Risk Factors for Overdose in Young People Who Received Substance Use Disorder Treatment.

BACKGROUND AND OBJECTIVES: To identify substance and psychiatric predictors of overdose (OD) in young people with substance use disorders (SUDs) who received treatment. METHODS: We conducted a retrospective review of consecutive medical records of young people who were evaluated in a SUD program between 2012 and 2013 and received treatment. An independent group of patients from the same program who received treatment and had a fatal OD were also included in the sample. OD was defined as substance use associated with a significant impairment in level of consciousness without intention of self-harm, or an ingestion of a substance that was reported as a suicide attempt. t Tests, Pearson's χ2 , and Fisher's exact tests were performed to identify predictors of OD after receiving treatment. RESULTS: After initial evaluation, 127 out of 200 patients followed up for treatment and were included in the sample. Ten (8%) of these patients had a nonfatal OD. Nine patients who received treatment and had a fatal OD were also identified. The sample's mean age was 20.2 ± 2.8 years. Compared with those without OD, those with OD were more likely to have a history of intravenous drug use (odds ratio [OR]: 36.5, P < .001) and mood disorder not otherwise specified (OR: 4.51, P = .01). DISCUSSION AND CONCLUSIONS: Intravenous drug use and mood dysregulation increased risk for OD in young people who received SUD treatment. SCIENTIFIC SIGNIFICANCE: It is important to identify clinically relevant risk factors for OD specific to young people in SUD treatment due to the risk for death associated with OD. (Am J Addict 2019;28:382-389).

Neuropsychological changes in patients with substance use disorder after completion of a one month intensive outpatient treatment program.

BACKGROUND AND OBJECTIVES: Data suggest individuals with substance use disorders (SUD) exhibit high rates of executive functioning (EF) impairment, and that EF level can predict treatment retention. The primary aim of the present study was to investigate if patients who completed a 1 month intensive outpatient program (IOP) for SUD demonstrated recovered EF. METHODS: Baseline and follow-up neurocognitive functioning was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the self-reported Behavior Rating Inventory of Executive Functioning (BRIEF-A) questionnaire. RESULTS: The final sample included 15 patients who completed the one month IOP and for whom data were available (53% male, aged 36 years ± 13.4). Despite exhibiting general improvements in EF and significant improvements in organization, subjects continued to manifest significant executive dysfunction as evaluated by self-report and computerized assessment. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Patients with SUD often manifest high levels of executive dysfunction upon entry into SUD treatment that, while improving minimally, appears to persist despite intensive outpatient treatment at 1 month. These persistent EF deficits may affect patient engagement and participation in treatment, thus necessitating SUD programs to assess and accommodate EF issues throughout treatment. (Am J Addict 2018;XX:1-7).

Longitudinal associations between depression and problematic substance use in the Youth Partners in Care study.

Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.

The Relationship Between Cannabis Use and Self-Reported Trait Anger in Treatment-Seeking Young People.

Objective: Trait anger has been shown to be predictive of emotion-focused coping and alcohol use. Yet, the connection between cannabis use and trait anger remains poorly characterized. The present study sought to investigate the relationship between cannabis use and self-reported trait anger in youth seeking substance use treatment. Methods: A retrospective chart review was conducted on youth (n=168) aged 14-26 presenting for an initial evaluation at an outpatient substance use treatment program. Patients self-reported trait anger score (TAS) and lifetime, recent, and Diagnostic and Statistics Manual-5th Edition diagnostic status of cannabis use were assessed. Clinician-coded psychiatric and substance use patterns were collected, along with urine carboxy delta-9-tetrahydrocannabinol (THC) concentration levels. Additional measures of anxiety, depression, and demographic variables were assessed. Results: Higher self-reported TAS were associated with cannabis use, cannabis use disorder (CUD), and more recent and frequent cannabis use. The presence of a CUD was independently associated with TAS after controlling for the presence of other substance use disorders and co-occurring depression and anxiety disorders. Higher urine THC concentration levels were associated with higher TAS. Conclusions: Findings support an association between heavy, chronic cannabis use and elevated self-reported trait anger at intake. There may be important neurological consequences of heavy, chronic cannabis use that impact anger regulation. It is also plausible that trait anger maybe a predisposing factor for elevated cannabis use. Better controlled prospective research is needed to help determine directionality. Treatment programs should target both cannabis use and anger regulation in youth.

Considerations for Treating Young People With Comorbid Autism Spectrum Disorder and Substance Use Disorder.

Although substance use disorder (SUD) and autism spectrum disorder (ASD) are highly comorbid with other mental disorders and commonly have onset during childhood,1 little attention has been paid to their overlap. Despite limited data suggesting that up to 4% of patients with ASD also have substance-related problems,2 there are no existing guidelines, protocols, or tailored resources focused on SUD in young people with co-occurring ASD. This is concerning given that the simultaneous presence of these disorders presents unique challenges that complicate clinical care. In particular, many of the symptoms of ASD can interfere with standard SUD treatment. Thus, when treating patients with this comorbidity, practitioners should consider the following: communication difficulties, diminished capacity for motivation and insight, limited social interactions, and obstacles to treatment engagement.

Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders.

OBJECTIVE: Overdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care. METHODS: A systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD. RESULTS: We examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05). CONCLUSIONS: High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.

Brief Report: Autism Spectrum Disorder and Substance Use Disorder: A Review and Case Study.

There is limited literature available on the comorbidity between autism spectrum disorder (ASD) and substance use disorder (SUD). This paper reviews existing literature and exemplifies the challenges of treating this population with a case report of an adult male with ASD and DSM-5 alcohol use disorder. This review and case study seeks to illustrate risk factors which predispose individuals with ASD to developing SUD and discuss the obstacles to and modifications of evidence-based treatments for SUD. A review of the therapeutic interventions implemented in the treatment of this young male are described to highlight potential recommendations for the general management of SUD in those with ASD.

Maternal depression, maternal expressed emotion, and youth psychopathology.

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors-maternal depression within the child's lifetime and maternal EE-in a study of children at risk for depression. One hundred and seventy-one youth, ages 8-12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist-Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children's own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers' reports of children's Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers' reports of children's Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children's depression diagnoses.

Patterns of alcohol consumption in bipolar patients comorbid for alcohol abuse or dependence.

OBJECTIVES: Despite a high prevalence rate, patients with bipolar disorder and active alcohol use are routinely excluded from controlled clinical trials leaving clinicians with little evidence-based medicine to guide treatment. This report evaluates preliminary data of alcohol consumption patterns utilizing the Alcohol Timeline Followback (TLFB) method in actively drinking patients with bipolar disorder. METHODS: A sample of 30 patients underwent a Structured Diagnostic Interview for DSM-IV (SCID-IV) as well as completing various measures of alcohol use and associated morbidity. RESULTS: In the month prior to study entry, the TLFB reported 18.4/30+/-9.12 drinking days, 9.9+/-4.73 drinks per drinking day and 169.4+/-101.71 total standard drinks for this study group. There was a significant difference in the number of drinks per drinking day between those diagnosed with rapid cycling than non-rapid cycling bipolar disorder and those with a new diagnosis versus established diagnosis of bipolar disorder. DISCUSSION: This study highlights heavy alcohol use in patients with bipolar disorder and alcohol comorbidity. The TLFB method provides 'real world' quantification of use. Further studies are encouraged to elucidate implications of heavy drinking patterns as found in our rapid cycling and newly diagnosed cohorts.