRIs), especially sertraline, showed effective results in posttraumatic stress disorder and in comorbid AnxD-AUD. However, SSRIs should be used with caution when patients are actively drinking because they may increase alcohol consumption. Buspirone, gabapentin, and pregabalin were found to be effective in comorbid AnxD-AUD. The treatment of dual AnxDs should start as early as possible. Since AUDs and AnxDs can reinforce each other, treatments targeting both pathologies can be effective. Women suffer from higher levels of stress and AnxDs than men, and they are also more vulnerable to maintaining alcohol consumption levels. Further research is needed in this comorbid patient population, including the study of different types of patients and gender perspectives.
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Affiliation(s)
- Carmen Gimeno
- Unit for Addictive Behaviours, Conselleria de Sanitat, Alicante, Spain
- Sociedad Española de Patología Dual, Madrid, Spain
| | - Marisa Luisa Dorado
- Sociedad Española de Patología Dual, Madrid, Spain
- Unit for Addictive Behaviors of Guillen de Castro, Conselleria de Sanitat, Valencia, Spain
| | - Carlos Roncero
- Sociedad Española de Patología Dual, Madrid, Spain
- Addiction and Dual Diagnosis Unit, Psychiatric Service, Hospital Vall Hebron-ASPB, CIBERSAM, Psychiatric Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Szerman
- Sociedad Española de Patología Dual, Madrid, Spain
- Salud Mental Retiro, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Pablo Vega
- Sociedad Española de Patología Dual, Madrid, Spain
- Instituto de Adicciones, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Service of Psychiatry, La Fe University and Polytechnic Hospital, Department of Medicine, Medical School, University of Valencia, CIBERSAM, International Society for Nutritional Psychiatry Research (ISNPR), Valencia, Spain
| | - F. Javier Alvarez
- Sociedad Española de Patología Dual, Madrid, Spain
- Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- CEIC/CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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24
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Forman-Hoffman VL, Glasheen C, Batts KR. Marijuana Use, Recent Marijuana Initiation, and Progression to Marijuana Use Disorder Among Young Male and Female Adolescents Aged 12-14 Living in US Households. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817711159. [PMID: 28615948 PMCID: PMC5462494 DOI: 10.1177/1178221817711159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/23/2017] [Indexed: 12/04/2022]
Abstract
Marijuana initiation during adolescence, and early adolescence in particular, is associated with adverse health consequences. Our study used 2005–2014 data from the annual, cross-sectional National Survey on Drug Use and Health to study the prevalence and correlates of marijuana initiation, use, and marijuana use disorder (MUD; abuse or dependence) among 12- to 14-year olds living in civilian US households (n = 84 954). Examined correlates included age, sex, race/ethnicity, poverty status, metropolitan status, year of survey, depression, tobacco use, alcohol use, and fighting at school. Sex differences in the correlates of lifetime use and past year marijuana initiation were tested via interaction. Lifetime prevalence of marijuana use was 5.5%; 3.2% reported past year initiation. About 1 in 6 (16.8%) past year initiates progressed to MUD within 12 months of first use. Although men had higher prevalence of lifetime use than women, past year initiation did not differ by sex. On examining the sex*race/ethnicity interaction effects, findings determined that non-Hispanic black and Hispanic men had higher prevalence estimates of ever using marijuana and incidence of past year initiation as compared with non-Hispanic white men; these race/ethnicity differences were not found among women. Identifying correlates of initiation and progression to MUD among young adolescents is critical to improve prevention and treatment program targets.
