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CORK Bibliography: Psychiatric Co-morbidity

71 citations. January 2003 to present

Prepared: June 2003

Back SE; Sonne SC; Killeen T; Dansky BS; Brady KT. Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence. American Journal on Addictions 12(2): 169-189, 2003. (56 refs.)

Examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among 74 treatment-seeking women (aged 18-55 yrs) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to serious accidents, other situations involving serious injury, and other extraordinarily stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PTSD group scored higher on the Clinician Administered PTSD Scale avoidance, hyperarousal, and total subscale scores. Findings may have important implications for the design of dual-diagnosis interventions.

Bradizza CM; Stasiewicz PR. Qualitative analysis of high-risk drug and alcohol use situations among severely mentally ill substance abusers. Addictive Behaviors 28(1): 157-169, 2003. (25 refs.)

Situational factors have been found to influence relapse to alcohol and drug use in general samples of substance abusers. However, little research exists examining the influence of interpersonal and intrapersonal determinants in samples of individuals dually diagnosed with a severe mental illness (SMI) and a substance use disorder (SUD). This study assessed high-risk alcohol and drug use situations in dually diagnosed individuals using focus group methodology. Qualitative data analysis yielded 10 themes that encompassed 33 high-risk situations: Psychological symptoms, positive and negative affect, reminders of substance use, being around people who use drugs and alcohol, interpersonal conflict, offers of drugs or alcohol, experiencing loss, receiving money, loss of appetite, and being abstinent. These results suggest that individuals with an SMI and SUD experience a number of unique high-risk situations that differ from those reported by non-SMI substance abusers. This study provides the basis for future quantitative studies assessing the prevalence of these situations in representative samples of SMI alcohol and drug abusers. This information allows for the development of relapse assessment instruments and treatment strategies appropriate for this population.

Brennan PL; Nichol AC; Moos R. Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval. Psychology of Addictive Behaviors 17(1): 42-48, 2003. (31 refs.)

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.

Breslau N; Davis GC; Schultz LR. Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry 60(3): 289-294, 2003. (43 refs.)

Background: We examine whether exposure to traumatic events increases the risk for nicotine dependence or alcohol or other drug use disorders, independent of posttraumatic stress disorder (PTSD). Methods: Data come from a longitudinal epidemiologic study of young adults in southeast Michigan. Prospective data covering a 10-year period and retrospective lifetime data gathered at baseline were used to estimate the risk for onset of substance use disorders in persons with PTSD and in persons exposed to trauma without PTSD, compared with persons who have not been exposed to trauma. The National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R was used. Logistic regression was used to analyze the prospective data, and Cox proportional hazards survival analysis with time-dependent variables was applied to the lifetime data. Results: The prospective and retrospective data show an increased risk for the onset of nicotine dependence and drug abuse or dependence in persons with PTSD, but no increased risk or a significantly (P = .004) lower risk (for nicotine dependence, in the prospective data) in persons exposed to trauma in the absence of PTSD, compared with unexposed persons. Exposure to trauma in either the presence or the absence of PTSD did not predict alcohol abuse or dependence. Conclusions: The findings do not support the hypothesis that exposure to traumatic events per se increases the risk for substance use disorders. A modestly elevated risk for nicotine dependence might be an exception. Posttraumatic stress disorder might be a causal risk factor for nicotine and drug use disorders or, alternatively, the co-occurrence of PTSD and these disorders might be influenced by shared risk factors other than traumatic exposure.

Brown ES; Nejtek VA; Perantie DC; Orsulak PJ; Bobadilla L. Lamotrigine in patients with bipolar disorder and cocaine dependence. Journal of Clinical Psychiatry 64(2): 197-201, 2003. (64 refs.)

Background: Bipolar disorder is associated with the highest substance abuse rates of any psychiatric illness. Therefore, treatments that stabilize mood and decrease drug use or cravings are of great interest. Open-label lamotrigine was examined in 30 outpatients with DSM-IV bipolar disorder and cocaine dependence. Lamotrigine was either added to existing medication regimens or used as monotherapy. Method: Lamotrigine was started at a dose of 25 mg/day (12.5 mg/day in those taking valproic acid) and titrated to a maximum dose of 300 mg/day. Subjects received a baseline evaluation including a structured clinical interview and weekly assessments for 12 weeks with the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Cocaine Craving Questionnaire (CCQ). At each appointment, a urine sample was obtained, and participants reported drug use during the previous week. The subjects consisted of 13 men and 17 women with cocaine dependence and bipolar I disorder (N = 22), bipolar II disorder (N = 7), or bipolar disorder not otherwise specified (N = 1), with a mean +/- SD age of 35.4 +/- 7.2 years. Data were analyzed using the last observation carried forward on all subjects who completed the baseline evaluation and at least 1 postbaseline assessment. Results: Significant improvement was observed in HAM-D, YMRS, and BPRS scores (p less than or equal to .02). Cravings also significantly decreased as measured by the CCQ (p < .001). Dollar amount spent on drugs decreased nonsignificantly. Lamotrigine was well tolerated, with no subjects discontinuing due to side effects. Conclusion: Lamotrigine treatment was well tolerated in this sample and associated with statistically significant improvement in mood and drug cravings but not drug use. The findings suggest that larger controlled trials of lamotrigine are needed in this population.

Brown PJ; Read JP; Kahler CW. Comorbid posttraumatic stress disorder and substance use disorders: treatment outcomes and the role of coping. IN: Ouimette PC; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 171-188. (Book refs.)

In this chapter we describe a study that examines the prospective relationship between PTSD and substance use disorders (SUDs) among patients recently treated for substance abuse or dependence. To provide a context for this study, the authors survey the relevant prospective literature on SUD-PTSD comorbidity and review factors suggested by this literature to affect symptom presentation, treatment, and remission of these two disorders. Specifically, we discuss the role of gender and coping skills in the relationship between SUDs and PTSD. The present study builds on previous research and examines the relationship between PTSD and SUD outcomes as well as the relationship between alcohol and drug use and PTSD outcomes. We also explored how adaptive and maladaptive coping influence the SUD-PTSD relationship. Because our study sample consists of both male and female patients, we also analyzed data for possible gender differences and assessed the impact of gender on both SUD and PTSD outcomes.

Chandra PS; Carey MP; Carey KB; Jairam KR. Prevalence and correlates of areca nut use among psychiatric patients in India. Drug and Alcohol Dependence 69(3): 311-316, 2003. (28 refs.)

Objectives: To estimate the prevalence and identify the correlates of areca nut use among men and women being treated for a major psychiatric disorder in India. Methods: Inpatients (N=988) admitted to the adult psychiatry department of the National Institute of Mental Health and Neuro Sciences in India were interviewed regarding their use of the areca nut, tobacco, alcohol, and other drugs. Medical records were reviewed to obtain psychiatric diagnosis and history. Results: About 24% of the sample reported recent areca nut use, and 10% reported severe use suggesting dependence. Common reasons for use include to improve mood (31% of users), socialization (31%), digestion (22%), or performance (7%) and to decrease aches and pains (6%). Predictors of current areca nut use included less education, diagnosis of bipolar disorder, and current tobacco use. Predictors of severe use were older age, female gender, less education, and current tobacco use. Conclusion: Areca nut use occurs commonly among Indian psychiatric patients, and deserves further investigation.

Clark DB; De Bellis MD; Lynch KG; Cornelius JR; Martin CS. Physical and sexual abuse, depression and alcohol use disorders in adolescents: Onsets and outcomes. Drug and Alcohol Dependence 69(1): 51-60, 2003. (66 refs.)

Adolescents with alcohol use disorders (AUDs) often have major depressive disorder (MDD). While physical abuse and sexual abuse (PS Abuse) have been observed to be common in adolescents with AUDs, the influence of PS Abuse on comorbid MDD and AUD has not been determined. The effect of pre-existing PS Abuse on the young adulthood outcomes of adolescents with AUDs has also not been adequately explored. This study examined the relationships among PS Abuse, MDD, and AUD in adolescence, as well as related young adult outcomes. Adolescents (mean age: 16.4 years; range: 14-18 years) were recruited from clinical and community sources and classified into four groups: (1) AUD+PS Abuse (n = 154), (2) AUD only (n = 255), (3) PS Abuse only (n 74), and (4) Controls (n = 268). Subjects were longitudinally assessed through young adulthood (age 19 years or older). Measures included interview assessments of DSM-IV AUD and MDD, classified as "primary" or "secondary", and questionnaire measures of alcohol consumption and depression. Primary MDD preceded AUD whereas secondary MDD had a later onset than AUD. PS Abuse accelerated the onsets of primary MDD, secondary MDD and AUD. While affected adolescents had typically improved in both alcohol consumption and depression at the young adult assessment, the majority of those with adolescent AUD had AUDs in young adulthood, and MDD remained common in those with a history of PS Abuse. These results indicate that MDD among adolescents with AUD may be partly attributable to PS Abuse.

