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...on Clinical Issues
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www.ProjectCork.org
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Fall 2007
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Gender moderates the relationship between substance-free activity enjoyment and alcohol use.
Murphy JG; Barnett NP; Goldstein AL; Colby SM. Psychology of Addictive Behaviors 21(2): 261-265, 2007. (26 refs.)
Laboratory research suggests that there is an inverse relationship between substance use and substance-free reinforcement, but the relevance of this relationship to the prevention of human substance abuse remains somewhat unclear. The present study evaluated the relationship between alcohol use and enjoyment from substance-free activities in a sample of college students who had previously completed an alcohol intervention (N = 107; 55% women; 45% men). The authors used a modified 30-day timeline follow-back interview to collect data on enjoyment from specific substance-free activities that occurred in the evening. Regression analyses revealed that there was a negative association between alcohol consumption and substance-free activity enjoyment for women but not for men. Women who reported greater enjoyment on abstinent evenings reported lower past-month alcohol consumption. Greater average enjoyment from substance-free activities was associated with greater motivation to change drinking among men and women. Although further research is required to determine procedures for increasing participation in substance-free activities and to explicate possible gender differences, these results suggest that increasing enjoyable substance-free activities may be an important prevention component. Copyright 2007, American Psychological Association.
Group and individual couple treatment for substance abuse clients: A pilot study.
Li S; Armstrong MS; Chaim G; Kelly C; Shenfeld J. American Journal of Family Therapy 35(3): 221-233, 2007. (25 refs.)
Brief Couples Therapy is an eight-session, structured treatment for couples with substance-abuse problems. A randomized control study was conducted to compare a group format of BCT (Multiple Couples Treatment) to an individual couple format (Individual Couple Treatment). Twenty-seven couples were recruited and 20 completed treatment. Six-month follow- up data showed significant improvement in Brief Symptom Inventory and Adverse Consequences scores in both treatment groups. Male clients in both conditions and female clients in the ICT condition improved significantly in Dyadic Adjustment scores. Over two-thirds of the substance-abuse clients were able to meet or maintain their drug use goals at the end of treatment. These findings, together with the positive evaluation by the clients, support the use of BCT as a treatment modality for couples with substance use problems. Copyright 2007, Taylor & Francis.
High abstinence rates in heroin addicts by a new comprehensive treatment approach.
De Jong CAJ; Roozen HG; van Rossum LGM; Krabbe PFM; Kerkhof JFM. American Journal on Addictions 16(2): 124-130, 2007. (35 refs.)
In this multi-center, naturalistic study, the effectiveness of naltrexone maintenance combined with the Community Reinforcement Approach (CRA) was investigated in detoxified, opioid-dependent patients (N = 272). Patients were recruited from methadone maintenance programs. With intention-to-treat analysis, 10 months of treatment yielded abstinence rates of 28% and 32% at 10 and 16 months after detoxification. The cumulative abstinence rate at 16 months was 24%. Quality of life, craving, general psychopathology, use of other psychoactive substances, and addiction severity of the abstinent group significantly improved when compared to the relapsed group. This abstinence-oriented approach appears to be a feasible goal, and remains an important option next to long-term methadone maintenance in the management of opioid dependence. Copyright 2007, Taylor & Francis.
How do heroin users spend their spare time?
Neale J; Bloor M; McKeganey N. Drugs: Education, Prevention and Policy 14(3): 231-246, 2007. (24 refs.)
Aims: Data from a national longitudinal study of drug users entering treatment in Scotland are used to undertake an exploratory investigation of how heroin users like to spend their spare time. Specific aims are to explore heroin users' self-reported interests at two time points; their continuity of interests over time; and demographic and behavioural factors associated with having at least one non-drug pastime. Methods: 606 heroin users (70% males; 30% females) were interviewed using structured questionnaires at treatment entry and again 33 months later. Univariate analyses were undertaken using chi-square tests and independent t-tests. Multivariate analyses were undertaken using stepwise logistic regression. Findings: 359 respondents (59%) reported at least one leisure interest at treatment entry and 521 (86%) reported at least one leisure interest 33 months later. Sport was the most common type of interest reported, but fifteen other hobby categories were identified. Many respondents reported multiple interests and 214 reported at least one same interest at both time points. The most consistent variables associated with having a spare time interest were being male and sleeping well. Conclusions: The study provides further evidence that many problem drug users participate in ordinary daily activities. Enjoying these is a positive aspect of everyday life and a behavioural pattern that should be supported and encouraged by service providers whenever possible. Copyright 2007, Taylor and Francis.
Interventions to promote retention in substance abuse treatment.
Corrigan JD; Bogner J. Brain Injury 21(4): 343-356, 2007. (63 refs.)
