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PubMed2004

Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment.

UNLABELLED: Alcohol-dependent women progress faster from onset of alcohol drinking to entry into treatment, experiencing an earlier onset (i.e., "telescoping") of alcohol-related complications. This phenomenon also appears to be evident in drug-dependent women, though the data available to support telescoping in drug dependence is less abundant. OBJECTIVE: To evaluate gender effects on progression to treatment entry and on the frequency, severity and related complications of DSM-III-R drug and alcohol dependence among 271 substance-dependent patients (mean age: 32.6 years; 156 women). METHOD: Multivariate and univariate ANCOVA was used to compare age at onset of regular use of cocaine, opioids, cannabis and alcohol and time elapsed between initiation of regular use of each substance and entry into an index or current substance abuse treatment. Scores on the Addiction Severity Index (ASI) were also examined. RESULTS: There was no gender difference among patients in the age at onset of regular use of any substance. Women experienced fewer years of regular use of opioids and cannabis, and fewer years of regular alcohol drinking before entering treatment. Although the severity of drug and alcohol dependence did not differ by gender, women reported more severe psychiatric, medical and employment complications. CONCLUSIONS: These findings support the notion of an accelerated progression to treatment entry among opioid-, cannabis- and alcohol-dependent women, and suggest that there exists a gender-based vulnerability to the adverse consequences of these disorders.

Adult↗
PubMed2003

Treatment success rate among Iranian opioid dependents.

AIMS: The goal of this study was to assess the characteristics and treatment success rate (outcome) among Iranian opioid addicts. MEASUREMENTS: The data were gathered from 437 opioid addicts (using DSM-IV criteria) seeking treatment in 1998. FINDINGS: Their mean age was 35.6yr., and 72.8% were married. Of these subjects 34.1% listed secondary school, 25.9% primary school, and 23.6% listed high school as their level of education. Of these addicts 26.1% were unemployed, 24.5% miscellaneous workers, and 22.4% were drivers. About 49.4% reported opium, 31.8% heroin, 12.4% cooked dross, and 6.4% reported other opioids as the substance currently used. Of the 437 addicts, the majority (54%) did not complete detoxification phase, 35% had experienced abstinence at least for three months, and 11% relapsed prior to completion of three months of abstinence. The relation was statistically significant between outcome and type of used opioid and also between dose of used opioid and outcome. CONCLUSIONS: The most commonly used opioids were opium, heroin, and cooked dross. During recent years, some demographic characteristics of the Iranian addicts have changed. Cultural attitudes toward drug use are quite likely to affect types and amount of use and also outcome of treatment. These findings can be considered when planning preventive and therapeutic programs.

Adolescent↗
PubMed2003

Early intervention strategies in substance abuse.

Since the mid-eighties many efforts have been made to develop spezialized intervention strategies and interview techniques aiming at harm reduction and motivational enhancement in patients with substance related disorders. Firstly, the "Transtheoretical Model of Change" by Prochaska and DiClemente, which defines motivation as a dynamic process with several stage dependent intervention possibilities. Secondly, the "Motivational Interviewing" technique by Miller and Rollnick, who strongly suggest an empathic communication style deriving from humanistic psychology. It has been shown that especially persons in early stages of substance related disorders profited very well from such early interventions. Psychiatric institutions not involved in specialized addiction treatment have to face frequent comorbid substance abuse among their patients. Findings of the efficacy of early interventions in general psychiatry are encouraging. Despite there is strong evidence of efficacy of early and motivational intervention strategies in several medical fields, their implementation tends to be very difficult.

Humans↗
PubMed2002

Drug problem recognition, desire for help, and treatment readiness in a soup kitchen population.

This study determined hypothesized predictors of three components of motivation for change--drug problem recognition, desire for help, and treatment readiness--in a high-risk, drug-using population. The sample consisted of 190 guests at two inner-city soup kitchens in Brooklyn, NY who reported drug/alcohol use and were not participating in substance dependency treatment. Ever receiving addiction treatment, having no trade/job skills, and more severe symptoms of depression were associated with greater drug problem recognition. More recent days of drug/alcohol use, intensive pattern of drug use, and greater problem recognition were associated with greater desire for help. Caring for children, more recent days of drug/alcohol use, physical health problems, and desire for help were the direct predictors of treatment readiness. Problem recognition had a strong indirect effect on readiness mediated through desire for help. Knowledge of a drug user's motivational state and the factors leading to it can help guide the development of more effective interventions.

Adolescent↗
PubMed1999

The Helping Alliance Questionnaire: psychometric properties in patients with substance dependence.

Psychometric properties of the Helping Alliance Questionnaire (HAQ) are analyzed in a population of 340 substance-dependent patients of an addiction clinic in the Netherlands. Factor analysis yields a two-factor structure: Cooperation and Helpfulness. The scales show fair correlations with three out of seven scales from the Barrett-Lennard Relationship Inventory. Length of Stay in Detox is predicted by scores on the Helpfulness scale and noncompliance by scores on the Cooperation scale. Besides this, intermediate outcome measures are correlated with HAQ scores. The HAQ seems to be a "quick scan" instrument to give a quick and global impression of the patients' perception of the quality of the working alliance with the therapist.

