Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. 

This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. 

The sample consisted of 587 adult subjects, of which 

• 82.3% were men, 
• 66.4% had used cocaine (sniffed and smoked) as their DOC, 
• 24.4% had a history with the criminal justice system, 
• 26.8% had committed crimes, 
• 19.3% had engaged in violent behavior, and 
• 12.2% had been involved in drug trafficking. 

In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence

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By:  Diehl A¹, Pillon SC², Dos Santos MA³, Rassool GH⁴, Laranjeira R⁵.

¹a National Institute of Alcohol and Drugs Policy (INPAD), Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

²b Professor, University of São Paulo (USP) , Psychiatric Nursing and Human Science Department, Faculty of Nursing at Ribeirão Preto, Ribeirão Preto, Brazil; PAHO/WHO Collaborating Centre for Nursing Research Development , Ribeirão Preto , Brazil.

³c Associate Professor, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto , University of São Paulo, São Paulo , Brazil.

⁴d Professor and Executive Director, Sakina Counselling Institute , Port Louis , Republic of Mauritius.

⁵e Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

J Psychoactive Drugs. 2016 Apr-Jun;48(2):124-134.

  

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Examining Risk for Frequent Cocaine Use: Focus on an African American Treatment Population

BACKGROUND:

Cocaine use and its consequences are disproportionately higher and more severe among African Americans compared to other ethnic/racial groups.

OBJECTIVES:

The aims of this study were to examine a risk model specific for African American users and assess whether risk varies as a function of sex.

METHODS:

270 African American adults in a residential drug treatment facility completed measurements assessing first and past year crack/cocaine use frequency, childhood trauma, and stress reactivity. Multiple linear regression analysis was used to examine the unique effect of each predictor variable on past year crack/cocaine frequency. Sex was included as a moderator variable in the regression analysis.

RESULTS:

All predictor variables were positively correlated with past year crack/cocaine use. However, sex differences were also observed: females reported higher rates of childhood emotional abuse, childhood sexual abuse, and stress reactivity-as well as past year crack use and cocaine use-than males. Regression analyses were performed with sex, first year use, and stress reactivity emerging as the only significant predictors for frequency of crack and cocaine use among all study participants. Moreover, sex differences were observed in the influence of first year crack use frequency on past year crack use frequency, such that the effect was stronger for males than for females. Conclusion/Importance: This study offers a clearer understanding of the risk factors for crack and cocaine abuse specific to African Americans, as well as sex specific pathways to risk, providing useful implications for future prevention and treatment efforts.

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By:  Zapolski TC1, Baldwin P1, Lejuez CW2.

• 1 Department of Psychology , Indiana University Purdue University-Indianapolis , Indianapolis , Indiana , USA.
• 2 Department of Psychology , University of Maryland , College Park , Maryland , USA. 
• Subst Use Misuse. 2016 Apr 21:1-10. 

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Prompted to Treatment by the Criminal Justice System: Relationships with Treatment Retention & Outcome among Cocaine Users

BACKGROUND AND OBJECTIVES:

A substantial portion of individuals entering treatment for substance use have been referred by the criminal justice system, yet there are conflicting reports regarding treatment engagement and outcome differences compared to those not referred. This study examined baseline characteristic and treatment outcome differences among cocaine-dependent individuals participating in cocaine treatment randomized trials.

METHODS:

This secondary analysis pooled samples across five completed randomized controlled trials, resulting in 434 participants. Of these, 67 (15%) were prompted to treatment by the criminal justice system.

RESULTS:

This subsample of criminal justice prompted (CJP) individuals did not differ from those not prompted by the criminal justice system in terms of gender, race/ethnicity, marital status, or age. However, the CJP group reported more years of regular cocaine use, more severe employment and legal problems, as well as less readiness to change prior to treatment. Treatment outcomes did not differ significantly from those without a criminal justice prompt, and on some measures the outcomes for CJP group were better (e.g., percentage of days cocaine abstinent, number of therapy sessions attended).

DISCUSSION AND CONCLUSIONS:

These findings suggest that being prompted to treatment by the criminal justice system may not lead to poorer treatment engagement or substance use outcomes for individuals participating in randomized controlled treatment trials.

SCIENTIFIC SIGNIFICANCE:

Despite some baseline indicators of poorer treatment prognosis, individuals who have been prompted to treatment by the criminal justice system have similar treatment outcomes as those presenting to treatment voluntarily.