Coffey SF; Dansky BS; Brady KT. Exposure-based, trauma-focused therapy for comorbid posttraumatic stress disorder-substance use disorder. IN: Ouimette P; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 127-146

This chapter reviews exposure-based, trauma-focused therapy for comorbid posttraumatic stress disorder-substance use disorder (PTSD-SUD). The authors present a brief review and description of exposure-based treatments of PTSD, addressing two of the more common techniques: (a) exposure through imagery and (b) in vivo exposure. The authors also present two example of exposure-based treatments for PTSD and SUDs, substance dependence PTSD therapy and concurrent treatment of PTSD and cocaine dependence. Clinical guidelines for using exposure-based therapies are discussed.

Conrod PJ; Stewart SH. Experimental studies exploring functional relations between posttraumatic stress disorder and substance use disorder. IN: Ouimette PC; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 57-71. (Book refs.)

Another approach to understanding substance use disorder-PTSD comorbidity, alternative to patient self-report methods, is to examine this relationship in the laboratory using experimental methods. Direct examination of the effects of administration of alcohol and other drugs in conjunction with controlled investigations of the characteristics of patients with PTSD can provide important information on the potential reinforcing effects of drugs for individuals suffering from PTSD. Through control over extraneous variables, these studies can allow for much stronger conclusions regarding causality. In this chapter we review relevant laboratory findings, present a model for understanding the mechanisms of action of drugs of abuse on PTSD symptoms, point out gaps in the literature to date, and make suggestions for future laboratory-based experimental research.

Darke S; Ross J; Lynskey M. The relationship of conduct disorder to attempted suicide and drug use history among methadone maintenance patients. Drug and Alcohol Review 22(1): 21-25, 2003. (29 refs.)

In order to examine the effects of a diagnosis of childhood conduct disorder (CD) on history of attempted suicide and drug use, unconfounded by early onset heroin use, 181 methadone maintenance patients who commenced heroin use after the age of 15 were interviewed. CD was diagnosed in 54% of patients. Compared to other patients, CD patients were younger and less educated. The onset of drug use, injecting drug use and heroin use occurred, on average, 2 years earlier than in other patients, and they had broader histories of injecting polydrug use. CD patients were more likely to have attempted suicide and to have been hospitalized after an attempt, and to have attempted suicide while enrolled in their current treatment. The current study indicates that a history of CD increases the risk of attempted suicide over and above the higher risks associated with injecting drug use per se.

Dausey DJ; Desai RA. Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse. Journal of Nervous and Mental Disease 191(1): 10-17, 2003. (38 refs.)

This article compares the differences in HIV prevalence and risk behaviors in singly diagnosed patients with substance abuse problems and dually diagnosed patients with comorbid psychiatric and substance abuse problems. The National Treatment Improvement Evaluation Study (NTIES) was used to conduct a cross-sectional study on 6593 persons treated for substance abuse disorders. Logistic regression using hierarchal linear modeling (HLM) was utilized to compare risk behaviors of singly and dually diagnosed persons. Compared with singly diagnosed patients, dually diagnosed patients were more likely to share a needle, have sex for money or gifts, have sex with an intravenous drug user, and report being raped. Patients dually diagnosed with psychiatric and substance abuse disorders are an especially high-risk group for HIV infection, in part due to a higher likelihood of engaging in high-risk behavior, and should be targeted for more intense HIV interventions.

Davis TM; Bush KR; Kivlahan RD; Dobie DJ; Bradley KA. Screening for substance abuse and psychiatric disorders among women patients in a VA health care system. Psychiatric Services 54(2): 214-218, 2003. (43 refs.)

Screened women Veterans Affairs (VA) health care patients for the prevalence of past-year smoking, hazardous and problem drinking, other drug abuse, and psychiatric disorders. Screening measures included questions about cigarettes, questions from the Alcohol Use Disorders Identification Test about consumption (hazardous drinking), a drug abuse screen, the Patient Health Questionnaire (psychiatric conditions), and the PTSD Checklist. 1,257 patients returned surveys with complete substance use data. Patients reported a relatively high rate of past-year smoking (29.1%) and hazardous drinking, problem drinking, or both (31.1%). The rate of past-year drug use was much lower (4.9%). Younger age was associated with greater substance abuse: 59% of women under age 35 screened positive for smoking, hazardous or problem drinking, or drug abuse. Screening positive for a psychiatric condition (N=504) was also associated with substance abuse: The rate of past-year drug abuse among women screening positive for a psychiatric condition (9.7%) was double the rate for the entire sample. Of the women who screened positive for depression, PTSD, eating disorders, or panic disorders, 57% screened positive for substance abuse (including smoking).

Degenhardt L; Hall W. Patterns of co-morbidity between alcohol use and other substance use in the Australian population. Drug and Alcohol Review 22(1): 7-13, 2003. (39 refs.)

The present study describes patterns of co-morbidity between alcohol use and other substance use problems in the Australian population using data from the 1997 National Survey of Mental Health and Well-Being. Multiple regression analyses examined whether the observed associations between alcohol and other drug use disorders were explained by other variables, including demographic characteristics and neuroticism. We also assessed whether the presence of co-morbid substance use disorders affected treatment seeking for a mental health problem. Alcohol use was related strongly to the use of other substances. Those who did not report alcohol use within the past 12 months were less likely to report using tobacco, cannabis, sedatives, stimulants or opiates. Higher rates again were observed among those with alcohol use disorders: half (51%) of those who were alcohol-dependent were regular tobacco smokers, one-third had used cannabis (32%); 15% reported other drug use; 15% met criteria for a cannabis use disorder and 7% met criteria for another drug use disorder. These associations were not accounted for by the demographic and other variables considered here. Co-morbid substance use disorders (sedatives, stimulants or opioids) predicted a high likelihood of seeking treatment for a mental health problem among alcohol-dependent people.

Delligatti N; Akin-Little A; Little SG. Conduct Disorder in girls: Diagnostic and intervention issues. Psychology in the Schools 40(2): 183-192, 2003. (27 refs.)

Current prevalence rates of Conduct Disorder (CD) in girls may be an underestimate due to inappropriate diagnostic criteria, biased perceptions by those responsible for reporting problematic behavior, and differential social constraints for each gender. Relatively few published studies of CD and related behaviors in girls exist. Available evidence suggests adolescent girls with CD have a poor outcome including early and violent death, arrest, substance abuse and dependence, antisocial personality disorder, failure to finish high school, pregnancy, sexual promiscuity, and contraction of sexually transmitted disease. Even with its relatively low, possibly underestimated prevalence rate in comparison with that of boys, CD has been found to be the second most common psychiatric disorder in adolescent girls. In addition to examining possible reasons for the lack of research on CD in girls, this article reviews possible risk factors and suggested assessment and intervention strategies for this population. Particular attention is paid to implications for practitioners in the school setting.

Dumaine ML. Meta-analysis of interventions with co-occurring disorders of severe mental illness and substance abuse: Implications for social work practice. Research on Social Work Practice 13(2): 142-165, 2003

A quantitative analysis of 15 empirical studies is conducted to determine effective interventions with the dually diagnosed. Client and practitioner characteristics, types of interventions, and treatment effectiveness are examined through meta-analytic techniques. Age of client was positively correlated with effect size. There were no statistically significant correlations between practitioner training or practitioner-to-client ratio and effect size. Intensive case management was associated with the greatest effect size, and a small positive effect size was found for standard aftercare with outpatient psychoeducational treatment groups. Social work practice implications, based on the results of the quantitative analysis and trends identified in the studies, are that there is a unique role for practitioners in advocating for linkage of resources, additional supports for clients, and the dismantling of barriers that impede resource access.

Farrell M; Howes S; Bebbington P; Brugha T; Jenkins R; Lewis G et al. Nicotine, alcohol and drug dependence, and psychiatric comorbidity - results of a national household survey (Reprinted from British Journal of Psychiatry 179, pgs 432-437, 2001). International Review of Psychiatry 15(1-2): 50-56, 2003. (25 refs.)

There is a well-recognized relationship between substance use disorders and other psychiatric disorders. This relationship has been well documented in a range of population-based studies. This study aims to report on consumption patterns of and dependence on nicotine, alcohol, and non-prescribed drugs and to report on the levels of psychiatric morbidity in these groups. A national household study of psychiatric morbidity was conducted in England and Wales. Psychiatric assessment was based on the Clinical Interview Schedule-Revised (CIS-R). Measures of nicotine, alcohol and drug use and dependence were obtained. This paper compares the levels of psychiatric morbidity in the non-dependent and the nicotine-, alcohol- and drug-dependent cases. Twelve per cent of the non-dependent population were assessed as having any psychiatric disorder compared with 22% of the nicotine-dependent, 30% of the alcohol-dependent, and 45% of the drug-dependent population. There is a clear relationship between dependence on nicotine, alcohol, and drugs and other psychiatric morbidity.

