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CORK Bibliography: Self-Medication

62 citations. January 2009 to present

Prepared: March 2012

Asher CJ; Gask L. Reasons for illicit drug use in people with schizophrenia: Qualitative study. BMC Psychiatry 10: e-article 94, 2010. (37 refs.)

Background: Drug misuse is an important clinical problem associated with a poorer outcome in patients who have a diagnosis of schizophrenia. Qualitative studies have rarely been used to elicit reasons for drug use in psychosis, but not in schizophrenia. Methods: Seventeen people with a diagnosis of schizophrenia and who had used street drugs were interviewed and asked to describe, in narrative form, their street drug use from their early experiences to the present day. Grounded theory was used to analyse the transcripts. Results: We identified five reasons for continuing street drug use. The reasons were: as an 'identity defining vocation', 'to belong to a peer group', due to 'hopelessness', because of 'beliefs about symptoms and how street drugs influence them' and viewing drugs as 'equivalent to taking psychotropic medication'. Street drugs were often used to reduce anxiety aroused by voice hearing. Some participants reported street drugs to focus their attention more on persecutory voices in the hope of outwitting their perceived persecutors. Conclusions: It would be clinically useful to examine for the presence of the five factors in patients who have a diagnosis of schizophrenia and use street drugs, as this is likely to help the clinician to tailor management of substance misuse to the individual patient's beliefs.

Audrain-McGovern J; Rodriguez D; Kassel JD. Adolescent smoking and depression: Evidence for self-medication and peer smoking mediation. Addiction 104(10): 1743-1756, 2009. (96 refs.)

Aims: The nature of the relationship between adolescent smoking and depression is unclear and the mechanisms that account for the comorbidity have received little investigation. The present study sought to clarify the temporal precedence for smoking and depression and to determine whether these variables are linked indirectly through peer smoking. Participants: The sample was composed of 1093 adolescents participating in a longitudinal study of the behavioral predictors of smoking adoption. Design and measurements In this prospective cohort study, smoking, depression, peer smoking and other covariates were measured annually from mid-adolescence (9th grade; age 14) to late adolescence (12th grade, age 18). Findings: Parallel processes latent growth curve models supported a bidirectional relationship between adolescent smoking and depression, where higher depression symptoms in mid-adolescence (age 14) predicted adolescent smoking progression from mid- to late adolescence (ages 14-18). A significant indirect effect indicated that higher depression symptoms across time predicted an increase in the number of smoking peers, which in turn predicted smoking progression from mid-adolescence to late adolescence. In addition, smoking progression predicted a deceleration of depression symptoms from mid- to late adolescence. A significant indirect effect indicated that greater smoking at baseline predicted a deceleration in the number of smoking peers across time, which predicted a deceleration in depression symptoms from mid-adolescence to late adolescence. Conclusions: The current study provides the first evidence of bidirectional self-medication processes in the relationship between adolescent smoking and depression and highlights peer smoking as one explanation for the comorbidity.

Bacon AK; Ham LS. Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorders: An avoidance-coping cognitive model. Addictive Behaviors 35(11): 925-939, 2010 , 2010. (137 refs.)

Despite the frequent comorbidity of social anxiety disorder and alcohol use disorders, no theoretical model currently exists to explain the specific mechanisms underlying the comorbidity between these two disorders. An integration of existing theoretical models and empirical evidence across the social anxiety and alcohol use literatures is presented as the Avoidance-Coping Cognitive Model, which proposes that socially anxious individuals may be particularly vulnerable to the anxiolytic effects of alcohol through reductions in attention biases to social threat. The disproportionate reduction in anxiety may then make alcohol an attractive method of avoidance coping. Gaps in the empirical literature are reviewed in light of this model as future directions are suggested.

Blum K; Liu YJ; Shriner R; Gold MS. Reward circuitry dopaminergic activation regulates food and drug craving behavior. (review). Current Pharmaceutical Design 17(12): 1158- 1167, 2011. (127 refs.)

Neural circuits implicated in drug conditioning, craving and relapse overlap extensively with those involved in natural reward and reinforcement like food. Exposure to drug-related cues in human addicts results in drug craving and localized activation of central circuits that are known to mediate cue-induced reinstatement of drug-seeking behavior in animal models of relapse. Similar regional activation patterns occur in humans in response to cues associated with foods. Furthermore, drug-and food-related cues not only activate common neuroanatomical regions but also result in similar activity-regulated gene expression programs within these shared areas. Cues predictive of food availability are powerful modulators of appetite as well as food-seeking and ingestive behaviors. The upregulation of a number of early genes in unique patterns within corticostriatal, thalamic, and hypothalamic networks suggests that food cues are capable of powerfully altering neuronal processing in areas mediating the integration of emotion, cognition, arousal, and the regulation of energy balance. The dopaminergic, enkephalinergic, and fos gene expressions are important regulatory genetic pathways for food craving behaviors. An umbrella term to describe common genetic antecedents of multiple impulsive, compulsive and addictive behaviors is Reward Deficiency Syndrome (RDS). Individuals possessing a paucity of serotonergic and/or dopaminergic receptors and an increased rate of synaptic dopamine catabolism, due to high catabolic genotype of the COMT gene, are predisposed to self-medicating any substance or behavior that will activate dopamine release including alcohol, opiates, psychostimulants, nicotine, glucose, gambling, sex, and even excessive internet gaming, among others. Finally, utilizing the long term dopaminergic activation approach will ultimately lead to a common safe and effective modality to treat RDS behaviors including aberrant food and drug craving behaviors.

Bolton JM; Robinson J; Sareen J. Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders 115(3): 367-375, 2009. (32 refs.)

Background: Using alcohol or drugs to reduce emotional distress (self-medication) has been proposed as an explanation for the high comorbidity rates between anxiety and substance use disorders. Self-medication has been minimally studied in mood disorders despite equally high rates of alcohol and drug use. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large (n=43,093, age 18 years and older) nationally representative survey of mental illness in community-dwelling adults. Prevalence rates of self-medication were determined for DSM-IV mood disorders: dysthymia, major depressive disorder, bipolar I disorder, and bipolar II disorder. Multiple logistic regression generated odds ratios for the association between each category of self-medication and anxiety and personality disorders. Results: Almost one-quarter of individuals with mood disorders (24.1%) used alcohol or drugs to relieve symptoms. The highest prevalence of self-medication was seen in bipolar I disorder (41.0%). Men were more than twice as likely as women to engage in self-medication (Adjusted Odds Ratio=2.18; 95% Confidence Interval 1.90-2.49). After controlling for the effects of substance use disorders, self-medication was associated with higher odds of comorbid anxiety and personality disorders when compared to individuals who did not self-medicate. Limitations: Cross-sectional design. Conclusions: The use of alcohol and drugs to relieve affective symptoms is common among individuals with mood disorders in the general population, yet is associated with substantial psychiatric comorbidity. These findings may help clinicians identify a subgroup of people with mood disorders who suffer from a higher mental illness burden.

Bonn-Miller MO; Babson KA; Vujanovic AA; Feldner MT. Sleep problems and PTSD symptoms interact to predict marijuana use coping motives: A preliminary investigation. Journal of Dual Diagnosis 6(2): 111-122, 2010 , 2010. (32 refs.)

The present study empirically tested the theory-based hypothesis that greater sleep problems and post-traumatic stress disorder (PTSD) symptom severity would both individually and multiplicatively predict higher levels of coping-motivated marijuana use. Twenty (15 women) adults (M-age = 34.00 years, SD = 11.96) who had PTSD and were currently using marijuana participated. Results indicated a positive independent relation with sleep problems and a significant interaction between sleep problems and PTSD symptom severity in relation to coping-motivated marijuana use. Results also indicated nonsignificant omnibus regression models for all other marijuana use motives. The results suggest that there may be segments of the PTSD population that are more likely to use marijuana to cope by virtue of individual differences in sleep problems.

Bottorff JL; Johnson JL; Moffat BM; Mulvogue T. Relief-oriented use of marijuana by teens. Substance Abuse Treatment, Prevention and Policy 4: e-article 7, 2009. (40 refs.)

Background: There are indications that marijuana is increasingly used to alleviate symptoms and for the treatment of a variety of medical conditions both physical and psychological. The purpose of this study was to describe the health concerns and problems that prompt some adolescents to use marijuana for therapeutic reasons, and their beliefs about the risks and benefits of the therapeutic use of marijuana. Methods: As part of a larger ethnographic study of 63 adolescents who were regular marijuana users, we analyzed interviews conducted with 20 youth who self-identified as using marijuana to relieve or manage health problems. Results: Thematic analysis revealed that these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced. These teens used marijuana to gain relief from difficult feelings (including depression, anxiety and stress), sleep difficulties, problems with concentration and physical pain. Most were not overly concerned about the risks associated with using marijuana, maintaining that their use of marijuana was not 'in excess' and that their use fit into the realm of 'normal.' Conclusion: Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.

Broekmans S; Dobbels F; Milisen K; Morlion B; Vanderschueren S. Pharmacologic pain treatment in a multidisciplinary pain center: Do patients adhere to the prescription of the physician? Clinical Journal of Pain 26(2): 81-86, 2010. (23 refs.)