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Affiliation(s)
| | - Cristie Glasheen
- Behavioral Health and Criminal Justice Division, RTI International, Durham, NC, USA
| | - Kathryn R Batts
- Behavioral Health and Criminal Justice Division, RTI International, Durham, NC, USA
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25
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Lee JY, Brook JS, De La Rosa M, Kim Y, Brook DW. The association between alcohol use trajectories from adolescence to adulthood and cannabis use disorder in adulthood: a 22-year longitudinal study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017. [PMID: 28635349 DOI: 10.1080/00952990.2017.1288734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Due to the increasing prevalence of cannabis use disorder (CUD), the impact of cannabis use on public health may be significant. OBJECTIVE The present study seeks the possible precursors (e.g., alcohol use) of CUD in order to minimize the potential negative consequences of CUD such as impaired coordination and performance. METHOD The Harlem Longitudinal Development Study included 674 participants (53% African Americans, 47% Puerto Ricans), with 60% females (n=405) from a six wave survey. We used a growth mixture model to obtain the trajectories of alcohol use from the mean ages of 14 to 36. To examine the associations between alcohol use trajectories and CUD, we used logistic regression analyses with the indicator of CUD as the dependent variable and the indicator of membership in each trajectory group as the independent variables. RESULTS A three alcohol use trajectory group model was selected. Male gender, higher frequency of cannabis use in adolescence, and a lower educational level were associated with an increased likelihood of having CUD. Membership in the increasing alcohol use group (OR=27.44, p < .01; AOR=15.54, p < .01) and the moderate alcohol use group (OR=10.40, p < .05; AOR=8.63, p < .05) were associated with an increased likelihood of having CUD compared with the membership in the no or low alcohol use group. CONCLUSIONS The findings of our study support the hypothesis that addressing alcohol use at an early age could impact later CUD.
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Affiliation(s)
- Jung Yeon Lee
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Judith S Brook
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Mario De La Rosa
- b Center for Research on U.S. Latino HIV/AIDS and Drug Abuse , Florida International University , Miami , FL , USA
| | - Youngjin Kim
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - David W Brook
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
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26
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Marín-Navarrete R, Medina-Mora ME, Horigian VE, Salloum IM, Villalobos-Gallegos L, Fernández-Mondragón J. Co-Occurring Disorders: A Challenge for Mexican Community-Based Residential Care Facilities for Substance Use. J Dual Diagn 2016; 12:261-270. [PMID: 27494051 PMCID: PMC6929207 DOI: 10.1080/15504263.2016.1220207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In Mexico, specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. More than 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however, suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high-quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology, and other health risks. METHODS This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology, and psychiatric disorder diagnostic criteria. RESULTS The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%), followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73]; p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78]; p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). CONCLUSIONS Co-occurring disorders are highly prevalent in community-based residential centers in Mexico and are associated with significantly increased probability of other health risks. This highlights the need to develop care standards for this population and the importance of clinical research in these settings.
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Affiliation(s)
- Rodrigo Marín-Navarrete
- a Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM) , Mexico City , Mexico
| | - María Elena Medina-Mora
- a Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM) , Mexico City , Mexico
| | - Viviana E Horigian
- b Department of Public Health Sciences , Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Ihsan M Salloum
- c Division of Alcohol and Drug Abuse, Department of Psychiatry & Behavioral Sciences , Miller School of Medicine, University of Miami , Miami , Florida , USA
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Leeman RF, Sun MQ, Bogart MD, Beseler CL, Sofuoglu M. Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Subst Use Misuse 2016; 51:553-64. [PMID: 27002858 PMCID: PMC5097614 DOI: 10.3109/10826084.2015.1122063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally representative sample involving primarily prescription opioid misuse would expand knowledge. METHODS Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N = 839). Cocaine-only, opioid-only, and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric, and medical conditions/events. RESULTS Opioid-only users were the largest group (n = 622), followed by cocaine-only (n = 144) and co-users (n = 73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions, or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. CONCLUSIONS/IMPORTANCE This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.
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Affiliation(s)
- Robert F Leeman
- Yale School of Medicine, Psychiatry, CMHC, 34 Park Street, New Haven, 06519 United States
| | | | | | | | - Mehmet Sofuoglu
- Yale School of Medicine, Psychiatry, New Haven, United States
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28
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Fischer B, Imtiaz S, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities. J Public Health (Oxf) 2016; 38:183-8. [PMID: 25630540 PMCID: PMC4750519 DOI: 10.1093/pubmed/fdv005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. METHODS Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. RESULTS MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. CONCLUSIONS The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.