Within treatment outcomes according to criminal justice prompt

	Prompted by Criminal Justice System (CJP) N = 67	Not Prompted by Criminal Justice System (non-CJP) N = 367	Total N = 434
	Mean (SD)	Mean (SD)	Mean (SD)	X2 or F
Days retained in treatment protocol	55.4 (29.3)	53.4 (33.1)	53.7 (32.5)	0.22
Completed treatment period, n (%)	36 (53.7)	186 (51.0)	222 (51.4)	0.68
Percentage of cocaine positive urine specimens	55 (37)	62 (37)	61 (37)	1.43
Percentage of days abstinent from cocaine	83 (19)	74 (26)	76 (25)	6.27*
Maximum consecutive days abstinent	24 (20.6)	22.3 (24.9)	22.6 (24.2)	0.25
Maximum days of continuous abstinence during last two weeks of treatment	10 (4.0)	8.3 (4.7)	8.6 (4.6)	4.65*
3+ weeks of continuous abstinence, n (%)	31 (46.3)	149 (40.8)	180 (41.7)	0.69
‘Good Functioning’ = zero cocaine use, employment, or psychological problems last 28 days of treatment, n (%)a	4 (7.5)	48 (14.5)	52 (13.5)	1.89

*p<.05

**p<.01

***p<.001

asample size reduced due to missing data

Full article at:   http://goo.gl/DiHFbZ

By:  Kiluk BD1, Serafini K, Malin-Mayor B, Babuscio TA, Nich C, Carroll KM.

• 1Yale University School of Medicine, New Haven, Connecticut. 
• Am J Addict. 2015 Apr;24(3):225-32. doi: 10.1111/ajad.12208. Epub 2015 Mar 24.

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An Effective Web Presence for Substance Abuse Treatment Facilities

BACKGROUND:

Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page.

OBJECTIVES:

The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry.

METHODS:

This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score.

RESULTS:

The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites.

CONCLUSIONS:

The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.

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By:   Link TW1,2, Hefner JL3, Ford EW4, Huerta TR5.

• 1 Department of Management , University of North Carolina at Greensboro , Greensboro , North Carolina , USA.
• 2 Department of Health Policy and Management , The George Washington University , Washington, DC , USA.
• 3 Family Medicine, The Ohio State University , Columbus , Ohio , USA.
• 4 Bloomberg School of Public Health, Johns Hopkins University , Baltimore , Maryland , USA.
• 5 Departments of Family Medicine and Biomedical Informatics , Ohio State University Medical Center , Columbus , Ohio , USA.
• Subst Use Misuse. 2016 Mar 24:1-4.  

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Personal Networks of Women in Residential & Outpatient Substance Abuse Treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. 

The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. 

Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. 

These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse...

Upon treatment entry, women report child related concerns, psychosocial difficulties, physical/sexual abuse, health issues and mental health problems to a far greater degree than their male counterparts (Wechsberg et al., 1998). These complex problems present difficulties for women in accessing social support and developing supportive personal network relationships (Tracy & Martin, 2007), thereby compromising their recovery (Warren, Stein, & Grella, 2007; Wenzel, Tucker, Golinelli, Green, & Zhou, 2010). Although different clinical profiles have been identified between women in residential and outpatient substance abuse treatment, no previous studies have examined or identified differences in personal network characteristics between these two groups of women. The purpose of this study was to identify differences in personal network characteristics between women entering residential substance abuse treatment and those entering intensive outpatient treatment. A deeper understanding of these differences may add an important dimension to substance abuse treatment planning, and may be utilized to inform treatment interventions for women in residential and outpatient treatment settings.

Clinical characteristics by treatment modality (N = 377).

