Is pre-college interpersonal trauma associated with cannabis use?

OBJECTIVE: To examine the prevalence and correlates of lifetime cannabis use (i.e., experimental [use 1-5 times] and non-experimental [use ≥ 6 times]) in relation to interpersonal trauma (IPT) above and beyond relevant covariates. PARTICIPANTS: A large (n = 9,889) representative sample of college students at an urban university in the southeastern part of the United States. METHODS: Participants were 4 cohorts of first-year college students who completed measures of demographics, cannabis, alcohol, nicotine, and IPT. Associations were estimated using multinomial logistic regressions. RESULTS: The prevalence of lifetime cannabis use was 28.1% and 17.4% for non-experimental and experimental cannabis use, respectively. IPT was significantly associated with experimental and non-experimental cannabis use above and beyond effects of sex, race, cohort, alcohol, and nicotine. CONCLUSIONS: Results show that cannabis use is prevalent among college students and is associated with IPT above and beyond associations with sex, race, and other substance use.

Coffee and energy drink use patterns in college freshmen: associations with adverse health behaviors and risk factors.

BACKGROUND: Public health concern over college students mixing caffeine-containing energy drinks (EDs) and alcohol has contributed to an array of ED-focused research studies. One review found consistent associations between ED use and heavy/problem drinking as well as other drug use and risky behaviors (Nutr Rev 72:87-97, 2014). The extent to which similar patterns exist for other sources of caffeine is not known. The present study examined associations between coffee and ED consumption and alcohol, tobacco and other drug use; alcohol use problems; and parental substance abuse and mental health problems in a sample of college freshmen. METHODS: Subjects were N = 1986 freshmen at an urban university who completed an on-line survey about demographics; caffeine; alcohol, tobacco and other drug use; and family history. The sample was 61% female and 53% White. Chi-square analyses and multivariable binary or ordinal logistic regression were used to compare substance use, problem alcohol behavior, and familial risk measures across 3 caffeine use groups: ED (with or without Coffee) (ED + Co; N = 350); Coffee but no ED (Co; N = 761); and neither coffee nor ED (NoCE; N = 875) use. RESULTS: After adjusting for gender and race, the 3 caffeine use groups differed on 8 of 9 symptoms for alcohol dependence. In all cases, the ED + Co group was most likely to endorse the symptom, followed by the Co group and finally the NoCE group (all p < .002). A similar pattern was found for: use 6+ times of 5 other classes of drugs (all p < .05); extent of personal and peer smoking (all p < .001); and paternal problems with alcohol, drugs and anxiety/depression as well as maternal alcohol problems and depression/anxiety (p < .04). CONCLUSIONS: The response pattern was ubiquitous, with ED + Co most likely, Co intermediate, and NoCE least likely to endorse a broad range of substance use, problem alcohol behaviors, and familial risk factors. The finding that the Co group differed from both the ED + Co and NoCE groups on 8 measures and from the NoCE group on one additional measure underscores the importance of looking at coffee in addition to EDs when considering associations between caffeine and other risky behaviors.

Patterns and Correlates of Polysubstance Use Among Individuals With Severe Alcohol Use Disorder.

AIM: The present study examined patterns and correlates of polysubstance use among individuals with severe alcohol use disorder (AUD). METHODS: Participants were 2785 individuals (63% female; mean age = 43 years, range = 18-78 years) from the Genes, Addiction and Personality Study. All participants met lifetime criteria for severe AUD (6+ symptoms). We used latent class analysis to identify patterns of frequency of lifetime use for cigarettes, marijuana, cocaine, stimulants, sedatives, opioids and hallucinogens. A variety of demographic and behavioral correlates of latent class membership were tested in univariable and multivariable models. RESULTS: A five-class solution was selected: extended range polysubstance use (24.5%); cigarette and marijuana use (18.8%); 'testers,' characterized by high probabilities of smoking 100 or more cigarettes, using marijuana 6+ times, and trying the remaining substances 1-5 times (12.3%); moderate range polysubstance use (17.1%) and minimal use (reference class; 27.3%). In univariable analyses, all potential correlates were related to latent class membership. In the multivariable model, associations with gender, race/ethnicity, age of onset for alcohol problems, dimensions of impulsivity, depressive symptoms, antisocial behavior and family history density of alcohol problems remained significant, though the pattern and strength of associations differed across classes. For instance, sensation-seeking, lack of premeditation and family history were uniquely associated with membership in the extended range polysubstance use class. CONCLUSION: Patterns of polysubstance use are differentially related to demographic and behavioral factors among individuals with severe AUD. Assessing use across multiple substances may inform the selection of targets for treatment and prevention.