Farrell M; Howes S; Taylor C; Lewis G; Jenkins R; Bebbington P et al. Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey (Reprinted from Addictive Behaviours 23, pgs 909-918, 1998). International Review of Psychiatry 15(1-2): 43-49, 2003. (23 refs.)

There have been a number of national surveys of psychiatric morbidity, which have included questions on drugs, alcohol, and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders, and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals, and the homeless survey of hostels, night shelters, day centres, and private sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol, and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.

Finnell DS. Use of the transtheoretical model for individuals with co-occurring disorders. Community Mental Health Journal 39(1): 3-15, 2003. (27 refs.)

Because of the interactive nature between their mental disorder and their substance-use disorder, individuals with co-occurring disorders may experience factors that complicate behavioral change, such as considering abstinence from alcohol and drugs. This study examined the relationships between the stages-of-change and the processes of change, constructs of the Transtheoretical Model by Prochaska and DiClemente. There was partial support for the theory. The findings suggest that individuals with co-occurring disorders require support and clinical interventions throughout the entire change process.

Fisckenscher A; Novins D. Gender differences and conduct disorder among American Indian adolescents in substance abuse treatment. Journal of Psychoactive Drugs 35(1): 79-84, 2003. (25 refs.)

Studies have found high prevalences of conduct disorder among youth in residential substance abuse treatment programs, but no studies have examined this issue among American Indian adolescents while taking into account gender differences. The Diagnostic Interview Schedule for Children, Youth Version and the Composite International Diagnostic Interview, Substance Abuse Module were used to determine the diagnostic status of 89 American Indian adolescents aged between 13 and 18 years who were admitted to a residential treatment program. Seventy-four percent of the adolescents met full DSM-IV criteria for conduct disorder. More than 85% of the participants met at least one criterion for conduct disorder. Conduct disorder was common among both boys and girls in this sample of American Indian adolescents, but the specific antisocial behaviors displayed and their relationships to other psychiatric disorders varied by gender.

Flory K; Lynam DR. The relation between attention deficit hyperactivity disorder and substance abuse: What role does conduct disorder play? Clinical Child and Family Psychology Review 6(1): 1-16, 2003. (74 refs.)

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD-substance-abuse relation. These studies have generally found that the ADHD-substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.

Forbes D; Creamer M; Hawthorne G; Allen N; McHugh T. Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder. Journal of Nervous and Mental Disease 191(2): 93-99, 2003. (30 refs.)

Post-traumatic stress disorder (PTSD) is a difficult condition to treat, and existing studies show considerable variability in outcome. Investigations of factors that influence outcome have the potential to inform alternate treatment approaches to maximize benefits gained from interventions for the disorder. Because PTSD is commonly associated with comorbidity, it is important to investigate the influence of comorbidity on symptom change after treatment. This article examines pretreatment and 9-month follow-up data for 134 Australian Vietnam veterans who attended a treatment program for combat-related PTSD. A series of analyses were conducted to investigate the influence of the comorbid factors of anxiety, depression, anger, and alcohol use on PTSD symptom change after treatment. Analyses identified anger, alcohol, and depression as significant predictors of symptom change over time, independent of the effect of initial PTSD severity. Further analyses indicated that anger at intake was the most potent predictor of symptom change. Further investigations of anger as an influence on symptom change after treatment of combat-related PTSD is recommended.

Friedmann PD; Lemon SC; Anderson BJ; Stein MD. Predictors of follow-up health status in the Drug Abuse Treatment Outcome Study (DATOS). Drug and Alcohol Dependence 69(3): 243-251, 2003. (51 refs.)

This study examined the predictors of self-reported health status at follow-up in the Drug Abuse Treatment Outcomes Study (DATOS), a longitudinal study of drug abuse treatment programs and patients in 1991-1993. Baseline and follow-up interviews of 2966 patients in 75 programs were performed. The follow-up assessment was targeted to occur 12 months after treatment terminated; long-term methadone patients in treatment for the entire 12-month period were interviewed 24 months after intake. A composite measure, developed through principal component analysis, assessed health status. A multivariate hierarchical linear regression model adjusted for identified independent baseline predictors of health status at follow-up. Poor physical health status (including the composite measure, comorbid conditions and pain) and greater severity of psychiatric symptoms at baseline were the strongest predictors of poor health status at follow-up. Other predictors of worse health status included older age, public insurance coverage and unemployment. We conclude that baseline health status and psychiatric symptoms predict the subsequent health status of patients in substance abuse treatment patients as in other clinical populations. Future research should examine whether early identification and treatment of physical and mental health problems among patients in addiction treatment programs might remediate their adverse effects on long-term health status outcomes.

Green AI; Burgess ES; Dawson R; Zimmet SV; Strous RD. Alcohol and cannabis use in schizophrenia: effects of clozapine vs. risperidone. Schizophrenia Research 60(1): 81-85, 2003. (27 refs.)

Background: Alcohol and cannabis use disorders worsen the course of schizophrenia. While the typical antipsychotics are of limited value in controlling substance use in schizophrenic patients, previous studies suggest that the novel antipsychotic clozapine (CLOZ) may decrease their substance use. We describe a retrospective study of the effects of the novel antipsychotics risperidone (RISP) and clozapine on alcohol and cannabis use in patients with schizophrenia or schizoaffective disorder and comorbid alcohol and/or cannabis use disorder. Method: This study involved retrospective assessment of abstinence (cessation of alcohol and cannabis use) in 41 patients treated with either risperidone (n = 8) or clozapine (n = 33) for at least 1 year. In 32 of these 41 patients, information was available on whether abstinence occurred during the 1-year period. Results: Abstinence rates were significantly higher in patients treated with clozapine than in those treated with risperidone (54% vs. 13%, p = 0.05). The nine patients treated for at least I year, but excluded from the analysis because time of cessation of use was not known, had all stopped alcohol/cannabis use during clozapine treatment. Discussion: While the limitations of this retrospective study must be recognized, the data suggest that comorbid patients treated with clozapine are more likely to abstain from alcohol and cannabis use than are those treated with risperidone. Further prospective studies will be required to confirm these intriguing results.

Green AI; Canuso CM; Brenner MJ; Wojcik JD. Detection and management of comorbidity in patients with schizophrenia. (review). Psychiatric Clinics of North America 26(1): 115+, 2003. (216 refs.)

Approximately half of patients with schizophrenia have at least one comorbid psychiatric or medical condition, worsening prognosis and contributing to the high rate of morbidity and mortality. Depression is associated with suicide, the leading cause of premature death in patients with schizophrenia; obsessive-compulsive symptoms may worsen prognosis; alcohol and substance use disorders are associated with a poor outcome; and comorbid medical conditions, including cardiac and pulmonary disease, infectious diseases, diabetes, hyperlipidemia, hypogonadism, and osteoporosis, are often underrecognized and undertreated. The new generation of antipsychotic medications has improved the potential outcome of patients with schizophrenia. Providing optimal treatment for patients and fully realizing the potential of these new agents require focused attention on detection, recognition, and treatment of comorbid psychiatric and medical conditions in patients with schizophrenia.

Green CA; Polen MR; Brody KK. Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members. American Journal of Health Behavior 17(4): 269-275, 2003. (17 refs.)

Purpose. To study relationships between depression, functional limitations, psychiatric treatment, and the health-related practices of elderly individuals. Design. Cross-sectional, observational study based on survey data (response rate 90%) analyzed using multiple linear and logistic regression models. Setting. Kaiser Permanente Northwest, a large nonprofit HMO. Subjects. Medicare members (4615) aged 65-103 years who responded to a health status survey. Measures. Depression, health and functional status, frequency of alcohol consumption, smoking status, advance medical directive completion, influenza or pneumonia vaccinations, mammograms, recent psychiatric treatment, and attempts to lose weight or increase exercise. Results. Self-reported depression was related to a greater risk of smoking (odds ratio [OR] = 1.54). Health-related functional limitations were related to fewer attempts to change health behaviors and less preventive service use (significant ORs ranged from 0.84 to 0.94). Minority group membership and Supplemental Security Income were negatively associated with better health practices and with completing advance medical directives (ORs 0.41 and 0.79, respectively). Falls in the prior year, more prescription medications, and psychiatric treatment were positively associated with better health Practices (significant ORs ranged from 1.12 to 1.88). Conclusions. Depression and smoking are associated among elderly individuals, as are psychiatric treatment and attempts to lose weight. Those with functional limitations, minority status, or Supplemental Security Income use fewer preventive services; the latter two groups are less likely to complete advance medical directives. Older adults with these characteristics might need assistance in improving health-related practices.

Greenfield SF; Hennessy G; Sugarman DE; Weiss RD. What general psychiatrists ask addiction psychiatrists: A review of 381 substance abuse consultations in a psychiatric hospital. American Journal on Addictions 12(1): 18-28, 2003. (56 refs.)