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Affiliation(s)
- Benedikt Fischer
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada V6B 5K3
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
| | - Sameer Imtiaz
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
| | - Katherine Rudzinski
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
- WHO/PAHO Collaborating Centre for Mental Health and Addiction, Toronto, CanadaM5S 2S1
- Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden 01069, Germany
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The association between cannabis use and anxiety disorders: Results from a population-based representative sample. Eur Neuropsychopharmacol 2016; 26:493-505. [PMID: 26775742 DOI: 10.1016/j.euroneuro.2015.12.037] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 09/15/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
The cross-sectional association between cannabis use and anxiety disorders is well documented, yet less is known about the longitudinal association between the two. This study explored the association between cannabis use, cannabis use disorders (CUDs) and anxiety disorders in a 3-year prospective study. Data was drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Anxiety disorders, including generalized anxiety disorder, social anxiety, panic disorder and specific phobias, were controlled for at baseline. Initiation of cannabis use was defined as any cannabis use by former lifetime abstainers in the time period between baseline and follow-up, CUDs were defined as a diagnosis of cannabis abuse or dependence. Results indicate that cannabis use was not associated with increased incidence of any anxiety disorder (Adjusted Odds Ratio (AOR)=1.12(0.63-0.98)). Though heavy cannabis use was associated with increased incidence of social anxiety in most models, this was not fully retained in the final adjusted model (AOR=1.98(0.99-1.98)). Investigation of the association between baseline CUDs and anxiety disorders at follow-up revealed similar results. Any baseline anxiety disorder was not associated with future initiation of cannabis use (AOR=1.03(0.62-1.69)) or onset of a CUD (AOR=0.68(0.41-1.14)), yet individuals with baseline panic disorder were more prone to initiate cannabis use at follow-up (AOR=2.2(1.15-4.18)), possibly as a means of self-medication. Our findings suggest that cannabis use and CUDs are not associated with increased incidence of most anxiety disorders and inversely, most anxiety disorders are not associated with increased incidence of cannabis use or CUDs.
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Stimulant dependence and stimulant-associated psychosis: clinical characteristics and age of onset in a native American community sample. J Addict Med 2016; 8:241-8. [PMID: 24755633 DOI: 10.1097/adm.0000000000000039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Native Americans experience some of the highest rates of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) stimulant dependence (SD) of all US ethnic groups. The present report examined the clinical characteristics and age of onset of stimulant use, SD, remission from SD, and stimulant-associated psychosis (SAP) in a Native American community sample. METHODS Demographic information, stimulant (methamphetamine or cocaine) use, and lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder diagnoses were assessed in 858 Native Americans. Logistic regression was used to assess the associations of demographic, stimulant use, and psychiatric disorder variables with SD, remission from SD, and SAP. Kaplan-Meier survival analyses were used to assess time from first use to the onset of SD. RESULTS The overall rate of SD was 33%, of remission from SD 73%, and of SAP 17%. Stimulant dependence was associated with older age, less current annual household income, fewer lifetime years of education, intravenous stimulant use, and earlier age of first stimulant use. Remission from SD was associated with older age, currently being married, and never having used stimulants intravenously. Attention-deficit/hyperactivity disorder (assessed as a lifetime disorder), increased number of years of daily stimulant use, and intravenous use were independently associated with SAP. Younger age at first use was significantly associated with shorter survival to the onset of SD. CONCLUSIONS Stimulant dependence is prevalent in this population and is associated with less income and education and an earlier age at first use. Intravenous stimulant use adds additional risk for SD, nonremission, and psychosis.
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Roncero C, Szerman N, Terán A, Pino C, Vázquez JM, Velasco E, García-Dorado M, Casas M. Professionals' perception on the management of patients with dual disorders. Patient Prefer Adherence 2016; 10:1855-1868. [PMID: 27698553 PMCID: PMC5034926 DOI: 10.2147/ppa.s108678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.
