Identifying prognostic indicators for undiagnosed HCV is crucial to attenuate the negative impact of this disease. This study explored the influence of recent and more distal injection drug use on biologically-confirmed HCV infection among a sample (N = 260) of older and younger African Americans. Data from the baseline assessment of the NEURO-HIV epidemiologic study was analyzed using confounder adjusted regression techniques. Older adults were more likely to test positive for HCV (OR = 2.80, 95% CI = 1.53-5.11) due to lifetime injection drug use (AOR = 5.37, 95% CI = 3.10-9.28). Clinical implications are discussed.
HCV; Older Adult; Substance Use; Medically Underserved
Cognitive-affective mechanisms related to the maintenance of smoking among trauma-exposed individuals are largely unknown. Cross-sectional data from trauma-exposed treatment-seeking smokers (n = 283) were utilized to test a series of multiple mediator models of trauma exposure and smoking, as mediated by the sequential effects of negative affect and affect-modulation smoking motives. The sequential effects of both mediators indirectly predicted the effect of greater trauma exposure types on nicotine dependence, a biochemical index of smoking, perceived barriers to smoking cessation, and greater withdrawal-related problems during past quit attempts. Negative affect and affect-modulation motives for smoking may contribute to the trauma-smoking association.
trauma; smoking; nicotine dependence; negative affect; negative reinforcement; PTSD
Drug users (DUs) are at high risk of viral hepatitis A, B, and C (HAV, HBV, HCV).
We examined the prevalence of HAV, HBV, and HCV, associated factors, and vaccine seroconversion among drug treatment program participants in a randomized controlled trial of hepatitis care coordination.
Of 489 participants, 44% and 47% required HAV/HBV vaccination, respectively; 59% were HCV positive requiring linkage to care. Factors associated with serologic statuses, and vaccine seroconversion are reported; implications for strategies in drug treatment settings are discussed.
Results suggest generalizable strategies for drug treatment programs to expand viral hepatitis screening, prevention, vaccination and linkage to care.
viral hepatitis; hepatitis C; methadone maintenance treatment program; vaccination
Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18–29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions.
former Soviet Union immigrants; prescription opioid misuse; drug use trajectories; transition to heroin; transition to injection; young injectors; injection risk behavior; HCV risk
An intensive, 9-session Motivational Interviewing (IMI) intervention was assessed using a randomized clinical trial of 217 methamphetamine (MA) dependent persons. Intensive motivational interviewing (IMI) was compared with a standard single standard session of MI (SMI) combined with eight nutrition education sessions. Interventions were delivered weekly over two months. All study participants also received standard outpatient group treatment three times per week. Both study conditions showed significant decreases in MA use and ASI drug scores, but there were no significant differences between the two conditions. However, reductions in ASI psychiatric severity scores and days of psychiatric problems during the past 30 days were found for clients in the IMI condition but not SMI. SMI may be equally beneficial to IMI in reducing MA use and problem severity, but IMI may help alleviate co-occurring psychiatric problems that are unaffected by shorter MI interventions. Additional studies are needed to assess the problems, populations, and contexts for which IMI is effective.
Methamphetamine; Motivational Interviewing; Randomized Clinical Trial; Psychotherapy; Treatment Dose
This longitudinal study investigated the extent to which substance abuse (SA) clinician turnover is associated with SA-specific knowledge loss due to change in professions (professional turnover) versus SA-specific knowledge transfer due to movement from one SA clinical setting to another (treatment program turnover). For this study, clinicians had to voluntarily leave their current treatment program. Eligible clinicians completed a quantitative survey while employed and a qualitative post-employment exit interview 1 year later. Compared to those that exited the SA profession (N = 99), clinicians who changed treatment programs (N = 120) had greater SA-specific formal knowledge and were more likely to be personally in recovery. No differences were found between the two groups in terms of SA-specific practical knowledge.
clinician turnover; addiction treatment staff turnover; human capital investment; knowledge workers
The most widely used illicit drug in the United States (US) continues to be marijuana, and its use among emerging adults continues to rise. Marijuana use can result in a range of negative consequences and has been associated with other drug use in adolescents and emerging adults. This study examined the relationship between marijuana use frequency and use of six other drug classes (opiates, cocaine, stimulants, hallucinogens, inhalants, and sleep medications) among emerging adults. The design was a cross-sectional interview with a community sample of 1,075 emerging adults in the northeastern US. Using logistic regression analysis controlling for age, ethnicity, gender, and frequency of binge alcohol, daily marijuana use was associated with a significant increase in the expected odds of opiate, cocaine, stimulant, hallucinogen, inhalant, and tobacco use. The findings identify a subgroup of emerging adult marijuana users – those who use daily –that may be vulnerable to additional negative consequences associated with polysubstance use.