We reviewed the records of 381 consecutive substance abuse consultations completed by the Substance Abuse Consultation Service (SACS) of McLean Hospital to ascertain (1) the most frequent reasons why general psychiatrists consulted the SACS, and (2) the clinical characteristics of these patients. The most frequent reasons for consultation were to make aftercare recommendations (66.1%) or to make (19.7%) or clarify (6.3%) a substance use disorder (SUD) diagnosis. Mood disorders were the most prevalent co-occurring psychiatric disorder; alcohol use disorders were the most prevalent co-occurring psychiatric disorder; alcohol use disorders were the most prevalent SUDs. The findings indicate the potential utility of a substance abuse consultation service in a psychiatric hospital.

Hartwell S. Short-term outcomes for offenders with mental illness released from incarceration. International Journal of Offender Therapy and Comparative Criminology 47(2): 145-158, 2003. (51 refs.)

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.

Hauenstein EJ. Depression in adolescence. Journal of Obstetric, Gynecologic and Neonatal Nursing 32(2): 239-248, 2003. (32 refs.)

Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic failure, poor peer relationships, behavioral problems, conflict with parents and other authority figures, and substance abuse are some of the consequences of major depressive disorder in this age group. Effective treatments include nontricyclic antidepressants and coping skills training. The nurse is key to depression detection and suicide prevention, especially in primary care settings. Through psychoeducation, nurses can promote recovery from depression by encouraging a healthy lifestyle, enhancing social skills, and assisting the adolescent to identity and use sources of social support. These measures can prevent premature death and promote long-term well-being of the adolescent.

Haver B. Comorbid psychiatric disorders predict and influence treatment outcome in female alcoholics. European Addiction Research 9(1): 39-44, 2003. (32 refs.)

Drinking patterns, psychiatric comorbidity and personality disorders (PD) at intake and at a 2-year follow-up were studied in 120 female alcoholics early in their treatment career. At follow-up, the women had improved their drinking patterns, but their mental health still differed significantly from women of the general population. Psychiatric comorbidity at intake correlated with a significantly worse drinking and mental health outcome. Subjects with high scores on phobias more frequently dropped out of treatment and thereby had a worse drinking outcome. Subjects with depression at follow-up also had a poorer drinking outcome, as well as subjects with schizoid PD. When tested by multivariate analyses, only depression at follow-up contributed significantly to the increased explained variance in drinking outcome when controlling for drinking pattern and treatment duration.

Holahan CJ; Moos RH; Holahan CK; Cronkite RC; Randall PK. Drinking to cope and alcohol use and abuse in unipolar depression: A 10-year model. Journal of Abnormal Psychology 112(1): 159-165, 2003. (36 refs.)

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1, 4, and 10-year follow-ups and for more drinking problems at 1- and 4-year follow-ups. Findings elucidate a key mechanism in this process by showing that drinking to cope strengthened the link between depressive symptoms and drinking behavior. Individuals who bad a stronger propensity to drink to cope at baseline showed a stronger connection between depressive symptoms and both alcohol consumption and drinking problems.

Huang YY; Oquendo MA; Friedman JMH; Greenhill LL; Brodsky B; Malone KM et al. Substance abuse disorder and major depression are associated with the human 5-HT1B receptor gene (HTR1B) G861C polymorphism. Neuropsychopharmacology 28(1): 163-169, 2003. (39 refs.)

The 5-HT1B receptor has been implicated in several psychopathologies, including pathological aggression, alcoholism and suicide. To test these and related potential genetic relationships in a single population, the human 5-HT1B receptor (h5-HTR1B) genotype for the 6861C polymorphism was determined in 394 psychiatric patients and 96 healthy volunteers. Structured clinical interviews generated DSM III-R diagnoses. No significant association of the genotype or allele frequencies of the h5-HTR1B G861C locus was observed with diagnoses of alcoholism, bipolar disorder, schizophrenia or a history of a suicide attempt. Exploratory analyses indicated an association of the genotype and allele frequencies of the h5- HTR1B 6861C locus with a history of substance abuse disorder (chi(2) = 9.51, df= 2, p = 0.009; chi(2) = 7.31, df = 1, p=0.007, respectively) and with a diagnosis of a major depressive episode (chi(2) = 6.83, df = 2, p = 0.033; chi(2) = 5.81, df = 1, p=0.016, respectively). Significant gene dose effects on the risk for substance abuse disorder and a major depressive episode were observed with the 861C allele (Armitage linearity tendency test: chi(2) = 7.20, df = 1, p = 0.008; chi(2) = 6.80, df =1, p = 0.009, respectively). Substance abuse disorder and major depression appear to be associated with the h5-HTR1B G861C locus in the patient population, but other psychopathologies such as bipolar disorder, schizophrenia, alcoholism, and suicide attempts were not found to be associated with this polymorphism. This preliminary result will need replication, given the limitations of association studies.

Johnson SD; Cunningham-Williams RM; Cottler LB. A tripartite of HIV-risk for African American women: The intersection of drug use, violence, and depression. Drug and Alcohol Dependence 70(2): 169 - 175, 2003. (25 refs.)

The intersection of drug use, violence, and depression with HIV-risk among African American women is an under explored area of research. The current analyses examine whether particular sexual risk behaviors are associated with exposure to violence, depression or both among 420 African American out-of-treatment female drug users. Women were stratified into four mutually exclusive groups: drug users with exposure to violence (n=64), drug users with clinical depression (n=62), drug users with both (n=41), and drug users only (n=253). Multinomial logistic regression analyses examined the association of demographics and sexual risk behaviors across the tripartite groups. Women with a history of sexually transmitted diseases were more likely to experience violence and depression both alone and jointly. Women who had two or more sexual partners in the last 30 days (OR=2.26) and women who had an early onset of alcohol use (OR=2.50) were at an increased risk for having the full tripartite of drug use, violence and depression. Never being married was a protective factor for the full tripartite. As expected, more risk factors were found among women who had the full tripartite than among women with one or two of the factors. The co-existence of the tripartite factors and sexual risk behaviors may indicate a need to ultimately provide more specialized prevention and intervention efforts to combat HIV infection. This area of research may improve our understanding of the numerous obstacles to HIV intervention among drug-using populations.

Keel PK; Dorer DJ; Eddy KT; Franko D; Charatan DL; Herzog DB. Predictors of mortality in eating disorders. Archives of General Psychiatry 60(2): 179-183, 2003. (28 refs.)

Background: Anorexia nervosa, but not bulimia nervosa, has one of the highest mortality rates among psychiatric disorders. However, potential predictors of mortality, such as comorbid psychiatric illnesses, remain unclear. We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa. Methods: Women (N = 246) diagnosed as having either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) between January 1, 1987, and December 31, 1991, participated in a prospective longitudinal study. Vital status was determined by ongoing contact and a National Death Index search as of December 1998 (overall ascertainment, 99.8%) and telephone contact as of October 2000 (ascertainment, 95.0%). Results: Eleven women died. Standardized mortality ratios were elevated for all causes of mortality (11.6; 95% confidence interval, 5.5-21.3) and suicide (56.9; 95% confidence interval, 15.3-145.7) in anorexia nervosa but not for death (1.3; 95% confidence interval, 0.0-7.2) in bulimia nervosa. Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up (P<.001). Hospitalization for an affective disorder before baseline assessment seemed to protect women from a fatal outcome (P<.001). Conclusions: Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake.

Kendler KS; Liu XQ; Gardner CO; McCullough ME; Larson D; Prescott CA. Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. American Journal of Psychiatry 160(3): 496-503, 2003. (43 refs.)

Objective: The role of religion in mental illness remains understudied. Most prior investigations of this relationship have used measures of religiosity that do not reflect its complexity and/or have examined a small number of psychiatric outcomes. This study used data from a general population sample to clarify the dimensions of religiosity and the relationships of these dimensions to risk for lifetime psychiatric and substance use disorders. Method: Responses to 78 items assessing various aspects of broadly defined religiosity were obtained from 2,616 male and female twins from a general population registry. The association between the resulting religiosity dimensions and the lifetime risk for nine disorders assessed at personal interview was evaluated by logistic regression. of these disorders, five were "internalizing" (major depression, phobias, generalized anxiety disorder, panic disorder, and bulimia nervosa), and four were "externalizing" (nicotine dependence, alcohol dependence, drug abuse or dependence, and adult antisocial behavior). Results: Seven factors were identified: general religiosity, social religiosity, involved God, forgiveness, God as judge unvengefulness, and thankfulness. Two factors were associated with reduced risk for both internalizing and externalizing disorders (social religiosity and thankfulness), four factors with reduced risk for externalizing disorders only (general religiosity, involved God, forgiveness, and God as judge), and one factor with reduced risk for internalizing disorders only (unvengefulness). Conclusions: Religiosity is a complex, multidimensional construct with substantial associations with lifetime psychopathology. Some dimensions of religiosity are related to reduced risk specifically for internalizing disorders, and others to reduced risk specifically for externalizing disorders, while still others are less specific in their associations. These results do not address the nature of the causal link between religiosity and risk for illness.

