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1.
Fam Community Health ; 46(1): 1-12, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36383229

RESUMEN

Despite concerns about negative neurocognitive effects of in utero substance exposure on child and brain development, research in this area is limited. This study gathered perspectives of persons with lived experience of substance use (eg, alcohol, prescription and illicit opioids, and other illicit substances) during a previous pregnancy to determine facilitators and barriers to research engagement in this vulnerable population. We conducted structured, in-depth, individual interviews and 2 focus groups of adult persons with lived experience of substance use during a previous pregnancy. Questions were developed by clinical, research, bioethics, and legal experts, with input from diverse stakeholders. They inquired about facilitators and barriers to research recruitment and retention, especially in long-term studies, with attention to bio-sample and neuroimaging data collection and legal issues. Interviews and focus groups were audio-recorded, transcribed, and analyzed using inductive coding qualitative analysis methods. Ten participants completed in-depth interviews and 7 participated in focus groups. Three main themes emerged as potential barriers to research engagement: shame of using drugs while pregnant, fear of punitive action, and mistrust of health care and research professionals. Facilitative factors included trustworthiness, compassion, and a nonjudgmental attitude among research personnel. Inclusion of gender-concordant recovery peer support specialists as research team members was the most frequently identified facilitator important for helping participants reduce fears and bolster trust in research personnel. In this qualitative study, persons with lived experience of substance use during a previous pregnancy identified factors critical for engaging this population in research, emphasizing the involvement of peer support specialists as research team members.


Asunto(s)
Atención a la Salud , Trastornos Relacionados con Sustancias , Adulto , Embarazo , Niño , Femenino , Humanos , Investigación Cualitativa , Grupos Focales
2.
Addict Behav ; 136: 107491, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36115085

RESUMEN

Problematic substance use during adolescence predicts numerous adverse outcomes, including increased risk of substance use disorders in adulthood. Adolescents often use substances to cope with stress, particularly adolescents who have experienced environmental stress in childhood (e.g., low-income environments), but research indicates stress-related substance use disorders may develop differently across gender. This highlights a need to identify coping resources for stress-related substance use and understand whether these coping resources are differentially effective across gender. Mindfulness has garnered evidence as a coping resource for stress-related problematic substance use; however, there is limited research on how specific mindfulness facets (e.g., nonjudgment) may buffer against stress-related substance use among adolescents. This study examined whether overall mindfulness and specific facets buffered the association between stress and substance use differentially across gender in a predominantly low-income, racially-diverse (42 % Black, 24 % White, 15 % Hispanic/Latinx, 13 % Asian, 3 % American Indian/Alaskan Native, and 3 % multiracial) sample of adolescents (n = 212) using moderated moderation models. Girls with lower levels of two mindfulness facets (i.e., acceptance/nonjudgement, decentering/nonreactivity), relative to girls with higher levels, demonstrated a greater probability of substance use with increased stress. Conversely, boys with higher levels of acceptance/nonjudgement and decentering/nonreactivity, relative to boys with lower levels, reported a greater probability of substance use with increased stress. Results suggest that acceptance/nonjudgment and decentering/nonreactivity may be protective against stress-related substance use for girls and potentially contraindicated for boys, indicating that adolescent substance use prevention and intervention efforts may need to be tailored by gender.


Asunto(s)
Atención Plena , Trastornos Relacionados con Sustancias , Adaptación Psicológica , Adolescente , Adulto , Femenino , Humanos , Masculino , Atención Plena/métodos , Pobreza , Factores Sexuales , Trastornos Relacionados con Sustancias/epidemiología
3.
Addict Behav ; 136: 107493, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36137447

RESUMEN

OBJECTIVE: We examined the direct and indirect effects of older siblings' substance use behaviors (i.e., cannabis and e-cigarettes) on younger siblings' later substance use intentions via their substance use expectations. MATERIAL AND METHODS: Data were collected from 682 families (N = 2,046) with two adolescent siblings (older siblings: M age = 15.67 years, 51% female; younger siblings: M age = 13.14 years, 48% female) and one parent (M age = 45.15 years; 85% female). Participants completed annual online surveys at two occasions. Older siblings reported on their cannabis and e-cigarette use frequencies (Time 1) and younger siblings reported on their substance use expectations (Time 1) and intentions (Time 1 and 2); parents reported on adolescents' sociodemographic characteristics and their own substance use (Time 2). RESULTS: Structural equation modeling results suggested that older siblings' cannabis and e-cigarette use was indirectly related to younger siblings' later intentions to use these substances through their positive expectations about substances, after accounting for younger siblings' earlier intentions to use substances and control variables including parents' and friends' use. There were no significant direct relations between older siblings' cannabis or e-cigarette use and younger siblings' intentions to use them. CONCLUSIONS: Findings indicate that older siblings are critical and unique socialization agents of younger siblings' expectations and intentions to use substances. Intervention and prevention programs that target adolescents' substance use should consider the ways in which siblings shape each other's substance use.


