Polydrug Use and Dating Violence Among Emerging Adults

We examined sociodemographic and psychosocial risk factors that moderate the (poly) substance use and dating violence victimization and perpetration relationship among emerging adults. Using an ethnically diverse sample (N = 698), we used latent class analyses to identify mutually exclusive groups based on monthly and past-year substance use. We then examined these groups as they relate to dating violence victimization and perpetration and the moderating effect of various risk factors. Five classes were identified based on substance use patterns: (a) Regular Alcohol use, (b) Polysubstance use, (c) Heavy Alcohol and Marijuana use, (d) Mild Alcohol use, and (e) Occasional Alcohol and Marijuana use classes. Participants in the Polysubstance use class were the most likely to perpetrate dating violence followed by Heavy Alcohol and Marijuana use, Occasional Alcohol and Marijuana use, Regular Alcohol, and Mild Alcohol use classes. Similarly, participants in the Polysubstance use class were the most likely to be victims of dating violence followed by Occasional Alcohol and Marijuana, Heavy Alcohol and Marijuana, Regular Alcohol, and Mild Alcohol use classes. Depending on substance use class, gender, ethnicity, socioeconomic status, history of dating violence, and trauma symptoms differentially influenced dating violence perpetration and victimization at 1-year follow-up. Our findings support the need to comprehensively address dating violence among emerging adults. Intimate partner violence prevention and intervention programs may benefit from targeting emerging adults who misuse substances and incorporating substance use interventions into dating violence prevention efforts.

Are Polydrug Users More Physically and Verbally Aggressive? An Assessment of Aggression Among Mono- Versus Polydrug Users in a University Sample

Early research has revealed that patterns of aggression and antisocial behavior are present among polydrug users. Often missing from this discourse is the examination of whether polydrug users are quantitatively different from monodrug users in their use of aggression. Theoretical perspectives are often centered on the psychopharmacological effects of substance use on behavior. Consideration of possible poly- versus monodrug use differences and their impact on aggression has not been investigated. Data from this study were derived from a sample of Midwestern university students (N = 793). The relationship between violence, aggression, and concurrent polydrug use in the last year is assessed with a series of multivariate ordinary least squares (OLS) regression models. Results demonstrate that higher incidents of physical and verbal aggression are reported among polydrug users compared to monodrug users and abstainers. When analyses were broken down by polydrug users (those who engaged in alcohol/marijuana and alcohol/NMUPD [nonmedical use of prescription drugs] stimulants), polydrug users reported higher levels of physical aggression compared to monodrug users. Similarly, monodrug users reported higher levels of physical aggression compared to nonusers. This research extends our understanding of aggression among users from two different subcategories: polydrug users in comparison to those who only engage in one form of substance use. Scholars and practitioners who work with violent offenders should consider patterns of drug use behavior when addressing substance use-related aggression.

An experimental study of aggressive and neutral interpretative bias in opiate-dependent and opiate-abstinent men

There is a paucity of research on the relationship between opiate use and aggression, and no previous study has examined this from a cognitive theoretical perspective, which views an individual's interpretation of information as a central mediator of their response to it. This study aimed to determine whether opiate users and ex-users differed from opiate-naïve controls on a task which involved processing ambiguous sentences. In an independent group design, the interpretative bias task was administered to 64 participants: 21 opiate-dependent receiving methadone maintenance treatment, 21 opiate-abstinent in rehabilitation, and 22 healthy unemployed controls. We found that both opiate-dependent and opiate-abstinent groups interpreted ambiguous sentences in a neutral rather than an aggressive way, whereas controls showed no bias in either direction. In the opiate-dependent group, neutral interpretative bias correlated both with their current dose of methadone and years of methadone use. These findings indicate that current and ex-opiate users in treatment have a bias towards neutral interpretations of ambiguous information. The fact that neutral interpretative bias in opiate-dependent individuals correlated with current dose and years of methadone use suggests that methadone treatment is associated with a neutral cognitive bias. Decreased testosterone levels associated with chronic opiate use may underpin this neutral bias.

Methamphetamine use, self-reported violent crime, and recidivism among offenders in California who abuse substances

This study uses data from 641 state prison parolees in California to examine the associations between methamphetamine use and three measures of criminal behavior: (a) self-reported violent criminal behavior, (b) return to prison for a violent offense, and (c) return to prison for any reason during the first 12 months of parole. Methamphetamine use was significantly predictive of self-reported violent criminal behavior and general recidivism (i.e., a return to custody for any reason). However, methamphetamine use was not significantly predictive of being returned to custody for a violent offense. These trends remained even after controlling for involvement in the drug trade (i.e., sales, distribution, or manufacturing).

Underdiagnosis of bipolar disorder in men with substance use disorder

OBJECTIVE

Recent reports indicate that bipolar disorder is frequently underdiagnosed in the clinical population, leading to overuse of antidepressants and underuse of mood stabilizers. This study assessed rates of diagnosis of bipolar disorder in a substance abuse population.

METHOD

The study involved a retrospective chart review of data from 295 patients admitted to an inpatient substance abuse program for men. Data were then analyzed from the 85 patients in the sample who were diagnosed as meeting DSM-IV criteria for bipolar disorder on intake into the program. Charts were reviewed for relevant clinical and demographic data. The primary outcome measure was the rate of previous misdiagnosis.