Background: Medication nonadherence is a frequent problem in chronic conditions. In chronic noncancer pain, medication is often used as an important cornerstone of the treatment. Studies on medication nonadherence in this population, however, are scarce. Aim: The aim of this study was to determine the prevalence of medication underuse and overuse nonadherence in a large sample of chronic pain patients treated in a multidisciplinary pain center. Second, an extensive list of demographic, disease-related, treatment-related and health behavior-related factors was included to compare these factors between adherent, overusers, and underusers, respectively. Methods: Self-report was used to measure medication adherence. Results: Forty-eight percent of the patients were nonadherent, with 34% of them showing underuse and 14% overuse of the prescribed medication. Multivariable analyses showed a significant association between younger age and medication nonadherence (both underuse and overuse). Furthermore, underuse was significantly associated with self-medication. Overuse was associated with current smoking, opioid prescription, and more medication intake moments. Conclusions: We can conclude that medication nonadherence, especially underuse of medication, occurs frequently among patients with chronic nonmalignant pain. Prospective research is needed to learn about the impact of medication overuse or underuse on clinical outcomes. Future research should examine underuse and overuse as different types of nonadherence as different factors might predict this behavior.

Bujarski SJ; Feldner MT; Lewis SF; Babson KA; Trainor CD; Leen-Feldner Ellen et al. Marijuana use among traumatic event-exposed adolescents: Posttraumatic stress symptom frequency predicts coping motivations for use. Addictive Behaviors 37(1): 53-59, 2012. (49 refs.)

Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age)=15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.

Carrasco-Garrido P; Hernandez-Barrera V; de Andres AL; Jimenez-Trujillo I; Jimenez-Garcia R. Sex-differences on self-medication in Spain. Pharmacoepidemiology and Drug Safety 19(12): 1293-1299, 2010. (45 refs.)

Purpose: This study mainly aimed at describing the factors associated with self-medicated consumption of drugs in Spain from a gender perspective. Methods: Descriptive, cross-sectional study covering the Spanish adult population, using data drawn from the 2006 and 2007 Spanish National Health Survey (SNHS). A total of 20,738 subjects were analyzed. The independent variables were sociodemographic, lifestyle, and health-related, and the dependent variable was self-medicated drug use. Using logistic multivariate regression models we have estimated the independent effect of each of these variables on the self-medicated consumption. Two models were generated, one for female and one for male. Results: The 20.17% of all Spaniards indulge in self-medication. The prevalence of self-medication was 16.93% (2715) for women and 14.46% (1469) for men (p<0.05). The variables that were independently and significantly associated with a greater probability of self-medicated consumption in women were: lower age; consumption of alcohol; smoking habit. Among men, self-medication is associated with nationality (immigrants were more likely to self-medicate), income, and alcohol consumption. Conclusions: The prevalence of self-medicated drug use is higher in women than men. In our population, the influence of unhealthy lifestyles, such as alcohol and tobacco consumption, are related to a higher likelihood of self-medication.

Cascone P; Zimmermann G; Auckenthaler B; Robert-Tissot C. Cannabis dependence in Swiss adolescents: Exploration of the role of anxiety, coping styles, and psychosocial difficulties. Swiss Journal of Psychology 70(3): 129-139, 2011. (71 refs.)

This naturalistic cross-sectional study explores how and to what extent cannabis dependence was associated with intrapersonal aspects (anxiety, coping styles) and interpersonal aspects of adolescent functioning (school status, family relationships, peer relationships, social life). A convenience sample of 110 adolescents (aged 12 to 19) was recruited and subdivided into two groups (38 with a cannabis dependence and 72 nondependent) according to DSM-IV-TR criteria for cannabis dependence. Participants completed the State-Trait Anxiety Inventory (STAI-Y), the Coping Across Situations Questionnaire (CASQ), and the Adolescent Drug Abuse Diagnosis (ADAD) interview investigating psychosocial and interpersonal problems in an adolescent's life. Factors associated with cannabis dependence were explored with logistic regression analyses. The results indicated that severity of problems in social life and peer relationships (OR = 1.68, 95% CI = 1.21 - 2.33) and avoidant coping (OR = 4.22, 95% CI = 1.01 - 17.73) were the only discriminatory factors for cannabis dependence. This model correctly classified 84.5% of the adolescents. These findings are partially consistent with the "self-medication hypothesis" and underlined the importance of peer relationships and dysfunctional coping strategies in cannabis dependence in adolescence. Limitations of the study and implications for clinical work with adolescents are discussed.

Chaiton M; Cohen J; O'Loughlin J; Rehm J. Use of cigarettes to improve affect and depressive symptoms in a longitudinal study of adolescents. Addictive Behaviors 35(12): 1054-1060, 2010 , 2010. (43 refs.)

Smoking to alleviate negative affect or improve physiological functioning (i.e., self-medication) is one explanation for the association between depression and smoking in adolescents. This study tests whether using cigarettes to improve mood or physiological functioning is associated with the onset, and change over time, of elevated depressive symptoms. Data were drawn from the Nicotine Dependence in Teens study which followed 1293 participants initially aged 12-13 years in Montreal. Canada every three months for five years. The subsample included 662 adolescents who had been current smokers (reported smoking during the previous three months) at any point during the study. Survival analysis was used to test whether self-medication scores predicted onset of elevated depressive symptoms. Changes over time in depressive symptom scores relative to self-medication scores were modeled in growth curve analyses controlling for sex and number of cigarettes smoked per week. Smokers who reported higher self-medication scores had higher depressive symptom scores. The interaction between self-medication scores and the acceleration rate in depressive symptom scores was significant and negative, suggesting that participants with higher self-medication scores had decelerated rates of change in depression over time compared to participants with lower self-medication scores. Smoking appears to be ineffective at reducing depressive symptoms. These findings are consistent with a version of the Positive Resource Model that suggests that smoking will not lower depressive symptoms, but could slow the rate of change over time. Alternatively, the perceived positive benefits may be the result of alleviation of symptoms of withdrawal and craving resulting from abstinence. The self-medication scale may identify a population at risk of increased levels of depressive symptoms.

Chakroun N; Johnson EI; Swendsen J. Mood and personality-based models of substance use. Psychology of Addictive Behaviors 24(1): 129-136, 2010. (46 refs.)

Mood and personality-based vulnerabilities have been extensively examined in patients with substance use disorders, but their relevance as models of etiology remains to be fully investigated. The present investigation examined mood and personality-based models of substance use in a nonclinical sample of young adults. Two-hundred and twelve individuals were assessed for personality and clinical characteristics and participated in computerized ambulatory monitoring of mood states and substance use over a I-week period. Personality factors were strong predictors of substance use frequency over the previous 30 days, as well as of substance use in daily life using ambulatory monitoring. A linear increase was also observed in the intensity of novelty seeking and antisocial personality traits as a function of the social deviance of substances used. However, mood disorder history was related only to the use of illicit drugs other than cannabis, and fluctuations in mood states did not prospectively predict daily use of substances in a manner consistent with self-medication. Moreover, there was little evidence that personality characteristics moderated relations between mood states and substance use in daily life. The relevance of results for mood and personality models of substance use etiology is discussed.

Chambers RA. A nicotine challenge to the self-medication hypothesis in a neurodevelopmental animal model of schizophrenia. Journal of Dual Diagnosis 5(2): 139-148, 2009 , 2009. (40 refs.)

Nicotine addiction is the leading cause of premature illness and death in the general population. Up to half of all cigarettes are consumed by a minority of the population: persons with schizophrenia and other forms of mental illness. Ironically, despite nicotine dependence being considered a serious and deadly form of addiction in the general population, research on smoking in mental illness is predominantly guided by the idea that smoking has beneficial medication-like treatment effects. This article considers pitfalls of adherence to the self-medication hypothesis as an exclusively held dogma. New evidence from animal modeling work suggests the need to broaden hypothesis-driven research on smoking in mental illness. Adolescent smoking could predispose to mental illness and/or increased nicotine dependence in schizophrenia may represent an involuntary, general addiction vulnerability that has little to do with the 'helpful' psychoactive effects of nicotine or other drugs.

Charles V; Weaver T. A qualitative study of illicit and non-prescribed drug use amongst people with psychotic disorders. Journal of Mental Health 19(1): 99-106, 2010. (24 refs.)

Background: The reasons for drug use amongst people with psychosis are poorly understood. Aims: To investigate patterns of drug use and self-reported reasons for drug use amongst people with psychosis. Method: Qualitative interviews with 14 patients with psychosis who misuse drugs. Results: Most participants felt drug use was implicated in the development or exacerbation of psychosis. Most changed their pattern of drug use post-onset, reported transient motivation to abstain from drug use but became discerning drug users. Despite awareness of the negative physical and mental health consequences of drug use participants reported that drugs were used for social reasons, to achieve pleasurable intoxication, to relieve dysphoria or the side effects of anti-psychotic medication and to enhance or modify mood. Self-medication in response to psychotic symptoms was not reported. Conclusions: Participants described reasons for drug use that were consistent with those previously reported, but we found no strong evidence that patients self-medicated in response to their psychotic symptoms. Transient motivation to abstain from drug use may provide opportunities for intervention but psychiatric professionals need to assess each patient's motivations for use to intervene effectively.

Cranford JA; Nolen-Hoeksema S; Zucker RA. Alcohol involvement as a function of co-occurring alcohol use disorders and major depressive episode: Evidence from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 117(2-3): 145-151, 2011. (71 refs.)