Objectives: Compare two methods of improving retention in substance abuse treatment for persons with traumatic brain injury. Design: Randomized clinical trial with control group comparison. Interventions: Provision of a financial incentive and reduction of logistical barriers. Outcome measures: Treatment attendance, perceived therapeutic alliance, premature termination. Results: Provision of a financial incentive was highly effective for facilitating early attendance and appeared to promote eventual successful treatment completion. Reduction of logistical barriers did not significantly improve attendance or successful discharge. The hypothesized role of improved therapeutic alliance as a consequence of intervention and a mediator for preventing premature termination was not supported. However, results suggested that intervention, particularly financial incentives, promoted congruence between counsellor and client perceived therapeutic alliance. Conclusions: For clients with traumatic brain injuries, provision of a financial incentive at an early point in substance abuse treatment substantially improves attendance and reduces the likelihood of premature termination. The basis for this effect appears to involve more than enhancement of the therapeutic alliance. We posit that concrete incentives can provide an opportunity for successful rule- governed behaviour that may generalize to other areas of improved impulse control. Copyright 2007, Taylor & Francis.
Investigating the association between moderate drinking and mental health.
El-Guebaly N. Annals of Epidemiology 17(5, Supplement S): S55-S62, 2007. (52 refs.)
In an attempt to relate "moderate drinking" to "mental health," inadequacies of definition for both terms become apparent. Moderate drinking can be variously defined by a certain number of drinks to "nonintoxicating" to "noninjurious" to "optimal," whereas mental health definitions range from "the absence of psychopathology" to "positive psychology" to "subjective well-being." Nevertheless, we evaluated the relation by conducting an electronic search of the literature from 1980 onwards using the terms "moderate drinking," "moderate alcohol consumption," "mental health," and "quality of life." Most studies report a "J-shaped curve," with positive self-reports of subjective mental health associated with moderate drinking but not with heavier drinking. The relevance of expectancies has been unevenly acknowledged, and studies on the cultural differences among expectancies are largely lacking. The potential role of moderate drinking in stress reduction and studies of social integration have yielded inconsistent results as previous levels of drinking, age, social isolation, and other factors have often not been adequately controlled. Future anthropological, epidemiological, and pharmacological interactions preferably must be studied through a prospective design and with better definitions of moderate drinking and mental health. Copyright 2007, Elsevier Science.
Legal piperazine-containing party pills: A new trend in substance misuse.
Sheridan J; Butler R; Wilkins C; Russell B. Drug and Alcohol Review 26(3): 335-343, 2007. (63 refs.)
In this Harm Reduction column Sheridan, Butler, Wilkins and Russell address the emergent phenomenon of so-called 'legal party pills' which have become a significant drug issue in New Zealand and elsewhere. Although banned in a number of countries, they are currently legally available in New Zealand where they are marketed as 'safe' alternatives' to 'illicit' drugs often used in the dance scene such as MDMA and amphetamines. The authors describe the availability and use of these substances in New Zealand, summarize what is known about their effects, and speculate on harm reduction interventions and mechanisms of control and their possible sequelae. The paper provides a timely account of an emerging drug issue of relevance to harm reduction internationally. Copyright 2007, Taylor & Francis.
Overdose after detoxification: A prospective study.
Wines JD; Saitz R; Horton NJ; Lloyd-Travaglini C; Samet JH. Drug and Alcohol Dependence 89(2-3): 161-169, 2007. (76 refs.)
Objective: The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol. Methods: We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use. Results: Lifetime prevalence for any OD was 30.9% (145/470) in the total sample and 42.3% (85/201) inpatients with opioid problems. During the 2-year follow-up, OD was estimated to occur in 16.9% of the total sample and 26.7% of the opioid problem subgroup, with new-onset (incidence) OD estimated at 5.7% and 11.0%, respectively. Factors associated with an increased hazard of OD in both samples included white race, more depressive symptoms, and prior OD regardless of intent. Prior suicidal ideation or attempt was not associated with future OD. Conclusions: Findings underscore both the high prevalence of non-fatal OD among detoxification patients especially opioid users, and the potency of prior OD as a risk factor for future OD. Depressive symptoms, a modifiable risk factor, may represent a potential intervention target to prevent OD, including some "unintentional" ODs. Copyright 2007, Elsevier Science.
Substance use disorder among adoptees: A clinical comparative study.
Westermeyer J; Bennett L; Thuras P; Yoon G. American Journal of Drug and Alcohol Abuse 33(3): 455-466, 2007. (30 refs.)