	n (%)
	Residential (n = 119)	Outpatient (n = 258)	χ2 or t	p
Substance use disorder (SUD)
Marijuana	44 (37.9)	105 (41.0)	0.32	0.574
Amphetamine	3 (2.6)	1 (0.4)	3.62	0.092†
Sedatives	5 (4.3)	14 (5.5)	0.22	0.638
Cocaine	78 (67.2)	135 (52.7)	6.87	0.009
Opiates	35 (30.2)	51 (19.9)	4.72	0.030
Hallucinogens	0 (0.0)	9 (3.5)	4.18	0.062†
Inhalants	0 (0.0)	1 (0.4)	0.45	>0.999†
Phencyclidine	3 (2.6)	9 (3.5)	0.22	0.761†
Alcohol	63 (54.3)	112 (43.8)	3.57	0.059
Multiple SUD (yes)	74 (63.8)	132 (51.8)	4.67	0.031
Mental health disorder
Generalized anxiety	21 (17.6)	68 (26.5)	3.50	0.062
Posttraumatic	39 (32.8)	108 (42.0)	2.92	0.087
Major depressive episode	68 (57.1)	149 (58.0)	0.02	0.879
Dysthymia	5 (4.2)	7 (2.7)	0.57	0.531†
Manic episode	27 (22.7)	91 (35.4)	6.11	0.013
Hypomanic episode	9 (7.6)	31 (12.1)	1.73	0.188
Dual diagnosis	89 (74.8)	186 (72.7)	0.19	0.664
Previous treatment	90 (75.6)	185 (72.3)	0.47	0.493
HIV test result (positive)	1 (0.9)	5 (2.0)	0.66	0.669†
Multiple chronic health condition (2 or more)	26 (22.0)	65 (25.2)	0.44	0.507
Trauma symptom checklist, M(SD)	49.40 (20.94)	42.51 (21.29)	2.93	0.004

†Fisher’s Exact Test.

Full article at:   http://goo.gl/lxtcy6

By:  HyunSoo Kim,1 Elizabeth Tracy,2 Suzanne Brown,3 MinKyoung Jun,4 Hyunyong Park,2 Meeyoung Min,2 and Chris McCarty5

¹Department of Social Welfare, Dongguk University, Gyeongju-si, Republic of Korea

²The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA

³School of Social Work, Wayne State University, Detroit, MI, USA

⁴Gyeonggido Family & Women’s Research Institute, Gyeonggido, Suwon, Republic of Korea

⁵Survey Research Center, University of Florida, Gainsville, FL, USA

Correspondence: Dr Elizabeth Tracy, The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland 44106, OH

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Pilot Outcome Results of Culturally Adapted Evidence-Based Substance Use Disorder Treatment with a Southwest Tribe

INTRODUCTION:

Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview.

METHODS:

In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment.

RESULTS:

Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedges's g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = -0.66) and 5 of the 7 Addiction Severity Index domains (range of g = -0.42 to -0.98) also emerged.

CONCLUSIONS:

Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

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By:  Venner KL1, Greenfield BL2, Hagler KJ1, Simmons J3, Lupee D4, Homer E4, Yamutewa Y4, Smith JE3.

• 1University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131; Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106.
• 2University of Minnesota, Duluth, 1049 University Dr, Duluth, MN 55812.
• 3University of New Mexico, Department of Psychology, 1 University of New Mexico, MSC 03 2220, Albuquerque, NM 87131.
• 4Anonymous Tribal Agency. 
• Addict Behav Rep. 2016 Jun 1;3:21-27.

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Psychiatric Disorders Are Overlooked in Patients with Drug Abuse

INTRODUCTION:

Psychiatric disease is overlooked in drug users. Patients with both drug abuse and a psychiatric disease - dual diagnosis - suffer decreased compliance to treatment and decreased life expectancy compared with single-diagnosis patients. Identifying the patients among either drug addicts or mentally ill patients is difficult.

METHODS:

All drug addicts autopsied at the Department of Forensic Medicine, University of Copenhagen, Denmark, in the years 1992, 2002 and 2012 were included. The group was divided into two subpopulations of possible dual diagnosis patients either according to police reports stating mental illness or to psychotropics found in the toxicology screening after autopsy.

RESULTS:

We found a rise in possible mental illness in both subpopulations in the study period. Drug addicts with psychotropics in the blood at the time of death increased from 3.1% in 1992 to 48.1% in 2012, and this group was significantly younger at the time of death than those without psychotropics in the blood.

CONCLUSIONS:

Suspected dual diagnosis patients have increased in number. They die earlier than their drug addict counterparts. Methadone remains the leading cause of death in all subpopulations. Possible causes are misuse of treatment and/or illegally bought methadone, wrongly assigned cause of death due to unknown tolerance and/or polydrug toxicity in combination with psychotropic medicine.

Full PDF article at:   http://goo.gl/G7u3m5

By:  Kruckow L1, Linnet K, Banner J.

• 1line.kruckow@sund.ku.dk. 

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