Prevalence and Social Acceptability of Cannabis, Tobacco, and Alcohol Use in Adult Women.

Background: As more US states legalize cannabis use, prevalence of use continues to rise and attitudes toward use are changing. This study examined (1) the relationship between cannabis use and social acceptability of use and (2) how social acceptability and use of cannabis relate to anxiety, depression, and several pain conditions. Materials and Methods: Participants were n = 210 nonpregnant women recruited from two women's health clinics for an anonymous survey of complementary and integrative health practices. Survey domains included demographics, recent and lifetime cannabis, cigarette, and alcohol use, depression, anxiety, pain, and social acceptability of substances studied. Results: The sample had a mean age of 38.7 years and was 50.0% Black. Approximately 12.9% of the sample endorsed recent cannabis use, 17.2% endorsed recent cigarette use, and 57.5% endorsed recent alcohol use. Acceptability of use varied by substance. One-third (33.3%) of women found cannabis use to be socially acceptable. Higher social acceptability scores for cannabis were correlated with higher acceptability scores for each of the other substances studied, with the strongest correlation for e-cigarettes (R 2 of 0.395, p < 0.001) and the weakest for alcohol (R 2 of 0.296, p < 0.001). Women reporting anxiety (38.9%) and recent acute pain (28.6%) rated cannabis use as more socially acceptable than those without such symptoms. Conclusions: Women with recent cannabis use were more likely to find use of alcohol, tobacco, and cannabis to be socially acceptable than those not reporting cannabis use. More research is needed to better understand these relationships, as they might help to identify opportunities for education and intervention in this population.

Death anxiety in patients with primary brain tumor: Measurement, prevalence, and determinants.

OBJECTIVE: This study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population. METHODS: Two cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression. RESULTS: The DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety. SIGNIFICANCE OF RESULTS: The DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.

Screening for Psychotherapeutic Medication Misuse in Primary Care Patients: Comparing Two Instruments.

INTRODUCTION: Prescription psychotherapeutic medication misuse is a growing problem in the United States, but no method exists to routinely screen for this in primary care. Our study sought to (1) describe the prevalence of prescription psychotherapeutic medication misuse in primary care and the characteristics of patients who misuse and (2) compare 2 screening instruments modified to identify prescription medication misuse in primary care. METHODS: Primary care patients from underserved, urban clinics within a health system completed anonymous computer-directed health screens that included standard questions about prescription medication misuse. They were also administered the 4-item Cut down, Annoyed, Guilty, and Eye-opener questionnaire modified to focus on prescription medications (RxCAGE) and a 6-item Prescription Opioid Misuse Index (POMI-e) expanded to include other prescription medications. RESULTS: Of 2,339 respondents, 15.3% were positive for at least 2 items on the RxCAGE and 18.6% were positive for at least 2 items on the POMI-e. Using our computer-directed health screen as a comparison, we found that POMI-e had a higher area under the curve (0.63). A positive POMI-e was associated with being male, white and unemployed, having depression and anxiety, and currently using illicit substances, smoking, and misusing alcohol. CONCLUSIONS: Rates of prescription medication misuse were substantial with both RxCAGE and POMI-e showing promise as screening instruments. Future studies are needed to test prescription medication misuse screening tools in broader populations and pilot interventions for those screening positive.

Feasibility and Acceptability of e-Screening and Brief Intervention and Tailored Text Messaging for Marijuana Use in Pregnancy.

