In an effort to enhance patient safety in Opioid Treatment Programs
(OTPs), the Substance Abuse and Mental Health Services Administration (SAMHSA)
convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone.
Panel members reviewed the literature, regulatory actions, professional
guidances, and OTPs’ experiences regarding adverse cardiac events
associated with methadone.
The Panel concluded that, to the extent possible, every OTP should have a
universal Cardiac Risk Management Plan (incorporating clinical assessment, ECG
assessment, risk stratification, and prevention of drug interactions) for all
patients, and should strongly consider patient-specific risk minimization
strategies (such as careful patient monitoring, obtaining ECGs as indicated by a
particular patient’s risk profile, and adjusting the methadone dose as
needed) for patients with identified risk factors for adverse cardiac events.
The Panel also suggested specific modifications to informed consent documents,
patient education, staff education, and methadone protocols.
The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs.
This longitudinal study examines comorbid trajectories of cigarette smoking and depressive mood from adolescence to adulthood and its association with low perceived self-control and low well-being in adulthood. Participants (N=607) were interviewed at six time waves. Growth mixture modeling (GMM) determined membership in joint trajectory groups of comorbid smoking and depressive mood from mean ages 14–32 years. Multivariate logistic regression was used to assess the associations between earlier trajectory group memberships and low perceived self-control and low well-being in adulthood. Trajectory groups characterized by earlier, comorbid chronic/heavy smoking and chronic/high depressive mood were most at risk for low perceived self-control and low well-being in adulthood. Counseling for adolescents and young adults with low perceived self-control and low well-being should address smoking and depressive mood. Interventions to reduce smoking and depressive mood may result in increased self-control and well-being.
Smoking; Depression; Public Health; Longitudinal Studies; Psychopathology
Homeless men on parole are a hard-to-reach population with significant community reintegration challenges. This cross-sectional study describes socio-demographic, cognitive, psychosocial and drug-related correlates of alcohol and methamphetamine use in 157 homeless male parolees (age range 18–60) enrolled in a substance abuse treatment center in Los Angeles. Logistic regression results revealed that being African American and older were negatively related to methamphetamine use, while being older and more hostile were related to riskier alcohol abuse. Findings from this study provide a greater understanding of correlates of methamphetamine and alcohol- two of the most detrimental forms of substances abused among currently homeless parolees.
Substance use; alcohol use; methamphetamine use; parolees; homeless
We examine the influence of family processes and acculturation for gender differences in alcohol and drug use among a sample representative of the Hispanic population in Miami-Dade County, Florida (N= 734). We find that (a) increases in age at marriage and acculturation were associated with greater substance use, (b) the associations between age at marriage, acculturation, and substance use were found to be greater for Hispanic women than men, and (c) with each additional child born, Hispanic women are increasingly less likely to use substances than Hispanic men. Data reveal that family processes and acculturation jointly impact substance use.
substance use; gender; race; ethnicity; family processes; acculturation
This study describes cognitive functioning and its relation to psychiatric and substance use severity among adults with long duration methamphetamine (MA) use careers. Study participants (N=405) completed a battery of tests from the Automated Neuropsychological Assessment Metrics (ANAM), examining cognitive accuracy, processing speed and efficiency. Multivariate analyses indicate lower accuracy but faster speed on tests of learning and spatial and delayed memory were correlated with more days of past-month MA use. Lifetime months of MA use was not related to cognitive functioning. Poorer cognitive efficiency was related to other problems including crack/cocaine use, depressive symptomatology and poorer emotional state.
Methamphetamine; cognitive functioning; substance use; mental health
Research consistently documents the negative effects of work-family conflict; however, little focuses on alcohol use. This study embraces a tension-reduction theory of drinking, wherein alcohol use is thought to reduce the negative effects of stress. The purpose of the present study was to test a moderated mediation model of the relationship between work-family conflict and alcohol use in a Chicagoland community sample of 998 caregivers. Structural equation models showed that distress mediated the relationship between work-family conflict and alcohol use. Furthermore, tension reduction expectancies of alcohol exacerbated the relationship between distress and alcohol use. The results advance the study of work-family conflict and alcohol use, helping explain this complicated relationship using sophisticated statistical techniques. Implications for theory and practice are discussed.