Landheim AS; Bakken K; Vaglum P. Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics: Substance abusers treated in two counties in Norway. European Child & Adolescent Psychiatry 9(1): 8-17, 2003. (30 refs.)

Objective: Gender differences in the prevalence of Axis I and 11 disorders in poly-substance abusers and pure alcoholics and between these two groups are explored. Method. A consecutive sample (n = 260) of in- and outpatients from two Norwegian counties were assessed by CIDI (Axis I disorders) and MCMI-II (Axis 11 disorders). Results: Major depression, post-traumatic stress disorder (PTSD), and eating disorders were significantly more prevalent in women than in men. A significantly higher prevalence of antisocial, passive-aggressive, and borderline personality disorders (PD) was observed among poly-substance abusers, whereas pure alcoholics were found to have dependent PDs more often. Female poly-substance abusers differed significantly from all other substance abusers by suffering more often from major depression, simple phobia, PTSD and borderline PD. Male poly-substance abusers more often presented antisocial PD and less often Cluster C disorders than all other substance abusers. Female pure alcoholics more often had major depression and Cluster C disorders than all other substance abusers. Male pure alcoholics presented less often with Axis I disorders, major depression, and PTSD, but more often with Cluster A disorders, in particular schizoid PD, than all other substance abusers. Conclusion: The pattern of comorbid disorders is clearly different between male and female poly- substance abusers and pure alcoholics. This implies that these four subgroups have important differences in their treatment needs.

Langbehn DR; Cadoret RJ; Caspers K; Troughton EP; Yucuis R. Genetic and environmental risk factors for the onset of drug use and problems in adoptees. Drug and Alcohol Dependence 69(2): 151-167, 2003. (69 refs.)

Applying survival analysis methodology to age-of-onset data from an adoption study (N = 196), we present evidence that risks for both drug use and drug problems (DSM abuse or dependence) are elevated when combined antisocial personality (ASP) and substance abuse is present in the same biological parent. It is increased not only in comparison to adoptees with no known biological risk, but also when compared to adoptees with a biological background for only substance problems or only ASP. Neither of these later groups showed a statistically higher risk when compared with controls. Among adoptees with recurrent drug use, adolescent aggressivity is also elevated when the combined substance abuse/ASP biological diathesis is present. Statistical control for aggressivity diminished but did not eliminate the predictive significance of the combined biological diathesis for drug problems. We also verify, using more refined methodology, our previous reports of gender and adverse adoptive environmental influences on drug-related outcomes in these subjects. We could not document a biology-environment interaction, but power to do so was rather low. We argue that the observed biological associations are broadly consistent with generalization to other substances of an alcoholism phenotype similar to Cloninger's Type II or Babor's Type B.

Loewenthal KM; MacLeod AK; Cook S; Lee M; Goldblatt V. Beliefs about alcohol among UK Jews and Protestants: Do they fit the alcohol-depression hypothesis? Social Psychiatry and Psychiatric Epidemiology 38(3): 122-127, 2003. (24 refs.)

Background: Some research has suggested that Jews drink less alcohol than other cultural groups, and may have different beliefs about its use. Differences in beliefs about alcohol, and different patterns of use, may play a role in accounting for cultural and gender variations in depression prevalence. Alcohol may act as an escape route from depression, thus deflating depression rates in certain groups of people, in particular, men from Protestant backgrounds. Methods: Self-reported use and beliefs about alcohol were assessed in a UK sample of 70 Jews and 91 Protestants, including non-practising people of Jewish and Protestant background. The effects of religious group and of gender on measures of alcohol behaviour and beliefs were examined. Results: Some differences were found between Jews and Protestants. Jews had less favourable beliefs about alcohol and drank less than Protestants. More importantly, and in line with our hypotheses, there were gender differences in Protestants but not Jews with respect to some beliefs about alcohol and actual use of alcohol. Conclusions: The study goes some way in supporting the notion that religious-cultural and gender differences in beliefs and behaviour towards alcohol may contribute to religious-cultural and gender differences in rates of depression.

Magura S; Laudet AB; Mahmood D; Rosenblum A; Vogel HS; Knight EL. Role of self-help processes in achieving abstinence among dually diagnosed persons. Addictive Behaviors 28(3): 399-413, 2003. (49 refs.)

The effectiveness of participation in dual-focus groups (i.e., focusing on both mental health and substance use) has not been studied empirically. The study examined whether three hypothesized active ingredients of self-help (helper-therapy, reciprocal-learning, and emotional-support processes) are associated with drug/alcohol abstinence outcomes for members of a 12-step dual-focus fellowship, Double Trouble in Recovery (DTR). The study was able to control for member attitudes and behaviors at baseline, which might be related to both self-help processes and outcomes, i.e., extent of participation in DTR and traditional 12-step groups, prior drug/alcohol use, severity of psychiatric symptoms, motivation for change, stressful life events, perceived coping, self-efficacy for recovery, and social support. Members of 24 DTR groups in New York City were recruited, interviewed, and reinterviewed after 1 year. Drug/alcohol abstinence in the past year increased from 54% at baseline to 72% at follow-up. Helper-therapy and reciprocal-learning activities were associated with better abstinence outcomes, independent of other attitudes and behaviors of the members. However, emotional support was not related to outcome. We conclude that specific elements of self-help participation contribute substantially to progress in recovery for members of dual-focus groups; facilitating such self-help processes should be encouraged by clinicians and senior fellowship members.

McEvoy JP; Allen TB. Substance abuse (including nicotine) in schizophrenic patients. Current Opinion in Psychiatry 16(2): 199-205, 2003. (16 refs.)

Purpose of review: Comorbid substance-use disorders are present in at least 25% of patients with schizophrenia, and 70-80% of these patients smoke. It is important to understand how substance-use disorders affect outcomes in this already impaired population. Recent findings Substance-use disorders occur most commonly in males, and are most prevalent in the young. Substance-use disorders are associated with bad outcomes, including medication noncompliance, rehospitalization, homelessness, contact with the criminal justice system, medical morbidity and suicide, and these bad outcomes seem to be more likely among those patients who utilize multiple drugs rather than alcohol alone. Psychosocial and behavioral treatments produce few successes. Early indications suggest that clozapine may reduce substance-use disorders. Nicotine corrects certain neurophysiological deficits (e.g. eye-tracking abnormalities) in patients with schizophrenia. Maternal smoking during pregnancy may increase the likelihood of antisocial behavior and substance-use disorder in the offspring. Atypical antipsychotics plus bupropion increase the likelihood of smoking reduction/cessation in patients with schizophrenia. Summary: The recent literature clearly documents the devastating effects of comorbid substance-use disorders in schizophrenia. Promising new treatment options will require further study.

McGrew JH; Pescosolido B; Wright E. Case managers' perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services 54(3): 370-376, 2003. (26 refs.)

The authors examined Identified case managers' perspectives on the critical ingredients, therapeutic mechanisms of action, and gaps in implementation of the critical ingredients of assertive community treatment. 73 assertive community treatment teams that attended the 1997 National Assertive Community Treatment Conference rated the degree to which 16 clinical activities were beneficial to clients and rated the importance of 27 possible critical ingredients of the ideal team as well as the extent to which each ingredient characterized their team. Results show that at least 50% of the teams rated 24 of the 27 critical ingredients as "very important." Having a full-time nurse on the team was rated as the most important ingredient, and medication management was rated as the most beneficial clinical activity. The ratings of teams from urban and rural settings were highly correlated. Critical elements that the teams reported as being the most underimplemented included the presence of a full-time substance abuse specialist, a psychiatrist's involvement on the team, team involvement with hospital discharge, and working with a client support system.

Metrikin AS; Galanter M; Dermatis H; Bunt G. Somatization, anxiety and depression in a drug-free residential therapeutic community. American Journal on Addictions 12(1): 60-70, 2003. (33 refs.)

This study aims to assess the nature and prevalence of somatization and related psychiatric symptoms among residents in Daytop Village, a drug-free residential therapeutic community (TC). Three hundred and twenty two residents at Daytop were surveyed, and when compared with a normal, non-patient reference group, residents at Daytop exhibited higher levels of somatization, depression, and anxiety as measured with the Brief Symptom Inventory. Multiple linear regression analysis showed that being widowed or divorced, having marijuana/hallucinogens as greatest drug problem, and the importance of a religious figure in entering Daytop were associated with higher levels of somatization. A length of stay of 3-6 months and acceptance of Daytop program philosophy was inversely correlated with somatization scores. These findings are discussed with particular attention focused on the role of somatization among TC residents.

Najavits LM. Seeking safety: A new psychotherapy for posttraumatic stress disorder and substance use disorder. IN: Ouimette P; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 147-169

This chapter reviews Seeking Safety, a cognitive-behavioral based therapy for the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder. The author provides (a) a description of Seeking Safety and how it was developed, (b) a comparison with existing treatments, (c) a review of outcome research on it, and (d) ideas for future directions.

