substance related disorder [keywords]
- Pain moderates changes in psychological flexibility but not substance use symptoms during substance use disorder treatment. [JOURNAL ARTICLE]
- Psychiatry Res 2016 Aug 5.:51-57.
Pain-related problems frequently complicate substance use disorder (SUD) course and prognosis. However, it is unclear if the negative outcomes associated with co-occurring pain are due to its link with greater SUD severity, disruption of SUD treatment processes, or connection to a third psychological process. The current study modeled the longitudinal effects of pain during a 4-week intensive outpatient treatment (IOP) on SUD symptoms and limited psychological flexibility (PF), a common feature of psychological well being that is commonly restricted in both SUD and pain patients. After controlling for initial severity of SUD symptoms, current pain level at treatment intake moderated change in a sub-component of PF, values commitment, but not SUD symptoms during the IOP. During the treatment, pain level also limited improvement in PF but not self-reported SUD symptoms. Targeting additional increases in psychological flexibility surrounding commitment to values during SUD treatment may help improve outcomes among patients who began treatment with significant pain symptoms.
- Understanding Risk Factors for Opioid Overdose in Clinical Populations to Inform Treatment and Policy. [JOURNAL ARTICLE]
- J Addict Med 2016 Aug 11.
Overdoses involving opioid analgesics represent a significant public health problem in the United States. We reviewed the literature on risk factors for overdose, with a focus on studies that examine clinical populations of patients receiving opioids for pain and potential risk factors for overdose in these populations. A structured review resulted in 15 articles published between 2007 and 2015 that examined risk factors for fatal and nonfatal overdose in patients receiving opioid analgesics. Opioid dosage was the factor most consistently analyzed and also associated with increased risk of overdose. Other risk factors include concurrent use of sedative-hypnotics, use of extended-release/long-acting opioids, and the presence of substance use and other mental health disorder comorbidities. Future research is needed to better characterize populations taking opioids for pain to help clarify discrepancies between existing studies and identify previously unexplored risk factors for overdose. Given that policy and clinical practice have shifted as a result of prior studies reviewed here, further efforts in understanding patient groups and opioid-related prescribing practices associated with overdose risk have great potential to impact policy and practice in the treatment of pain while improving the safety around opioid prescribing.
- PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients. [Journal Article]
- J Clin Med 2016; 5(8)
Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions.Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions.After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse).In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment.
- Personalizing substance use treatment based on pre-treatment impulsivity and sensation seeking: A review. [REVIEW, JOURNAL ARTICLE]
- Drug Alcohol Depend 2016 Jul 27.
Theoretically, substance use disorder (SUD) treatment that matches an individual's etiology and/or maintaining factors should be more effective than a treatment that does not directly address these factors. Impulsivity and sensation/reward seeking may contribute to the development and maintenance of SUDs, and are potential candidate variables for assigning patients to treatment. The goal is to identify whether current research can provide insight into which treatments may be most effective for individuals high in impulsivity or sensation seeking, relative to other treatments. A secondary goal is to provide recommendations for personalizing SUD treatment based on etiology or maintaining factors.This review summarizes clinical trials that speak to the differential effectiveness of two or more treatments for alcohol, tobacco, and other drug use disorders, based on pre-treatment impulsivity, sensation seeking, or related constructs.Few studies examine the differential effectiveness of two or more treatments for individuals high in impulsivity or sensation seeking. Very preliminary evidence suggests that contingency management may hold promise for individuals high in impulsivity. Pharmacological trials were under-represented in the current review, despite evidence that the effectiveness of some pharmacological interventions may be moderated by impulsivity.Potential reasons for slow rate of progress to date are provided. Given slow accumulation of evidence, an alternative method for personalizing treatment based on pre-treatment psychosocial factors, including impulsivity and sensation/reward seeking, is proposed. Future research may explore the role of contingency management for SUD among individuals with high pre-treatment impulsivity or sensation seeking. Finally, novel, technology-enhanced behavioral mechanisms are discussed as an adjunct to SUD treatment for these high-risk populations.
- Presentation of Coping Strategies Associated with Physical and Mental Health During Health Check-ups. [JOURNAL ARTICLE]
- Community Ment Health J 2016 Aug 11.
We identified coping behaviors during regular health check-ups and examined whether they were related to physical and mental health. We assessed coping strategies with the Brief COPE scale in 201 people who underwent a regular health check-up in a clinic. We found several significant relationships between coping and physical/psychological conditions presented in health check-up: Humor and systolic blood pressure, Substance use and high-density lipoprotein cholesterol, Venting and low-density lipoprotein cholesterol, Self-blame and depression, and Behavioral disengagement and sleep disorder. By evaluating coping strategies and screening depression as part of a regular health check-up, General practitioner can provide psychological intervention such as cognitive behavioral therapy which may improve both mental and physical health of the people.
- Substance Misuse Education for Physicians: Why Older People are Important. [Journal Article, Review]
- Yale J Biol Med 2016 Mar; 89(1):97-103.
This perspective article focuses on the need for training and education for undergraduate medical students on substance-related disorders, and describes initiatives undertaken in the United Kingdom (UK), Netherlands, United States (US), and Norway to develop the skills, knowledge, and attitudes needed by future doctors to treat patients adequately. In addition, we stress that in postgraduate training, further steps should be taken to develop Addiction Medicine as a specialized and transverse medical domain. Alcohol use disorder is a growing public health problem in the geriatric population, and one that is likely to continue to increase as the baby boomer generation ages. Prescription drug misuse is a major concern, and nicotine misuse remains problematic in a substantial minority. Thus, Addiction Medicine training should address the problems for this specific population. In recent years, several countries have started an Addiction Medicine specialty. Although addiction psychiatry has been a subspecialty in the UK and US for more than 20 years, in most countries it has been a more recent development. Additional courses on addiction should be integrated into the curriculum at both undergraduate and postgraduate levels, as well as form part of the continuous training of other medical specialists. It is recommended that further research and mapping of what is currently taught in medical programs be undertaken, so as to enhance medical education in addiction and improve treatment services.
- Sex Differences in the Association Between Internalizing Symptoms and Craving in Methamphetamine Users. [JOURNAL ARTICLE]
- J Addict Med 2016 Aug 8.
Methamphetamine (MA) users often have substantial psychiatric comorbidities, with nearly a third reporting lifetime mood disorders and over a quarter reporting lifetime anxiety disorders. Female MA users are more likely to endorse depression and anxiety symptoms compared with men. Craving has been related to mood/anxiety symptoms in MA users. To extend the literature on sex differences in MA use disorder, the present study examines the role of sex as a moderator of the relationship between mood/anxiety symptoms and MA craving.Participants (N = 203) were nontreatment-seeking, current MA users, recruited from the Los Angeles community for enrollment in a larger pharmacotherapy trial. At the assessment visit, participants completed multiple measures including the Methamphetamine Urge Questionnaire, the Beck Depression Inventory, and the Beck Anxiety Inventory.The relationship between depression symptomatology and MA craving was moderated by sex (F = 6.18, P = 0.01), such that the relationship was positive and significant for men (P < 0.001), but was not significant for women. Similarly, sex significantly moderated the relationship between anxiety and MA craving (F = 5.99, P = 0.02), such that the relationship was also positive and significant in men, but not in women (P < 0.001).These results suggest that men may be more sensitive to the effects of internalizing symptoms on MA craving than women. Given craving's propensity to predict relapse, these initial findings indicate the necessity of treating comorbid psychiatric problems in male MA users, which may in turn assist in the attenuation of craving.