Work-Family Conflict; Alcohol; Psychological Distress; Tension Reduction Expectancy; Structural Equation Modeling
Patients with opioid addiction who receive prescription opioids for treatment of chronic non-malignant pain present a therapeutic challenge. Fifty-four patients with chronic pain and opioid addiction were randomized to receive methadone or buprenorphine/naloxone. At the 6-month follow-up, 26 (48.1%) participants who remained in the study noted a 12.75% reduction in pain (P = 0.043) and compared to 5 in the buprenorphine group, none in the methadone group reported illicit opioid use (P = 0.039). Other differences between the two conditions were not found. Long-term low-dose methadone or buprenorphine/naloxone treatment produced analgesia in patients with chronic pain and opioid addiction.
Opioid addiction; chronic pain; buprenorphine; methadone; opioids
In this study, subscales from the Center for Epidemiologic Studies Depression Scale (CESD), assessed prior to treatment, were examined as predictors of withdrawal, craving, and affect during the first week of abstinence, as well as smoking abstinence during the first week of abstinence and at the end of treatment. The negative affect and somatic features CESD subscales were related to higher levels of nicotine withdrawal. The relationship between the interpersonal disturbance CESD subscale and nicotine withdrawal approached significance. This study suggests the need to examine novel psychological mechanisms that may account for the relationship between depression symptoms and smoking cessation.
Smoking Cessation; Depression; CESD; withdrawal
Since stimulant use disorders (SUDs) remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with SUDs. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision-making, verbal learning/memory, executive function and set shifting are important cognitive domains to screen clinically and treat in aging adults with SUDs. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with SUDs.
cocaine; methamphetamine; aging; addiction; neurocognitive
High stimulant-using and at-risk HIV populations, such as African American and Latino men who have sex with men (MSM), are increasingly using social networking technologies. However, no known research has explored associations between stimulant use, sexual risk behaviors, and social networking among these populations. Participants were recruited using state-of-the-art computer science methods, which narrowed the sample to 118 (primarily African American and Latino MSM) active Facebook users. Participants completed demographic, Internet/social media usage, and drug use survey items. Participants reported high rates of cocaine and methamphetamine usage (both over 15% within 12 months). Over 80% reported using social networking technologies to meet people and over 30% used them to find sex partners. A multivariate logistic regression showed that: 1) participants using social networks to find sex partners were more likely to have used methamphetamines within 12 months, and 2) those who were more comfortable talking online compared to face-to-face had over 4 times the odds of reported methamphetamine usage and over 6 times the odds of cocaine use within 12 months. Minority MSM who engaged social networks to meet men and find sex partners had high risk for stimulant use. Understanding drug use among minority social networking users will provide insights to incorporate these technologies into drug prevention interventions.
Methamphetamine; Cocaine; African American MSM; Latino MSM; social networking technologies
This study reports on the prevalence of bullying victimization at school and work among college freshmen, and the relationships between victimization and changes in alcohol consumption and alcohol problems. Web survey data at two points in time from a sample of 2118 freshmen from eight colleges and universities in the Midwestern United States indicated that 43% of students experienced bullying at school, and 33% of students experienced bullying at work. Bullying, particularly at school, consistently predicted alcohol consumption and problematic drinking, controlling for baseline drinking and other school and work stressors.