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Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
- Correspondence: Carlos Roncero, Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 4294, Fax +34 93 489 4587, Email
| | - Néstor Szerman
- Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Terán
- Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain
| | - Carlos Pino
- Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain
| | - José María Vázquez
- Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain
| | - Elena Velasco
- Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain
| | | | - Miguel Casas
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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Abstract
AIMS To assess the prevalence and correlates of remission from cannabis use disorders (CUDs), focusing on the proportion of individuals with CUDs that remit without abstaining from cannabis use. DESIGN Three-year longitudinal study. SETTING Wave 1 (2001) and wave 2 (2004) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of US adults aged 18 years and over. PARTICIPANTS Our sample included 444 individuals diagnosed with DSM-IV cannabis abuse and/or dependence during the 12 months prior to wave 1 of the NESARC. MEASUREMENTS Baseline socio-demographic and clinical correlates were analysed for possible outcomes of CUDs after 3 years: abstinent remission, non-abstinent remission and sustained disorder. FINDINGS Approximately two-thirds (67%) of individuals with baseline CUD remitted at follow-up. Approximately 37% of those who remitted were non-abstinent. Remission was associated with Hispanic ethnicity [odds ratio (OR)=2.59; 95% confidence interval (CI)=1.27-4.87], baseline daily or almost daily use of cannabis (OR=1.91; 95% CI=1.15-3.16), baseline use of other drugs (OR=1.63; 95% CI=1.04-2.56) and two or more medical conditions at baseline (OR=8.40; 95% CI=2.67-26.41). Non-abstinent remission was associated with baseline daily or almost daily use of cannabis (OR=1.92; 95% CI=1.05-3.51). CONCLUSIONS A substantial level of remission from cannabis use disorders (CUDs), including non-abstinent remission, suggests that the nature of CUDs may be more unstable than reported previously.
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Affiliation(s)
- Daniel Feingold
- Ariel University, Ariel, Israel.,Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Jonah Fox
- New York State/American Program, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shaul Lev-Ran
- Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel.,Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Randall JR, Vokey S, Loewen H, Martens PJ, Brownell M, Katz A, Nickel NC, Burland E, Chateau D. A Systematic Review of the Effect of Early Interventions for Psychosis on the Usage of Inpatient Services. Schizophr Bull 2015; 41:1379-86. [PMID: 25745034 PMCID: PMC4601703 DOI: 10.1093/schbul/sbv016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services. METHODS A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period. RESULTS Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18-0.63, bed-days usage SMD: -0.38, 95% CI -0.53 to -0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses. CONCLUSION These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms.
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Affiliation(s)
- Jason R. Randall
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sherri Vokey
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Hal Loewen
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Patricia J. Martens
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marni Brownell
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nathan C. Nickel
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;
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Demographic and psychological factors associated with lifetime cocaine use: An exploratory factor analysis of baseline questionnaires. ADDICTIVE DISORDERS & THEIR TREATMENT 2015; 14:70-77. [PMID: 26170765 DOI: 10.1097/adt.0000000000000046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Underlying heterogeneity among individuals with cocaine dependence is widely postulated in the literature, however, identification of a group of factors that explain risk of cocaine use severity has yet to be confirmed. METHODS Latent mixture modeling evaluated 338 cocaine-dependent individuals recruited from the community to assess the evidence for the presence of distinct subgroups. Variables included 5 baseline questionnaires measuring cognitive function (Shipley), impulsivity (BIS), mood (BDI), affective lability (ALS), and addiction severity (ASI). Results failed to suggest multiple subgroups. Given a lack of evidence for discrete latent classes, an exploratory factor analysis (EFA) followed by exploratory structural equation modeling (ESEM) was implemented to identify functional dimensions to enhance interpretation of these variables. RESULTS Findings from the EFA indicated a 3-factor model as the best fit, and the subsequent ESEM solution resulted in associations with lifetime cocaine use. Factor 1, best characterized by demographic factors (gender, age), is associated with less lifetime cocaine use. Psychological problems best characterize factor 2, which is associated with higher lifetime cocaine use. Finally, factor 3 is characterized by other substance use (alcohol and marijuana). Although this factor did not demonstrate a statistically reliable relation with self-reported, lifetime cocaine use, it did indicate a potentially meaningful positive association. CONCLUSIONS These 3 factors delineate dimensions of functioning that likewise help characterize the variability found in previously established associations with self-reported cocaine use.
