Substance Abuse: Research and Treatment最新文献

Gambling disorder and symptoms of post-traumatic stress are highly comorbid. Numerous studies suggest that the presence of one (either disordered gambling or post-traumatic stress) substantially increases the odds of later developing the other. However, little is known about the etiological links between these two domains or the nuances of the comorbidity. Past research has suggested that symptoms of post-traumatic stress might be related to unique motivations for and beliefs about gambling. The present work sought to examine whether or not symptoms of post-traumatic stress might also be related to specific situational vulnerabilities to gambling behaviors. Using a large cross-sectional sample of Internet-using adults in the United States who were primarily recreational gamblers (N = 743; 46% men, M_age  = 36.0, SD = 11.1), as well as an inpatient sample of US Armed Forces veterans seeking treatment for gambling disorder (N = 332, 80% men, M_age  = 53.5, SD = 11.5), the present work tested whether or not symptoms of post-traumatic stress were uniquely related to a variety of gambling situations. Results in both samples revealed that even when controlling for potentially confounding variables (eg, substance use and trait impulsivity), symptoms of post-traumatic stress were uniquely related to gambling in response to negative affect, gambling in response to social pressure, and gambling due to a need for excitement. These findings are consistent with recent work suggesting that individuals with post-traumatic stress symptoms are more likely to engage in gambling behaviors for unique reasons that differ from gamblers without such symptoms.

This study attempted to disentangle the effects of peer selection and socialization on heavy drinking and marijuana use among adolescents whose parents received 2 distinct brief interventions (BIs). It also examined whether the two BI models-Family Check-Up and Psychoeducation-had differential effects on peer processes. Parents were randomized to BI conditions and their adolescents (61% male, age 12-19 years) completed self-report measures of days of heavy drinking, days of marijuana use, and perceived peer substance involvement at baseline, 6 months, and 12 months. Separate cross-lagged panel models revealed evidence of selection and socialization for both heavy drinking and marijuana over the first 6 months and evidence of only selection over the subsequent 6 months. Consistent with prior studies, a less robust pattern of peer processes was found when simultaneously controlling for both heavy drinking and marijuana. Results highlight the need to examine multiple substances simultaneously and suggest that the BIs may have had protective effects on peer influences over time.

Despite a dramatic increase in e-cigarette popularity in recent years, the relationship between acculturation and e-cigarette use among immigrants largely remains unknown. We investigated the association between acculturation, measured by both self-reported English proficiency and length of stay in the United States, and immigrants' use of e-cigarettes using data from the 2016-2017 National Health Interview Survey. Multivariate logistic regressions were used to examine the associations of acculturation factors with ever and current use of e-cigarettes. We found that high English proficiency increased the odds of ever using e-cigarettes among immigrants (adjusted odds ratios: "well," 2.22; "very well," 3.24; with the reference group being "not well"). The association was significant among only men. However, we did not find a significant association between length of stay in the United States and e-cigarette use after adjusting for English proficiency. Future research is warranted to investigate how peer use, family-level factors, country of origin, and marketing strategies jointly influence e-cigarette use among immigrants, especially men.

The numbers of women using opioids who become pregnant have captured the attention of media, research, policy, and community. At the same time, there is an ever-growing use of alcohol among women who continue drinking during pregnancy that has received less focus. Although both untreated opioid use disorder and alcohol misuse pose risks for maternal, fetal, and child morbidities, alcohol is the substance with the most significant documentation of harms. As we focus on the opioid epidemic in the United States, it is critical that we do not overlook alcohol use during pregnancy. Both opioid use and alcohol use during pregnancy are important public health challenges and often happen concurrently. Thus, this commentary aims to (1) highlight the historical and current context of opioid and alcohol use during pregnancy; (2) summarize the current knowledge of opioids and alcohol use during pregnancy; and (3) detail future directions in how health care providers can help identify and therapeutically respond to women with concurrent opioid and alcohol use disorder.