Background: Co-occurring alcohol use disorder and major depression (C-ALDP) is a major public health problem. Yet, the available evidence is mixed regarding the implications of C-ALDP for alcohol involvement. The purpose of this research was to examine the associations between past 12-month co-occurring AUDs (abuse and dependence) and major depressive episode (MDE) and alcohol involvement in a representative community sample. Design: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a national household survey of 43,093 adults ages 18 and older. For the NESARC, the target population is the civilian noninstitutionalized population, 18 years of age and older, living in the United States and the District of Columbia. Methods: All NESARC interviews were conducted with the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM IV Version (AUDADIS-IV; Grant et al., 2003a). Results: Prevalence of past 12-month co-occurring AUD (abuse or dependence) and MDE was 1.2%, corresponding to about 2.4 million adults ages 18 and older. Among males with alcohol dependence, comorbid MDE was associated with a greater number of days drinking at home alone. Among females and males with alcohol abuse and dependence, comorbid MDE was associated with higher prevalence of drinking to enhance depressed mood. Comorbid MDE was also associated with lower levels of some drinking behaviors among those with alcohol abuse. Conclusions: Co-occurring AUDs and MDE are associated with specific dimensions of alcohol involvement, and this association is more consistent for alcohol dependence than abuse.

de Moraes ACF; Delaporte TRM; Molena-Fernandes CA; Falcao MC. Factors associated with medicine use and self medication are different in adolescents. Clinics 66(7): 1149-1155, 2011. (23 refs.)

OBJECTIVE: To estimate the prevalence of medicine use among high school students (14-18 years old) living in an urban area in Southern Brazil and the proportion who self-medicate and to explore the association between medicine use and demographic, socioeconomic, and behavioral variables. METHODS: A school-based survey was conducted among high school students in the city of Maringa/PR, Brazil in 2007. The sample students were selected through two-stage random sampling. The sample included 991 students (54.5% females) from eight public and four private high schools. The data were collected using a structured questionnaire. Only medications used within the 15 days preceding data collection were considered. The independent variables studied were sex, age, socioeconomic status, living with parents, employment status, smoking habits, and alcohol use. RESULTS: The prevalence of medicine use among the adolescents was 55.8% (females = 64.3%, males = 45.7%, p<0.001) and 52.6% of this use represented self medication (females = 51.0%, males = 56.8, p = 0.21). The factors associated with medicine use were age, employment, and smoking, while the factors associated with self medication were male gender and employment. Chronic users did not tend to self-medicate. CONCLUSION: The data from this study demonstrate a high prevalence of medicine use and self medication; however, the variables associated with medicine use and self medication differed. Urgent strategies to promote the rational use of drugs in this population and their families are necessary.

Ditre JW; Heckman BW; Butts EA; Brandon TH. Effects of expectancies and coping on pain-induced motivation to smoke. Journal of Abnormal Psychology 119(3): 524-533, 2010 , 2010. (68 refs.)

The prevalence of tobacco smoking among persons with recurrent pain is approximately twice that observed in the general population. Smoking has been associated with the development and exacerbation of several chronically painful conditions. Conversely, there is both experimental and cross-sectional evidence that pain is a potent motivator of smoking. A recent study provided the first evidence that laboratory-induced pain could elicit increased craving and produce shorter latencies to smoke (Ditre & Brandon, 2008). To further elucidate interrelations between pain and smoking, and to identify potential targets for intervention, in the current study, we tested whether several constructs derived from social cognitive theory influence the causal pathway between pain and increased motivation to smoke. Smokers (N = 132) were randomly assigned to I of 4 conditions in this 2 x 2 between-subjects experimental design. Results indicated that manipulations designed to (a) challenge smoking-related outcome expectancies for pain reduction and (b) enhance pain-related coping produced decreased urge ratings and increased latencies to smoke, relative to controls. An unexpected interaction effect revealed that although each manipulation was sufficient to reduce smoking urges, the combination was neither additive nor synergistic. These findings were integrated with those of the extant literature to conceptualize and depict a causal pathway between pain and motivation to smoke as moderated by smoking-related outcome expectancies and mediated by the use of pain coping behaviors.

Fossos N; Kaysen D; Neighbors C; Lindgren KP; Hove MC. Coping motives as a mediator of the relationship between sexual coercion and problem drinking in college students. Addictive Behaviors 36(10): 1001-1007, 2011. (63 refs.)

Sexually coercive experiences, heavy alcohol use, and alcohol-related problems occur at relatively high base rates in college populations. As suggested by the self-medication hypothesis, alcohol consumption may be a means by which one can reduce negative affect or stress related to experiences of sexual coercion. However, few studies have directly tested the hypothesis that coping motives for drinking mediate the relation between sexual assault and problem drinking behaviors, and no published studies have tested this in men. The current study tested this hypothesis using structural equation modeling in a sample of 780 male and female undergraduates. Results: revealed that coping motives partially mediated the relation between sexual coercion and drinking and alcohol-related negative consequences. In addition, direct and indirect paths between sexual coercion and drinking were found for men whereas only indirect paths were found for women. Results provide support for self-medication models of drinking and suggest the importance of exploring gender differences in mechanisms for drinking.

Gehricke JG; Hong N; Whalen CK; Steinhoff K; Wigal TL. Effects of transdermal nicotine on symptoms, moods, and cardiovascular activity in the everyday lives of smokers and nonsmokers with attention-deficit/hyperactivity disorder. Psychology of Addictive Behaviors 23(4): 644-655, 2009. (82 refs.)

The aim of the study was to test the self-medication hypothesis by examining the effects of nicotine in the everyday lives of smokers and nonsmokers with attention-deficit/hyperactivity disorder (ADHD). Fifty-two adults with ADHD (25 abstinent smokers and 27 nonsmokers) participated in a double-blind placebo controlled study with one nicotine patch condition and one placebo patch condition in counterbalanced order. Each condition continued for two consecutive days in which patches were administered each morning. The effects of nicotine on ADHD symptoms, moods, and side effects were assessed with electronic diaries. Cardiovascular activity was recorded with ambulatory blood pressure monitors and physical activity was monitored with actigraphs. Nicotine reduced reports of ADHD symptoms by 8% and negative moods by 9%, independent of smoking status. In addition, nicotine increased cardiovascular activity during the first 3 to 6 hours after nicotine patch administration. The results support the self-medication hypothesis for nicotine in adults with ADHD and suggest that smoking cessation and prevention efforts for individuals with ADHD will need to address both the symptom reducing and mood enhancing effects of nicotine.

Glass K; Flory K. Why does ADHD confer risk for cigarette smoking? A review of psychosocial mechanisms. (review). Clinical Child and Family Psychology Review 13(3): 291-313, 2010 , 2010. (97 refs.)

Research has documented that adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking, but less attention has examined why this risk exists. The current paper reviews the literature on different psychosocial mechanisms [self-medication hypothesis, social factors (social modeling, social impairments), cognitive factors (attitudes, coping skills), and psychological variables (ADHD symptom dimensions, comorbidity)] that might explain this increased smoking risk. Results of the review suggest that, while the self-medication hypothesis has some theoretical merit, it has not been adequately examined among adolescents and young adults with ADHD. Further, cognitive and social factors may be important mechanisms that help to explain the association between ADHD and cigarette smoking, but research in these areas is sparse. Finally, a larger body of literature suggests that different psychological aspects of ADHD (e.g., comorbidity, symptom dimensions) are related to smoking. Interpretation of findings of many of these studies was hindered due to significant methodological problems and the lack of a guiding theoretical orientation. Potential theories that might facilitate future work in this area are discussed. Future research should continue to explore these important psychosocial mechanisms as well as gene-environment interactions in examining the link between ADHD and cigarette smoking.

Gold J; Gold MS. Exercise for the overweight and obese. (review). Current Pharmaceutical Design 17(12): 1193- 1197, 2011. (45 refs.)

The development of new phamacological treatments for obesity has been challenging. In part, the lack of early diagnosis, early detection, early intervention and treatment has meant that more cases progress to life-threatening co-morbidities and surgical options. Pharmacological treatment of obesity has been limited. Self-medication with drugs of abuse and tobacco has been successful for some patients, but abuse and addiction make this approach quite dangerous. The advent of trendy 'diets du jour' has apparently made obesity and eating disorders more likely rather than less likely. Trials of novel anti-obesity compounds have generally compared the new medication and placebo to a dietary counseling intervention. Interventions for patients who are not obese enough for gastric banding or bariatric surgery are quite similar to those given to alcoholics in the 1970s, "drink less or stop drinking". We need to consume less in a modern life of desk and computer work, driving, and even internet shopping. However, we are driven and reinforced to consume and easily fall prey to television and other cues and messages driving this relationship to eating. This paper, after briefly reviewing the consensus on consumption and exercising suggests that new treatments may be developed by increasing exercise adherence and even increasing the reinforcing value or power of exercise itself. Food, sex, and drugs of abuse are highly valued and reinforced in our brains, so why not exercise?

Hall MT; Howard MO; McCabe SE. Subtypes of adolescent sedative/anxiolytic misusers: A latent profile analysis. Addictive Behaviors 35(10): 882-889, 2010 , 2010. (34 refs.)

Background: Few empirically-based taxonomies of nonmedical prescription drug misusers have been published. This study used latent profile analysis (LPA) to identify classes of adolescent sedative/anxiolytic misusers. Methods: Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youth in residential care for antisocial behavior. Sedative/anxiolytic misusers (N = 247) averaged 15.8 (S.D.= 1.1) years of age: a majority were male (83.8%), White (70.0%), and resided in rural/small town areas (53.8%). Results: LPA yielded a three-class solution. Class 1(59.1%) was comprised of youth with significantly lower levels of currently distressing psychiatric symptoms, fewer lifetime traumatic experiences, less problematic substance use histories, less frequent antisocial behavior, and less impulsivity than youth in Classes 2 and 3. Class 2 (11.3%) youth had high levels of currently distressing psychiatric symptoms and more frequent antisocial behavior compared to youth in Classes 1 and 3. Class 3 (29.5%) youth evidenced levels of psychiatric and behavioral problems that were intermediate to those of Class 1 and 2 youth. Frequency of sedative/anxiolytic misuse was significantly higher in Classes 2 and 3 compared to Class I. Members of Class 2 and Class 3 also had the highest levels of psychiatric symptoms for which sedatives/anxiolytics are commonly prescribed. Significant differences between classes were observed across a range of health, mental health, personality, and behavioral variables. Conclusions: Adolescents who misused prescription sedatives/anxiolytics evidenced significant heterogeneity across measures of psychiatric and behavioral dysfunction. Youth with comparatively high levels of anxiety and depression reported significantly more intensive sedative/anxiolytic misuse than their counterparts and may be at high risk for sedative/anxiolytic abuse and dependence.