Goals of the study were to assess whether adoptees in treatment for Substance Use Disorder (SUD) (1) were over-, equi-, or under-represented in a clinical sample of patients with (SUD) and (2) differed demograph-ically and clinically from non-adoptees with SUD. Sample consisted of 608 patients in two alcohol-drug treatment programs. Data collection included the Childhood Problems Scale, the Minnesota Substance Abuse Problem Scale, and the Minnesota Substance Abuse Treatment Questionnaire, and the Michigan Assessment-Screening Test/Alcohol-Drug. Findings showed that the prevalence of acloptees among SUD patients was 14 times higher than expected (95% Confidence Interval, 10 to 18 times). Adoptees reported childhood histories similar to those of non-adoptees with "any parental SUD", but they more closely resembled non-adoptees without parental SUD in regard to SUD severity and SUD treatment. Conclusion is that adoptees and their adoptive families should be alert to the increased risk of SUD among adoptees. Clinicians can expect that adoptees should manifest milder levels of SUD morbidity, similar to "non-heredity" SUD. Copyright 2007, Taylor & Francis.
Suicide attempts among individuals with opiate dependence: The critical role of belonging.
Conner KR; Britton PC; Sworts LM; Joiner TE. Addictive Behaviors 32(7):1395-1404, 2007. (35 refs.)
This study explored the role of three theoretically important interpersonal variables in attempted suicide and unintentional overdose using a diverse sample of one hundred thirty-one (69 women) methadone patients at an urban university hospital. Subjects completed a standardized interview including self-report measures of perceived 1) belonging 2) burdensomeness, and 3) loneliness. In separate multivariate logistic regression analyses, individuals with a history of attempted suicide were compared to non-attempters, and individuals with a history of unintentional overdose were compared to individuals without such a history. As hypothesized, low belonging distinguished suicide attempters but not individuals with a history of unintentional overdose, after accounting for covariates. Results concerning burdensomeness and suicide attempt were also suggestive. Findings underscore the relevance of a sense of belonging to vulnerability to suicidal behavior, and lend further support to the notion that suicide attempts and unintentional overdose have dissimilar correlates. Copyright 2007, Elsevier Science.
An investigation of stigma in individuals receiving treatment for substance abuse.
Luoma JB; Twohig MP; Waltz T; Hayes SC; Roget N; Padilla M et al. Addictive Behaviors 32(7): 1331-1346, 2007. (37 refs.)
This study examined the impact of stigma on patients in substance abuse treatment. Patients (N= 197) from fifteen residential and outpatient substance abuse treatment facilities completed a survey focused on their experiences with stigma as well as other measures of drug use and functioning. Participants reported experiencing fairly high levels of enacted, perceived, and self-stigma. Data supported the idea that the current treatment system may actually stigmatize people in recovery in that people with more prior episodes of treatment reported a greater frequency of stigma-related rejection, even after controlling for current functioning and demographic variables. Intravenous drug users, compared to non-IV users, reported more perceived stigma as well as more often using secrecy as a method of coping. Those who were involved with the legal system reported less stigma than those without legal troubles. Higher levels of secrecy coping were associated with a number of indicators of poor functioning as well as recent employment problems. Finally, the patterns of findings supported the idea that perceived stigma, enacted stigma, and self-stigma are conceptually distinct dimensions. Copyright 2007, Elsevier Science.
Gender differences in injection risk behaviors at the first injection episode.
Frajzyngier V; Neaigus A; Gyarmathy VA; Miller M; Friedman SR. Drug and Alcohol Dependence 89(2-3): 145-152, 2007. (50 refs.)
Objectives: To examine gender differences in drug injection equipment sharing at injecting initiation. Methods: Young injecting drug users (IDUs) in New York City February 1999-2003 were surveyed about injection risk behaviors and circumstances at initiation. Analyses were gender-stratified and excluded participants who initiated alone. Multiple logistic regression estimated adjusted odds ratios. Results: Participants (n = 249) were 66% male and 82% White. Mean initiation age was 19.2; mean years since initiating was 3.0. Women were significantly more likely to cite social network influence as a reason for initiating, to have male and sex partner initiators, and to share injecting equipment than men. Among women, sharing any injection equipment was associated with initiation by a sex partner and having >= 2 people present. Among men, being injected by someone else predicted sharing any injection equipment, while using a legally obtained syringe was protective. Conclusions: Social persuasion stemming from sexual and/or social relationships with IDUs may increase women's risk of sharing injection equipment at initiation, and consequently, their early parenteral risk of acquiring blood-borne infections. Interventions should focus on likely initiates, especially women in injecting-discordant sex partnerships, and IDUs (potential initiators). Copyright 2007, Elsevier Science.
"Phewww, bingoed!": Motivations and variations of methods for using heroin in Scottish prisons.
Wilson GB; Galloway J; Shewan D; Marshall L; Vojt G; Marley C. Addiction Research & Theory 15(2): 205-224, 2007. (18 refs.)