Despite research linking substance use/abuse to pejorative academic outcomes, the underlying behavior and cognitive mechanisms responsible for this association are largely unknown. This study addresses a specific call for understanding learning strategies and skills associated with substance alcohol use/abuse. Four hundred fifty undergraduates (59.6% female) completed measures of hazardous drinking behavior and student learning strategies. Approximately 35.3% of the sample reported hazardous drinking scores in the clinical range. Bivariate correlations and a regression framework were utilized to understand the associations among hazardous drinking behavior, academic skills/strategies, and student liabilities. In the present study, hazardous drinking behavior was associated with 4 learning strategies: note-taking/listening skills, test-taking strategies, organizational techniques, and time management. Moreover, hazardous drinking behavior was associated with 2 student liabilities: low academic motivation and concentration/attention difficulties. Results from follow-up analyses suggest that only organizational techniques and concentration/attention difficulties predicted hazardous drinking behavior. Promising areas for future research and potential intervention targets are discussed.

Background: Second-generation antipsychotics (SGAs) are assumed to have little abuse potential. However, reports of quetiapine abuse have emerged as prescribing has increased in recent years. The US Food and Drug Administration's (FDA) Adverse Event Reporting System (FAERS) provides postmarketing information regarding adverse drug events (ADEs). This is the first study to analyze quetiapine abuse-related ADEs reported to FAERS to determine whether a disproportionate rate of such events have been reported when compared with other commonly used SGAs.

Methods: A cross-sectional analysis of FAERS data from January 1, 2015, to December 31, 2017, was performed. The total number of all-cause and abuse-related ADEs reported to FAERS regarding quetiapine, olanzapine, aripiprazole, and risperidone were identified, along with demographic and mortality data. The proportional reporting ratio (PRR) was calculated to assess disproportionate reporting of abuse-related adverse drug reactions between quetiapine and each of three alternative SGA medications.

Results: Abuse-related ADEs represented 11% (3144/27 962) of total ADEs reported for quetiapine, 8% for olanzapine (1548/19 228), 5% (1380/29 699) for aripiprazole, and 3% (1168/45 518) for risperidone. The PRRs (95% confidence interval) for quetiapine versus olanzapine, aripiprazole, and risperidone were 1.40 (1.32-1.48), 2.42 (2.28-2.57), and 4.38 (4.10-4.68), respectively, indicating that abuse-related events were significantly more likely to be reported with quetiapine than each comparator drug. In addition, more deaths were reported among the abuse-related events regarding quetiapine (673) than olanzapine (200), aripiprazole (88), and risperidone (143).

Conclusion: This study corroborates recent evidence indicating that quetiapine might possess a significantly higher abuse potential than other commonly used SGAs. Although prospective studies are needed to better understand the abuse potential of quetiapine, increased vigilance in monitoring for signs of substance abuse might be warranted when prescribing quetiapine.

Relatively few individuals with a substance use disorder (SUD) seek or receive treatment, and knowledge about the effective ingredients in SUD treatment, from the perspective of those who receive it, is scarce. Our study purpose was to explore the experiences of those with long-term SUDs and the aspects they found helpful during treatment and long-term recovery. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a long-term SUD, and who had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to study planning, preparation, and initial analyses. Participants preferred individualized, long-term treatment, and support from both therapists and other clients. They further acknowledged the importance of their own sense of responsibility for their treatment and recovery success. Greater focus should be placed on viewing long-term SUD as a long-term condition, similar to somatic diseases, and SUD treatment services should place greater emphasis on developing partnership care models, long-term monitoring and support, and actively engaging recovered clients in the care of others in SUD treatment.

Background: Substance use disorders (SUDs) have been assumed to be rare in individuals with autism spectrum disorder (ASD). Recent research suggests that the rates of SUD among individuals with ASD may be higher than assumed although reliable data on the prevalence of SUD in ASD are lacking. Typical interventions for SUD may be particularly unsuitable for people with ASD but research on intervention and therapy are limited.

Methods: This study addresses ways of improving services for individuals with ASD and SUD by enhancing the competence of professionals in ordinary SUD outpatient clinics. Three therapists were given monthly ASD education and group supervision. The participants were ordinary referred patients who wanted to master their problems with alcohol or drugs. Four patients, all men diagnosed with ASD and intelligence quotient (IQ) ⩾ 70 completed the treatment. The participants were given cognitive behavioural therapy (CBT) modified for their ASD over a minimum of 10 sessions. The therapies lasted between 8 and 15 months. Standardised assessments were conducted pre- and post-treatment.

