Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders.

This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.

Assessing covariates of drug use trajectories among adolescents admitted to a drug addiction center: mental health problems, therapeutic alliance, and treatment persistence.

This study aimed to assess covariates of drug use trajectories among 102 adolescents admitted to a drug user treatment program between November 2005 and November 2006 in Québec, Canada. The influences of mental health, therapeutic alliance, and treatment persistence were examined. The Addiction Severity Index was used to measure drug use severity and mental health problems; the California Psychotherapy Alliance Scales was used for therapeutic alliance. latent growth curve analysis showed associations between (1) mental health and initial drug use severity; (2) therapeutic alliance and initial drug use severity; and (3) number of post-treatment sessions attended and drug use severity over time.

Substance abuse treatment for adolescents: how are family factors related to substance use change?

Parental involvement in adolescents' substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths' recovery are not well understood. The present study examines the association between (1) changes in adolescents' substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers' mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents' access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions.

Addiction Severity and Suicidal Behaviors Among Persons Entering Treatment.

The aim of this study was three-fold: to compare the rates for suicidal behaviors based on the problem substance, to look at the association between addiction severity and suicidal behaviors, and to identify the components of addiction severity associated with suicidal behaviors. Addiction Severity Index databases from three public rehabilitation centers were merged for analyses, yielding 6,551 evaluations. The rates for suicidal behaviors among those who have a problem with both alcohol and a drug are higher than for those who have a problem with any single substance. The effect of addiction severity on suicidal behaviors persists even when other problem areas are taken into account. Thus, clinicians must pay closer attention to persons with both alcohol and drug problem.

Clinical measurement of addictions.

INTRODUCTION AND AIMS: To conduct a systematic review of instruments for the clinical measurement of addictive behaviours and to determine whether substance addictive behaviours (SAB) and non-substance addictive behaviours (NSAB) are similarly conceptualised in clinical research. DESIGN AND METHODS: The analytic strategy employed comprised three steps: (i) major search engines were used to take stock of available clinical instruments for assessing addictive behaviours; (ii) an analysis grid was developed and validated, covering 21 parameters under four heuristic categories: dependence, temperament, social handicap and cognitive behaviour; and (iii) all instruments were analysed and compared via the grid. RESULTS: The search yielded 157 questionnaires covering 14 addictive behaviours.The analysis grid allowed rating all questionnaire items on one parameter only; very good interrater agreement was maintained throughout.The categories most evaluated by the questionnaires were dependence and cognitive behaviour; temperament and social handicap were much less frequently considered. Patterns were generally similar in terms of categories, whether questionnaires concerned SAB or NSAB; however, differences within categories indicated a greater frequency of psychologically oriented parameters for NSAB. CONCLUSIONS: The measurement of addictive behaviours appears clinically cohesive, as determined by a validated analysis grid applied to an exhaustive set of questionnaires identified through a systematic literature review.