Hearon BA; Calkins AW; Halperin DM; McHugh RK; Murray HW; Otto MW. Anxiety sensitivity and illicit sedative use among opiate-dependent women and men. (review). American Journal of Drug and Alcohol Abuse 37(1): 43-47, 2011. (26 refs.)

Objectives: Research has suggested that individuals with elevated anxiety sensitivity (AS) (the fear of benign bodily sensations associated with anxiety) are more likely to use substances to cope with distress, particularly substances with arousal-dampening effects such as benzodiazepines and other sedatives. Such coping motives may also vary as a function of gender, with women more likely to use substances for coping (self-medicating) purposes. Given these findings, we hypothesized that AS would be associated with illicit sedative use in an opioid-dependent sample and that gender would moderate this relationship, with a greater association among women. Method: Participants were 68 opioid-dependent patients recruited from a methadone maintenance clinic. A logistic regression was used to determine whether AS was associated with presence or absence of a history of illicit sedative use. Results: AS was significantly associated with sedative use and this relationship was moderated by gender; elevated AS was associated with greater sedative use only in women. Conclusions and Scientific Significance: The presence of elevated AS is related to greater illicit use of sedatives in women but not in men. Women may be more susceptible to seek sedatives as a means of coping with unpleasant, anxious sensations.

Heilig M; Egli M; Crabbe JC; Becker HC. Acute withdrawal, protracted abstinence and negative affect in alcoholism: Are they linked? (review). Addiction Biology 15(2): 169-184, 2010. (201 refs.)

The role of withdrawal-related phenomena in the development and maintenance of alcohol addiction remains under debate. A 'self-medication' framework postulates that emotional changes are induced by a history of alcohol use, persist into abstinence, and are a major factor in maintaining alcoholism. This view initially focused on negative emotional states during early withdrawal: these are pronounced, occur in the vast majority of alcohol-dependent patients, and are characterized by depressed mood and elevated anxiety. This concept lost popularity with the realization that in most patients, these symptoms abate over 3-6 weeks of abstinence, while relapse risk persists long beyond this period. More recently, animal data have established that a prolonged history of alcohol dependence induces more subtle neuroadaptations. These confer altered emotional processing that persists long into protracted abstinence. The resulting behavioral phenotype is characterized by excessive voluntary alcohol intake and increased behavioral sensitivity to stress. Emerging human data support the clinical relevance of negative emotionality for protracted abstinence and relapse. These developments prompt a series of research questions: (1) are processes observed during acute withdrawal, while transient in nature, mechanistically related to those that remain during protracted abstinence?; (2) is susceptibility to negative emotionality in acute withdrawal in part due to heritable factors, similar to what animal models have indicated for susceptibility to physical aspects of withdrawal?; and (3) to what extent is susceptibility to negative affect that persists into protracted abstinence heritable?.

Hien DA; Jiang HP; Campbell ANC; Hu MC; Miele GM; Cohen LR et al. Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network. American Journal of Psychiatry 167(1): 95-101, 2010. (22 refs.)

Objective: The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. Method: Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (non-response, substance use response, PTSD response, or global response [ improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period. Results: Subjects exhibiting non-response, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions. Conclusions: PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Immonen S; Valvanne J; Pitkala KH. Older adults' own reasoning for their alcohol consumption. International Journal of Geriatric Psychiatry 26(11): 1169-1176, 2011. (51 refs.)

Objective: The aim of the study was to investigate what the older adults themselves consider to be the reasons for their alcohol consumption. Methods: The data were collected with a postal questionnaire from a random sample of 2100 elderly people (>= 65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. Altogether 868 persons responded that they use alcohol. Of them, 831 gave reasons for their drinking. We defined "at-risk users'' as consuming >7 drinks per week, or >= 5 drinks on a typical drinking day, or using >= 3 drinks several times per week. Results: Main reasons given for alcohol consumption were "having fun or celebration'' (58.7%), "for social reasons'' (54.2%), "using alcohol for medicinal purposes'' (20.1%), and "with meals'' (13.8%). Younger age groups reported more often than the older age groups that they use alcohol for "having fun or celebration'' and "for social reasons.'' The older age groups used more often "alcohol for medicinal purposes''. Men used alcohol more often than women "as pastime'' or "as sauna drink''. Those defined as "at-risk users'' reported using alcohol because of "meaningless life,'' for "relieving depression,'' "relieving anxiety,'' and "relieving loneliness.'' Conclusions: Older adults have diverse alcohol consumption habits like people in other age groups. The oldest olds reported that they use alcohol for medicinal purposes. The "at-risk users'' admit they use alcohol because of meaningless life, and relieving depression, anxiety, and loneliness.

Klemenc-Ketis Z; Hladnik Z; Kersnik J. A cross sectional study of sex differences in self-medication practices among university students in Slovenia. Collegium Antropologicum 35(2): 329-334, 2011. (28 refs.)

Self-medication patterns in adults depend on sex. Self-medication among students is very common, but little is known about the influence of sex. The aim of the study was to determine the incidence of self-medication college students and to determine the effect of sex on self-medication patterns. A web based incidence study conducted on a sample of Slovenian university students. The main outcome measures were percentages of male and female students reporting the use of self-medication in the past year A majority of students (92.3%) reported the use of some sort of self-medication in the past year. Most female students (94.1%) and most male students (90.9%) reported the use of self-medication in the past year. The difference was not statistically significant. More female students than male ones (p<0.05) acquired the drugs for self-medication in pharmacies, used OTC drugs, herbal teas, herbs, vitamins and minerals, remedies for muscle mass gain, antibiotics, benzodiazepines, antacids, acetylsalicylic acid, topical corticosteroids, and nasal decongestives only with the advice of physicians or pharmacists, and thought that increasing drug dosage can be dangerous, that in case of side effects physicians' help must be sought, that no drug can be used during pregnancy, and that self-treatment can mask the symptoms and signs of diseases so the physicians can overlook them easily. Sex appears to be important factor in self-medication patterns even in young adults, such as students. The physicians should actively seek the presence of self-medication in this population. Inappropriate or unsafe use should be properly addressed and managed.

Kolliakou A; Joseph C; Ismail K; Atakan Z; Murray RM. Why do patients with psychosis use cannabis and are they ready to change their use? International Journal of Developmental Neuroscience 29(3, special issue): 335- 346, 2011. (121 refs.)

Numerous studies have shown that patients with psychosis are more likely to use illicit drugs than the general population, with cannabis being the most popular. There exists overwhelming evidence that cannabis use can contribute to the onset of schizophrenia and poor outcome in patients with established psychosis. Therefore, understanding why patients use cannabis and whether they are motivated to change their habits is important. The evidence is that patients with psychosis use cannabis for the same reasons the general population does, to 'get high', relax and have fun. There is little support for the 'self-medication' hypothesis, while the literature points more towards an 'alleviation of dysphoria' model. There is a lack of research reporting on whether psychotic patients are ready to change their use of cannabis, which has obvious implications for identifying which treatment strategies are likely to be effective.

Lagoni L; Crawford E; Huss MT. An examination of the self-medication hypothesis via treatment completion. Addiction Research & Theory 19(5): 416-426, 2011. (24 refs.)

A long-held clinical belief is that many of the mentally ill seek relief from their symptoms through the use of alcohol and other illicit substances. The notion of self-medication became formalized in the literature via the self-medication hypothesis (SMH) of addictive disorders (Khantzian, 1985). This study attempted to examine the role of treatment completion for the SMH by examining 696 participants in a dual diagnosis program. Logistic regressions were conducted using mental health demographic variables on drug of choice. In addition, this study extended previous research by employing a path analytic process and examining the complex relationships between these variables in the context of treatment completion. Results indicated little support for the presence of self-medication in this sample.

Lorberg B; Wilens TE; Martelon M; Wong P; Parcell T. Reasons for substance use among adolescents with bipolar disorder. American Journal on Addictions 19(6): 474-480, 2010 , 2010. (45 refs.)

We examined whether children and adolescents with bipolar disorder (BPD) "self-medicate" with cigarettes, alcohol, or other substances of abuse. One hundred and five adolescents with BPD and 98 controls were comprehensively assessed with a structured psychiatric diagnostic interview for psychopathology and the Drug Use Screening Inventory (DUSI) for self-medication. Thirteen control (mean +/- standard deviation [SD] = 15.31 +/- 1.18 years) and 27 BPD (15.30 +/- 2.09 years) subjects endorsed use of one of the listed drugs in the DUSI Section A within the past year and were included in all analyses. BPD adolescents were more likely than nonmood disordered, substance-using controls to report starting to use their preferred drug for mood-altering effects. There were no differences between groups in motivation for use with respect to starting substances to sleep better or get high, or in continuing substances to change mood, sleep better, or get high. These data may contribute to increased prevention of substance use disorders and to the treatment of adolescent BPD. Further studies clarifying the characteristics of self-medication are necessary.

