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Cheap and abundant, inhalants are an easy way for young people to get high. These substances are physically and psychologically addicting, and can cause death. Find out what nurses--and parents--need to know.
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BACKGROUND: Research on addiction treatment utilization in indigent samples mainly has been retrospective, without measures of addictive consequences, social network influences, and motivation. Prospective assessment of factors influencing utilization could inform policy and clinical care. OBJECTIVE: We sought to identify factors associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness. RESEARCH AND METHODS: This was a prospective cohort of patients detoxified from alcohol or drugs at baseline who were followed for 2 years in a randomized clinical trial of linkage to primary care (n = 274). Outcomes included utilization of Inpatient/Residential, Outpatient, Any Treatment, and Mutual Help Groups. Predictor variables in longitudinal regression analyses came from the literature and clinical experience, organized according to theoretical categories of Need, and non-Need (eg, Predisposing and Enabling). RESULTS: Many subjects used Inpatient/Residential (72%), Outpatient (62%), Any Treatment (88%) or Mutual Help Groups (93%) at least once. In multivariable analyses, addictive consequences (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.12-1.71), motivation (OR 1.32, 95% CI 1.09-1.60), and female gender (OR 1.80, 95% CI 1.13-2.86) were associated with most treatment types (ORs are for Any Treatment). Homelessness was associated with Residential/Inpatient (for Chronically Homeless vs. Housed, OR 1.75, 95% CI 1.04-2.94). Living with one's children (OR 0.51, 95% CI 0.31-0.84) and substance-abusing social environment (OR 0.65, 95% CI 0.43-0.98) were negatively associated with Any Treatment. CONCLUSIONS: In this cohort of substance-dependent persons, addictive consequences, social network variables, and motivation were associated with treatment utilization. Non-need factors, including living with one's children and gender, also were significant.
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Longitudinal patterns of alcohol use by narcotics addicts sampled from a drug-free treatment program and from several methadone maintenance treatment programs were examined. Overall, a high prevalence of alcohol use was found in both samples across several stages of the addicts' careers. Many addicts were also using nonnarcotic drugs and marijuana concurrently. Generally, levels of alcohol, as well as of other substances use, decreased as the narcotics addiction career began. Unlike other drug use, however, only alcohol consumption increased whenever a decrease occurred in narcotics use. Effects of ethnicity, gender, parental alcohol problems, and opiate and alcohol use onset sequence on the alcohol- and narcotics-related behavior are examined in detail. A pattern of early onset of heavy alcohol consumption before initial narcotics addiction was more common among Chicanos and was associated with a positive parental alcohol history. Women addicts typically had a much lower alcohol consumption level than their male counterparts. Among the 160 deaths of the original 581 addicts followed during the 20 years of the study, alcohol-related deaths accounted for 17.5% of the total. Treatment implications for addicts with an alcohol problem are discussed.
UNLABELLED: A retrospective chart review of clinical assessments encompassing psychiatric diagnosis, addiction severity and psychosocial functioning of cocaine-dependent pregnant or postpartum women during inpatient treatment was obtained. Predictive value of the elements of the assessment battery on aftercare compliance was determined. METHODS: The charts of forty-one cocaine-dependent pregnant or postpartum women treated for substance abuse were reviewed for addiction severity and aftercare compliance. Thirty of these patients were administered the Structured Clinical Interview for DSM-III-R (SCID I and II) and screened for history of victimization during inpatient treatment. All women were divided into two groups, aftercare treatment compliers (TCs) and aftercare treatment noncompliers (TNCs). TCs were those patients who attended at least one-half of the aftercare sessions. RESULTS: TCs had significantly lower scores on the psychiatric (p < or = .05) and employment (p < or = .01) subscales of the ASI, indicating lesser problem severity. The total composite mean ASI score, although not statistically significant, was also lower for TCs. Of the thirty subjects that were administered the SCID-I and II, sixty-seven percent had an Axis I disorder. TNCs were significantly more likely to have an anxiety disorder (p < or = 0.05). Eighty percent of subjects had at least one Axis II disorder. TNCs were also significantly more likely to have any Axis II disorder (p < or = 0.05), and to have Cluster B and Cluster C personality disorders (p < or = 0.05). In addition, seventy-three percent of subjects reported victimization, with TNCs significantly more likely (p < or = 0.05) to have experienced childhood abuse. CONCLUSIONS: In this sample of pregnant cocaine using women, the majority of women had current Axis I and II disorders as well as history of victimization. The results suggest that the ASI employment and psychiatric subscales may be predictive of aftercare compliance. The presence of certain Axis I and/or Axis II disorders also appear to be predictors of poor compliance. Treatment of pregnant substance using women must be designed to address issues of victimization as well as psychiatric disorders.