Asunto(s)
Conducta del Adolescente , Cannabis , Sistemas Electrónicos de Liberación de Nicotina , Trastornos Relacionados con Sustancias , Adolescente , Femenino , Humanos , Intención , Masculino , Persona de Mediana Edad , Motivación , Relaciones entre Hermanos , Hermanos , Trastornos Relacionados con Sustancias/epidemiología
4.
Addict Behav ; 136: 107492, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36156454

RESUMEN

BACKGROUND: Prior research indicates rising methamphetamine use and harms in the U.S., potentially related to increases in methamphetamine injection. To date, research on trends and correlates of methamphetamine injection is limited. METHODS: Analysis of trends and correlates of methamphetamine injection among treatment admissions among persons aged ≥ 12 whose primary substance of use at admission is methamphetamine. Data are from the Treatment Episode Data Set. Analyses includes descriptive statistics, trend analyses, and multilevel multivariable logistic regression. RESULTS: Primary methamphetamine treatment admissions increased from 138,379 in 2010 to 201,021 in 2019. Among primary methamphetamine admissions, injection as the usual route of use increased from 24,821 (18.0 % of admissions) in 2010 to 55,951 (28.2 % of admissions) in 2019. Characteristics associated with increased adjusted odds of reporting methamphetamine injection included: males (aOR = 1.13, 95 % CI = 1.10-1.15); admission age 25-34 years (aOR = 1.23, 95 % CI = 1.19-1.28) and 35-44 years (aOR = 1.12, 95 % CI = 1.08-1.17) compared to age 18-24; dependent living (aOR = 1.33, 95 % CI = 1.29-1.37) and homelessness (aOR = 1.58, 95 % CI = 1.54-1.63) compared to independent living; part-time employment (aOR = 1.08, 95 % CI = 1.02-1.14), unemployment (aOR = 1.39, 95 % CI = 1.34-1.44) and not in labor force (aOR = 1.43, 95 % CI = 1.37-1.49) compared to full-time employment; one to ≥ four prior treatment admissions (aORs ranging from 1.19 to 1.94) compared to no prior admissions; also reporting use of cocaine (aOR = 1.10, 95 % CI = 1.05-1.16), heroin (aOR = 3.52, 95 % CI = 3.40-3.66), prescription opioids (aOR = 1.61, 95 % CI = 1.54-1.67), or benzodiazepines (aOR = 1.42, 95 % CI = 1.32-1.52) at treatment admission. CONCLUSIONS: Findings lend further evidence to a resurgence of methamphetamine use that is intertwined with the ongoing opioid crisis in the U.S. Efforts to expand evidence-based prevention, treatment, and response efforts, particularly to populations at highest risk, are urgently needed.


Asunto(s)
Cocaína , Metanfetamina , Trastornos Relacionados con Sustancias , Analgésicos Opioides , Benzodiazepinas , Heroína , Humanos , Masculino
5.
Addict Behav ; 136: 107501, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36181745