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Le Foll B, Ng E, Di Ciano P, Trigo JM. Psychiatric disorders as vulnerability factors for nicotine addiction: what have we learned from animal models? Curr Top Behav Neurosci 2015; 24:155-170. [PMID: 25638337 DOI: 10.1007/978-3-319-13482-6_6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epidemiological studies indicate a high prevalence of tobacco smoking in subjects with psychiatric disorders. Notably, there is a high prevalence of smoking among those with dependence to other substances, schizophrenia, mood, or anxiety disorders. It has been difficult to understand how these phenomena interact with clinical populations as it is unclear what preceded what in most of the studies. These comorbidities may be best understood by using experimental approaches in well-controlled conditions. Notably, animal models represent advantageous approaches as the parameters under study can be controlled perfectly. This review will focus on evidence collected so far exploring how behavioral effects of nicotine are modified in animal models of psychiatric conditions. Notably, we will focus on behavioral responses induced by nicotine that are relevant for its addictive potential. Despite the clinical relevance and frequency of the comorbidity between psychiatric issues and tobacco smoking, very few studies have been done to explore this issue in animals. The available data suggest that the behavioral and reinforcing effects of nicotine are enhanced in animal models of these comorbidities, although much more experimental work would be required to provide certainty in this domain.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada,
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Dimaggio G, D'Urzo M, Pasinetti M, Salvatore G, Lysaker PH, Catania D, Popolo R. Metacognitive Interpersonal Therapy for Co-Occurrent Avoidant Personality Disorder and Substance Abuse. J Clin Psychol 2014; 71:157-66. [DOI: 10.1002/jclp.22151] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | - Paul H. Lysaker
- Richard L. Roudebush VA Medical Center
- Indiana University School of Medicine
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Sartor CE, Kranzler HR, Gelernter J. Rate of progression from first use to dependence on cocaine or opioids: a cross-substance examination of associated demographic, psychiatric, and childhood risk factors. Addict Behav 2014; 39:473-9. [PMID: 24238782 DOI: 10.1016/j.addbeh.2013.10.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/25/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A number of demographic factors, psychiatric disorders, and childhood risk factors have been associated with cocaine dependence (CD) and opioid dependence (OD), but little is known about their relevance to the rate at which dependence develops. Identification of the subpopulations at elevated risk for rapid development of dependence and the risk factors that accelerate the course of dependence is an important public health goal. METHODS Data were derived from cocaine dependent (n=6333) and opioid dependent (n=3513) participants in a multi-site study of substance dependence. Mean age was approximately 40 and 40% of participants were women; 51.9% of cocaine dependent participants and 29.5% of opioid dependent participants self-identified as Black/African-American. The time from first use to dependence was calculated for each substance and a range of demographic, psychiatric, and childhood risk factors were entered into ordinal logistic regression models to predict the (categorical) transition time to CD and OD. RESULTS In both the cocaine and opioid models, conduct disorder and childhood physical abuse predicted rapid development of dependence and alcohol and nicotine dependence diagnoses were associated with slower progression to CD or OD. Blacks/African Americans were at greater risk than European Americans to progress rapidly to OD. CONCLUSIONS Only a subset of factors known to be associated with CD and OD predicted the rate at which dependence developed. Nearly all were common to cocaine and opioids, suggesting that sources of influence on the timing of transitions to dependence are shared across the two substances.
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Szerman N, Vega P, Grau-López L, Barral C, Basurte-Villamor I, Mesías B, Rodríguez-Cintas L, Martínez-Raga J, Casas M, Roncero C. Dual diagnosis resource needs in Spain: a national survey of professionals. J Dual Diagn 2014; 10:84-90. [PMID: 25392250 DOI: 10.1080/15504263.2014.906195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.
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Affiliation(s)
- Nestor Szerman
- a Departament of Psychiatry Hospital Universitario Gregorio Marañon , Madrid , Spain
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Stacey BR, Moller JL. Marijuana for Pain Relief: Don't Jump to Conclusions. THE JOURNAL OF PAIN 2013; 14:1250-1. [DOI: 10.1016/j.jpain.2013.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/04/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
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