Nicotine addiction is the most prevalent of all substance dependence, resulting in profound medical, social, and psychologic costs. Evidence supporting the addictive nature of nicotine is compelling. Recognition of this addiction has opened treatment options not currently available, including pharmacologic options. Physicians can contribute to cessation success even with minimal interventions. For those interested in stronger interventions, careful assessment of the smoker is essential. This assessment should identify the degree of nicotine dependence, the presence of negative affect related to cessation, and the pervasiveness of meaning of tobacco in the patient's life. Treatment options include white knuckle or will power quitting, guided self-treatment, referral, and office cessation with or without pharmacologic support. A four-visit protocol that includes (1) recruitment, (2) assessment, (3) treatment, and (4) relapse prevention is described.
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The older view of addiction was that people became addicted because they were ignorant of the risks of addiction, they were unhappy, or they lacked healthy opportunities. Once addicted, they were hooked by physical dependence, causing them to continue use despite wanting to quit. The new paradigm of addiction focuses on reward and the powerful experience of falling in love with the feeling that addictive behaviors produce. Potential addicts seek brain reward and are heedless of the risks, of which they are seldom ignorant. Withdrawal is largely irrelevant. The problem of addiction is the power of brain reward. The new view of addiction has important implications for prevention, treatment, public policy, and medical treatment with controlled substances.
Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction includes behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral and social-context components. Whereas the basic treatment approach in substance dependence involves the medical field, psychosocial support is the second main area which has to be included in order to gain a successful treatment outcome. In addition, psychotherapy presents a third useful area in the field of the treatment of drug addiction, but only under the consideration that the addict shows a continuing motivation to change. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impinge on society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction. Treatment of substance dependence in men differs from treatment of substance dependence in women; drug addiction in females requires special attention when the woman is pregnant.
Some studies have suggested that nondisabled people follow the dictates of a 'kindness norm' when reacting to those who are disabled. Spinal cord injured substance abusers have sometimes used the kindness of others to help maintain their addictive behavior. A special unit for such substance abusers in a Veterans Affairs hospital has used group psychotherapy as one of the principal methods for moving beyond the kindness norm and challenging its patients to struggle with their substance abuse. Therapists in this group have had to become aware of the special content of denial in this population, of the role of physical problems specific to spinal cord injury, and of the need to set aside clinical issues at times in order to make on the spot responses to practical problems associated with the injury.
Past research has demonstrated that the characteristics of substance abusers vary considerably. Often, however, addicts are considered members of a single, homogeneous group. These erroneous designations may indeed prevent the successful rehabilitation of substance abusers. In the present study, hierarchical and K-means cluster analyses are used to identify a typology of substance users from a sample of 1,580 St. Louis arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program. Five clusters are yielded in the present analysis. The analyses illustrate not only that drug-using classifications differ between criminal and non-criminal populations, but that arrestee populations themselves vary interjurisdictionally. Given these findings, implications for local and regional drug treatment programs are assessed.
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The renewed public, governmental, and professional interest in addictive disorders should serve to encourage the interest of psychiatrists in this important and rapidly changing field. It is the view of the Group for the Advancement of Psychiatry (GAP) Committee on Alcoholism and the Addictions that all psychiatrists should possess expertise in the recognition, assessment, and treatment of substance use disorders. This position paper by the GAP committee reviews the role of the psychiatrist in the evaluation and treatment of patients with substance use disorders. It also notes some of the obstacles to full involvement in this field by medical practitioners in general and psychiatrists in particular. The psychiatrist has a critical role to play in the diagnosis and treatment of patients with substance use disorders. As biopsychosocial phenomena, substance abuse problems constitute a special and direct challenge to the psychiatrist, whose training, perspective, and competence should span all three domains. Psychiatrists must be willing to accept this challenge and fully participate in the development and application of treatment strategies adequate to cope with the enormous human suffering resulting from the abuse of alcohol and other psychoactive drugs.
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Explore the source record for details and available documents.