First-generation immigrants and hospital admission rates for psychosis and affective disorders: an ecological study in Ontario.

OBJECTIVE: The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas-Forward Sortation Areas (FSAs)-in Ontario. METHODS: Ontario's inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income. RESULTS: Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders. DISCUSSION: Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.

Increasing prevalence of cocaine as the primary detoxification diagnosis among admissions presenting with current intravenous drug use: a review of detoxification records from northern British Columbia, 1999-2005.

OBJECTIVES: This study sought to document the trends in drug use among intravenous drug users (IDUs) in northern British Columbia, and to discuss the public health implications. METHOD: We conducted a 7-year medical-chart review of all IDU-related admissions (n = 2072) to an inpatient alcohol and drug detoxification centre in Prince George, British Columbia. Primary detoxification diagnosis was modeled onto year of admission using generalized estimating equations (GEE). RESULTS: Our study demonstrated an increasing prevalence of cocaine as the primary detoxification diagnosis in IDU-related admissions in northern BC, from 32% of all IDU admissions in 1999 to 64% in 2001, and then a relatively steady elevated rate of approximately 60% between 2001-2005. CONCLUSIONS: Given that needle exchange programs and other harm reduction services for IDUs in British Columbia are not readily available in many northern and rural areas, the risks associated with intravenous cocaine use among northern IDUs represent a serious public health challenge. Tailored harm reduction strategies should take into account the prominence of intravenous cocaine use as an HIV risk factor. In areas without well-established intravenous drug use monitoring programs, such as rural and remote areas, detoxification treatment records may serve as important sentinels for changing drug use patterns among IDUs.

The prominence of smoking-related mortality among individuals with alcohol- or drug-use disorders.

INTRODUCTION AND AIMS: Even though individuals with substance-use disorders have a high prevalence of tobacco smoking, surprisingly little is known about smoking-related mortality in these populations. The current retrospective cohort study aims to address this gap. DESIGN AND METHODS: The study sample included cohorts of individuals hospitalised in California between 1990 and 2005 with alcohol- (n = 509 422), cocaine- (n = 35 276), opioid- (n = 53 172), marijuana- (n = 15 995) or methamphetamine-use (n = 36 717) disorders. Death records were linked to inpatient data. Age-, race- and sex-adjusted standardised mortality ratios (SMR) were generated for 19 smoking-related causes of death. RESULTS: Smoking-related conditions comprised 49% (79 188/163 191) of total deaths in the alcohol, 40% (1412/3570) in the cocaine, 39% (4285/11 091) in the opioid, 42% (554/1332) in the methamphetamine and 36% (1122/3095) in the marijuana cohorts. The SMRs for all smoking-linked diseases were: alcohol, 3.57 (95% confidence interval [CI] = 3.55 to 3.58); cocaine, 2.40 (95% CI = 2.39 to 2.41); opioid, 4.26 (95% CI = 4.24 to 4.27); marijuana, 3.73 (95% CI = 3.71 to 3.74); and methamphetamine, 2.58 (95% CI = 2.57 to 2.59). The SMRs for almost all of the 19 cause-specific smoking-related outcomes were elevated across cohorts. DISCUSSION AND CONCLUSIONS: Given the current findings, addressing tobacco smoking among persons with substance-use disorders should be a critical concern, especially given the heavy smoking-related mortality burden and the currently limited attention devoted to smoking in these populations. [Callaghan RC, Gatley JM, Sykes J, Taylor L. The prominence of smoking-related mortality among individuals with alcohol- or drug-use disorders. Drug Alcohol Rev 2018;37:97-105].

Comparative hazards of acute myocardial infarction among hospitalized patients with methamphetamine- or cocaine-use disorders: A retrospective cohort study.