RESUMEN

BACKGROUND: Simultaneous alcohol and cannabis (SAC) use is associated with more negative consequences than independent use of alcohol or cannabis. Contextual characteristics of drinking episodes are associated with the quantity of alcohol consumed and related risk. This study examined whether drinking contexts may also be associated with SAC use. METHODS: National Survey on Drug Use and Health (NSDUH) 2010-2019 data from past 30-day drinkers aged 12-20 (n = 39,456) were used. A weighted multivariable logistic regression model examined associations between contextual characteristics (alcohol source, number of people, drinking location) and SAC use during their most recent drinking occasion. Models adjusted for survey year, heavy episodic drinking, age, sex, race/ethnicity, student status, and metropolitan area status. RESULTS: More than one-in-five drinkers reported SAC use. Compared to getting alcohol from parents/family, those who took it from a home (OR = 1.51,95 %CI = 1.24,1.84), got it for free another way (OR = 2.30,95 %CI = 2.05,2.59), paid someone else for it (OR = 2.83,95 %CI = 2.46,3.25), or purchased it themselves (OR = 3.12,95 %CI = 2.66,3.67) had higher odds of SAC use. Compared to drinking alone, drinking with more than one person was associated with higher odds of SAC use (OR = 1.36,95 %CI = 1.12,1.66). Compared to drinking in their home, drinking in a bar (OR = 0.51,95 %CI = 0.41,0.64) had lower odds of SAC use, whereas drinking in someone else's home (OR = 1.12,95 %CI = 1.02,1.22), a car (OR = 1.36,95 %CI = 1.04,1.77), or multiple locations (OR = 1.29,95 %CI = 1.09,1.53) had higher odds of SAC use. CONCLUSIONS: Findings suggest that alcohol-related contextual characteristics are associated with SAC use among underage drinkers. Laws addressing underage alcohol consumption, including social host liability and sales to minors laws, may also decrease simultaneous cannabis use.


Asunto(s)
Cannabis , Trastornos Relacionados con Sustancias , Consumo de Alcohol en Menores , Consumo de Bebidas Alcohólicas/epidemiología , Encuestas Epidemiológicas , Humanos , Estados Unidos/epidemiología
6.
Artículo en Inglés | MEDLINE | ID: mdl-36029929

RESUMEN

Sleep disturbances are strongly linked with mental diseases such as substance use disorder (SUD) or schizophrenia (SZ) which can have a detrimental impact on quality of life (QOL), especially when both disorders are comorbid (dual disorder). In absence of studies about both circadian characteristics and QOL in patients with SUD and comorbid SZ (SUD + SZ), we examined a sample of 155 male under treatment, 75 with SUD + SZ and 80 only with SUD. Circadian functioning was evaluated by chronotype, social jet-lag and sleep quality (using the Pittsburgh Sleep Quality Index, PSQI), while the QOL was obtained by the World Health Organization's Quality of Life Questionnaire (WHOQOL)-BREF. SUD + SZ patients were more evening type than SUD, and this chronotype was linked to polydrug use in total sample and SUD + SZ group. We observed that the comorbidity did not lead to worse sleep quality in the SUD and SUD + SZ patients. QOL was poorer in SUD + SZ patients, who showed a negative association of Physical health, Psychological health and Social relationship with suicide attempts and severity of SZ. Lastly, patients with worse QOL also reported poorer sleep quality suggesting that treatment could include circadian adjustments along with a focused approach to lifestyle improvement.


Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Trastornos Relacionados con Sustancias , Humanos , Masculino , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Calidad de Vida , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Comorbilidad
7.
Int J Offender Ther Comp Criminol ; 67(1): 3-16, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-35435024

RESUMEN

There are cases in forensic psychiatric evaluations with inconclusive information or with important information missing. In such situations, when new information becomes available the judge may ask an expert to supplement his/her report in the light of new information. For the purpose of this study, we collected 42 supplemental evaluations written in the University Psychiatric Hospital Vrapce to determine possible factors which were associated with changes in supplemental evaluations. The following data were gathered: demographic data, types of criminal offenses, reasons for the supplement evaluation, court questions, and diagnoses. Changes in supplemental evaluations occured more often when the defendants were diagnosed with a personality disorder (PD) only, compared to those who had a PD with a comorbidity, especially substance use disorders. Defendants with the diagnosis of a substance use disorder were 63.7% less likely to have changed experts' evaluations. The evaluations remained the same when the reason for supplemental evaluations were new witnesses' testimonies. Considering the principle of economy of actions in a judiciary system, a more critical approach should be taken when the judge requests a supplemental report.