Adult↗
PubMed2002

The specificity of family history of alcohol and drug abuse in cocaine abusers.

This study addresses the issue of whether the increased rates of substance-related problems for family members of cocaine abusers are specific for each substance. The present analysis examined the prevalence of problems due to alcohol or drug use separately for mothers, fathers, sisters, and brothers using the Family History Assessment Module. The probands were 343 out-of-treatment subjects with DSM-III-R cocaine disorders who did or did not have additional alcohol and opiate disorders. After accounting for age, race, gender, and antisocial personality, family history of alcohol-related problems had an odds ratio of 1.6 (p <.05) if a participant was alcoholic in addition to abusing cocaine. Specifically, a significantly greater proportion of participants' sisters (p <.001) and brothers (p <.05) had alcohol-related problems if the participant had a history of alcoholism. Among probands who reported opiate abuse or dependence, 38% had relatives with drug-related problems, while participants without opiate abuse or dependence had less than 31% of relatives with drug-related problems (p <.05). However, this association with opiate abuse or dependence and family history of drug-related problems was non-significant after controlling for participants' age, race, gender, treatment status, and antisocial personality diagnosis (odds ratio = 1.4, 95% C.I. = 0.8-2.4). Associations between participants' alcoholism and first-degree relatives' drug-related problems (and vice versa) showed that participants' history of opiate addiction did improve prediction of first-degree relatives' alcohol-related problems, except for participants' brothers. Additional familial risks for alcoholism were seen among siblings of drug abusers who also reported abuse of or dependence on alcohol even after controlling for relatives' ages. Furthermore, parental prevalence of alcohol-related problems were greater when participants had opiate addiction in addition to cocaine addiction. This seems to indicate that opiate addiction in addition to cocaine addiction has particularly strong inheritance patterns. In contrast, parental prevalence of drug-related problems was not greater when participants had alcohol addiction in addition to cocaine addiction. Thus, the cross-substance parent-child familial risk is limited to the dually diagnosed illicit drug.

Adult↗
PubMed2004

A genomic scan for habitual smoking in families of alcoholics: common and specific genetic factors in substance dependence.

Smoking is a highly heritable, addictive disorder that commonly co-occurs with alcohol dependence. The purpose of this study is to perform a genomic screen for habitual smoking and comorbid habitual smoking and alcohol dependence in families from the Collaborative Study on the Genetics of Alcoholism (COGA). Subjects were assessed using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) to evaluate alcohol dependence and habitual smoking (smoking one pack per day or more for at least 6 months). Sixty seven multi-generational families with 154 independent sibling pairs affected with habitual smoking were genotyped in a screening sample. Analyses on 79 multi-generational families with 173 independent sibling pairs were repeated in a replication sample. Sibpair analyses were performed using ASPEX. Four chromosomal regions in the screening sample had increased allele sharing among sibling pairs for habitual smoking with a LOD score greater than 1 (chromosomes 5, 9, 11, and 21). The highest LOD score was on chromosome 9 (LOD = 2.02; allele sharing 58.9%). Four chromosomal regions also had modest evidence for linkage to the comorbid phenotype habitual smoking and alcohol dependence (chromosomes 1, 2, 11, 15); and the strongest finding was on chromosome 2 (LOD = 3.30; allele sharing 69.1%). Previously identified areas (chromosomes 1 and 7) implicated in the development of alcohol dependence in this same data set did not provide evidence for linkage to habitual smoking in the screening sample. In the replication data set, there continued to be increased allele sharing near peaks identified in the screening sample on chromosomes 2 and 9, but the results were modest. An area on chromosome 7, approximately 60 cM from a location previously identified in linkage analysis with alcohol dependence, had increased allele sharing for the comorbid habitual smoking and alcohol dependence. These data provide evidence of specific genetic regions involved in the development of habitual smoking and not alcohol dependence. Conversely, genetic regions that influence the development of alcohol dependence do not appear to contribute to the development of habitual smoking. Finally, there is also evidence of an area on chromosome 2 that may reflect a common genetic vulnerability locus to both habitual smoking and alcohol dependence.

Adolescent↗
PubMedDate not supplied

Treatment of maternal addiction to prevent child abuse and neglect.

Substance abusing mothers are a population neglected by the broader fields of substance abuse research and treatment. They are also at special risk for child abuse and neglect. This paper proposes a treatment model, drawn from the child maltreatment literature, that is also strongly supported by substance abuse research. Barriers within the substance abuse field to the adoption of treatment methods suggested by this model are considered and methods of surmounting those barriers are described. Finally, the need for scientists in the child maltreatment field to draw from the expertise of substance abuse researchers and clinicians is illustrated by data from an ongoing project; these data document the strong link between risk for maltreatment and a history of substance abuse. The need for future collaboration between the two fields is indicated by both literatures and strongly urged here.

Adolescent↗
PubMed1996

Mothers in recovery: rebuilding families in the aftermath of addiction.