Loue S; Sajatovic M; Mendez N. Substance use and HIV risk in a sample of severely mentally ill Puerto Rican women. Journal of Immigrant and Minority Health 13(4): 681-689, 2011. (66 refs.)

Latinos, and Puerto Ricans in particular, have been disproportionately impacted by HIV/AIDS. Severe mental illness (SMI) is associated with an increase in HIV risk. Relatively little research has focused on the role of SMI among Puerto Rican injection drug users (IDUs) and non-IDUs in susceptibility to and transmission of HIV and there are few published reports on HIV risk among Latina SMI. We conducted a longitudinal mixed methods study with 53 Puerto Rican women with schizophrenia, bipolar disorder, or major depression to examine the cultural context of HIV risk and HIV knowledge, beliefs, and behaviors among a larger study with Puerto Rican and Mexican women with serious mental illness (SMI). There was a high prevalence of past and current substance use and a high prevalence of substance use-associated HIV risk behaviors, such as unprotected sexual relations with an IDU. The violence associated with substance use frequently increased participants' HIV risk. Choice of substance of abuse depended on cost, availability, and use within the individual participant's network. Participants attributed their substance use to the need to relieve symptoms associated with their mental illness, ameliorate unpleasant feelings, and deaden emotional pain. HIV prevention interventions for poorer Puerto Rican women with SMI must target the individuals themselves and others within their networks if the women are to be supported in their efforts to reduce substance use-related risk. The content of any intervention must address past and current trauma and its relationship to substance use and HIV risk, as well as strategies to prevent HIV transmission.

Lybrand J; Caroff S. Management of schizophrenia with substance use disorders. Psychiatric Clinics of North America 32(4): 821-+, 2009. (75 refs.)

Around 50% of patients with schizophrenia develop a co-occurring substance use disorder involving alcohol or illicit substances at some time during their lives. The comorbid substance abuse will markedly affect the course of illness of schizophrenia. In this article, the authors review the epidemiology, theories of causation, effect on the course of illness, and treatment of co-occurring schizophrenia and substance use disorder.

Marin GH; Canas M; Carlson S; Silvestrini MP; Corva S; Mestorino N; Errecalde J et al. Self-medication, substance abuse and alcohol consumption in students attending to La Plata National University, Argentina. Latin American Journal of Pharmacy 29(8): 1425-1430, 2010. (32 refs.)

The World Health Organization raises self-care as a strategy for health promotion. Although self-medication is included in self-care strategy, often it is associate to an irrational medicine's usage. This factor associated with illicit drugs and alcohol consumption becomes in a public health problem. In order to establish frequency of self-medication and the prevalence of illicit drugs and alcohol consumption among university students of La Plata, Argentina, was started the present project. Information was collected by anonymous survey, that evaluated age, sex, origin, cohabitants, type, frequency of consumption, and career. A total of 5170 students were polled. 46.64 % consumes regularly some medicine and 50.11 % of this consumption was self-medication. Mainly this consumption consisted in analgesics (88 %) and antibiotics (45 %). Benzodiazepines were also consumed in 6.9 ck (39 % by self-medication). The consumption of illicit drugs was 38.1 % (29 % marihuana, 4 % cocaine, 1,2 % "paco" and 2.9 % "ecstasy"). The consumption of alcoholic drinks was 82 % for beer, 56 % fernet, 55 % wine and 48 % whiskey. Medicines were obtained outside pharmacies in 30.1 % of the cases. The major consumption of cocaine was given among students of Social Careers [Odds Ratio (OR) 2.3], and in those that lives without their families (1.5). The results indicate that self-medication is common among university students. Those students that live alone had a significant higher risk of being self-medicated than those that lives with their families. More than 30 % of the medicines were obtained at the informal market (other place that pharmacies).

Marshall-Berenz EC; Vujanovic AA; MacPherson L. Impulsivity and alcohol use coping motives in a trauma-exposed sample: The mediating role of distress tolerance. Personality and Individual Differences 50(5): 588-592, 2011. (31 refs.)

The present investigation examined the mediating role of distress tolerance in the association between impulsivity and alcohol use coping motives among trauma-exposed individuals. Participants were 86 adults (64.3% women; M-age = 23.4, SD = 9.3) who met the DSM-IV-TR posttraumatic stress disorder (PTSD) Criterion A for at least one traumatic life event and endorsed alcohol use in the past month. Distress tolerance at least partially mediated the association between impulsivity and alcohol use coping motives, after controlling for the variance explained by PTSD symptom severity and alcohol use problems. Clinical implications and future directions related to this line of inquiry are presented and discussed.

Menary KR; Kushner MG; Maurer E; Thuras P. The prevalence and clinical implications of self-medication among individuals with anxiety disorders. Journal of Anxiety Disorders 25(3): 335-339, 2011. (21 refs.)

Alcohol dependence (AD) is more likely to occur among individuals with rather than without an anxiety disorder. Self-medication theory (SMT) holds that drinking behavior is negatively reinforced when alcohol temporarily reduces anxiety and that the resulting escalation of drinking increases the risk for AD. We set out to empirically scrutinize SMT using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset. We found that only a minority (about 20%) of anxiety disordered individuals endorsed drinking to control anxiety symptoms. This minority drank more alcohol, had a higher cross-sectional rate of AD, and was at higher risk for developing new AD over four years compared to anxiety disordered non-self-medicators and individuals with no anxiety disorder. Consistent with SMT, increased prospective risk for AD among self-medicators is partially mediated by an increased level of alcohol use. Understanding the processes that promote and inhibit self-medication should be a priority for anxiety disorder researchers.

Mineur YS; Picciotto MR. Biological basis for the co-morbidity between smoking and mood disorders. Journal of Dual Diagnosis 5(2): 122-130, 2009 , 2009. (42 refs.)

Nicotine dependence is still the major preventable cause of death in the developed world, and it has strong co-morbidity with mood disorders including major depression. Depressed patients are more likely to smoke cigarettes, and quitting can precipitate an episode of depression in some individuals. Interestingly, antidepressants, particularly the atypical antidepressant bupropion, are therapeutics that can help smokers quit. Despite these observations, the underlying biological factors of the relationship between smoking and depression remain unclear. Results from clinical and preclinical studies have seemed somewhat paradoxical because heightened cholinergic activity can induce depression, while both nicotine and nicotinic antagonists can be antidepressant-like. These observations can be reconciled by considering that high-affinity nicotinic receptors in the brain can be desensitized by chronic nicotine use, leading to blunted cholinergic activity. Based on this hypothesis, nicotinic antagonists have recently been tested as treatments for depression in humans, particularly as adjunct therapy along with classical antidepressants. These data suggest that the relationship between smoking and depression may be partially explained by the fact that depressed patients smoke in an effort to self-medicate depressive symptoms by desensitizing their nicotinic receptors. This possibility suggests new avenues for treatment of both nicotine dependence and depressive disorders.

Moonzwe LS; Schensul JJ; Kostick KM. The role of MDMA (ecstasy) in coping with negative life situations among urban young adults. Journal of Psychoactive Drugs 43(3): 199-210, 2011. (77 refs.)

This article examines the role of Ecstasy (MDMA or 3, 4-methylenedioxymethamphetamine) as a drug used for self-medication and coping with both short- and long-term negative life situations. We show that urban youth who do not have a specific diagnosed mental illness are more likely than those who have been diagnosed and have received treatment to use Ecstasy to cope with both situational stress and lifetime trauma. Diagnosed and treated youth sometimes self-medicate with other drugs, but do not choose Ecstasy for mediation of their psychological stress. We discuss the implications of self-medication with Ecstasy for mental health services to urban youth experiencing mental health disparities, and for the continued testing and prescription of MDMA for therapeutic use in controlled clinical settings.

Moos RH; Brennan PL; Schutte KK; Moos BS. Older adults' health and late-life drinking patterns: A 20-year perspective. Aging & Mental Health 14(1): 33-43, 2010. (62 refs.)

Objectives: This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. Methods: A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later. Results: Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems. Conclusion: Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

North CS; Ringwalt CL; Downs D; Derzon J; Galvin D. Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Archives of General Psychiatry 68(2): 173-180, 2011. (57 refs.)

Context: Although several studies have suggested that alcohol use may increase after disasters, it is unclear whether any apparent postdisaster increases regularly translate into new cases of alcohol use disorders. Objective: To determine the relationship of predisaster and postdisaster prevalence of alcohol use disorders and to examine the incidence of alcohol use disorders in relation to disasters. Design: Data from 10 disasters, studied within the first few postdisaster months and at 1 to 3 years postdisaster, were merged and examined. Participants: Six hundred ninety-seven directly exposed survivors of 10 disasters. Measures: The Diagnostic Interview Schedule for DSM-III-R provided lifetime diagnoses of alcohol abuse and dependence, and onset and recency questions allowed a determination of whether the disorder had been present either prior to or following the event, or both. Results: While the postdisaster prevalence of alcohol use disorders was 19%, only 0.3% of the sample developed an acute new postdisaster alcohol use disorder. Most of those in recovery, however, consumed alcohol after the disaster (83%) and coped with their emotions by drinking alcohol (22%). Those with a postdisaster alcohol use disorder were more than 4 times as likely as those without to cope with their disaster-related emotions by drinking alcohol (40% vs 9%). Conclusions: The vast majority of postdisaster alcohol use disorders represented the continuation or recurrence of preexisting problems. Findings suggest that those in recovery as well as those who drink to cope with their emotions represent groups warranting potential concern for postdisaster mental health intervention. Further research is needed to clarify the clinical significance of changes in alcohol use after disasters.