Background: There are at present no evidence-based interventions for marijuana use during pregnancy, despite it being by far the most commonly used illicit drug during pregnancy. Lack of treatment-seeking, combined with implementation challenges, has limited the extent to which at-risk women receive interventions of any kind. This study sought to evaluate the feasibility and acceptability of two high-reach technology-based interventions: electronic screening and brief intervention (e-SBI) and tailored text messaging, delivered either alone or in combination. Materials and Methods: In this exploratory feasibility trial, pregnant women seeking prenatal care services and scoring positive for marijuana use risk (n = 45) were randomly assigned to e-SBI, text messaging, or e-SBI plus text messaging. We examined completion rates and acceptability ratings as a function of intervention condition and participant characteristics. Results: All participants assigned to receive the e-SBI (n = 30) were able to complete it during the in-clinic baseline session. Participants assigned to text messaging (n = 30) received a median of 24 text messages before giving birth; 6 of 30 (20%) chose to end text messages before giving birth. Acceptability ratings for the e-SBI were high, with most being above 4.4 on a 5-point scale (e.g., for ease of use, respectfulness, and helpfulness). Acceptability ratings for some aspects of the texting intervention were also high (e.g., for ease of understanding and respectfulness). Participants in the combined e-SBI plus texting condition chose to stop messages at a rate of 13.3% (2 of 15), versus 26.7% (4 of 15) in the texting-only condition (p = 0.37). Conclusions: These two high-reach intervention elements showed strong feasibility and modest to high acceptability. Future efforts evaluating efficacy are warranted, and should specifically examine the possibility that combining text messaging with a brief intervention may promote retention.

Screening for At-Risk Alcohol and Drug Use in the Antenatal Period: How Do Young Women Compare with Older Adult Women?

STUDY OBJECTIVE: In the present study we compared results of standardized screening tools for problem alcohol and other drug use in younger (ages 18-24 years) and older (ages 25 and older) women attending the same clinic. We separately investigated pregnant and nonpregnant women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a cross-sectional study of women attending an urban, university-affiliated obstetrics and gynecology clinic. Women were recruited while awaiting appointments with their providers. In total, 3317 provided consent and completed a brief anonymous survey with standardized questions about alcohol and other drug problems. Measures included the T-ACE (acronym for Tolerance, Annoyed when others express concern, Cut down on drinking, Eye-opener) for alcohol and CAGE for other drugs (CAGE is a mnemonic for the following items: (1) Have you ever felt you should cut down on your use of other drugs? (2) Have people annoyed you by criticizing your use of other drugs? (3) Have you ever felt bad or guilty about your use of other drugs? and (4) Have you ever used drugs first thing in the morning to steady your nerves, avoid withdrawal, or get rid of a hangover [eye opener]?). Individual item responses and screener summary scores were compared separately for pregnant and nonpregnant younger (ages 18-24 years) and older adult (25 years of age or older) women using χ2 for categorical and t tests for continuous variables. RESULTS: For pregnant women, 386/1460 (26%) of older women screened at-risk for problem drinking compared to 250/1203 (21%) of younger women (P = .001). For other drugs, however, 192/1203 (16%) of younger pregnant women screened at risk compared to 186/1461 (13%) of older adult pregnant women (P = .02). For nonpregnant women, screen positive rates for at-risk drug use were nearly 2 times higher among older compared with younger women, with 48/321 (15%) of older women screening at risk compared to 28/332 (8%) of younger women (P < .01). CONCLUSION: The present findings affirm the need for routine screening for alcohol and drug problems in women of all ages, regardless of pregnancy status.

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial.

BACKGROUND: Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence. METHODS: Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators. RESULTS: Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change. CONCLUSIONS: The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate.

Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women.

OBJECTIVE: To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). METHOD: A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. RESULTS: Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. CONCLUSION: As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.

BACKGROUND: The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. OBJECTIVE: To validate the TAPS-1 in primary care patients. DESIGN: Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). PARTICIPANTS: Two thousand adult patients at five primary care sites. MAIN MEASURES: DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use. KEY RESULTS: Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker. CONCLUSIONS: The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy, and may have utility in primary care for rapid triage.

A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use.

INTRODUCTION AND AIMS: Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-min, electronic screening and brief intervention (e-SBI) for alcohol use among postpartum women. DESIGN AND METHODS: In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n = 61) or a time-matched control condition (n = 62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. RESULTS: No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition versus 82% for control at 3 months (odds ratio = 1.6) and 72% versus 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. DISCUSSION AND CONCLUSIONS: This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the 3-month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technology's reproducibility and modularity to isolate key components. [Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use. Drug Alcohol Rev 2016;35:710-718].

Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial.