In the mid-1980s maternal substance abuse in the United States increased dramatically, resulting in significant increases in the foster care caseload. Moreover, because of systemic inequities children of poor women of color experienced increased risk of foster care placement. Partly in response to court decisions legitimating mothers' rights to rehabilitation and family preservation services and the increased costs of providing foster care services, New York City implemented the Family Rehabilitation Program as an alternative to placement. This article reports the findings of a qualitative, exploratory study that examined outcomes for 20 women who had successfully completed the program and identifies client characteristics associated with successful drug rehabilitation and practice interventions that support retention in drug treatment. Implications for the redirection of policy and practice to focus on prevention and family preservation for this underserved population are discussed.

Adolescent↗
PubMed1995

[Femoral pseudoaneurysms in drug addicts].

Four cases of femoral pseudoaneurysms from substance abuse are presented. One patient, a 32 year-old women needed amputation (by disarticulation of the hip) after failed revascularization. Another patient had symptoms of claudication after triple ligation and resection without bypass grafting. The last two had an uneventful recovery: one after saphenous vein bypass, the other after simple resection and repair with a vein patch.

Adult↗
PubMed1990

Adjunctive drug use among opiate addicts.

In a study of 249 opiate (mainly heroin) addicts special attention was paid to adjunctive drug use. Generally, nicotine (cigarette smoking), alcohol and cannabis preceded the use of heroin, and continued to be used as adjunctive drugs after the establishment of heroin addiction. Nicotine was the most common substance used together with opiates. Alcohol and cannabis were used as adjunctive drugs in about two-thirds of the cases. In the late stages of heroin addiction, benzodiazepines were also used concomitantly with opiates. The most frequently reported reason for the use of adjunctive drugs was to intensify the effect of the opiate. Three-quarters or more of the addicts had used different adjunctive drugs to boost the euphoric feeling derived from the primary drug, i.e. heroin. Attempt at self-treatment of withdrawal symptoms was a less frequently reported reason for adjunctive drug use. The findings show that heroin addiction is the major problem. The use of adjunctive drugs, especially benzodiazepines, can be partly explained on economic grounds. They must be clearly distinguished from the primary drug of abuse, heroin. For policy-making decisions, it is important that the elimination of heroin abuse through effective prevention measures would ultimately wipe out the problem of adjunctive drug use, while reduction of the overall supply of heroin without reduction in actual demand might result in an increasing trend to adjunctive drug use.

Alcohol Drinking↗
PubMed1998

Substance abuse and the course of welfare dependency.

OBJECTIVES: New provisions in welfare reform target recipients with addictions, even though there is limited research on how substance abuse affects people's experiences on welfare. This prospective study examined substance abuse as a determinant of subsequent welfare dependency. METHODS: Representative samples of clients on Aid to Families with Dependent Children (AFDC) and general assistance in a California county were interviewed while applying for services in 1989 and were reinterviewed in 1995. RESULTS: Among AFDC recipients, substance abuse was not a significant determinant of long welfare stays, repeat welfare use, or the total time a person remained on welfare during the 6-year period. However, substance abuse was a strong predictor of repeat welfare use among general assistance recipients. CONCLUSIONS: Alcohol and drug problems have played dramatically different roles in welfare dependency within the AFDC and general assistance populations. Under welfare reform, local general assistance programs will be the final safety net for recipients removed from federal entitlement programs. These programs will probably be confronted with clients with more complex disabilities related to addiction, as well as with greater family needs for cash assistance.

Adult↗
PubMed1993

The epidemiology of the comorbidity of psychiatric and addictive disorders: a critical review.

Assessing the prevalence of the comorbidity of psychiatric and addictive disease using epidemiologic methods results in artifactually high rates. Use of a clinical sample will yield falsely high rates, because substance use is associated with exacerbation of mental illness. Cross sectional design will inflate rates of psychiatric comorbidity in addicts, who attribute substance use to psychological symptoms until well into recovery. Application of exclusionary criteria for independent diagnosis is subject to investigator bias, particularly about the unproven yet popular "self-medication" hypothesis. The psychiatric symptoms which are common in active addiction generally clear within weeks to months of treatment for addiction but do not respond to standard psychopharmacologic treatment for primary mental illness. When lengthy follow up periods are employed, substance induced psychiatric syndromes typically resolve. We conclude that while patients treated in psychiatric settings often have comorbid and independent addictive illness, patients treated in addiction settings uncommonly have comorbid psychiatric illness despite common psychiatric symptoms.

Comorbidity↗
PubMed1993

Perinatal substance abusers. Psychological and social characteristics.

Forty perinatal substance abusers were administered multiple psychosocial, addiction, and psychological measures before beginning treatment. Results indicate that these patients are limited intellectually, educationally, financially, and emotionally. Psychiatric comorbidity was high, with 45% having non-substance abuse axis I diagnoses and 75% having confirmed (by two or more tests) axis II pathology. The most frequently identified axis I disorders were depression and anxiety. The most frequently detected personality disorders were antisocial, borderline, paranoid, and dependent. The average IQ was 87 (low average range) and nearly one third of the sample were found to be somewhat impaired intellectually. These data suggest that treatment programs must take psychological characteristics into account if they are going to succeed in helping these women achieve and maintain abstinence.

Anxiety Disorders↗