Negrete JC. Clinical aspects of substance abuse in persons with schizophrenia. (review). Canadian Journal of Psychiatry 48(1): 14-21, 2003. (58 refs.)

Objective: To review the current knowledge on the problem of psychoactive substance abuse by persons with schizophrenia, with particular attention to issues of direct relevance to clinical practice. Method: The author examined the literature from the last 2 decades and data from studies in which he was involved. Results: Schizophrenia sufferers show an elevated liability for substance abused. Such comorbidity may derive from self-medication attempts, a common neuropathology for addiction and schizophrenia, the psychotogenic properties of certain drugs, or the influence of environmental factors. Among schizophrenia patients receiving treatment, substance misuse is associated with more severe symptoms and poorer therapeutic response. The presence of a chronic psychosis impedes treatment of the substance problem in traditional, nonpsychiatric addiction programs. Better outcomes are observed in integrated therapy services, where patients receive appropriate care for both conditions. Conclusion: Dual-pathology patients need comprehensive care with appropriate pharmacotherapy and psychosocial interventions. This treatment can be best provided within the context of a continuing care psychiatric service.

O'Neill ML; Lidz V; Heilbrun K. Adolescents with psychopathic characteristics in a substance abusing cohort: Treatment process and outcomes. Law and Human Behavior 27(3): 299-313, 2003. (49 refs.)

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B.B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL: YV; A. E. Forth, S. D. Kosson,& R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.

Patrick DD. Dual diagnosis: substance-related and psychiatric disorders. Nursing Clinics of North America 38(1): 67+, 2003. (16 refs.)

One of the most challenging situations facing mental health professionals is intervening effectively with patients who present with a mental illness and a substance abuse problem. Central to this problem is that a universal definition of dual diagnosis or dual disorder does not currently exist. Diminished resources, in the form of financial reimbursement and clinical programs for this complex, diverse population, compound the issue. Finally, as long as clinicians who deal with this population continue to intervene from a dichotomous stance of psychiatry versus chemical dependence, things are not likely to change. This dichotomous clinical approach parallels the federal and state governments' systems that continue to have separate departments for mental health and for alcohol and drug issues. Even more detrimental is that funding sources continue to provide different benefit levels for the two sets of disorders.

Patten CA; Hurt RD; Offord KP; Croghan IT; Gomez-Dahl LC; Kottke TE et al. Relationship of tobacco use to depressive disorders and suicidality among patients treated for alcohol dependence. American Journal on Addictions 12(1): 71-83, 2003. (49 refs.)

This population-based, retrospective cohort study examined the association of tobacco use and diagnosis of a depressive disorder and suicide attempts before and after discharge from an inpatient addiction program (IAP). All 813 Olmsted County, Minnesota residents (mean age 41.5 yrs) admitted for the first time to the IAP for treatment of alcoholism during the period 1972-1983 were studied. Tobacco use status at admission was classified as ever (current or former use) (85.5%), never (8.6%), or missing (5.9%). Subjects were followed through 1994. Current or former use of tobacco was markedly lower among those with a prior diagnosis of depressive disorder than those without this diagnosis (73.6% vs. 89.3%). Although females were more likely to have a diagnosis of depressive disorder and were less likely to have ever used tobacco than males, gender did not explain the relationship between tobacco use and depressive disorder. Tobacco use status was unrelated to a depressive disorder diagnosis after discharge from the IAP and was not associated with suicide attempts.

Patten CA; Vickers KS; Martin JE; Williams CD. Exercise interventions for smokers with a history of alcoholism: Exercise adherence rates and effect of depression on adherence. Addictive Behaviors 28(4): 657-667, 2003. (27 refs.)

This study examined the adherence rates and the effect of depression on adherence in two studies conducted among smokers with a past history of alcoholism. In both studies, subjects participated in a 12-session group-based exercise intervention for smoking cessation. The target quit date (TQD) was Session 8. Participants in Study 1 were 73 smokers (43% female). Exercise instructions began at Session 8 and continued through Session 12. Mean frequency and number of minutes of exercise decreased during the 4 weeks of exercise treatment (P<.001). Study 2, conducted with 18 smokers (50% female), examined the feasibility of commencing exercise at Session 1, well before the TQD. The mean number of minutes exercised increased from Sessions 1 to 12 (P=.013). In both studies, average session attendance was high (82%). Combining subjects from both studies, depressed smokers at baseline reported greater mean frequency of exercise per week than nondepressed smokers (P=.05). The results suggest that depressed smokers can be engaged in an exercise program. Further research is needed to determine if commencing exercise early during treatment, prior to the TQD, improves adherence.

Pencer A; Addington J. Substance use and cognition in early psychosis. Journal of Psychiatry & Neuroscience 48-54(2003): 28, 2003. (44 refs.)

Objective: To determine the relation between substance use and cognition in individuals experiencing their first episode of psychosis. Design: Prospective cross-sectional and longitudinal study. Setting: An Early Psychosis Treatment and Prevention Program, an outpatient clinic in a psychiatry department at a university-affiliated hospital. Participants: Individuals with a psychotic illness who were admitted to an Early Psychosis Program; 266 patients were assessed at initial presentation, 159 at I year and 90 at 2 years. Most were outpatients. Measures: The effects of substance use (alcohol, cannabis, hallucinogens, cocaine, stimulants) on cognition were assessed. Substance use was determined by DSM-IV criteria, and the Case Manager Rating Scale was used to determine the level of substance use. A comprehensive cognitive battery of tests was used, and the Positive and Negative Syndrome Scale for schizophrenia was administered to all subjects to determine levels of positive and negative symptoms. Results: Overall, both cross-sectionally and longitudinally, there were no significant associations between cognitive functioning and the use of various substances. Substance use was associated with higher positive symptoms. Conclusions: Individuals with psychotic disorders who show mild-to-moderate abuse of substances, in particular alcohol and cannabis, do not exhibit more cognitive impairment than those who do not do use the substances. However, substance use may have other detrimental effects on the process of the psychotic illness.

Pomerleau CS; Zucker AN; Stewart AJ. Patterns of depressive symptomatology in women smokers, ex-smokers, and never-smokers. Addictive Behaviors 28(3): 575-582, 2003. (19 refs.)

To investigate the possibility that specific symptom patterns contribute differentially to excess depression among smokers, we analyzed Center for Epidemiological Studies--Depression (CES-D) and subscale scores in 931 women current smokers (CS), ex-smokers (ES), and never-smokers (NS). After adjusting for differences in age, education, and marital status, significant group differences were found for the CES-D overall and for Depressed Affect, Anhedonia, and Somatic Features, but not Interpersonal Distress. Both CS and ES scored significantly higher than NS on most measures, whereas differences between CS and ES failed to reach significance. CS were significantly more likely than NS to be taking antidepressants. Alcohol intake also showed significant group differences, with CS>ES>NS, suggesting that the link between current smoking and alcohol intake is mediated by factors other than depression, since CS and ES were comparably depressed. We conclude that studying specific symptom patterns may elucidate the smoking-depression link. Our observation that ES and CS exhibit similar levels of depressive symptomatology further suggests that interventions for depressed smokers need to take into account the likely persistence of depression following cessation.

Potter CC; Jenson JM. Cluster profiles of multiple problem youth - Mental health problem symptoms, substance use, and delinquent conduct. Criminal Justice and Behavior 30(2): 230-250, 2003. (47 refs.)

The prevalence and patterns of co-occurring mental health problem symptoms, substance use, and delinquent conduct were examined in a sample of multiple problem, detained youth. Three distinct patterns of co-occurrence were found using cluster analysis. Youth in two of the clusters had moderate mental health problems but differed in the severity of substance abuse and delinquent conduct. A third group displayed serious mental health symptoms and suicidality coinciding with high rates of substance use and crime.

Rafiroiu AC; Sargent RG; Parra-Medina D; Drane WJ; Valois RF. Covariations of adolescent weight-control, health-risk and health-promoting behaviors. American Journal of Health Behavior 27(1): 3-14, 2003. (28 refs.)

Assessed the prevalence of dieting and investigated clusters of risk behaviors among adolescents. Data were secured from a random sample of 4,187 adolescents and analyzed using bivariate methods and logistic regression. From the survey sample, 19.2% adolescents were classified as extreme, 43.2% as moderate dieters, 37.2% as nondieters. Extreme dieters were more likely to use alcohol, cigarettes, and/or marijuana and to attempt suicide and less likely to practice vigorous exercise. Moderate dieters were less likely to use cigarettes, marijuana and more likely to engage in vigorous exercise, with differences across gender-race categories. Results have relevance for developing multicomponent programs for adolescents.

Read JP; Bollinger AR; Sharkansky E. Assessment of comorbid use disorder and possttraumatic stress disorder. IN: Ouimette P; Brown PJ, eds. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 111-125. (Book refs.)