RESULTS

Of the 85 patients diagnosed with bipolar disorder upon intake, 42 (49%) had not been previously diagnosed with bipolar disorder; of these 42, 6 (14%) patients had not been assessed previously, while 36 (86%) had been assessed previously and had received many other psychiatric diagnoses, including major depression (77%), attention-deficit/hyperactivity disorder (20%), and panic disorder (3%). Among the comorbid substance use disorders in these patients, alcohol dependence was the most common (62%), followed by cocaine (38%), opioid (26%), polysubstance (12%), and sedative-hypnotic (2%) dependence. Other comorbid Axis I disorders included posttraumatic stress disorder (14%), attention-deficit/hyperactivity disorder (10%), panic disorder (2%), and generalized anxiety disorder (2%).

CONCLUSION

This study found that bipolar disorder had not been previously diagnosed in approximately 50% of a sample of Caucasian males in a substance abuse population who were diagnosed with bipolar disorder upon admission to an inpatient substance abuse program.

The bipolar patient with comorbid substance use disorder: recognition and management

Bipolar patients with comorbid substance abuse or dependence ("dual diagnosis" patients) represent a major public health problem. Substance abuse generally predicts poor outcome and higher morbidity/mortality in bipolar disorder. For the purposes of this review, open and controlled studies of dual diagnosis assessment and treatment were located through electronic searches of several databases. Pertinent case reports were also evaluated. The results of the search were evaluated in light of the authors' own research on dual diagnosis patients. Literature searching revealed few controlled studies to guide pharmacotherapy of bipolar patients with comorbid substance abuse or dependence. However, preliminary evidence suggests that the best outcomes are usually achieved with antiepileptic mood stabilisers and/or atypical antipsychotics, combined with appropriate psychosocial interventions. The latter may include classical 12-step groups, integrated group therapy or individual psychotherapy. While it is often difficult to determine the precise pathway to comorbid bipolar disorder/substance abuse, it is clear that both disorders must be vigorously treated. This requires a carefully integrated biopsychosocial approach, involving appropriate mood stabilisers and psychosocial interventions. Many more controlled studies of these combined treatment approaches are needed.

Drugs of abuse and the elicitation of human aggressive behavior

The drug-violence relationship exists for several reasons, some direct (drugs pharmacologically inducing violence) and some indirect (violence occurring in order to attain drugs). Moreover, the nature of that relationship is often complex, with intoxication, neurotoxic, and withdrawal effects often being confused and/or confounded. This paper reviews the existing literature regarding the extent to which various drugs of abuse may be directly associated with heightened interpersonal violence. Alcohol is clearly the drug with the most evidence to support a direct intoxication-violence relationship. The literatures concerning benzodiazepines, opiates, psychostimulants, and phencyclidine (PCP) are idiosyncratic but suggest that personality factors may be as (or more) important than pharmacological ones. Cannabis reduces likelihood of violence during intoxication, but mounting evidence associates withdrawal with aggressivity. The literature on the relationship between steroids and aggression is largely confounded, and between 3,4-methylenedioxymethamphetamine (MDMA) and aggression insufficient to draw any reasonable conclusions. Conclusions and policy implications are briefly discussed.

Clinician safety

Clinician safety is a serious concern for health care professionals because of the great risk of violence in health care workplaces, especially emergency and mental health departments. Assaults on mental health staff are often encountered from patients who are intoxicated with, or suffering withdrawal symptoms from, substances. Additionally, violence toward mental health professionals is frequently encountered from patients diagnosed with paranoid schizophrenia, personality disorders, learning disabilities, and mental retardation. Incidents of assault are often ignored by victims and administrators. Administrators must implement several measures to prevent clinician assault.

Aggression and recent substance abuse: absence of association in psychiatric emergency room patients

Substance abuse has been linked to aggression in community and psychiatric samples. A retrospective chart review in 311 consecutive psychiatric emergency room patients was conducted to assess the association of substance abuse and aggression in an acute psychiatric setting. Various indices of substance abuse, including positive urine toxicology for alcohol, cocaine, and/or cannabis, were not associated with aggressive behavior. Patients with positive toxicology for cocaine were less frequently aggressive than cocaine-negative patients. Among aggressive patients, the presence of psychotic symptoms was the most important factor associated with admission. These findings suggest that aggression is not a common acute manifestation of recent substance abuse in psychiatric emergency room patients. Selection factors in this population and the specifics of an acute psychiatric setting may obscure the association, if any. Acute psychosis seems to have a more important role in this setting. Future studies should focus on the prevention and early treatment of aggression in psychotic emergency room patients.

Current Understanding of Violence and Aggression: Assessment and Treatment

Links between violence, aggression, and mental illness are well documented. Despite this association, our current understanding of the causation and optimal treatment of aggression remains limited. This lack of knowledge is alarming because nurses treating patients with mentally illness are frequent targets of patient aggression. Consequently, the aim of this article is to provide contemporary information regarding the concept of patient aggression, assessment of violent behavior, and implementation of treatment interventions. A review of pharmacological and psychosocial strategies are presented as well. These findings provide psychiatric nurses with a conceptual model as well as practical interventions for patient aggression.