Asunto(s)
Trastornos Mentales , Trastornos Relacionados con Sustancias , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Testimonio de Experto , Defensa por Insania , Psiquiatría Forense , Trastornos de la Personalidad/diagnóstico , Medicina Legal , Trastornos Relacionados con Sustancias/diagnóstico
8.
J Interpers Violence ; 38(1-2): NP60-NP83, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35236175

RESUMEN

Stalking is a serious public health problem, estimated to affect about 15% of women and 6% of men. Victims of stalking have been reported to be at increased risk for psychological distress, depression, lowered social and daily functioning, and other forms of victimization. The present study sought to determine whether individuals with documented histories of childhood maltreatment and those with psychiatric disorders are at increased risk for stalking victimization. Participants included maltreated children and matched controls (N = 892) from a Midwestern, metropolitan area who were followed up into adulthood. Psychiatric disorders (major depressive disorder, post-traumatic stress disorder, antisocial personality disorder, and substance use disorders) were assessed at mean age 29 and borderline personality disorder at age 39. Participants reported lifetime stalking using the Lifetime Trauma and Victimization History instrument and based on a separate measure, past year intimate partner stalking victimization. Analyses controlled for sex, race, and age. Depression, PTSD, antisocial, and borderline personality disorders were associated with increased lifetime risk for stalking victimization. Childhood maltreatment, neglect, and psychiatric disorders (substance use, PTSD, antisocial personality, and borderline personality) predicted increased risk for past year stalking victimization. Findings indicated sex differences in lifetime risk of stalking victimization and race differences in past-year stalking victimization. Although the results reveal relationships among child maltreatment, psychiatric disorders, and stalking victimization, the impact of childhood maltreatment is most salient in terms of past year intimate partner stalking victimization, and particularly for individuals with histories of neglect. Future research is needed to better understand these race and sex differences in stalking victimization.


Asunto(s)
Maltrato a los Niños , Víctimas de Crimen , Trastorno Depresivo Mayor , Acecho , Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Niño , Femenino , Humanos , Masculino , Adulto , Acecho/psicología , Víctimas de Crimen/psicología , Maltrato a los Niños/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología
9.
J Interpers Violence ; 38(1-2): NP212-NP236, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35341388

RESUMEN

Sexual violence (SV) is common among college students, but the vast majority of these experiences are not formally reported to institutions of higher education (IHEs). While it is well known that alcohol and drug use is highly associated with SV, little is known about whether policies and procedures regarding substance use (SU) at IHEs may contribute to low rates of reporting. This study describes the association between SU violations and SV reporting at IHE campuses in the US and examines whether SU amnesty policies are associated with more SV reporting. Linear regression was used to estimate the association between SU violations and SV reporting and assess differences between IHE campuses by amnesty policy status. Around 50% of campuses between 2001 and 2018 document neither SV reports nor SU violations. IHE campuses with amnesty policies have more SV reports. On average, IHEs with amnesty policies have 2.7 SV reports per 1000 students and an additional 0.02 SV reports for each SU violation per 1000 students. Amnesty policies that reduce the potential costs of reporting like facing disciplinary action for alcohol or drug use are positively associated with both the level and rate of SV reporting. Institutions of higher education administrators interested in making reporting an option for more SV survivors should examine how their policies, especially those related to alcohol, may play in creating barriers to SV reporting.


Asunto(s)
Delitos Sexuales , Trastornos Relacionados con Sustancias , Humanos , Universidades , Estudiantes , Políticas
10.
J Interpers Violence ; 38(1-2): NP311-NP335, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35466765

RESUMEN

Adverse childhood experiences (ACEs) have been linked to a host of subsequent negative health and behavioral problems. However, the role of sex in the ramifications of early ACEs remains unclear, particularly for delinquency and substance use initiation in adolescence. A small body of research has produced mixed findings on sex differences in the relationship between ACEs and antisocial outcomes in adolescence, resulting in uncertainty about whether and how ACEs may operate differently for boys and girls. The current study drew on a high-risk group of adolescents (N=2455; Mage=15.4; 48% female; 50% Black, 23% Hispanic) from the Fragile Families and Child Wellbeing Study to examine the associations between accumulated ACEs across early childhood, and delinquency and substance use initiation of alcohol, cigarette, and cannabis in adolescence. We utilized mother and father reports on the exposure to seven different types of ACEs (i.e., physical abuse, psychological abuse, neglect, parental substance misuse, parental mental illness, parental intimate partner violence, and parental criminal behavior) when adolescents were ages 1, 3, and 5. Total ACEs scores and their relationships with delinquency, and lifetime use of alcohol, cigarettes, and cannabis were assessed separately for girls and boys. Results suggested that accumulated ACEs during early childhood may be implicated in boys' delinquency, while ACEs were not significantly associated with girls' self-reported delinquency or for boys' and girls' substance use initiation. Findings suggest that the enduring consequences of ACEs may be sex-specific, and have implications for the development of policies to mitigate ACEs and their harms.