While prison is recognised as a setting for infectious disease transmission among drug users, little is known about psychological and situational factors influencing high-risk behaviours, knowledge vital to prison-based interventions. Qualitative interview and focus group data were collected from staff and prisoners in six Scottish prisons. A general view was that prison heroin use had increased, but injecting and sharing remained a covert and minority behaviour. "Anti-injecting culture'' among staff and most prisoners emerged as an important factor, though not linked by prisoners to an "anti-drug culture''. Of individual and social risk factors identified, only the desire to inject in prison for maximum effect was unique to prison injectors and sharers. This decision-based behaviour requires further theory-focussed research. Given these findings, introducing needle exchanges into Scottish prisons could undermine their low drug injection rates. Enabling injecting, albeit within a public health framework, conflicts with the major prison objective of rehabilitation. Copyright 2007, Taylor and Francis.
Prevalence and correlates of opiate overdose among young injection drug users in a large US city.
Sherman SG; Cheng YK; Kral AH. Drug and Alcohol Dependence 88(2-3): 182-187, 2007. (41 refs.)
Objectives: The current study examines the prevalence and correlates of witnessing and experiencing opiate overdoses among a sample of young, injection drug users (IDUs) and non-injection drug users (NIDUs) in Baltimore, MD. Methods: Data were derived from a longitudinal study of 15-30 year old IDUs and NIDUs (N = 309) who had initiated heroin, cocaine, and/or crack use within 5 years prior to study enrollment. Chi-square and Wilcoxon rank-sum tests were used in bivariate analyses of demographic and drug use variables with each of the two dependent variables. Multivailate logistic regression models were used to identify correlates of experiencing and witnessing overdose. Results: Twenty-nine percent of participants reported having ever experienced an opiate overdose and 57% reported having ever witnessed an overdose. Having ever experienced an opiate overdose was independently associated with being White (Adjusted Odds Ratio [AOR] = 3.2; 95% Confidence Interval [CI]: 1.6, 6.4) recent homelessness (AOR = 2.9; 95% CI: 1.5, 5.7); and length of injection, 5.6-6.9 years versus < 5.6 years (AOR = 4.0; 95% CI: 1.8-8.9); injecting 7.0-7.9 years versus < 5.6 years (AOR = 2.5; 95% CI: 1.03-6.1); injecting > 8 versus < 5.6 years (AOR = 4.7; 95% CI: 2.2-10.2). Having witnessed an opiate overdose was independently associated with being White (AOR = 2.4; 95% CI: 1.4, 4.1) and injecting > 8 years versus < 5.6 years (AOR = 2.2; 95% CI: 1.2, 4.0). Conclusions: This study documents the high prevalence of witnessing and experiencing opiate overdoses among young, newly initiated IDUs and NIDUs. The results could inform the growing number of overdose prevention efforts throughout the U.S. Copyright 2007, Elsevier Science.
Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders.
Warren JI; Stein JA; Grella CE. Drug and Alcohol Dependence 89(2-3): 267-274, 2007. (54 refs.)
Individuals with co-occurring substance use and psychiatric disorders have a more severe clinical course and poorer outcomes than do individuals with one disorder. In an attempt to find intervening variables that may contribute to improvement in treatment outcomes among individuals with co-occurring disorders, we investigated the roles of social support and self-efficacy in a sample of 351 clients with co-occurring disorders in residential drug abuse treatment programs (53% male; 35% African American, 13% Hispanic). Given their demographic variability, we also explored how ethnicity and age influence self-efficacy and access to social support, as well as their relationships to the outcomes. Structural equation modeling was used to examine the impact of the demographics and baseline psychological status, substance use, social support, and self-efficacy on mental health and substance use outcomes 6 months after treatment entry. Time in treatment was included as a control. Greater social support at baseline predicted better mental health status and less heroin and cocaine use; greater self-efficacy predicted less alcohol and cocaine use. Older clients reported less social support. African-American ethnicity was associated with more cocaine use at baseline and follow-up; however, African Americans reported more self-efficacy, which moderated their cocaine use. The current study highlights the potential therapeutic importance of clients' personal resources, even among a sample of severely impaired individuals. Copyright 2007, Elsevier Science.
Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.
Carrico AW; Gifford EV; Moos RH. Drug and Alcohol Dependence 89(1): 66-73, 2007. (57 refs.)
Background: Previous investigations have observed that spirituality/religiosity (SIR) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) - awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses - accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode. Methods: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time. Results: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement. Conclusions: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement. © 2007, Elsevier Science.
Young-adult malt liquor drinkers: Prediction of alcohol problems and marijuana use.
Collins RL; Bradizza CM; Vincent PC. Psychology of Addictive Behaviors 21(2): 138-146, 2007. (43 refs.)
Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (>= 40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did nonconcurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use. Copyright 2007, American Psychological Association
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