This chapter is designed to review theoretical and procedural approaches to the comprehensive assessment of comorbid substance use disorder-posttraumatic stress disorder (SUD-PTSD). The authors outline several widely used assessment measures as well as methods to enhance accurate assessment of PTSD and SUD symptoms, discuss the importance of assessing other comorbidities and present procedural and provider issues that may affect assessment.

Richards HJ; Casey JO; Lucente SW. Psychopathy and treatment response in incarcerated female substance abusers. Criminal Justice and Behavior 30(2): 251-276, 2003. (47 refs.)

The authors rated 404 incarcerated female participants in a substance abuse treatment efficacy study using either the Hare Psychopathy Checklist-Revised (PCL-R) or the Psychopathy Checklist: Screening Version (PCL:SV). Participants were then randomly assigned among three treatment conditions. Psychopathy scores were significantly associated with poor treatment response with regard to program retention, removal for serious noncompliance, violent and disruptive rule violations, avoidance of urinalysis testing, treatment module attendance, and therapist ratings. Cox regression analyses indicated that psychopathy scores (particularly Factor I scores) better predicted new charges in the community than a combination of other variables. The authors concluded that Hare psychopathy scores can be used validly for assessment for placement, risk assessment, and individual treatment planning for female offenders.

Schaar I; Ojehagen A. Predictors of improvement in quality of life of severely mentally ill substance abusers during 18 months of co-operation between psychiatric and social services. Social Psychiatry and Psychiatric Epidemiology 38(2): 83-87, 2003. (24 refs.)

Background The aim of this study was to investigate predictors of Quality of Life in a group of severely mentally ill substance abusers. These patients took part in a multi-centre study aimed at improving cooperation between psychiatric and social services in Sweden during the years 1995 to 1998. Methods Two hundred and eighty-eight patients, 62.4 % men, were included in the study. The criteria to enter the study were to have a diagnosis of severe mental illness and a diagnosis of substance dependence according to the DSM-III-R criteria. Quality of Life (QoL) was measured by a global assessment, Cantril's ladder (1965). Initially and after 18 months the following measurements were also used: Addiction Severity Index (ASI), Symptom Check List 90 (SCL-90) and The Clinical Rating Scale (CRS) for Alcohol Use (AUS) and Drug Use (DUS). Results Initially those who were older and those who had an apartment of their own or who lived in sheltered living had a higher QoL than the others. Those belonging to the borderline personality disorder subgroup had a lower QoL than those belonging to other psychiatric diagnostic subgroups. At follow-up QoL had improved significantly. Improvement in QoL was related to improvements in physical health, legal and family problems, psychiatric symptoms and a reduction of alcohol and drug problems (ASI), global functioning (GAF) and psychological problems (SCL-90). A multiple stepwise regression analysis showed that improvement in QoL primarily was predicted by improvements in psychiatric symptoms. Number of months without alcohol and drugs were positively associated with improvement in QoL. As a whole, at follow-up the QoL is still not high. Conclusions In this group of severely mentally ill substance abusers, improvement in QoL was primarily predicted by improvements in psychiatric symptoms. Further, less alcohol and drug abuse seems to augment the subjective feeling of QoL.

Schuckit MA; Kelsoe JR; Braff DL; Wilhelmsen KC. Some possible genetic parallels across alcoholism, bipolar disorder and schizophrenia. (editorial). Journal of Studies on Alcohol 64(2): 157-159, 2003. (24 refs.)

Seedat S; Stein MB; Forde DR. Prevalence of dissociative experiences in a community sample: Relationship to gender, ethnicity, and substance use. Journal of Nervous and Mental Disease 191(2): 115-120, 2003. (39 refs.)

This study examined the relationship between gender, ethnicity, substance use, and dissociation in a community sample of adults. Telephone interviews were conducted using, among others, measures of dissociation (Dissociative Experiences Scale-Taxon [DES-T]) and alcohol use (Alcohol Use Disorders Identification Test [AUDIT]) to screen a representative sample of 1007 adults in Memphis, Tennessee. Six percent of respondents endorsed four or more lifetime dissociative symptoms, whereas approximately one third of respondents endorsed at least one symptom. Only 2% were identified as having pathological dissociation on the DES-T. DES-T scores were significantly associated with gender (male), ethnicity (African-American), and harmful alcohol use. Dissociative symptoms appear to be relatively common in the population, but only a small proportion of individuals suffer from significant levels of dissociation. Further assessment of the link between demographic factors and the severity and expression of dissociative phenomena in nonclinical samples is warranted.

Spring B; Pingitore R; McChargue DE. Reward value of cigarette smoking for comparably heavy smoking schizophrenic, depressed, and nonpatient smokers. American Journal of Psychiatry 160(2): 316-322, 2003. (50 refs.)

Objective: The study goal was to determine whether schizophrenic and depressed smokers perceive the reinforcement value of cigarette smoking differently from nonpsychiatric smokers who smoke as heavily. Method: The authors assessed the preferences for smoking cigarettes versus engaging in other pleasant activities, the perceived advantages and disadvantages of smoking, and the amount of reinforcement that would be needed to attain smoking abstinence among 26 schizophrenic, 26 depressed, and 26 nonpsychiatric heavy smokers. Results: Both schizophrenic and depressed participants chose smoking as their preferred activity more often than nonpsychiatric smokers, and they did not differ from each other. The patients also exceeded the comparison group in the benefits they ascribed to smoking and felt they would require more incentives to quit, but they attributed comparable drawbacks to smoking. Conclusions: Schizophrenic and depressed smokers recognize many drawbacks associated with smoking, but compared to nonpatients who smoke as heavily, they also perceive more benefits and find cigarettes more appealing than alternative rewards. The heightened reward value of smoking warrants attention in tailoring tobacco control interventions for schizophrenic and depressed smokers.

Staton M; Leukefeld C; Webster JM. Substance use, health, and mental health: Problems and service utilization among incarcerated women. International Journal of Offender Therapy and Comparative Criminology 47(2): 224-239, 2003. (43 refs.)

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.

Steindl SR; Young RM; Creamer M; Crompton D. Hazardous alcohol use and treatment outcome in male combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress 16(1): 27-34, 2003. (49 refs.)

The relationship between alcohol problems and posttraumatic stress disorder (PTSD) remains unclear. Six hundred and eight combat veterans diagnosed with PTSD were assessed for PTSD symptoms and alcohol problems prior to group cognitive-behavioral treatment. They were reassessed 3 and 9 months after treatment. Participants were classified into low-risk and hazardous drinkers at each time point. Drinking status at intake did not predict PTSD symptoms at intake or follow-up. However, drinking status was associated with PTSD symptoms when both were assessed at follow-up. PTSD arousal symptoms were the only symptom cluster to differentiate drinking groups.

Stewart DG; Trupin EW. Clinical utility and policy implications of a statewide mental health screening process for juvenile offenders. Psychiatric Services 54(3): 377-382, 2003. (26 refs.)

The authors consider the utility of screening adjudicated juvenile offenders for mental health symptoms at intake and assessed the ability of a screening measure, the Massachusetts Youth Screening Inventory, second edition (MAYSI-2), to identify youths with mental health problems and co-occurring substance use problems. This study also examined the relationship of these symptoms to treatment utilization both before and after intake to the juvenile justice system. Ethnic and gender differences in the screening results were studied. The MAYSI-2 was administered to 1,840 youths consecutively admitted to state custody. Results show that youths who reported a high level of mental health symptoms were more likely to have received previous mental health treatment than youths with a low level of mental health symptoms. Youths with a high level of mental health symptoms were more likely to receive extraordinary sentences and were thus less likely to be eligible for community transition programs. Significant gender and ethnic differences in mental health symptom reporting on the screening inventory were found. Female offenders were significantly more likely to report a high level of symptoms, and Hispanic youths were significantly less likely to report a high level of symptoms.

Thompson KM; Crosby RD; Wonderlich SA; Mitchell JE; Redlin J; Demuth G et al. Psychopathology and sexual trauma in childhood and adulthood. Journal of Traumatic Stress 16(1): 35-38, 2003. (13 refs.)

This study evaluates the occurrence of psychopathology among 97 women who (1) experienced sexual abuse in childhood only, (2) were raped in adulthood only, (3) experienced both childhood sexual abuse and rape in adulthood, or (4) experienced no sexual trauma. Women were recruited from advertisements and assessed using the Structured Clinical Interview for DSM-IV (SCID-I/P) and the Modified PTSD Symptom Scale Self-Report. Women who reported sexual trauma were significantly more likely to exhibit psychopathology than controls. Being sexually victimized in childhood and raped in adulthood was associated with a particular risk for substance dependence.

Uzun O; Cansever A; Basoglu C; Ozsahin A. Smoking and substance abuse in outpatients with schizophrenia: A 2-year follow-up study in Turkey. Drug and Alcohol Dependence 70(2): 187 - 192, 2003. (37 refs.)