Results: Post-treatment, 2 participants had ended their drug and alcohol abuse completely, 1 had reduced his abuse, and 1 still had a heavy abuse of alcohol. Physical well-being was the most prevalent reported positive aspect of drug or alcohol use, whereas the experience of being left out from social interaction was the most frequent negative aspects of intoxication.

Conclusions: CBT may represent a promising treatment option for individuals with ASD and SUD. The results suggest that patients' symptoms can be reduced by providing monthly ASD education and group supervision to therapists in ordinary SUD outpatient clinics. This group of patients need more sessions than other client groups, the therapy has to be adapted to ASD, ie, direct, individualised, and more extensive. Moreover, the patients need psychoeducation on ASD generally, social training, and support to organise several aspects of their lives and some patients need more support than can be provided in an outpatient clinic.

Opioid use disorder (OUD) is reaching epidemic proportions worldwide, and is notoriously difficult to treat. Compassion focused therapy (CFT) has emerged as therapeutic tool for treating individuals exhibiting high levels of self-criticism and low self-esteem, both of which are common in OUD. Until now, however, there had been no research investigating this therapy in patients with OUD. Before running a premature clinical trial, it is important to fully assess the feasibility and acceptability of this treatment in this group of individuals. We aimed to assess the feasibility of CFT treatment in individuals with OUD in a short group intervention, which was co-created by the research team, service users and a local drugs service. The intervention involved three 2-hour sessions held over 3 weeks, where participants engaged in compassion-orientated psychoeducation and self-compassionate exercises. Individuals were randomly assigned to either the CFT group (n = 15), the active control (relaxation) group (n = 12) or the waitlist control group (n = 11). Of 103 individuals approached, 45% attended a baseline visit suggesting the treatment was acceptable to this group. A relatively low attrition rate across the 3 groups was found for CFT (21.1%), with no difference in drop-out between the groups. Qualitative analysis of interviews with participants identified a desire for more sessions. Compassion focused therapy was thus feasible and well-tolerated in those with OUD, and a further trial to evaluate any clinical differences may be warranted.

Background: The importance of alcohol and cannabis consumption for the effectiveness of treatment of chronic hepatitis C virus (HCV) infection with direct acting antivirals (DAAs) in people on opioid substitution therapy (OST) has not been investigated in detail.

Methods: We investigated sustained virological response (SVR) rates and proportion of lost to follow-up (LTFU) between OST (n = 739) and non-OST patients (n = 7008) in the German Hepatitis C-Registry (Deutsches Hepatitis C-Register, DHC-R), which is a national multicenter prospective non-interventional real-world registry. Non-OST patients comprised patients with former/current drug use (non-OST/DU; n = 1500) and patients never consuming drugs (non-OST/NDU; n = 5508).

Findings: SVR 12/24 rates (intention to treat [ITT]) in patients consuming no or less than 30 g/day (women) or 40 g/day (men) were significantly higher in non-OST/NDU (range 91%-92%) vs OST patients (range 83%-86%), mainly due to significantly higher LTFU rates in OST (range 11%-12%) compared with non-OST/NDU (range 2%-3%). In non-OST/NDU with high alcohol consumption of more than 30/40 g/day, SVR 12/24 rates (ITT) were lower (85%) but did not differ to OST (85%) with high alcohol consumption. No significant differences could be seen for SVR 12/24 in per-protocol (PP) analysis independent of alcohol consumption or amount of alcohol intake. Cannabis use did not significantly influence SVR 12/24 in ITT or PP or LTFU.

Conclusions: High SVR rates could be achieved in both OST and non-OST patients irrespective of alcohol or cannabis consumption. However, LTFU is more likely in patients with current or former drug use than in patients without drug history and in patients with high alcohol consumption but occurred mainly after end of antiviral treatment (EOT), leaving a high chance for HCV elimination in these patients.