bullying; stress; alcohol use; problem drinking; college students
Substance use during pregnancy is associated with poor obstetrical and neonatal outcomes. Although intervention for substance use including alcohol improves pregnancy outcomes, a substantial number of women continue to use drugs or consume alcohol during treatment. To determine whether gestational age at entry into treatment (specifically first trimester enrollment) was associated with lower risk of continued substance use, we analyzed the North Carolina Treatment Outcomes and Program Performance System, an administrative database of drug treatment clinics, between 2000 and 2004. There were 847 pregnant women using substances who met our inclusion criteria. Demographic and other risk factor data were collected. We conducted logistic regression and a Generalized Estimating Equation analysis. Gestational age at enrollment was not associated with continued substance use (odds ratio [OR] = 0.88; 95% confidence interval [CI] = 0.51, 1.51). Women who had child care provided, were less likely to continue substance use (OR = 0.64; 95% CI = 0.48, 0.84), whereas those referred from the criminal justice system were more likely to continue (OR = 1.53; 95% CI = 1.01, 2.30). Although earlier gestational age at enrollment in treatment does not predict greater abstinence at any time point, this data does suggest that the provision of childcare may improve treatment success.
Pregnancy; Generalized Estimating Equation Analysis; drug; alcohol treatment
Outcome predictors between two methadone maintenance treatment clinics in Tel-Aviv, Israel, and Las Vegas, Nevada, were determined by comparing patients’ characteristics. All patients admitted to the two clinics (302 from Las Vegas and 492 from Tel-Aviv) were studied with respect to variables at admission and follow-up. Las Vegas patients were older, contained more females, had more hepatitis C positive markers, and more urine analyses that were positive for cocaine, amphetamines, and tetrahydrocannabinol (THC) on admission than the Tel-Aviv patients. After 1 year, Tel-Aviv patients had higher retention (73.6% vs. 61.6%) and similar opiate abstinence (65.8% vs. 64.9%) compared to Las Vegas patients. Predictors for cumulative retention (Cox regression) for both clinics were higher methadone dosages greater than or equal to 100 mg/day (Tel-Aviv OR [odds ratio] = 2.1, 95% confidence interval [CI] = 1.6–2.9; Las Vegas OR= 1.8, 95% CI = 1.3–2.5). Also, in Tel-Aviv, predictors were no opiate use after 1 year (OR = 1.7, 95% CI = 1.4–2.2) and no benzodiazepine after 1 year, and in Las Vegas no cocaine and no amphetamines after 1 year and age less than or equal to 30 years. The two major predictors in the two clinics were successful in both outcomes: 1 year retention and opiate abstinence.
Methadone maintenance treatment; countries’ differences; Kaplan-Meier analyses; retention; predictors
Little is empirically known about clinical supervision in addiction treatment. This study describes multiple domains of clinical supervision in addiction treatment from the perspectives of clinical supervisors and their counselors. Survey data were obtained from 484 matched clinical supervisor-counselor dyads working in diverse addiction treatment programs across the U.S. Supervisors report wide-ranging experience and training in supervision. Counselors’ generally perceive their supervisors’ job performance as effective. Supervisors and their counselors largely differ in their perceptions of supervision practices with supervisors reporting greater supervision given and their counselors reporting less supervision received. Implications are discussed.
clinical supervision; addiction counselors; job performance; supervisor-counselor dyad
The purpose of this study was to advance our understanding of nonmedical use of prescription medications by identifying distinguishing characteristics of two subtypes of adolescent nonmedical users of prescription opioids described by Boyd and McCabe1. A web-based, self-administered survey was completed by 2,597 7th – 12th grade students. Sensation seeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self treating users were best characterized by somatic complaints, anxiety/depressive symptoms, and history of sexual victimization.
prescription opioids; motives; adolescents; substance abuse; problem behaviors
Research suggests that Attention Deficit Hyperactivity Disorder (ADHD) and nicotine withdrawal symptoms are related; however, it is unknown how this relationship extends across ADHD symptom gradations, differs between inattention and hyperactivity-impulsivity symptom types, and generalizes to a national sample. This study examined cross-sectional associations between childhood ADHD symptom indexes (total, inattention, and hyperactivity-impulsivity) and lifetime DSM-IV nicotine withdrawal symptoms. Results showed that each ADHD symptom index associated with almost every withdrawal symptom (Ps < .01). After controlling for hyperactivity-impulsivity and inattention symptom overlap, inattention (but not hyperactivity-impulsivity) retained incremental associations with most withdrawal symptoms. These findings are relevant for understanding mechanisms of ADHD and smoking comorbidity.