BACKGROUND: It is assumed that recreational use of methamphetamine can trigger acute myocardial infarction (AMI) events, but estimates of longitudinal hazards of AMI among methamphetamine users are lacking. METHODS: Retrospective cohort study: Competing-risks analysis was used to estimate time-to-AMI patterns in methamphetamine versus matched appendicitis (population-proxy) and matched cocaine (drug-control) groups. Cohorts were propensity-score-matched using demographic and clinical variables. SETTING: California, 1990-2005. PARTICIPANTS: Cohorts of individuals with no prior or concurrent history of AMI hospitalized with methamphetamine- (n = 73,056), cocaine- (n = 47,726), or appendicitis-related conditions (n = 330,109). MEASUREMENTS: ICD-9/ICD-10 indications of AMI (ICD-9 410.X; ICD-10 I21.X) in death records or inpatient hospital data. RESULTS: Patients in methamphetamine cohort were more likely to develop subsequent AMI in comparison to those in matched appendicitis cohort [Hazard ratio (HR): 1.41; 95% CI, 1.23-1.62, p < 0.0001], with increased risk most marked in young methamphetamine users (age 15-34 years; HR: 2.04; 95% CI, 1.63-2.57, p = 0. 0001). Risk was slightly increased vs. that in matched cocaine group (HR: 1.19; 95% CI, 1.02-1.39, p = 0. 029). Individuals in cocaine cohort were also more likely to experience AMI outcome vs. appendicitis cohort (HR: 1.25; 95% CI, 1.08-1.45, p = 0. 0023). CONCLUSION: Our longitudinal data support results of earlier epidemiological studies suggesting that persons with methamphetamine- (or cocaine-) use disorders might have increased AMI risk. However, because of potential study limitations and the unexpectedly modest magnitude of the observed increased AMI hazard, these findings must be considered preliminary and require replication.

Do total smoking bans affect the recruitment and retention of adolescents in inpatient substance abuse treatment programs? A 5-year medical chart review, 2001-2005.

Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population ( approximately 80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between cigarette-smoking bans and key clinical outcomes. The current study examined the medical charts of all adolescents (N = 520) admitted to the only adolescent hospital-based substance abuse treatment program in the northern two thirds of the province of British Columbia, Canada. During the span of the study period (March 2001-December 2005), the treatment site moved from a partial smoking ban to a total smoking ban, and then retreated to partial smoking ban. The total smoking ban was not associated with a lower proportion of adolescent smokers seeking treatment at the facility or a lower treatment completion rate among smokers. Total smoking bans do not appear to be an obstacle for adolescent smokers seeking residential substance abuse treatment, nor do total smoking bans appear to compromise the treatment completion rates of smokers in comparison to nonsmokers. Despite these null findings, the effective implementation of smoke-free policies in adolescent substance abuse treatment programs requires not only large-scale organizational change but also the transformation of current commonly held beliefs about tobacco dependence in addictions treatment and recovery communities.

A case-matched comparison of readmission patterns between primary methamphetamine-using and primary cocaine-using adolescents engaged in inpatient substance-abuse treatment.

OBJECTIVE: In the United States and Canada, elevated patterns of methamphetamine-related treatment admissions among youth have triggered questions about appropriate substance-abuse treatment strategies for methamphetamine-using adolescents. This study aimed to provide a comparative examination of the readmission patterns of primary methamphetamine-using and primary cocaine-using adolescents to a cognitive behavioral therapy (CBT)-based alcohol-and-drug inpatient treatment program. METHODS: The current study employed a 5-year medical-chart review of all consecutive admissions to an inpatient, hospital-based substance-abuse treatment program for adolescents in northern British Columbia, Canada. After using a propensity-score-matching approach to construct a case-matched sample (n=202) of primary methamphetamine-using and primary cocaine-using adolescents, we employed a Kaplan-Meier survival analysis technique to test group differences in time-to-readmission. RESULTS: The findings demonstrated that the methamphetamine group did not have a more severe time-to-readmission profile. CONCLUSIONS: General CBT-based treatment-as-usual approaches appear to produce similar long-term readmission outcomes for these two groups of treatment-seeking adolescents.

Mobility patterns of Aboriginal injection drug users between on- and off-reserve settings in northern British Columbia, Canada.

