One-year sobriety improves satisfaction with life, executive functions and psychological distress among patients with polysubstance use disorder.

INTRODUCTION: Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder (SUD), with a higher risk of developing comorbid psychiatric symptoms, more pervasive deficits in cognitive functions, and inferior treatment results. The present study investigates if individuals with polysubstance use disorder who achieve at least one year of abstinence show greater improvements in satisfaction with life, executive functions, and psychological distress, compared to relapsers and controls. The prospective recovery from polysubstance use disorder assessed with broad output indicators remains understudied. A better understanding of the pattern of recovery of the chosen output indicators could shed light on the recovery process for this group of patients. MATERIAL AND METHODS: We investigated changes in satisfaction with life, executive functions and psychological distress over a period of 12months in patients who remained abstinent and in those who relapsed. Subjects with polysubstance use disorder (N=115) were recruited from outpatient and residential treatment facilities; healthy controls (N=34) were recruited by posters exhibited at social welfare and GP offices. Executive functions were assessed by the Behaviour Rating Inventory of Executive Function-Adult self-report version (BRIEF-A), psychological distress by the Symptom Checklist-90-R (SCL-90-R), and satisfaction with life by the Satisfaction With Life Scale (SWLS). Substance use was assessed by self-reports on the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Participants were categorized as "relapsers" if they had AUDIT score ≥8, or DUDIT score ≥2 for women and ≥6 for men. RESULTS: Results indicated that the abstinent group had the greatest improvement on all the indicators compared with relapsers and controls. Participants who successfully quit substance use for one year showed improved satisfaction with life, executive functions, and psychological distress compared to participants who relapsed and controls. CONCLUSIONS: Our study provides support for the view that there is a clinically and statistically significant recovery of satisfaction with life, executive functions, and psychological distress for SUD patients following one-year of abstinence. This knowledge highlights the importance of time and continued abstinence. Our findings suggest that a gradual and careful step-up of learning requirement should be adopted, and SUD treatment should initially focus on stabilizing the patient and achieving abstinence, while interventions for co-morbid problems and more cognitively demanding treatment components are more likely to succeed later in the treatment sequence.

One-year abstinence improves ADHD symptoms among patients with polysubstance use disorder.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a common comorbid disorder in patients suffering from substance use disorder (SUD). Individuals with co-occurring SUD and ADHD are more likely than SUD patients without ADHD to have developed SUD at a younger age, be polysubstance users, and need inpatient treatment more often. The present study investigates whether individuals with polysubstance use disorder who remain abstinent for a year after entering treatment have a more substantial reduction in ADHD symptoms than those who relapsed and controls. MATERIAL AND METHODS: Subjects were SUD patients (N = 115) and healthy controls (N = 34). ADHD symptoms were assessed using the adult ADHD Self-Report Scale (ASRS). Substance use was assessed by self-reports on the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Participants were defined as having relapsed if they had an AUDIT score ≥ 8 or a DUDIT score ≥ 2 for women and ≥ 6 for men. RESULTS: Patients who remained abstinent for one year reported a substantial reduction of ADHD symptoms compared to patients who relapsed and controls. CONCLUSIONS: Abstinence alleviates ADHD symptoms among patients with polysubstance use disorder. We suggest that confirmation of an ADHD diagnosis should follow a period of abstinence to avoid identification of false-positive cases.

Assessment of Executive Function in Patients With Substance Use Disorder: A Comparison of Inventory- and Performance-Based Assessment.

INTRODUCTION: Chronic polysubstance abuse (SUD) is associated with neurophysiological and neuroanatomical changes. Neurocognitive impairment tends to affect quality of life, occupational functioning, and the ability to benefit from therapy. Neurocognitive assessment is thus of importance, but costly and not widely available. Therefore, in a busy clinical setting, procedures that include readily available measures targeting core cognitive deficits would be beneficial. This paper investigates the utility of psychometric tests and a questionnaire-based inventory to assess "hot" and "cold" neurocognitive measures of executive functions (EF) in adults with a substance use disorder. Hot decision-making processes are associated with emotional, affective, and visceral responses, while cold executive functions are associated with rational decision-making. MATERIAL AND METHODS: Subjects with polysubstance abuse (n=126) and healthy controls (n=32) were compared on hot (Iowa Gambling Task) and cold (Stroop and the Trail Making Test) measures of EF, in addition to a questionnaire assessing everyday EF related problems (BRIEF-A; Behavior Rating Inventory of Executive Function - Adult, self-report version). Information about the substance abuse and social adjustment were assessed by self-report. Logistic regression analyses were applied to assess independent correlates of SUD status and social adjustment. A multiple linear regression was performed to predict the number of previous treatment attempts. RESULTS: The psychometric test of hot EF (the Iowa Gambling Task) did not differentiate the patients with polysubstance abuse from controls, and was not associated with social adjustment. The psychometric tests of cold EF distinguished somewhat between the groups and were associated with one indicator of social adjustment. The BRIEF-A differentiated between groups on all the clinical scales and was associated with three out of five social adjustment indicators ("criminal lifestyle," "conflict with caregiver," and "stable housing."). CONCLUSIONS: The BRIEF-A inventory was the most sensitive measure of executive function in patients with substance use disorder, followed by measures of cold executive function. BRIEF-A should therefore be considered as an integral part of the clinical routine when assessing patients with SUD.

Traffic behaviour among adolescents using mopeds and light motorcycles.

INTRODUCTION: Motorcycling is recognized to be a relatively risky activity. Powered two wheelers (PTW) are classified as mopeds, light, and heavy motorcycles, the first two categories being denoted light PTWs. This paper reviews the scientific literature on accident risks and traffic behavior among users of light PTWs with the aim of clarifying the current state of knowledge. METHOD: Based on a risk analytical and an anthropological perspective on motorcycling, the paper discusses the significance of cultural and social factors as important aspects of safety. More targeted and effective safety measures, for example better training programs, are needed to prevent motorcycle accidents. This means developing a deeper understanding of the rider as an individual, and the individuals within different groups and settings. Why and how motorcyclists approach the road, its function as a social arena, the varieties of goals and values, and the motorcyclists' own perceptions of the behavior that ensures their "achievements" or "successes", are some of the issues. Today, this kind of knowledge is scarce and almost entirely absent from the scientific literature. RESULTS: We conclude that the massive quantities of data on numbers of accidents, the categorization of situations, the causal explanations related to speed, gender, age, lack of concentration so forth, can only be employed as support for safety measures as long as they are linked to social and cultural factors. IMPACT ON INDUSTRY: Risk informed decision making has become an integral part of authorities' and manufacturers' implementation of safety measures. This tendency is strengthened by the fact that the responsibility of product safety rests upon the manufacturers, cf. for example EU safety regulations. Therefore it is paramount that a thorough understanding of social and cultural factors related to the PTW driving is necessary for the industry to develop targeted and efficient safety measures.