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PubMed2004

A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery.

This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety.

Convalescence↗
PubMedDate not supplied

Suicide attempts, substance abuse, and personality.

The prevalence and relevance of a positive suicide attempt history among 103 subjects who had entered a substance abuse program and participated in a study of personality was examined. Twenty subjects had a positive suicide attempt history. Women were more likely to attempt suicide. Attempters were more likely to have additional psychiatric diagnoses, such as major depression. Attempters had higher addiction severity scores, abused more substances, and were more likely to have abused alcohol and sedative hypnotics than were nonattempters. DSM-III-R and Eysenck personality measures were compared across groups. Attempters had significantly higher neuroticism and borderline scores. Impulse dysregulation may predispose this group to more severe addictions.

Adult↗
PubMedDate not supplied

Introduction to the Special Issue on "Anxiety Sensitivity and Addictive Behaviors".

Anxiety sensitivity (AS) is a cognitive, individual difference variable characterized by a fear of arousal-related bodily sensations due to beliefs that such sensations are signs of impending catastrophic physical, psychological, or social outcomes. AS has been linked to increased risk for the development and maintenance of panic attacks and anxiety disorders, and more recently has been related to risk for other psychopathological conditions including those related to substance misuse. This article introduces a special issue of Addictive Behaviors focusing on cutting edge findings on the relations of AS to substance use and abuse. We set the stage for the following series of eight novel empirical papers by providing a review of background on the ways in which AS has been hypothetically linked to increased risk for the development of substance abuse and addiction. We also consider whether AS might be differentially related to risk for abuse of specific classes of drugs with different pharmacological effects (e.g., depressants vs. stimulants). Finally, we consider how AS might be related to substance use disorder maintenance or relapse risk through its putative effects in increasing drug withdrawal severity and in lowering tolerance for withdrawal symptoms. Our overriding goal in writing this Introduction was to provide an organizational template for integrating the featured studies and to recommend promising directions for future work into the association of AS and substance use-related problems.

Anxiety Disorders↗
PubMed2005

The probable impacts of the removal of the addiction disability benefit in Ontario.

In Ontario, those dependent on substances are no longer eligible for welfare payments based on an addiction disability. While the impact of this program has not been assessed, evidence from a similar policy shift in the USA suggests deleterious effects on the health and social functioning of about half of those who lose this form of social support. A review of the research on the chronic-illness view of addiction, the fostering of stigma by exclusionary social policies, and the negative effects on mental health and homeless status associated with the loss of welfare benefits leads to the conclusion that this is an ill-advised policy for Ontario. Its continuation there, and its extension to other provinces, is not recommended.

Eligibility Determination↗
PubMed1998

HIV/AIDS knowledge and attitudes among alcohol and drug abusers in Egypt.

The aim of this study was to assess knowledge, attitudes and practice towards HIV/AIDS among alcohol and drug abusers and the effect of health education (HE) on their knowledge and attitudes. Participants were 265 substance abusers, recruited from 8 addiction rehabilitation centers. A base line study preceding HE was done using a questionnaire composed of five sections. Three scores were developed to assess HIV/AIDS related knowledge. The base line study indicates that addicts with good knowledge scores > or =75%) regarding modes of transmission were significantly higher among males than females. About 70% of the addicts had negative attitudes towards dealing with HIV/AIDS patients, while 55.5% felt sympathy for them. Eleven percent of the injection drug abusers were sharing needle with others, while 38% of the participating females were previously convicted of prostitution. Logistic analysis showed that high level of education was the best predictive variable for good knowledge scores (> or =75%). Evaluation of the health education program revealed a highly significant increase in the knowledge scores among both males and females compared to the pretest scores. An increase in the percentages of male and female addicts with improved attitudes towards HIV/AIDS patients was also noted after HE. So, HE was found to be a successful tool in improving the knowledge and attitudes of substance abusers towards HIV/AIDS.

Adult↗
PubMed1981

Current issues in the management of cancer pain: Memorial Sloan-Kettering Cancer Center.

Recent attention to the management of cancer pain in the mass media (TV, books, newspapers) and the medical press provides ample evidence to suggest that many cancer patients are not receiving appropriate therapy for their pain. Since cancer therapy is often not curative, only palliative, specific attention to the management of pain in such patients is essential. However, the management of cancer pain requires a specific approach and expertise. Narcotic analgesics are the mainstay of therapy in the management of such patients, yet physicians lack sufficient knowledge of narcotic pharmacology to use these drugs appropriately. Recent controversy has arisen in 3 specific aspects of narcotic drug therapy: 1) the choice of a narcotic drug and its method of administration; 2) the development of tolerance, and 3) the risk of substance abuse, drug dependence, and addiction.

Drug Tolerance↗
PubMed1993

A psychotherapeutic approach to substance abuse: preliminary observations.