Asunto(s)
Experiencias Adversas de la Infancia , Trastornos Relacionados con Sustancias , Niño , Adolescente , Femenino , Preescolar , Humanos , Masculino , Caracteres Sexuales , Abuso Físico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología
11.
J Affect Disord ; 321: 33-40, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36273681

RESUMEN

BACKGROUND: The associations of current and remitted bipolar disorder (BD) with health-related quality of life (HRQOL) have been under-studied, and we aim to address these gaps. METHODS: The 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized adults in the US. Using DSM-5 criteria, three groups were operationalized as: 1) adults who met criteria for BD in the past year (i.e., current BD; n = 566 unweighted); and 2) adults who met criteria for BD previously but not in the past year (i.e., BD in remission; n = 187); and 3) adults with no BD in their lifetime (n = 35,556). HRQOL and quality-adjusted life years (QALYs) were compared by these groups. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates. RESULTS: Overall, 1.5 % of the study sample, representing 3.6 million adults nationwide, met criteria for current BD, and 0.5 %, representing 1.3 million adults, met criteria for BD in remission. Adults with current BD and BD in remission had lower mental HRQOL and QALYs, as compared to adults who never had BD. However, these differences were no longer significant when adjusted for behavioral co-morbidities (e.g., psychiatric and substance use disorders). CONCLUSION: Both current BD and BD in remission were adversely associated with HRQOL and QALYs, while these associations were not independent of behavioral co-morbidities. Because behavioral co-morbidities are common in individuals with current BD or those with BD in remission, they should be treated together to improve HRQOL.


Asunto(s)
Trastornos Relacionados con Alcohol , Trastorno Bipolar , Trastornos Relacionados con Sustancias , Humanos , Adulto , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Calidad de Vida , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Comorbilidad , Trastornos Relacionados con Sustancias/epidemiología
12.
J Affect Disord ; 320: 628-637, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36209778

RESUMEN

BACKGROUND: The general aggression model has shown that both individual and situational factors can predict aggression. However, past research has tended to discuss these two factors separately, which might lead to inconsistency. This study addresses this gap by examining the importance of each predictor of aggression in a Chinese compulsory drug treatment population and further explores the predictors of aggression in various substance use disorder populations. METHOD: Analyses were conducted using a sample of 894 male participants (mean = 38.30, SD = 8.38) in Chinese compulsory drug rehab. A machine learning model named LightGBM was employed to make predictions. We then used a game-theoretic explanatory technique, SHAP, to estimate the effect of predictors. RESULTS: In the full-sample model, psychological security, parental conflict, and impulsivity were the top 3 predictors. Depression, childhood abuse, and alexithymia positively predicted aggression, whereas psychological security, family cohesion, and gratitude negatively predicted aggression. There were significant differences in the predictive effects of depressants and stimulants. Although the importance of predictors varied between drug-use groups, several individual and situational factors were consistently the most important predictors. LIMITATIONS: All participants in this study were male, and the data were acquired through self-reports from the participants. Domestic and nondomestic aggression are not distinguished. Additionally, our findings cannot support causal conclusions. CONCLUSION: This study tested a series of classical theories of the predictors of aggression in China's compulsory drug treatment context and extended the ideas of the GAM to various substance use disorder groups. The findings have important implications for aggression treatment.


Asunto(s)
Maltrato a los Niños , Trastornos Relacionados con Sustancias , Humanos , Niño , Masculino , Femenino , Agresión/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Conducta Impulsiva , Aprendizaje Automático
13.
J Subst Abuse Treat ; 144: 108917, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36368259

RESUMEN

AIMS: Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DESIGN: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SETTINGS: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. PARTICIPANTS: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. MEASUREMENTS: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale. FINDINGS: Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only. CONCLUSIONS: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.


Asunto(s)
Personas sin Hogar , Trastornos Relacionados con Sustancias , Niño , Femenino , Humanos , Preescolar , Adolescente , Adulto Joven , Adulto , Vivienda , Madres , Autoeficacia , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/epidemiología
14.
J Subst Abuse Treat ; 144: 108928, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36370469

RESUMEN

BACKGROUND: Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use. METHODS: This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes. RESULTS: The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18-2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1-100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome. CONCLUSION: Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.