Patock-Peckham JA; Morgan-Lopez AA. Direct and mediational links between parental bonds and neglect, antisocial personality, reasons for drinking, alcohol use, and alcohol problems. Journal of Studies on Alcohol and Drugs 71(1): 95-104, 2010. (68 refs.)

Objective: The self-medication model suggests that some individuals may use alcohol as a means to cope with their negative experiences. Antisocial personality reflects a lack of concern for others and is often linked to alcohol use disorders. The aim of this investigation was to examine potential parental influences to both pathological reasons for drinking and antisocial personality as pathways to alcohol use and problems. Method: Direct and indirect links between parental bond (care, rejection, overprotection, autonomy, and neglect) and antisocial personality, pathological reasons for drinking, alcohol use, and alcohol-related problems were investigated. A two-group SEM path model with college students (164 female, 240 male) was examined. Results: In general, the overall patterns among male and female respondents were distinct. Among women, perceptions of having a caring mother lowered the likelihood of having antisocial tendencies, and perceptions of being rejected by one's father were directly linked to pathological reasons for drinking. Feeling neglected by one's mother was also directly linked to alcohol-related problems among women. Conversely, feeling neglected by one's father was directly linked to alcohol-related problems among males, suggesting a parent-offspring gender match. For men, antisocial personality mediated the impact of mother rejection and father overprotection on alcohol use. Conclusions: These findings suggest that parental influences regarding vulnerabilities for alcohol use are very complex and that the genders of the respondent and the parent must be considered jointly.

Potter CM; Vujanovic AA; Marshall-Berenz EC; Bernstein A; Bonn-Miller MO. Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance. Journal of Anxiety Disorders 25(3): 437-443, 2011. (55 refs.)

The present investigation examined the explanatory (i.e,. mediating) role of distress tolerance (DT) in the relation between posttraumatic stress (PTS) symptom severity and marijuana use coping motives. The sample consisted of 142 adults (46.5% women; M-age =22.18, SD = 7.22, range = 18-55), who endorsed exposure to at least one Criterion A traumatic life event (DSM-IV-TR, 2000) and reported marijuana use within the past 30 days. As predicted, results demonstrated that DT partially mediated the relation between PTS symptom severity and coping-oriented marijuana use. These preliminary results suggest that DT may be an important cognitive-affective mechanism underlying the PTS-marijuana use coping motives association. Theoretically, trauma-exposed marijuana users with greater PTS symptom severity may use marijuana to cope with negative mood states, at least partially because of a lower perceived capacity to withstand emotional distress.

Rabiner DL; Anastopoulos AD; Costello EJ; Hoyle RH; McCabe SE; Swartzwelder HS. Motives and perceived consequences of nonmedical ADHD medication use by college students are students treating themselves for attention problems? Journal of Attention Disorders 13(3): 259-270, 2009. (14 refs.)

Objective: This study examines why college students without a prescription take ADHD medication, what they perceive the consequences of this to be, and whether attention problems are associated with this behavior. Method: More than 3,400 undergraduates attending one public and one private university in the southeastern United States completed a Web-based survey. Results: Nonmedical ADHD medication use in the prior 6 months was reported by 5.4% of respondents and was positively associated with self-reported attention difficulties. Enhancing the ability to study was the most frequent motive reported; nonacademic motives were less common. Students perceived nonmedical use to be beneficial despite frequent reports of adverse reactions. Conclusion: Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success. The academic, social, and biomedical consequences of illicit ADHD medication use among college students should be researched further.

Richardson TH. Cannabis use and mental health: A review of recent epidemiological research. (review). International Journal of Pharmacology 6(6): 796-807, 2010. (117 refs.)

Cannabis is the most commonly used drug in the world. This review examines recent epidemiological research on the relationships between cannabis use and mental health problems. Relationships with depression, anxiety disorders, mania and psychosis are examined, with relevant issues such as the effect of confounding variables, temporal directions and causality being discussed. Factors which influence the relationship such as dose-response effects, age of first cannabis use and risk of mental health problems are also examined. Causality is often difficult to establish, as cannabis is often used by those with mental illness for self-medication. However, there is substantial evidence to suggest that cannabis may induce or exacerbate a number of mental health problems.

Riley JL; King C. Self-report of alcohol use for pain in a multi-ethnic community sample. Journal of Pain 10(9): 944-952, 2009. (64 refs.)

This study examined the occurrence of alcohol use to manage pain in community-dwelling adults with tooth pain, jaw joint/face pain, and arthritis. Race/ethnicity, sex, and age were examined to determine their associations with alcohol use for pain. Community-dwelling adults from South Florida with tooth pain (n = 1,767), jaw joint/face pain (n = 1,199), or arthritis pain (n = 1,355) completed a structured telephone interview. Logistic regression models indicted that, similar to population rates, nonHispanic whites and males were the most likely to use alcohol to manage pain. In addition, alcohol use for pain was highest in younger adults. Individuals who self-managed oral pain with alcohol were more likely to use prescription and over-the-counter pain medications, but this association was not found for arthritis. Additional characteristics of individuals who self-medicated regardless of pain condition included greater pain frequency, depression, and higher levels of education. Being married was protective against the use of alcohol to manage pain symptoms. Use of alcohol for pain should be assessed during treatment evaluation so that physicians and other health care providers are aware of their patient's concomitant use of alcohol and pain medication, assess for psychosocial impairment, and make the appropriate referrals and adjustment to treatment. Perspective: Self-medication of pain with alcohol is most common among younger non-Hispanic white males and associated with pain frequency, depression, and use of pain medications. Alcohol use for pain needs to be assessed so that health care providers can make appropriate referrals and adjustments to treatment.

Robinson J; Sareen J; Cox BJ; Bolton JM. Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry 68(8): 800-807, 2011. (52 refs.)

Context: Self-medication of anxiety symptoms with alcohol, other drugs, or both has been a plausible mechanism for the co-occurrence of anxiety disorders and substance use disorders. However, owing to the cross-sectional nature of previous studies, it has remained unknown whether self-medication of anxiety symptoms is a risk factor for the development of incident substance use disorder or is a correlate of substance use. Objective: To examine whether self-medication confers risk of comorbidity. Design: A longitudinal, nationally representative survey was conducted by the National Institute on Alcohol Abuse and Alcoholism. The National Epidemiologic Survey on Alcohol and Related Conditions assessed DSM-IV psychiatric disorders, self-medication, and sociodemographic variables at 2 time points. Setting: The United States. Participants: A total of 34 653 US adults completed both waves of the survey. Wave 1 was conducted in 2001-2002, and wave 2 interviews occurred 3 years later (2004-2005). Main Outcome Measures: Incident substance use disorders in participants with baseline anxiety disorders and incident anxiety disorders in those with baseline substance use disorders. Results: Logistic regression analyses revealed that self-medication conferred a heightened risk of new-onset substance use disorders in those with baseline anxiety disorders (adjusted odds ratios [AORs], 2.50-4.99 [P <.01]). Self-medication was associated with an increased risk of social phobia (AOR in baseline alcohol use disorders, 2.13 [P=.004]; AOR in baseline drug use disorders, 3.17 [P=.001]). Conclusions: Self-medication in anxiety disorders confers substantial risk of incident substance use disorders. Conversely, self-medication in substance use disorders is associated with incident social phobia. These results not only clarify several pathways that may lead to the development of comorbidity but also indicate at-risk populations and suggest potential points of intervention in the treatment of comorbidity.

Robinson JA; Sareen J; Cox BJ; Bolton JM. Correlates of self-medication for anxiety disorders results from the National Epidemiolgic Survey on Alcohol and Related Conditions. Journal of Nervous and Mental Disease 197(12): 873-878, 2009. (34 refs.)

Self-medication is a common behavior among individuals with anxiety disorders, yet few studies have examined the correlates of this behavior. The current study addresses this issue by exploring the pattern of mental health service use and quality of life among people who self-medicate for anxiety. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions and was limited to the subsample of individuals meeting criteria for an anxiety disorder in the past 12 months (n = 4880). Multiple regression analyses compared 3 groups-(1) no self-medication, (2) self-medication with alcohol, and (3) self-medication with drugs, on mental health service use and quality of life. After adjusting for potentially confounding covariates, individuals who engaged in self-medication had significantly higher service use compared with people with anxiety disorders who did not self-medicate (adjusted odds ratio = 1.41, 95% CI = 1.06-1.89). Self-medication was also associated with a lower mental health-related quality of life compared with those who did not self-medicate. Clinicians should recognize and respond to the unique needs of this particular subpopulation of individuals with anxiety disorders.

Schindler A; Thomasius R; Petersen K; Sack PM. Heroin as an attachment substitute? Differences in attachment representations between opioid, ecstasy and cannabis abusers. Attachment & Human Development 11(3): 307-330, 2009. (80 refs.)

Earlier studies indicated a relation between fearful-avoidant attachment and substance abuse. This study compares attachment representations (Family Attachment Interview; Bartholomew Horowitz, 1991) of three groups of substance abusers and non-clinical controls. Heroin abusers (N=22) were mainly fearful-avoidant, ecstasy abusers (N=31) were preoccupied, fearful-avoidant and dismissing-avoidant, cannabis abusers (N=19) were mainly dismissing and secure, and controls (N=22) were mainly secure. Groups did differ in their level of psychosocial functioning (GAF) (cannabisecstasy opioids). Differences in attachment prevailed when GAF was controlled. Based on the self-medication hypothesis we understand the preferences for specific substances to be influenced by specific attachment strategies. Heroin seems to be used as an emotional substitute for lacking coping strategies. Cannabis seems to be used to support existing deactivating and distancing strategies. Ecstasy abuse was related to insecure attachment but not to a specific attachment strategy.