BACKGROUND: Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus 3 tailored mailings, and estimated intervention effects. METHODS: We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were re-evaluated during their postpartum hospitalization. The primary outcome was 90-day period prevalence abstinence as measured by timeline follow-back interview. RESULTS: Participants rated the intervention as easy to use and helpful (4.7 to 5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (OR = 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no neonatal intensive care unit stay) were also of moderate magnitude in favor of e-SBI participants (OR = 3.3). As expected in this intentionally underpowered pilot trial, these effects were nonsignificant (p = 0.19 and 0.09, respectively). CONCLUSIONS: This pilot trial demonstrated the acceptability and preliminary efficacy of e-SBI plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach and should be confirmed in a fully powered trial.

Prevalence and Perceived Financial Costs of Marijuana versus Tobacco use among Urban Low-Income Pregnant Women.

OBJECTIVE: To examine the relative prevalence of marijuana and tobacco use among low-income post-partum women, using self-report, urine, and hair testing data; and to further explore perceptions of the substances among postpartum women by evaluating perceived risk and monetary cost of prenatal marijuana versus tobacco use. METHODS: Data from two studies were available for a total of 100 (Study 1) and 50 (Study 2) low-income, primarily African-American post-partum women. Study 1 participants completed brief self-report measures of substance use as well as urine and hair samples; study 2 participants completed a brief opinion survey regarding the risks and monetary costs of prenatal marijuana use. RESULTS: In Study 1, the self-reported prevalence of any tobacco or marijuana use in the past three months was 17% and 11%, respectively. However, objectively-defined marijuana use was more prevalent than self-reported tobacco use: 14% tested positive for marijuana by urinalysis, and 28% by hair analysis. Study 2 participants were more likely to believe that there is a safe level of marijuana use during pregnancy, and nearly half believed that using marijuana during pregnancy was less expensive than smoking cigarettes. CONCLUSION: Marijuana use may be as or more prevalent than tobacco use among low-income, African-American pregnant women. These findings may in part be attributable to perceptions of roughly equivalent cost and the lack of a clear public health message regarding prenatal marijuana use, combined with growing pro-marijuana advocacy. A broader public health response to address prenatal marijuana use, along with other substances of abuse, is needed.

A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy.

INTRODUCTION: Implementation of evidence-based interventions for smoking during pregnancy is challenging. We developed 2 highly replicable interventions for smoking during pregnancy: (a) a computer-delivered 5As-based brief intervention (CD-5As) and (b) a computer-assisted, simplified, and low-intensity contingency management (CM-Lite). METHODS: A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and randomly assigned to CD-5As (n = 26), CM-Lite (n = 28), CD-5As plus CM-Lite (n = 30), or treatment as usual (n = 26). Self-report of smoking, urine cotinine, and breath CO were measured 10 weeks following randomization. RESULTS: Participants rated both interventions highly (e.g., 87.5% of CD-5As participants reported increases in likelihood of quitting), but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence. CD-5As led to increased abstinence as measured by cotinine (43.5% cotinine negative vs. 17.4%; odds ratio [OR] = 10.1, p = .02) but not for CO-confirmed 7-day point prevalence (30.4% abstinent vs. 8.7%; OR = 5.7, p = .06). Collapsing across CM-Lite status, participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking (60.5% vs. 30.8%; OR = 3.0, p = .02). CONCLUSIONS: Low-intensity participant-initiated CM did not affect smoking in this sample, but the CD-5As intervention was successful in increasing abstinence during pregnancy. Further research should seek to replicate these results in larger and more diverse samples. Should CD-5As continue to prove efficacious, it could greatly increase the proportion of pregnant smokers who receive an evidence-based brief intervention.

A randomized clinical trial of a Therapeutic Workplace for chronically unemployed, homeless, alcohol-dependent adults.