OBJECTIVES: In Canada, public health policymakers and Aboriginal health service leaders have warned that the reciprocal movement of Aboriginal injection drug users (IDUs) between urban and rural settings may serve as a critical vector for the continuing spread of HIV among Aboriginal peoples. The current study aimed to describe the mobility patterns of Aboriginal injection drug users between on- and off-reserve locations in northern British Columbia. STUDY DESIGN: Retrospective medical-chart review of inpatient detoxification records. METHODS: We employed a medical-chart review of all self-reported Aboriginal IDUs (n = 302) admitted at least twice to an adult inpatient hospital-based substance-abuse detoxification treatment centre between 4 January 1999 and 31 December 2005, and analysed place-of-residence transitions between on- and off-reserve settings. RESULTS: Over the course of the 7-year study period, 26% (n = 73) of Aboriginal IDUs changed their primary residence from an off-reserve to an on-reserve location. Almost all (96%, n = 23) of those living on-reserve at their first IDU-related admission had moved to an off-reserve setting at a subsequent visit. CONCLUSIONS: The high rates of reciprocal movement between on- and off-reserve locations are a critical public health concern. The results show that the problems associated with both IDU and infectious disease are not limited to urban centres. Our results stand as a clear call for support of Aboriginal-directed, culturally appropriate and accessible services to reduce IDU-related harms. The specifics of such programs are a topic for Aboriginal health care leaders and the communities themselves to discuss, develop and implement.

Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model.

The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.

Recovery and URICA stage-of-change scores in three marijuana treatment studies.

Data from three outpatient studies of treatment of marijuana dependence were used to test whether behavior change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The primary analyses employed paired-sample t tests of statistical equivalence and sign tests, and 34 out of the 36 tests demonstrated that individuals remaining in the preaction stages of change over the treatment period showed clinically important and statistically significant treatment outcomes. Clinicians and researchers should exercise caution in their use of URICA-based indices as meaningful markers of the recovery process. Better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions.

The clinical characteristics of adolescents reporting methamphetamine as their primary drug of choice: an examination of youth admitted to inpatient substance-abuse treatment in northern British Columbia, Canada, 2001-2005.

We conducted a 5-year medical-chart review of all admissions to an inpatient adolescent substance-abuse program. Youth indicating methamphetamine as their primary drug of choice did not have worse dropout rates or a more severe baseline profile on 4 Addiction Severity Index subscales (Family/Social Conflict, Legal, Psychological, and Medical), compared to adolescents reporting another drug of choice.

A national survey of primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005 to 2006.

OBJECTIVE: Adolescent methamphetamine use has become a key issue for Canadian media and governments. Empirical studies, however, have not yet established the national scope of adolescent methamphetamine use or its impact on treatment services in Canada. The objective of the current study was to provide results from a national survey of primary methamphetamine-related admissions to Canadian residential substance abuse treatment facilities for youth. METHOD: We developed a comprehensive list of all Canadian residential substance abuse treatment facilities for youth, and then, we asked the executive director (or equivalent) of each facility about the site's annual caseload and the proportion of primary methamphetamine-related admissions during the previous 12 months. RESULTS: Responses were received from 46 of the 50 centres on our final master list. About 20% (1109/5169) of all national admissions to youth residential substance abuse treatment facilities were reported to be primarily due to methamphetamine use. A large majority of primary methamphetamine-related admissions occurred in British Columbia and Alberta. CONCLUSIONS: Adolescent methamphetamine use has had a major impact on entries into residential substance abuse treatment facilities in British Columbia and Alberta, while only a few centres outside these 2 western provinces have experienced elevated rates of primary methamphetamine-related admissions. Given the paucity of studies on adolescent methamphetamine treatment, future research needs to focus on developing effective clinical strategies in this area.

A gendered analysis of Canadian Aboriginal individuals admitted to inpatient substance abuse detoxification: a three-year medical chart review.

This study examined gender differences within a sample of Canadian Aboriginal individuals admitted to an inpatient, hospital-based substance abuse detoxification program. Even though alcohol was the most frequent primary drug of detoxification for both genders, women received proportionately higher rates of cocaine or opiate detoxification diagnoses. In addition to a younger age, females reported higher rates of physical and sexual abuse. Women were also administered antidepressants, antibiotic medication protocols, and more medical evaluation tests. It appears that Canadian Aboriginal women have a diverse set of psychological and medical needs. This study demonstrates the need for detoxification programs to address the substantial rates of intravenous drug use and the associated risk of infectious disease (eg, Hepatitis C, HIV) among this treatment-seeking population.