Segarra R; Zabala A; Eguiluz JI; Ojeda N; Elizagarate E; Sanchez P et al. Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. European Archives of Psychiatry and Clinical Neuroscience 261(4): 241-250, 2011. (46 refs.)

The self-medication hypothesis attempts to explain the extraordinary high levels of cigarette smoking in schizophrenia; patients may smoke in an attempt to reduce their cognitive deficits, symptoms, or the side effects of antipsychotics. In a previous report, we detected beneficial performance in attention and working memory in patients with first-episode psychosis who smoked compared to non-smoking patients soon after stabilization. In the present study, we examine differences in the course of those deficits 12 months after the initiation of antipsychotic treatment. We also explore the association between smoking and symptoms and side effects of medication. Neuropsychological assessments were performed at baseline, month 6 and month 12 using a computerized battery that included measures of sustained attention (Continuous Performance Test CPT-O), selective attention (Stroop interference task) and working memory (CPT-XO). Patients met the criterion of fitting in the same smoking category throughout the study: non-smoker (n = 15; 0 cigarettes/day) and smoker (n = 26; > 15 cigarettes/day). The non-smoking patients showed significant cognitive improvements, whereas smoking patients lost their superior baseline performance, which was probably obtained through nicotinic stimulation, at the 6- and 12-month assessments due to a static course of deficits. Smokers did not obtain any cognitive benefit after instauration of treatment and worsen their symptoms over the first year. These results suggest that smoking may constitute a marker of a more severe illness. Smoking was not associated with fewer extrapyramidal side effects. Smoking might improve attention and working memory to a similarly modest extent as atypical antipsychotics and could reflect an effort to ameliorate these cognitive dysfunctions previous to treatment instauration.

Sivapalan H. Khantzian's 'self-medication hypothesis' of drug addiction and films by Martin Scorsese. International Review of Psychiatry 21(3, Special Issue): 285-288, 2009. (23 refs.)

The portrayal of self-medication and drug use was studied in three films by Martin Scorsese: Raging Bull (1980), Goodfellas (1990) and The Departed (2006). Self-medication using nicotine in Raging Bull, cocaine in Goodfellas and sedatives in The Departed, exhibit mixed portrayals of the self-medication hypothesis. The temporal aspects of the hypothesis and credibility of character psychopathology show variation between the films. Across all films, the selection of particular drugs of choice for certain symptom clusters is consonant with that detailed in the self-medication hypothesis put forward by Khantzian.

Strahan EY; Panayiotou G; Clements R; Scott J. Beer, wine, and social anxiety: Testing the "self-medication hypothesis" in the US and Cyprus. Addiction Research & Theory 19(4): 302-311, 2011. (37 refs.)

The social anxiety literature often cites the self-medication hypothesis (SMH) to explain why socially phobic clients often present with alcohol problems. Based on some earlier hints that social anxiety and drinking might be related in a curvilinear way, we sought to examine the SMH to assess for possible non-linear relationships, and to examine whether cultural differences affect these relationships. We surveyed self-reported social anxiety, alcohol expectancies, and alcohol use in college students from Cyprus (N = 127) and the United States (US) (N =697). Participants were college students with a mean age of 19.8. Results revealed that positive and negative expectations about alcohol use were predictive of drinking for students from both cultures. Cypriot students endorsed fewer positive and more negative expectancies regarding alcohol use than their US counterparts, and engaged in less binge drinking. Social anxiety in men was related to drinking via a curvilinear relationship, in which drinking peaks at moderate levels of social anxiety. Among men, those with highest levels of social anxiety in both cultures drink the least. For women, there was no relationship between social anxiety level and drinking behavior. These findings demonstrate the complexity of the relationship between social anxiety and alcohol use. Far from being a linear relationship, these two variables are related in a curvilinear fashion, for men. This should inform future research on the SMH.

Swendsen J; Ben-Zeev D; Granholm E. Real-time electronic ambulatory monitoring of substance use and symptom expression in schizophrenia. American Journal of Psychiatry 168(2): 202-209, 2011. (40 refs.)

Objective: Despite evidence demonstrating elevated comorbidity between schizophrenia and substance use disorders, the underlying mechanisms of association remain poorly understood. The brief time intervals that characterize interactions between substance use and psychotic symptoms in daily life are inaccessible to standard research protocols. The authors used electronic personal digital assistants (PDAs) to examine the temporal association of diverse forms of substance use with psychotic symptoms and psychological states in natural contexts. Method: Of 199 community-dwelling individuals with schizophrenia or schizoaffective disorder who were contacted to participate in the study, 92% accepted and 73% completed the study. The 145 participants who completed the study provided reports of substance use, psychotic symptoms, mood, and event negativity multiple times per day over 7 consecutive days through PDAs. Results: Participants responded to 72% of the electronic interviews (N=2,737) across daily life contexts. Strong within-day prospective associations were observed in both directions between substance use and negative psychological states or psychotic symptoms, but considerable variation was observed by substance type. Consistent with the notion of self-medication, alcohol use was most likely to follow increases in anxious mood or psychotic symptoms. Cannabis and other illicit substances, demonstrating more complex patterns, were more likely to follow certain psychological states but were also associated with the later onset of psychotic symptoms. Conclusions: The dynamic interplay of substance use and psychotic symptoms is in many cases consistent with both causal and self-medication mechanisms, and these patterns of association should be considered in the design of treatment and prevention strategies.

Terranova C; Tucci M; Forza G; Barzon L; Palu G; Ferrara SD. Alcohol dependence and glutamate decarboxylase gene polymorphisms in an Italian male population. Alcohol 44(5): 407-413, 2010 , 2010. (31 refs.)

Knowledge of alcohol use disorder and of substance-related problems has recently found some initial support in genetic studies. With a view to further understanding of this particular aspect, in the light of the "self-medication hypothesis," we focused our attention on the gamma aminobutyric acid system and, in particular, on single nucleotide polymorphisms (SNPs) in the glutamate decarboxylase 67 or glutamic acid decarboxylase 67 (GAD67) gene region in association with alcohol dependence. The research was structured as a case control study. The patient cohort included 283 Caucasian males from the Veneto region, North-east Italy; 107 were alcohol dependent according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) criteria, and 176 were controls recruited from blood donors. We analyzed 26 SNPs located in the coding and untranslated regions of the GAD67 gene with the GenomeLab SNPStream Genotyping System (Beckman Coulter, Fullerton, CA). Fisher's Chi-square test for allele and genotype distributions and Hardy Weinberg equilibrium analysis for cases and controls were performed. Ten SNPs at the GAD67 gene were valid for further statistics. Preliminary results show a difference in genotype distribution (P = .003; chi(2) = 11.6081) between alcoholic subjects and controls of SNP rs 11542313 located in exon 3 of the GAD67 gene, responsible for a silent mutation (His37His). This is the first genetic study regarding the GAD67 gene in relation to the condition of alcohol dependence in an Italian population of subjects all coming from the same region (Veneto). The results highlight a statistical association between one SNP of GAD67 and the condition of alcohol dependence. To clarify the possible meaning of this association, further genetic analyses are being undertaken. In particular, we are investigating other genetic polymorphisms, both upstream and downstream from rs 11542313, which may interfere with splicing and/or GAD67 mRNA stability.

Todorov O. Psychotherapeutic experiences with methadone maintained patients in the framework of multidisciplinary clinical institution. Heroin Addiction and Related Clinical Problems 11(1): 35-40, 2009. (22 refs.)

This communication presents a number of theoretical and clinical formulations that belong to a psychodynamic framework specifically constructed to foster the understanding and treatment of drug addiction. I find this framework useful not merely for the purpose of conceptualizing drug addiction as a clinical category, but also in explaining the complex experiences involved in the therapeutic process to people suffering from that condition. Contemporary psychoanalytic tradition sees drug addiction as an unsuccessful attempt to ward off the unbearable and unmanageable effects through self-medication, but also, more importantly, as a massive disorder originating in early interactions with significant others, resulting in a fragmentation of the self that prompts the individual to self-injury, constant traumatic experiences and a paradoxical fear/pain/pleasure relationship with the drug via addictive fantasies. All of this, enacted in everyday life and in therapeutic sessions, evokes complex emotional experiences on the part of patients, therapists and whole institutions. Relieving, bearing, getting to understand and. crucially, modifying these experiences is seen to be the task at stake in the therapeutic encounter. The final part of the article reflects on some of the advantages for the psychotherapeutic work that derive from methadone maintenance treatment and well-organized team work within a specialized clinic.

Topper LR; Castellanos-Ryan N; Mackie C; Conrod PJ. Adolescent bullying, victimisation and alcohol-related problem behaviour mediated by coping drinking motives over a 12 month period. Addictive Behaviors 36(1-2): 6-13, 2011. (36 refs.)