AIMS: To assess the efficacy of the Therapeutic Workplace, a substance abuse intervention that promotes abstinence while simultaneously addressing the issues of poverty and lack of job skills, in promoting abstinence from alcohol among homeless alcoholics. METHODS: Participants (n = 124) were randomly assigned to conditions either requiring abstinence from alcohol to engage in paid job skills training (Contingent Paid Training group), offering paid job skills training with no abstinence contingencies (Paid Training group) or offering unpaid job skill training with no abstinence contingencies (Unpaid Training group). RESULTS: Participants in the Contingent Paid Training group had significantly fewer positive (blood alcohol level ≥ 0.004 g/dl) breath samples than the Paid Training group in both randomly scheduled breath samples collected in the community and breath samples collected during monthly assessments. The breath sample results from the Unpaid Training group were similar in absolute terms to the Contingent Paid Training group, which may have been influenced by a lower breath sample collection rate in this group and fewer reported drinks per day consumed at intake. CONCLUSION: Overall, the results support the utility of the Therapeutic Workplace intervention to promote abstinence from alcohol among homeless alcoholics, and support paid training as a way of increasing engagement in training programs.

Drug use during pregnancy: validating the Drug Abuse Screening Test against physiological measures.

This study examined the ability of the Drug Abuse Screening Test (DAST-10) to identify prenatal drug use using hair and urine samples as criterion variables. In addition, this study was the first to use "best practices," such as anonymity, ACASI technology, and a written screener, to facilitate disclosure in this vulnerable population. 300 low-income, post-partum women (90.3% African-American) were recruited from their hospital rooms after giving birth. Participation involved (a) completing a computerized assessment battery that contained the DAST-10 and (b) providing urine and hair samples. Twenty-four percent of the sample had a positive drug screen. The sensitivity of the DAST-10 was only .47. Nineteen percent of the sample had a positive toxicology screen but denied drug use on the DAST-10. Findings suggest that brief drug use screeners may have limited utility for pregnant women and that efforts to facilitate disclosure via reassurance and anonymity are unlikely to be sufficient in this population.

Caffeine dependence in combination with a family history of alcoholism as a predictor of continued use of caffeine during pregnancy.

OBJECTIVE: The purpose of the study was to examine whether caffeine dependence and a family history of alcoholism are associated with continued use of caffeine during pregnancy. METHOD: Forty-four women seeking obstetrical care in an office-based practice completed questionnaires and provided saliva samples at three prenatal visits occurring 2-3, 3-4, and 7 months postconception. On visit 1, the patients received the physician's instructions to stop using caffeine. Structured interviews were used to assign a diagnosis of caffeine dependence (lifetime) and to identify family history of alcoholism. Outcome measures included self-reported levels of caffeine use and saliva caffeine levels at the three prenatal visits. RESULTS: Although most women eliminated or substantially reduced their caffeine consumption between pregnancy awareness and prenatal visit 1, those with a lifetime diagnosis of caffeine dependence and a family history of alcoholism had higher levels of caffeine use and lower rates of abstinence throughout pregnancy. Saliva caffeine levels confirmed these effects. Withdrawal symptoms, functional impairment, and craving were cited as reasons they failed to eliminate or cut back on caffeine use. Fifty percent of the women with both a lifetime diagnosis of caffeine dependence and a family history of alcoholism continued to use caffeine in amounts (>300 mg/day) greater than those considered safe during pregnancy, compared to none of the women without caffeine dependence and a family history of alcoholism. Women with a lifetime diagnosis of caffeine dependence and a family history of alcoholism also reported higher rates of past cigarette smoking and problematic alcohol use. CONCLUSIONS: Caffeine-dependent women with a family history of alcoholism were not able to follow their physician's advice to reduce or eliminate caffeine consumption during pregnancy, despite their wanting to do so. This subgroup may require more intensive intervention to ensure caffeine abstinence and may be at greater risk for abuse of or dependence on other drugs.

Identification and treatment of patients with nicotine problems in routine clinical psychiatry practice.

The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.

Motivational enhancement therapy for nicotine dependence in methadone-maintained pregnant women.

Pregnant women who are dependent on nicotine and illicit substances are at especially high risk for health complications and psychosocial problems. Motivational enhancement therapy (MET) for reducing smoking during pregnancy was compared with standard-care practitioner advice in a 2-group randomized design. Participants were 63 pregnant opioid-dependent smokers seeking substance abuse treatment, methadone maintenance, and prenatal care. At a 10-week follow-up, self-report and biological measures (i.e., CO, cotinine) indicated no differences in smoking between the MET and standard-care groups. However, MET participants were more likely to have moved forward on the stage of change continuum than those in standard care. Intensive treatment for nicotine dependence, environmental interventions, and innovative harm reduction strategies are recommended to address the barriers to quitting observed in this population of pregnant women.