Twenty-four long-term substance abusers were told that addiction is an attempt to adapt to an insufficiency in natural neurochemicals that contribute to a sense of well-being; this insufficiency is experienced as a craving for abuse substances which mimic the missing anxiolytic and euphorigenic neurochemicals. They were also told that they could satisfy their cravings immediately and completely without taking abuse substances by intentionally restoring adequate levels of the depleted neurochemicals. To perform this self-regulation, they were taught a specific psychological technique that united reason and emotion in an unambivalent order to the brain. Nineteen abusers (79%) were able to use the procedure to relieve all substance cravings and withdrawal symptoms. Their remissions have lasted 41 to 66 months to date (July 1991). A replication of the findings reinforces the desirability of further studies of the treatment's effectiveness and mechanisms.

Adaptation, Psychological↗
PubMed1991

The substance-abusing family: consideration for nursing research.

Investigations to explore and document the characteristics of addicted families are possible for nurse researchers in a variety of settings. Addicted families can be identified through hospitals, clinics, or community substance abuse treatment centers. Confidentiality issues must be addressed with carefully designed consent forms. A thorough understanding of addicted family systems is essential. System, role, and family theories provide a framework for understanding the influence of substance abuse on all family members. Anticipation of common social, economic, and criminal crises of addicted families will assist the researcher to avoid conflicts between research and service. Methodological limitations are common in research with addicted families, but well-designed, descriptive studies with small- to moderate-sized self-selected samples can add greatly to our nursing knowledge base over time.

Confidentiality↗
PubMed2005

Negative Mood Regulation (NMR) expectancies, mood, and affect intensity among clients in substance disorder treatment facilities.

Negative mood regulation (NMR) expectancies, stress, anxiety, depression and affect intensity were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, addicts reported significantly higher levels of stress, anxiety, depression and affect intensity and lower levels of NMR compared to non-addict controls. NMR was negatively correlated with stress, anxiety, depression and affect intensity. The findings indicate that mood self-regulation is impaired in addicts. Low NMR and high affect intensity may predispose to substance abuse and addiction, or alternatively may reflect chronic drug-induced affective dysregulation.

Adaptation, Psychological↗
PubMed2005

Changes in quality of life for pregnant women in substance user treatment: developing a quality of life index for the addictions.

UNLABELLED: Using preference weights from a community sample, items from the Addiction Severity Index (ASI) were converted into a quality of life index (QOLI) and used to compare the cost-effectiveness of five addiction treatment modalities for pregnant women. METHODS: Interviews using the time trade-off methodology were conducted with 143 members of Massachusetts local health planning boards to determine preference weights for different health states resulting from active addiction. A multi-attribute utility formula was used to convert these seven preference weighted scores into a single QOLI. To apply the QOLI, these preference weights were combined with the number of problem days reported in each ASI domain by a sample of 439 pregnant women in MA in five treatment modalities, 1992-1996. RESULTS: Starting at 10 years with an addiction problem, board members indicated that they would give up between 0.83 and 3.96 years to avoid the problems in one domain caused by addiction. The average QOLI was 0.68 at intake but increased by 0.19 points by 6-month follow-up to 0.87. All five treatment groups showed notable improvement in their quality of life. Mean improvements ranged from a high of 0.23 QOLIs for clients who received both residential and outpatient treatment to a low of 0.16 for clients who received only detoxification. Treatment costs ranged from 10,187 dollars for residential and outpatient combined to 2535 dollars for detoxification only, with costs per QOLI ranging from 14,912 dollars to 44,291 dollars. CONCLUSIONS: Although this QOLI could benefit from further refinement and development, it showed promise as a single outcome measure for CEAs in the chemical dependency field. This QOLI was sensitive enough to distinguish between the treatment groups, it correlated well with other outcome measures and can be easily converted from the ASI using spreadsheet software and a simple formula.

Adult↗
PubMed2006

Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment.

BACKGROUND: Patients presenting for treatment of substance use disorders (SUDs) often exhibit medical comorbidities that affect functional health status and healthcare costs. Providing primary care within addictions clinics (onsite care) may improve medical and SUD treatment outcomes in this population. OBJECTIVE: The objective of this study was to compare outcomes among Veterans' Administration (VA) patients who receive medical care within the SUD clinic and those referred to a general medicine clinic at the same facility. METHODS: Veterans entering SUD treatment with a chronic medical condition and no current primary care were randomized to receive primary medical care: 1) onsite in the VA SUD clinic (n = 358), or 2) in the VA general internal medicine clinic (n = 362). Subjects were assessed at baseline and at 3, 6, and 12 months postrandomization. Intention-to-treat analyses used random-effects regression. MEASURES: Measures included SF-36 Physical and Mental Component Summaries (PCS, MCS), VA service utilization, SUD treatment retention, Addiction Severity Index (ASI) scores, 30-day abstinence, and total VA healthcare costs. RESULTS: Over the study year, patients assigned to onsite care were more likely to attend primary care (adjusted odds ratio [OR] = 2.20; 95% confidence interval [CI] = 1.53-3.15) and to remain engaged in SUD treatment at 3 months (adjusted OR = 1.36; 1.00-1.84). Overall, outcomes on the MCS (but not the PCS) and the ASI improved significantly over time but did not differ by treatment condition. Total VA healthcare costs did not differ reliably across conditions. CONCLUSIONS: Compared with referral care, providing primary care within a VA addiction clinic increased primary care access and initial SUD treatment retention but showed no effect on overall health status or costs.

