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
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