Asunto(s)
Trastornos Relacionados con Sustancias , Humanos , Adolescente , Análisis Costo-Beneficio , Trastornos Relacionados con Sustancias/terapia , Resultado del Tratamiento
15.
J Subst Abuse Treat ; 144: 108929, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36402124

RESUMEN

INTRODUCTION: Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. METHODS: We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. RESULTS: Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. CONCLUSIONS: Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.


Asunto(s)
Prueba de VIH , Trastornos Relacionados con Sustancias , Estados Unidos , Humanos , Estudios Transversales , Práctica Clínica Basada en la Evidencia , Analgésicos Opioides , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapia
16.
Addict Behav ; 137: 107530, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36308839

RESUMEN

This study aimed to explore the prospective associations between both alcohol and cannabis use (frequency and DSM-5 substance use disorder symptom counts) as they relate to academic performance over a period of âˆ¼ four years. The study members were students enrolled in college in the Southeastern United States (N = 209, 62 % female, 90 % white). Baseline survey data were obtained in the first year of college while participants finished the follow-up assessments âˆ¼ 1 and âˆ¼ 4 years from baseline (80+ % retention rates). We aimed to tease apart antecedent from consequence in the associations between substance use and academic performance using a sophisticated modeling technique that accounts for between-person influences in evaluating within-person change over time. Results showed that greater alcohol use disorder symptoms in the first year of college were associated with a within-person decline in grades in the second year of college. This was not demonstrated for alcohol or cannabis frequency, alcohol quantity, or cannabis use disorder symptoms or in relation to the later developmental transition out of college. In addition to widely implemented prevention efforts, these results indicate that screening first-year college students for alcohol use disorder symptoms and connecting them with resources and treatment may be beneficial in attempts to promote academic performance.


Asunto(s)
Éxito Académico , Alcoholismo , Trastornos Relacionados con Sustancias , Femenino , Humanos , Masculino , Universidades , Trastornos Relacionados con Sustancias/epidemiología , Estudiantes , Consumo de Bebidas Alcohólicas
17.
Addict Behav ; 137: 107536, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36334313

RESUMEN

BACKGROUND: There is significant heterogeneity in alcohol and cannabis use patterns among college students, with some engaging in use patterns that heighten their risk for adverse consequences. Person-centered approaches can help identify those subgroups of students with riskier use patterns. Latent Profile Analyses (LPA) were conducted to identify subgroups based on alcohol and cannabis use frequency and quantity, to explore demographic covariates and to examine mean differences across subgroups on alcohol- and cannabis-related consequences, simultaneous use, and other substance use. METHODS: Participants were 2,423 college students (Mage = 20.1; 72  % female) recruited from seven US universities who endorsed past-month alcohol and cannabis use and completed an online survey of substance use behaviors. RESULTS: A four-profile solution was the best fitting model. Profile 1 represented "light, infrequent alcohol and cannabis use" (73.8 %), Profile 2 represented "heavy, infrequent alcohol and moderate, frequent cannabis use" (15.9 %), Profile 3 represented "moderate, frequent alcohol and cannabis use" (5.6 %) and Profile 4 represented "very heavy, frequent alcohol and heavy, frequent cannabis use" (4.7 %). Students who identify as male, White non-Hispanic, and/or Greek-affiliated were more likely to be in the heavy alcohol use profiles. Profiles 3 and 4 represent high-risk profiles, with both having a higher likelihood of simultaneous use, Profile 3 endorsing more cannabis consequences, and Profile 4 endorsing more alcohol consequences. CONCLUSION: Results suggest that heavy alcohol or heavy co-use heightens risk for serious adverse consequences.


