Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders.

PURPOSE: To examine gender differences in the associations between childhood adversity and different types of substance use disorders and whether gender moderates these relationships. METHODS: We analyzed data from 19,209 women and 13,898 men as provided by Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender moderates the associations between childhood adversity and DSM-IV defined lifetime occurrence of alcohol, drug, and polysubstance-related disorders. We used multinomial logistic regression, weighted to be representative of the US adult civilian, noninstitutionalized population, and we calculated predicted probabilities by gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pair-wise comparisons corrected for multiple comparisons using Bonferroni's method. RESULTS: For each type of substance use disorder, risk was increased by more exposure to childhood adversity, and women had a lower risk than men. However, moderation effects revealed that with more experiences of childhood adversity, the gender gap in predicted probability for a disorder narrowed in relation to alcohol, it converged in relation to drugs such that risk among women surpassed that among men, and it widened in relation to polysubstances. CONCLUSIONS: Knowledge regarding substance-specific gender differences associated with childhood adversity exposure can inform evidence-based treatments. It may also be useful for shaping other types of gender-sensitive public health initiatives to ameliorate or prevent different types of substance use disorders.

Technological aids for improving longitudinal research on substance use disorders.

BACKGROUND: There is a broad consensus that addictive behaviors tend to be chronic and relapsing. But for field studies of substance users, successfully tracking, locating, and following up with a representative sample of subjects is a challenge. METHODS: The purpose of this paper is to provide a general overview of how current technological aids can support and improve the quality of longitudinal research on substance use disorders. The review is grouped into four domains: (1) tracking and locating, (2) prompting/engaging, (3) incentivizing, and (4) collecting data. RESULTS & CONCLUSIONS: Although the technologies described in this review will be modified or replaced over time, our findings suggest that incorporating some or all of these currently available approaches may improve research efficiency, follow-up rates, and data quality.

Program Capacity to Eliminate Outcome Disparities in Addiction Health Services.

We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.

Adolescent obesity and future substance use: Incorporating the psychosocial context.

A growing body of work has shown that obese adolescents are at risk of engaging in problematic substance use, but mixed findings highlight the complexity of the relationship. Incorporating the psychosocial context into this research may inform past discrepancies. The current study assessed whether obese adolescents had a higher likelihood of experiencing a psychosocial context that predicted problematic substance use in young adulthood. Latent class analysis on 10,637 adolescents from The National Longitudinal Study of Adolescent to Adult Health (Add Health) identified four psychosocial classes in adolescence: Adjusted, Deviant Peer/Victimization, Moderate Depression, and Maladjusted. Obese adolescents were more likely to belong to the Maladjusted class, characterized by higher levels of depression and deviant peer affiliation. Those in the Maladjusted class had the second highest levels of cigarette smoking and marijuana use in young adulthood. Obese adolescents' psychosocial context should be considered in future research linking obesity and substance use.

Discrimination and substance use disorders among Latinos: the role of gender, nativity, and ethnicity.

OBJECTIVES: We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. METHODS: Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders. RESULTS: Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups. CONCLUSIONS: It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.

Psychiatric correlates of alcohol and tobacco use disorders in U.S. adults aged 65 years and older: results from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions.

OBJECTIVE: To examine associations of alcohol and tobacco use disorders and psychiatric conditions among older U.S. adults. METHODS: Sample was individuals aged at least 65 years (N = 8,205) who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Measurements included lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol use disorders (AUDs), tobacco use disorders (TUDs), and psychiatric conditions. RESULTS: Among older adults, prevalence of lifetime and past 12-month AUDs were 16.1% and 1.5% and lifetime and past 12-month TUDs were 8.7% and 4.0%, respectively. Lifetime TUD was associated with increased odds of both lifetime (odds ratio [OR]: 4.17; 95% confidence interval [CI]: 3.30-5.26) and past 12-month (OR: 2.52; 95% CI: 1.50-4.24) AUDs, and lifetime AUD was associated with increased odds of both lifetime (OR: 4.13; 95% CI: 3.28-5.210 and past 12-month (OR: 3.51; 95% CI: 2.47-4.96) TUDs. Any lifetime mood, anxiety, or personality disorder among older adults was associated with increased odds of lifetime AUD and TUD, any lifetime mood disorder was associated with increased odds of past 12-month AUD and TUD, and any personality disorder was associated with past 12-month TUD. CONCLUSION: There is a strong association between AUD and TUD among older U.S. adults as well as associations between AUD and TUD with mood, anxiety, and personality disorders. Understanding the psychiatric conditions associated with AUDs and TUDs, especially past 12-month use disorders involving alcohol or tobacco, will enable healthcare providers to target screening and be more aware of symptoms and signs of potential AUDs and TUDs among those at higher risk.

Patterns of medical marijuana use among individuals sampled from medical marijuana dispensaries in los angeles.