Marijuana; cannabis; emerging adults; illicit drug use
The purpose of this article was to review follow up studies of children with prenatal drug exposure from preschool through adolescence. Specifically, the authors focus on the effects of prenatal exposure to cocaine, methamphetamine, and opiates on behavior and development. The largest number of studies have examined cocaine-exposed children. The authors identified 42 studies that suggest that there are unique effects of prenatal cocaine exposure on 4- to 13-year-old children, particularly in the areas of behavior problems, attention, language, and cognition. In addition, studies make reasonable attempts to control for possible confounding factors. Systematic research on the long-term effects of prenatal methamphetamine exposure is just beginning but seems to be showing similar effects to that of cocaine. The literature on the on the long-term effects of children with prenatal opiate exposure is more substantial than the methamphetamine literature but it is still relatively sparse and surprising in that there is little recent work. Thus, there are no studies on the current concerns with opiates used for prescription mediation. There is a growing literature using neuroimaging techniques to study the effects of prenatal drug exposure that holds promise for understanding brain/behavior relationships. In addition to pharmacological and teratogenic effects, drugs can also be viewed from a prenatal stressor model. The author discuss this “fetal origins” approach that involves fetal programming and the neuroendocrine system and the potential implications for adolescent brain and behavioral development.
Prenatal drug exposure; follow-up; fetal origins
We conducted a study of alcohol use biomarkers and cognitive performance among 85 veterans with problematic alcohol use and posttraumatic stress disorder (PTSD). All analyses were adjusted for demographics, depression, anxiety, and PTSD symptoms. Elevated levels of aspartate aminotransferase (AST) were associated with worse performance on the Trail Making Test Part A and Hopkins Verbal Learning Test. Two other biomarkers were not associated with any neurocognitive measures. Indirect alcohol use biomarkers (e.g., AST) may have a specific role in identifying those veterans with problematic alcohol use and PTSD who show a change in psychomotor speed and immediate verbal memory performance.
alcohol use biomarkers; cognitive performance; problematic alcohol use; posttraumatic stress disorder
Urgency (i.e. the tendency to act rashly during negative/positive affect) may increase vulnerability to a variety of risky behaviors. This cross-sectional study of non-treatment-seeking smokers examined the relationship between urgency, level of nicotine dependence, and smoking reinforcement expectancies. Both positive and negative urgency were associated with nicotine dependence. Mediational analyses illustrated that smoking reinforcement expectancies significantly accounted for urgency-dependence relations, with negative reinforcement expectancies displaying incremental mediational effects. If replicated and extended, these findings may support the use of treatments that modify beliefs regarding smoking reinforcement outcomes as a means of buffering the risk of nicotine dependence carried by urgency.
This cross-sectional study of 540 homeless ex-offenders exiting prisons and jails assessed sociodemographic, childhood and drug-related differences. Older ex-offenders from prison were more likely to have been married, come from a two-parent family and used crack while younger ex-offenders were more likely to have used methamphetamine. Older ex-offenders from jail were more likely to be African-American, have children, and report a history of crack and injection drug use, while those younger were more likely to have engaged in binge drinking and be in a gang. Our findings showcase the need to understand unique correlates of younger and older incarcerated populations.
age and ex-offender; homeless; illicit drugs
The purpose of this research is to expand our knowledge of motivational factors among admissions to various substance abuse treatment modalities and among those entering special programs. Differences in motivation are reported in a convenience sample of over 6000 admissions to 38 programs. Results from multilevel analyses show (1) an ordered increase in motivation by settings from referral to out patient, to methadone maintenance, to highest levels in residential programs; (2) significantly lower motivation among admissions to programs for special populations. Results are discussed in relation to the demand characteristics of treatment and non-recovery reasons for entering treatment.
Substance Abuse Treatment; Motivation; Drug Use; Recovery; Treatment Modalities
Impulsive behaviors are observed in a wide range of psychiatric disorders, including substance use, bipolar, attention-deficit hyperactivity, antisocial and borderline personality, gambling, and eating disorders. The shared phenotype of impulsivity is thought to significantly contribute to both the etiology and perpetuation of these disorders. In this review, we focus upon the relevance of impulsivity to the addictive disorders, particularly substance use disorders. First, the literature supporting the presence of impulsive behaviors prior to the onset of drug use and addiction is discussed. The relevance of impulsivity to relapse is then presented, with a focus on three distinct neurocognitive constructs: automaticity, response inhibition, and decision making. Automaticity is a quickly occurring relapse process resulting from the learned habits induced by persistent drug use. Addicted persons with response inhibition deficits are unable to suppress these previously reinforced behaviors. Decision-making deficits contribute to relapse through a poorly considered assessment of the consequences of drug use. The brain regions associated with each model of impulsive behavior are described, and relevant neurobiologic disruptions in addicted subjects are discussed in the context of their specific neurocognitive deficit(s). Descriptive confusions in the terminology and confounds inherent in the study of impulsivity are described. Empirical investigations documenting the hypothesized relationship between specific deficits in impulsive behaviors, coupled with their neurobiological correlates, and relapse should be the focus of future studies.