Background: Despite the adverse externalising risks associated with bullying victimisation no study has investigated the underlying mechanisms of adolescent victims engagement with alcohol. This current study investigated the development of risky coping drinking motives as a mediator in the relationship between adolescent school victimisation and alcohol related problem behaviour, using a longitudinal design over 12 months. Method: We recruited 324 participants aged 13 to 15 from schools across London, England. Participants were surveyed during class time at 2 time points baseline and 12 months. At both time points participants answered questions related to bullying, victimisation, alcohol-related problem behaviour, drinking motives and the quantity by frequency of alcohol consumption. Results: The relationships between victimisation, drinking and drinking motives were investigated using Pearson correlations. Path analysis showed that victimisation leads both directly and indirectly through coping motives to alcohol-related problems, rather than to the quantity and frequency of alcohol use. Significance of mediation was tested using 5000 bias corrected and accelerated bootstrapped intervals. Baseline victimisation was significantly correlated with baseline alcohol related problem behaviour and predictive of future problems at 12 months. Drinking to cope at 12 months partially mediated the relationship between baseline victimisation and alcohol-related problems at 12 months. Conclusions: Results show that victims of bullying are drinking alcohol in a risky style partly due to the development of self-medicating drinking behaviour. Victims of bullying could therefore benefit from coping skills interventions targeting negative affect regulation in order to reduce the risk for future alcohol misuse.

Tull MT; Gratz KL; Aklin WM; Lejuez CW. A preliminary examination of the relationships between posttraumatic stress symptoms and crack/cocaine, heroin, and alcohol dependence. Journal of Anxiety Disorders 24(1): 55-62, 2010. (65 refs.)

High rates of co-occurrence between posttraumatic stress (PTS) and substance use disorders (SUDs) have led to the suggestion that substance use among individuals experiencing PTS symptoms might serve a self-medication function. However, research is still needed to provide a more comprehensive evaluation of the unique associations between PTS symptom clusters and substances (licit and illicit) with both anxiolytic/depressant and stimulant properties. Consequently, this study examined the relationship between severity of different PTS Symptom Clusters and heroin, crack/cocaine, and alcohol dependence among 48 treatment-seeking SUD patients with a history of traumatic exposure. No evidence was found for a relationship between PTS symptom clusters and crack/cocaine or alcohol dependence: however, results suggested a relationship between hyperarousal and avoidance (inversely related) symptoms and heroin dependence. Results are discussed in terms of their implications for understanding motivations underlying the substance of choice among individuals with PTS symptoms, as well as the development of treatments for co-occurring PTS and SUDs.

Vinson DC; Manning BK; Galliber JM; Dickinson LM; Pace WD; Turner BJ. Alcohol and sleep problems in primary care patients: A report from the AAFP National Research Network. Annals of Family Medicine 8(6): 484-492, 2010. (46 refs.)

PURPOSE Hazardous and harmful drinking and sleep problems are common but their associations among patients seen in primary care have not been examined We hypothesized that greater levels of alcohol consumption would be associated with several self reported sleep problems. METHODS: In a cross sectional survey in primary care practices 94 participating clinicians recruited up to 30 consecutive adult patients and both clinicians and patients completed anonymous postvisit questionnaires. Patients were asked questions on demographics alcohol consumption cardinal symptoms of alcohol use disorders sleep quality, insomnia sleep apnea and symptoms of restless leg syndrome Multivariate analyses explored the associations of drinking status (none moderate or hazardous) and sleep problems adjusting for demographics and clustering of patients within physician. RESULTS Of 1 984 patients who responded 1 699 (85 6%) provided complete data for analysis. Respondents mean age was 50 4 years (SD 174 years) 67% were women, and 72 9% were white. Of these 22 3% reported hazardous drinking, 47 8% reported fair or poor overall sleep quality, and 7 3% reported a diagnos's or treatment of sleep apnea. Multivariate analyses showed no associations between drinking status and any measure of insomnia overall sleep quality, or restless legs syndrome symptoms Moderate drinking was associated with lower adjusted odds of sleep apnea compared with nondrinkers (OR = 0 61 95% CI 0 38 1 00) Using alcohol for sleep was strongly associated with hazardous drink ing (OR = 4 58 95% CI 2 97 708 compared with moderate drinking). CONCLUSIONS: Moderate and hazardous drinking were associated with few sleep problems. Using alcohol for sleep, however, was strongly associated with hazardous drinking relative to moderate drinking and may serve as a prompt for physicians to ask about excessive alcohol use

Weyandt LL; Janusis G; Wilson KG; Verdi G; Paquin G; Lopes J et al. Nonmedical prescription stimulant use among a sample of college students relationship with psychological variables. Journal of Attention Disorders 13(3): 284-296, 2009. (41 refs.)

Objective: To further investigate use and potential misuse of prescription stimulants (e.g., Ritalin, Adderall, Concerta) among a sample of college students and to explore the relationship between psychological variables and nonmedical stimulant use. Method: The sample consisted of 390 college students (71.6% female, 28.4% male). Participants were asked to complete five questionnaires concerning demographic information, prescription stimulant use, internal restlessness, sensation seeking, and psychological distress. Results: The study findings revealed that, regarding nonprescribed stimulants, 7.5% reported use within the past 30 days; 60% reported knowing students who misused stimulants; and 50% agreed or strongly agreed that prescription stimulants were "easy to get on this campus." Findings: further revealed a relationship between stimulant use and degree of psychological distress and internal restlessness. Conclusions: Continued research regarding psychological variables, specific group membership (e.g., fraternity, sorority, athletics), and stimulant acquisition is suggested. Effective prevention and education efforts are needed to help address the nonmedical use of prescription stimulants on college campuses.

Williams M; Jayawickreme N; Sposato R; Foa EB. Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence. Addictive Behaviors 37(1): 47-52, 2012. (37 refs.)

Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety. The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N=167). Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans. Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.

Wing VC; Moss TG; Rabin RA; George TP. Effects of cigarette smoking status on delay discounting in schizophrenia and healthy controls. Addictive Behaviors 37(1): 67-72, 2012. (39 refs.)

Delay discounting is a measure of future-oriented decision-making and impulsivity. Cigarette smoking is associated with rapid discounting of the value of delayed outcomes. In schizophrenia, however, cigarette smoking improves certain neurocognitive impairments associated with the disorder which may explain the high smoking rates in this population. This study examined the relationship between cigarette smoking and delay discounting in schizophrenia and control participants. A total of N=130 participants, including those with schizophrenia (n=68) and healthy controls (n=62) were assessed on the Kirby Delay Discounting Task and compared across smoking status (smokers; non-smokers) and smoking history (current, former; never smokers). Smokers exhibited higher discounting rates (i.e., were more impulsive) than non-smokers of the same diagnostic group. Current and former smokers with schizophrenia exhibited similar and significantly higher discounting rates than never smokers, suggesting that in schizophrenia delay discounting is a trait-dependent phenomenon independent of current cigarette smoking. Consistent with previous studies, there was a trend for higher discounting rates in control current smokers compared to control former and never smokers. Smokers with and without schizophrenia have higher rates of delay discounting than non-smokers. However, in schizophrenia, rapid delay discounting appears to be a trait associated with having ever been a smoker (i.e., current and former smoking).

Winterer G. Why do patients with schizophrenia smoke? Current Opinion in Psychiatry 23(2): 112-119, 2010. (105 refs.)

Purpose of review: Among the mentally ill, smoking prevalence is highest in patients with schizophrenia (similar to 70-80%). This can impose a significant financial burden on patients, not to speak of increased smoking-related morbidity and mortality. Therefore, it is critical for clinicians to understand why patients with schizophrenia smoke in order to adapt treatment schemes. Understanding the reasons may also help to develop new drugs that target the nicotinic system in the brain as well as smoking cessation programs that are specifically designed for this particular patient population. Recent findings: So far, several reasons have been identified which are believed to explain tobacco consumption in patients with schizophrenia. Originally, it was widely believed that patients with schizophrenia smoke to increase hepatic clearance and to restore the dopamine blockade of certain antipsychotic drugs to diminish their side effects. However, more recently it became obvious that cigarette smoking may also be reinforcing for patients because it improves psychiatric symptoms, most notably negative and cognitive symptoms. The underlying molecular mechanisms of these nicotine effects are currently under intensive investigation. Summary: Heavy smoking in schizophrenia cannot simply be viewed as a 'bad habit'. Rather, self-medication of clinical symptoms and side effects of antipsychotic drugs appear to play a major role.

Zabala A; Eguiluz JI; Segarra R; Enjuto S; Ezcurra J; Pinto AG et al. Cognitive performance and cigarette smoking in first-episode psychosis. European Archives of Psychiatry and Clinical Neuroscience 259(2): 65-71, 2009. (48 refs.)

The purpose of this study is to describe possible differences in cognitive functioning between smoking and non-smoking patients with first-episode psychosis and to determine whether there is a better cognitive profile associated with smoking. We assessed 61 first-episode psychosis patients with a neuropsychological battery that included computerized measurements of attention, working memory, and executive functioning. Patients were grouped into two categories: non-smokers (0 cigarettes/day; n = 30) and smokers (a parts per thousand yen20 cigarettes/day; n = 31). No significant differences were detected in sociodemographic and clinical data between the two groups. For attention tasks, smokers exhibited shorter reaction times in the sustained attention test than non-smokers (P = 0.039) and needed less time to complete the Stroop interference test (P = 0.013). In the working memory task, smokers exhibited shorter reaction times (P = 0.029) and presented a significantly lower percentage of omission (P = 0.002) and commission errors (P = 0.020) than non-smokers. For executive functioning, no differences were detected between groups in performance on the Wisconsin Card Sorting Test. Results indicate that first-episode psychosis patients who are nicotine users have better cognitive functioning in the areas of attention and working memory than patients who are not nicotine users. This study supports the cognitive approach to the self-medication hypothesis, to explain the high rates of cigarette smoking among psychosis patients. These results may be relevant for developing new strategies involving nicotinic receptors for cognitive enhancement in psychosis.