The proliferation of medical marijuana (MM) dispensaries has led to concerns that they will lead to more widespread use of marijuana. The aim of the current study was to collect descriptive data on individuals using MM dispensaries in Los Angeles County. A mixed-method approach was employed that consisted of focus groups with 30 individuals and a survey of dispensary users (N = 182) in Los Angeles County. Differences between younger (less than 30 years old) and older individuals were examined in the survey sample. Most individuals in both samples had initiated marijuana use in adolescence. Nearly one-half of survey respondents had indications of risky alcohol use and one-fifth reported recent use of illicit drugs or misuse of prescription medications. Younger individuals had higher rates of tobacco use, visited dispensaries more frequently, and had more socially embedded patterns of use, but they were similar to older individuals in terms of their reasons for use. Nearly all participants believed that MM was beneficial in treating their health problems, although 65% reported symptoms of psychological distress in the past year. Interventions aimed at MM users should stress the related effects of tobacco and risky alcohol use as well as mental health needs.

Who Benefits from Gender Responsive Treatment? Accounting for Abuse History on Longitudinal Outcomes for Women in Prison.

This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). In order to identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post- treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6- and 12-months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression (OR = .29, p < .05, 95% CI = .10 - .86) and lowered rates of number of substances used (IRR = .52, p < .05, 95% CI = 0.28-0.98), in comparison to those who reported abuse and were randomized to the non-GRT group. GRT for women offenders who have experienced prior abuse would maximize the benefits of the trauma-informed, gender-sensitive intervention.

PREDICTORS OF RECIDIVISM OVER 3 YEARS AMONG SUBSTANCE-USING WOMEN RELEASED FROM JAIL.

This study examines predictors of recidivism over 3 years for 624 women released from a county jail using a comprehensive range of standardized measures derived from gender-responsive and gender-neutral criminogenic recidivism models. Although more than a dozen factors were related to recidivism in the univariate analysis, the multivariate analysis shows that recidivism can be reliably predicted (area under the curve = 0.90) with just four factors: age, no custody of children, substance use frequency, and number of substance problems. Exploratory analysis of women who recidivated in post-release months 1 to 3, 4 to 12, and 13 to 36 revealed that the effects of several variables (age, super optimism, and number of weeks in the jail treatment program) were dependent on the time elapsed since release from jail, whereas others (substance use and custody) had persistent effects over time. These findings support the development of re-entry services tailored for female offenders who address both gender-responsive and gender-neutral criminogenic risk factors.

Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs.

OBJECTIVE: Improved understanding of the relative strengths and weaknesses of treatment organizations' dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs' capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability. METHODS: We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services. RESULTS: The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains. CONCLUSIONS: Findings suggest that programs in the sample are functioning at a nearly dual diagnosis capable level. However, structural barriers continue to limit providers' capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability.

Access to Services for Pregnant People With Opioid Use Disorder in Jails in the United States.

The aim of this study was to assess the availability of medications for opioid use disorder (MOUD) and other services for pregnant people in jails in counties heavily impacted by opioid overdose in the United States. Counties were selected based on absolute number and population rate of opioid-overdose fatalities. Structured interviews were completed with representatives from 174 jails that house pregnant women. Descriptive statistics examine MOUD availability and differences in service provision and community-level characteristics based on MOUD availability. Most jails in the study sample (84.5%) had MOUD available for pregnant people; however, less than half of these jails ensured continuity of care. Jails without MOUD available are more likely to provide non-MOUD substance use services. These jails are more often located in smaller, rural counties in the Midwest and have higher rates of White residents and lower rates of Hispanic and African American residents. Gaps in MOUD availability in jails and continuity of care violate medical guidelines for treatment of pregnant patients with opioid use disorder and increase their risk of overdose. In addition, there are disparities across communities in access to MOUD for pregnant people in jails.

Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings.

BACKGROUND AND AIMS: Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment. DESIGN: A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC-PC) (n = 134) with follow-up assessments at 3 months post-baseline. SETTING: Four federally qualified health centers in the United States serving low-income populations. PARTICIPANTS: Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19-53]) who were referred to SUD treatment after SBIRT. INTERVENTIONS: SBIRT alone (control condition) compared with SBIRT + RMC-PC (experimental condition). MEASUREMENT: The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self-report. FINDINGS: At 3-month follow-up, those assigned to SBIRT + RMC-PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = -0.25) and cannabis (19.49, vs 28.6; d = -0.20). CONCLUSIONS: Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.

A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results.

BACKGROUND: Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC-PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. METHODS: Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC-PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post-enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self-report. RESULTS: Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC-PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC-PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = -0.20) and cannabis use (d = -0.20), and lower combined substance use frequency (d = -0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC-PC on days of abstinence. CONCLUSION: This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer-term treatment and substance use outcomes.

Impact of Abstinence Self-Efficacy and Treatment Services on Physical Health-Related Behaviors and Problems among Dually Diagnosed Patients.