Adult↗
PubMed1999

Genetics of alcoholism and substance abuse.

Twin studies have demonstrated that addictive disorders are genetically and environmentally influenced. Our knowledge of behavioral differences predisposing to addiction is advancing rapidly, particularly in alcoholism but also in the other addictions, through studies on animals and humans. Recently, linkage analyses in humans and rodents have pointed to genomic regions harboring genes which influence addiction or drug-associated behaviors. There is increasing evidence that the addictions have common as well as distinct neurobiological pathways. These advances in the understanding of the genetics of addictive disorders should facilitate the development of specific pharmacotherapies and the more accurate targeting of therapies using molecular diagnostic approaches.

Adolescent↗
PubMed1988

Coping and defending styles among Vietnam combat veterans seeking treatment for posttraumatic stress disorder and substance use disorder.

A review of the literature on coping processes in addiction disorders yields at least two notions: one, that substance abuse is associated with less efficient, avoidant ways of coping with problems in living; and two, that substance abusers with a background of traumatic and stressful experiences are readily distinguishable by even more avoidant coping styles. These notions were tested in the form of three hypotheses: (1) substance abusers in general employ more avoidant coping styles than do nonaddicted groups; (2) Vietnam combat veterans meeting DSM-III criteria for both substance use disorder and posttraumatic stress disorder (PTSD) evidence significantly more avoidant coping styles than do Vietnam combat veterans meeting criteria only for substance use disorder but not PTSD--particularly when dealing with internal states of anxiety; and (3) for those meeting both substance use disorder and PTSD criteria, black Vietnam combat veterans (who presumably have encountered more stress, as minority group members) evidence more avoidant coping styles than do white Vietnam combat veterans. These three hypotheses were tested with Peck's (1981) newly developed Individual Styles of Coping, measuring four stages in the coping process for five behavioral contexts. All three hypotheses were confirmed. Results were discussed as confirming recent changes in DSM-III-Revised (1987) criteria, emphasizing generalized avoidance manuevers as criterial, in part, for diagnosing PTSD (in addition to behaviors of specific avoidance of traumatic memories). Theoretical implications about a traumatogenic dimension for substance abuse among some Vietnam combat veterans were discussed, as well as ramifications for treatment programming.

Adult↗
PubMed2006

[Relevance of childhood trauma for later drug dependence].

UNLABELLED: There are various publications on the impact of the experience of violence and abuse during childhood as it relates to future substance abuse. This study aims to examine how childhood abuse differentiated by type and severity, impacts on future potential for substance abuse. Particular attention is paid to specific psychological symptoms and degree of addiction. METHODS: 100 patients being treated for substance abuse completed a questionnaire where they were questioned about a childhood history of sexual, physical and emotional abuse, neglect and family violence. Psychopathology and severity of addiction were assessed using the EuropASI and SCL-90. RESULTS: The results demonstrated that the respondents had been exposed to multiple risk factors in their childhood. The subjects were differentiated into groups according to type of abuse. The type and severity of psychological symptoms were measured by the SCL-90-R. The type and severity of psychosocial and environmental problems were measured by the EuropASI. It was shown that patients with a history of abuse had a significantly higher incidence of symptomatology, particularly of co-morbid psychological conditions. When differentiating victims of abuse by sex, women showed a significantly stronger impairment in 2 categories. These were insecurity in social contact and phobic fear. For all other variables of impairment, there were no differences between men and women. The severity of the various types of abuse was then correlated to the course of the disease. A strong correlation was found between severe forms of abuse where victims were involved in sexual abuse or family violence and future severe psychological symptoms.

Adult↗
PubMed2002

[Psycho(patho)logy of "addiction." Interpretative hypothesis].

This work deals with the possible role of psychopathological features as for the pathogenesis of substance use disorders, across three distinct stages of its spontaneous course: initiation, transition to habit, that is becoming accustomed to regular substance use, and eventual self-maintaining addiction. Reviewed data from literature are discussed concerning personality characteristics of addicted patients and the issue of addictive personality. On such basis, we propose a classification of addictive styles according to our personal experience in the field (environmental reaction, self-medication, and metabolic automacy) in the attempt to better illustrate the dynamics of the various stages of the abuse, each accounted for as a distinct milestone along the same path of pathogenesis. In fact, interpretative models elaborated so far, though partly useful in providing with a plausible explanation for special subpopulation of addicts, failed to portray an overall shared dynamic. In other words, no satisfactory explanation has been so far provided to justify the basic development of the addictive condition along the bare events observed along its course. Our integrated model especially accounts for the issue of mood disorders as the a weightsome psychic substrate for the development of a substance-resorting attitude.

Humans↗