Background: This study aimed to determine the prevalence of smoking and substance abuse in outpatients with schizophrenia, and to determine the relationship between smoking status and sociodemographic/clinical characteristics of schizophrenia. Methods: One hundred and thirty-six schizophrenic outpatients were assessed by the structured clinical interview for DSM-IV (SCID) and brief psychiatric rating scale (BPRS). Demographic and treatment variables were obtained from case records and interviews with patients and their family members. Results: The frequency of smoking among schizophrenic patients was 50%. However, the rate of substance abuse was 5.2%. We found no statistically significant differences between the smoker and the non-smoker patients on the demographic variables of age, sex, marital status, and employment status. There was no significant difference between the groups on BPRS scores. However, smokers were receiving a higher daily dose of neuroleptic than non-smokers. Conclusion: The prevalence of smoking among schizophrenic patients was similar to the rates found in Western cultures. However, the prevalence of substance abuse was lower in Turkish patients as compared with patients in the Western population.

Verdoux H; Sorbara F; Gindre C; Swendsen JD; van Os J. Cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Schizophrenia Research 59(1): 77-84, 2003. (35 refs.)

Objective: The aim of the present study was to explore the pattern of associations between cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Method: The Community Assessment of Psychic Experiences (CAPE), a 42-item self-report questionnaire that evolved from the Peters et al. Delusions Inventory [Schizophr. Bull. 25 (1999) 553], was used to measure dimensions of psychosis in a sample of undergraduate female students (n = 571). The participants were also asked to complete a self-report questionnaire collecting information on substance use. Results: Three correlated dimensions of positive, negative and depressive experiences were identified using principal components factor analysis. Frequency of cannabis use was independently associated with the intensity of both positive and negative psychotic experiences. No significant association was found between cannabis use and the depressive dimension, or between alcohol use and any of the three positive, negative and depressive dimensions. Conclusion: This cross-sectional study supports the hypothesis that exposure to cannabis may induce the emergence of positive psychotic symptoms in subjects without clinical psychosis, and additionally suggests that cannabis users exhibit greater levels of negative symptoms. Prospective studies are required to explore the direction of causality and the impact of cannabis on the course of psychotic experiences in subjects from the general population.

Vermeiren R; Schwab-Stone M; Deboutte D; Leckman PE; Ruchkin V. Violence exposure and substance use in adolescents: Findings from three countries. Pediatrics 111(3): 535-540, 2003. (111 refs.)

Objective. To investigate relationships between exposure to community violence (witnessing and victimization) and reported substance use (cigarettes, alcohol, marijuana, and hard drugs) in a cross-national sample of adolescents, after controlling for the level of the adolescents' own violent behavior. Method. A self-report survey was conducted in 3380 14- to 17-year-old adolescents in urban communities of 3 different countries: Antwerp, Belgium (N = 958); Arkangelsk, Russia (N = 1036); and New Haven, Connecticut (N = 1386). Results. In all 3 countries, levels of reported smoking, alcohol use, marijuana use, and hard drug use showed increases with adolescent exposure to violence. Although positively related, substance use was increased less markedly in US adolescents who witnessed violence. Conclusion. Current findings further emphasize the association between violence exposure and potential severe physical and psychosocial health problems in adolescents. In addition, the findings suggest that violence exposure and its consequences are a worldwide urban phenomenon. Cross-national differences were found, however, that warrant additional research, and prospective studies are needed to investigate the pathways from violence exposure to substance abuse.

Wilens TE; Faraone SV; Biederman J; Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature (review). Pediatrics 111(1): 179-185, 2003. (56 refs.)

Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes. Methods. A search of all available prospective and retrospective studies of children, adolescents, and adults with ADHD that had information relating childhood exposure to stimulant therapy and later SUD outcome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates. Results. Six studies-2 with follow-up in adolescence and 4 in young adulthood-were included and comprised 674 medicated subjects and 360 unmedicated subjects who were followed at least 4 years. The pooled estimate of the odds ratio indicated a 1.9-fold reduction in risk for SUD in youths who were treated with stimulants compared with youths who did not receive pharmacotherapy for ADHD (z = 2.1; 95% confidence interval for odds ratio [OR]: 1.1-3.6). We found similar reductions in risk for later drug and alcohol use disorders (z = 1.1). Studies that reported follow-up into adolescence showed a greater protective effect on the development of SUD (OR: 5.8) than studies that followed subjects into adulthood (OR: 1.4). Additional analyses showed that the results could not be accounted for by any single study or by publication bias. Conclusion. Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.

Wu L-T; Ringwalt CL; Williams CEE. Use of substance abuse treatment services by persons with mental health and substance use problems. Psychiatric Services 54(3): 363-369, 2003. (25 refs.)

The authors provide population estimates of mental syndromes and substance use problems and whether the co-occurrence of mental health and substance use problems is associated with the use of substance abuse treatment services. Study data were drawn from the 1997 National Household Survey on Drug Abuse. Of the total sample of 16,661 18-50+ yr olds, 2% reported using services for alcohol or drug use problems in the previous year. Among the 3,474 who reported at least one alcohol or drug use problem, 6% used substance abuse services. Four percent of persons who reported substance use problems alone received any substance abuse treatment service in the previous year. Three percent of persons who reported alcohol use problems alone received such services. Among persons with one or more substance use problems, the prevalence of service use was 11% among persons who reported one co-occurring mental syndrome and 18% among those who reported 2 or more mental syndromes. A number of subgroups were identified who might have needed substance abuse services but did not receive them, including women, Asians and Pacific Islanders, college graduates, persons employed full-time, persons who abused alcohol only, and persons with substance use problems who reported no coexisting mental syndromes.

Xie H; McHugo G; Drake R; Sengupta A. Using discrete-time survival analysis to examine patterns of remission from substance use disorder among persons with severe mental illness. Mental Health Services Research 51(1): 55-64, 2003. (20 refs.)

Investigators in mental health research are often interested in examining critical events such as onset, relapse, and recovery from illness, including substance use disorders. As data on these critical events are often collected at discrete-time intervals (e.g., weekly, monthly, or yearly), discrete-time survival models are more appropriate than well-known continuous-time methods. In this paper, the authors present discrete-time survival analysis methods at an introductory level. Using data collected every 6 mo from a 3-yr study of assertive community treatment in New Hampshire, they show that discrete-time survival models can be used to analyze patterns of remission from substance use disorder among clients with severe mental illness. The main questions investigated are (1) when are remissions more likely to occur? and (2) what variables predict remission? The results indicate that remission is more likely to occur in the 1st 6 mo and in the 3rd yr of the study. Gender, age, baseline use of substances, and diagnosis are strong predictors of remission.

Yen CF; Chong MY; Liu YH. Juvenile drug offenders who use amphetamine recommitted to a remand center: The role of psychiatric morbidity. Substance Use & Misuse 38(1): 141-150, 2003. (18 refs.)

One hundred consecutive juvenile drug offenders with amphetamine use in a remand center were assessed for extent of substance use and psychiatric morbidity by a psychiatrist from 1998 to 1999. They were monitored for one year. after discharge. The "risk" of being recommitted to the remand center against use of various drugs and psychiatric morbidity was determined. Amphetamine-use disorder was more prevalent in those who were recommitted than those who were not, while no significant difference was found with licit substances, psychiatric morbidity, or the number of substances used between these two groups. In view of the high dependency properties of amphetamine, early intervention is suggested to prevent reuse.

Zilberman ML; Tavares H; Blume SB; el-Guebaly N. Substance use disorders: Sex differences and psychiatric comorbidities. Canadian Journal of Psychiatry 48(1): 5-13, 2003. (77 refs.)

Objective: This article reviews sex differences in psychiatric comorbidity among individuals with substance use disorders and, in particular, the clinical significance of these differences for treatment outcome among women. Method: We undertook a computerized search of major health care databases. To enhance the search, we drew prior relevant articles from the reference list. Results: Women with alcohol and other drug use disorders present higher rates of psychiatric comorbidity, particularly mood and anxiety disorders, than do men. Moreover, the comorbid diagnosis, particularly of depression, is more often primary in women, while in men the comorbidity is more often secondary to the substance abuse diagnosis. In addition, there is evidence that psychiatric comorbidity is associated with distinct, sex- specific outcomes for substance use treatment. Conclusions: Sex differences in the clinical presentation of substance-dependent individuals with psychiatric comorbidity present specific treatment challenges and opportunities.

Zvolensky MJ; Schmidt NB; Stewart SH. Panic disorder and smoking. Clinical Psychology: Science and Practice 10(1): 29-51, 2003. (169 refs.)

An integrated theoretical conceptualization of the co- occurrence of panic disorder and smoking (PDSM) is presented. First, the nature and prevalence of this apparently costly, yet largely unrecognized, co-occurrence of health care problems is described. Second, a theoretical analysis regarding how smoking may negatively impact panic disorder is described. Third, the negative impact of panic disorder on smoking outcomes is discussed. Finally, primary implications of this conceptualization for the research and treatment of individuals with PDSM are elaborated, including the need to assess for smoking among persons with panic disorder and the potential need for specialized treatment approaches.

Last Updated on June 11, 2003