OBJECTIVE: Physical health problems are pervasive among patients with co-occurring substance use and mental disorders. Yet, drug treatment programs often ignore tobacco use and its association with health. Abstinence self-efficacy has been associated with improved outcomes for co-occurring disorders, which in turn may also impact physical health. This study had the goal of assessing whether abstinence self-efficacy for drugs and alcohol, and provision and use of services would influence tobacco use and other health-related outcomes among 351 individuals with co-occurring disorders in residential drug treatment. METHODS: Structural models tested the impact of baseline abstinence self-efficacy and treatment service characteristics on 6-month outcomes of health problems, functional limitations, health perceptions, and cigarette and heavy alcohol use. Demographics and baseline values for outcome variables were included as covariates. RESULTS: Correlations within time for poor health, cigarette use, and heavy alcohol use were substantial. A longer time in drug treatment was associated with less cigarette and heavy alcohol use at a 6-month follow-up. Baseline health problems were associated with more cigarette use and functional limitations at 6-months. Abstinence self-efficacy did not predict less cigarette use, but predicted less heavy alcohol use and fewer functional limitations. Availability of specialized dual-diagnosis groups and more on-site psychological services were not directly associated with outcomes, but had an impact through indirect effects on more psychological service utilization which predicted better subjective health. CONCLUSIONS: Improving overall treatment retention and services utilization among patients with co-occurring disorders may generalize to improved health perceptions, but specific health promotion and smoking-cessation interventions are warranted to improve health outcomes.

Scoping review of interventions to link individuals to substance use services at discharge from jail.

INTRODUCTION: Individuals with substance use disorders (SUD) must be linked to community-based SUD treatment and other services upon their release from jail, given their high service needs and risks for relapse, recidivism, and opioid-related overdose following release. METHOD: This scoping review identified 14 studies (28 affiliated publications) that used experimental or quasi-experimental designs to evaluate jail re-entry interventions for individuals with SUD. The team coded intervention components, study characteristics, and study outcomes based on a service continuum for treatment linkage and retention and for post-release substance use and criminal justice outcomes. RESULTS: This review included 4 randomized controlled trials (RCT) for linkage to treatment with medications for opioid use disorder (MOUD); 4 RCTs and 4 quasi-experimental studies for linkage to non-specific SUD treatment; and 2 RCTs for linkage to HIV + SUD services. Most studies (9/14) used case management and/or peer or patient navigation as the core intervention; 2 studies provided medical management for MOUD induction and/or facilitated referral to MOUD in the community; and 3 studies used motivational-based linkage interventions. A qualitative analysis of study outcomes found evidence to support the effectiveness of a diverse range of interventions to link individuals to community-based SUD treatment, MOUD, and other services at re-entry, but limited support for intervention effects on longer-term outcomes, including treatment retention, medication adherence, recidivism, and substance use. CONCLUSION: Future controlled trials and implementation studies should help to unpack and examine core components of jail re-entry interventions and their successful implementation to enhance treatment retention and improve post-release outcomes.

Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic.

BACKGROUND: The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS: The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS: The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS: The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.

Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S.

BACKGROUND: Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD "best practices" in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources. RESULTS: Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff. CONCLUSIONS: Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release.

Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state.

BACKGROUND: Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. METHODS: The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. RESULTS: Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses. CONCLUSION: The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.

Alcohol, tobacco, and nonmedical drug use disorders in U.S. Adults aged 65 years and older: data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions.

OBJECTIVES: To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older. DESIGN: The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample. SETTING: The United States. PARTICIPANTS: Eight thousand two hundred five adults aged 65 years and older. MEASUREMENTS: Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders. RESULTS: Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder. CONCLUSIONS: More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Methamphetamine use and high-risk sexual behaviors among incarcerated female adolescents with a diagnosed STD.

Juvenile detention settings provide an important venue for addressing the health-related needs of adolescent populations, who often have high rates of sexually transmitted diseases (STDs) and concomitant drug use. This study examines factors associated with methamphetamine use and risky sexual behaviors among 539 incarcerated female adolescents between ages 12-18 years with an STD diagnosis. Data were obtained from interviews with detainees receiving STD case management services within a California juvenile detention facility in January 2006-June 2007. High-risk behaviors characterized the sample, such as low use of condoms consistently (43.3%), prior STD infection (25%), pregnancy history (26%), arrest charge for prostitution or drug use (23%), and a history of prostitution (18%). Half of the sample reported weekly alcohol or drug use; most commonly used drugs were marijuana (37%), alcohol (21%), and methamphetamine (16%). In multivariate analysis, African Americans had a lower odds of methamphetamine use (odds ratio [OR] = .163) compared with whites. Detainees who reported inconsistent condom use had over twice the odds of methamphetamine use (OR = 2.7) compared with consistent condom users. In addition, those who reported alcohol use had twice the odds of methamphetamine use (2.0). There was a significant interaction between Latina ethnicity and having an arrest charge for drugs or prostitution; Latinas who had this charge had over 11 times the odds of using methamphetamine compared with those with other arrest charges (OR = 11.28). A better understanding of the relationship between drug use and sexual risk behaviors of STD-positive incarcerated female adolescents can inform the development of appropriate corrections and community-based interventions serving this segment of high-risk adolescents.