Asunto(s)
Cannabis , Alucinógenos , Trastornos Relacionados con Sustancias , Masculino , Femenino , Humanos , Adulto Joven , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudiantes , Universidades , Etanol
18.
Addict Behav ; 137: 107539, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36343473

RESUMEN

PURPOSE: Research showing substance use decreases over the life course has focused primarily on heterosexual adults. We examined how age-related patterns of cocaine and methamphetamine use vary by sexual identity and gender among a national sample. METHODS: We included 191,954 adults aged 18-64 from the 2015-2019 National Survey on Drug Use and Health. We described the weighted prevalence of past-year cocaine and methamphetamine use and used logistic regressions to estimate relative odds of past-year cocaine and methamphetamine use by age, stratified by gender and sexual identity (heterosexual, gay/lesbian, bisexual). RESULTS: Cocaine and methamphetamine use was highest among lesbian, gay, and bisexual (LGB) adults compared to their heterosexual counterparts. Gay/lesbian men and women and bisexual men were also more likely to use cocaine at later ages. Heterosexual adults ages 26-34 (adjusted odds ratio [aOR] = 0.73; confidence interval [CI] = 0.65-0.83) were less likely than those 21-25 to report past-year cocaine use, but there were no differences between those ages 26-34 and 21-25 among any LGB sub-group. Heterosexual (aOR = 1.62; CI = 1.28-2.04) and gay (aOR = 2.93; CI = 1.26-6.80), men ages 26-34 were more likely to report past-year methamphetamine use than their counterparts ages 21-25. There were no age-related differences in past-year methamphetamine use between bisexual men and gay/lesbian women. CONCLUSIONS: Patterns of cocaine and methamphetamine use across the life course for LGB individuals differ from those of heterosexuals. This has implications for targeted prevention efforts to address stimulant use among minoritized populations.


Asunto(s)
Cocaína , Metanfetamina , Minorías Sexuales y de Género , Trastornos Relacionados con Sustancias , Adulto , Masculino , Femenino , Estados Unidos/epidemiología , Humanos , Acontecimientos que Cambian la Vida , Bisexualidad , Heterosexualidad , Trastornos Relacionados con Sustancias/epidemiología
19.
Int J Qual Stud Health Well-being ; 18(1): 2149097, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36419342

RESUMEN

PURPOSE: This research examines the implementation of the Icelandic Prevention Model (IPM) in Canada to identify opportunities revealed by the COVID-19 pandemic to re-design our social eco-system to promote wellbeing. This paper has two objectives: 1) to provide a conceptual review of research that applies the bioecological model to youth substance use prevention with a focus on the concepts of time and physical space use and 2) to describe a case study that examines the implementation of the IPM in Canada within the context of the COVID-19 pandemic. METHOD: Study data were collected through semi-structured qualitative interviews with key stakeholders involved in implementing the IPM. RESULTS: Findings are organized within three over-arching themes derived from a thematic analysis: 1) Issues that influence time and space use patterns and youth substance use, 2) Family and community cohesion and influences on developmental context and time use and 3) Opportunities presented by the pandemic that can promote youth wellbeing. CONCLUSION: We apply the findings to research on the IPM as well as the pandemic to examine opportunities that may support primary prevention and overall youth wellbeing. We use the concepts of time and space as a foundation to discuss implications for policy and practice going forward.


Asunto(s)
COVID-19 , Trastornos Relacionados con Sustancias , Adolescente , Humanos , COVID-19/prevención & control , Islandia , Pandemias/prevención & control , Políticas
20.
Am J Geriatr Psychiatry ; 31(1): 67-74, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36266201

RESUMEN

Phenibut is a misused substance which has shown an increase in use over the past decade. Marketed as a "dietary supplement," it is not approved in the United States for use and is not regulated by the Food and Drug Administration. The substance, however, is readily available for purchase through online markets. It has a similar drug profile as alcohol, gabapentin and benzodiazepines. Clinical effects of this drug include physiologic dependence, euphoria, anxiolysis, antispasticity, sedation, and possible nootropic properties. While there are emerging new cases of managing phenibut withdrawal, no cases currently feature phenibut addiction and withdrawal management in the geriatric population. Here we discuss such a case of phenibut addiction and withdrawal in a 68-year-old male who initially began misusing phenibut to alleviate anxiety and insomnia precipitated by worsening affective disorder, sedative, hypnotic, or anxiolytic use disorder, and alcohol use disorder.


Asunto(s)
Trastornos Relacionados con Sustancias , Ácido gamma-Aminobutírico , Anciano , Masculino , Humanos , Ácido gamma-Aminobutírico/uso terapéutico , Hipnóticos y Sedantes/efectos adversos , Trastornos Relacionados con Sustancias/epidemiología , Benzodiazepinas/efectos adversos
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