Inattention; hyperactivity-impulsivity; smoking; relapse prevention; comorbidity
Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to HIV, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication assisted detoxification. This article provides a topical review of the three medications approved by the FDA for long-term treatment of opiate dependence: the opioid agonist methadone, the opioid partial agonist buprenorphine, and the opioid antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise. While no direct comparisons between extended release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared to methadone and buprenorphine. Further work is needed to compare directly each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.
Review; opiate; addiction; methadone; buprenorphine; naltrexone; pharmacotherapy
As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually-diagnosed clients to 12-step groups. This study examined the relationships among clinicians’ 12-step experiences, attitudes and referral practices in 6 NYC mental health clinics. A path analysis model showed that greater interest in learning about 12-step (12-step interest) directly predicted 12-step referral practices and that 12-step interest was predicted both by clinicians’ perception of the helpfulness of 12-Step groups and the severity of their patients’ problems with substance abuse. Clinicians’ responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-step groups.
12-step; referrals; dual-diagnosis; mental health; clinician; mutual-aid
Technology such as the Internet and mobile phones offers considerable promise for affecting the assessment, prevention, and treatment of and recovery from substance use disorders. Technology may enable entirely new models of behavioral health care within and outside of formal systems of care. This article reviews the promise of technology-based therapeutic tools for affecting the quality and reach of addiction treatment and recovery support systems, as well as the empirical support to date for this approach. Potential models for implementing technology-based interventions targeting substance use disorders are described. Opportunities to optimize the effectiveness and impact of technology-based interventions targeting addiction and recovery, along with outstanding research needs, are discussed.
Technology; mobile health; computer; substance abuse treatment; recovery
The aim of this pilot study was to assess the effectiveness of buprenorphine among marginalized opioid dependent individuals in terms of retention in and cycling in and out of a harm-reduction program. This pilot study enrolled 100 participants and followed them from November 2005 to July 2008. The overall proportion of patients retained in the program at the end of 3, 6, 9, and 12 months was 68%, 63%, 56%, and 42%, respectively. This pilot study demonstrated that buprenorphine could be successfully used to treat marginalized heroin users.
To assess whether adolescent marijuana exposure represents a modifiable predictor of adult STI risk, we used nationally-representative, longitudinal data from Waves I (1994–1995, adolescence) and III (2001–2002, adulthood) of the National Longitudinal Study of Adolescent Health (N=10,738) to examine racial/gender differences in associations between adolescent marijuana use, current use, and peer use and adulthood multiple partnerships, self-reported STI, and biologically-confirmed STI. Adulthood STI risk was predicted by adolescent marijuana use in all groups except Black females, and by peer marijuana use among Black males. Adolescents who use marijuana, or who have friends who use, constitute priority populations for STI prevention.
Marijuana; Sexually Transmitted Infections; Race/Ethnicity; Adolescence; Young Adulthood
The current study investigated whether emotion dysregulation (ED; difficulties in the self-regulation of affective states) mediated relations between anxiety sensitivity (AS; fear of anxiety and related sensations) and cognitive-based smoking processes.
Participants (n = 197; 57.5% male; Mage = 38.0) were daily smokers recruited as part of a randomized control trial for smoking cessation.
AS was uniquely associated with all smoking processes. Moreover, ED significantly mediated relations between AS and the smoking processes.
Findings suggest that ED is an important construct to consider in relations between AS and cognitive-based smoking processes among adult treatment-seeking smokers.
Anxiety Sensitivity; Smoking; Emotion Dysregulation; Expectancies