Addictive disorders; impulsive behavior; substance use; automaticity
Current marijuana use rates are the highest in the past decade and not likely to decrease given the legalization of marijuana for medicinal and/or recreational use. Concurrently, the nation is facing epidemic levels of obesity, cardiovascular disease and diabetes but little is known about the intersecting relationships of marijuana use and cardiometabolic health. The objective of this study was to explore emerging issues in context to the intersection of cardiometabolic risk and marijuana use. This topic has potential important implications for our nation's health as we relax our approach to marijuana but continue to have unacceptable rates of cardiometabolic illnesses.
Cannabis; Marijuana; Cardiometabolic Risk; Obesity; Diabetes
The present study examined the association of smoking cessation (≥ 1 year without relapse) and self-reported psychosocial and physical outcomes among a community sample of women (N=195; mean age=63.7 years, S.D.=5.7). Data were collected in 1985–86 and 2009. Successful smoking cessation for ≥ 1 year was significantly associated with each of the outcome measures, e.g. less financial stress [Adjusted Odds Ratio (AOR)=0.50, 95% Confidence Interval (C.I.)=0.25–1.00, p< 0.05], less life dissatisfaction (AOR=0.51, 95% CI=0.24–1.09, p< 0.05). Findings suggest that older women should be included in smoking cessation programs, and the important benefits of quitting should be used to encourage cessation.
smoking cessation; older women and smoking cessation; smoking cessation and health; smoking cessation and financial stress; smoking cessation and the social network
The current study examines the longitudinal relationship between anxiety disorders in general, specific phobia in particular, and subsequent-onset alcohol use disorders in an adult population-based sample. In addition, we explore whether the hypothesized associations vary by gender. Approximately 23 years of data from the Baltimore ECA (Epidemiological Catchment Area) Follow-up (N=587) allow for the estimation of the development of incident alcohol use disorders in later life among those with anxiety disorders at the time of the baseline interview in 1981. Though baseline specific phobias were common, neither number of, nor any specific fear was statistically associated with the onset of alcohol use disorders. Rather, the findings suggested a modest association between adult sub-clinical specific phobia (without substantial distress or interference) and later-onset alcohol use disorders (OR=3.2). Moreover, we find that this association might be stronger for women than for men.
Anxiety; Alcohol; Sub Clinical; Specific Phobia; Cohort
This qualitative study examines the interpersonal and structural barriers to drug-treatment entry, retention and outcomes experienced by injection drug-using couples, and the program policies regarding IDU couples seeking treatment in New York City. Our findings reveal a mismatch between the substantial need for concurrent and coordinated treatment for partnered IDUs and programmatic policies that are antithetical to such treatment approaches. This discrepancy can be attributed to the lack of viable options for couple-focused treatment approaches that fit within the current drug treatment system. We provide a rationale and a roadmap for the development of innovative approaches for couple-based drug treatment.
IDU couples; partnered IDUs; injection drug use; drug treatment barriers; couples-based drug treatment
The costs of addiction are well documented but the potential benefits of recovery are less well known. Similarly, substance use issues among both active duty military personnel and veterans are well known but their recovery experiences remain under-investigated. Further, little is known about whether and how addiction and recovery experiences differ between veterans and non veterans. This knowledge can help refine treatment and recovery support services. Capitalizing on a national study of persons in recovery (N = 3,208) we compare addiction and recovery experiences among veterans (N = 481) and non veterans. Vets’ addiction phase was 4 years longer than non vets and they experienced significantly more financial and legal problems. Dramatic improvements in functioning were observed across the board in recovery with subgroup differences leveling off. We discuss possible strategies to address the specific areas where vets are most impaired in addiction and note study limitations including the cross-sectional design.
Addiction; recovery; veterans; military; substance use
The association between phencyclidine (PCP) use and violent behavior is unclear. The present investigation evaluated the association between PCP addiction and intimate partner violence, a specific violent behavior, using the substance abuse evaluations of 109 PCP, 81 cannabis, and 97 polysubstance (alcohol and cannabis) abusing offenders. Relative to both comparison groups, PCP users were more likely to receive inpatient referrals, have a significant legal history, and have perpetrated past-year general and intimate partner violence. Data suggest that PCP use may be associated with greater violence perpetration than cannabis use alone or in conjunction with problematic alcohol use.
Phencyclidine; PCP; Intimate Partner Violence; Forensic Evaluation
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