Substance abuse and personality disorder comorbidity in adolescent outpatients: Are girls more severely ill than boys?

Background

Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.

Methods

The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.

Results

18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.

Conclusions

We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.

Below:  PD symptoms in adolescents with SUD and other Axis I disorders. PD Symptoms any PD criteria meeting a score of 1,2 or 3 when measured with the SIDP-IV; SUD substance use disorders; alcohol and/or drug abuse or dependence. Alcohol alcohol abuse or dependence; CannabisCannabis abuse or dependence; Anxiety anxiety disorders, simple phobias, generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder; Mood mood disorders, dysthymia and major depressive episode; CD conduct disorder; ADHDattention deficit hyperactivity disorder. ** p < 0.05

Full article at:   http://goo.gl/szh4O2

By:  Hans Ole Korsgaard, Svenn Torgersen, Tore Wentzel-Larsen, and Randi Ulberg

Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway

Department of Psychology, University of Oslo, Oslo, Norway

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

Vestfold Hospital Trust, Tønsberg, Norway

Institute of Clinical Medicine, University of Oslo, Oslo, Norway

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Examining the Role of Substance Abuse in Elder Mistreatment: Results from Mistreatment Investigations

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. 

This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. 

Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated (p< .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. 

Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention.

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By:  Conrad KJ1, Liu PJ2, Iris M3.

• 1University of Illinois at Chicago, IL, USA Chestnut Health Systems, Normal, IL, USA kjconrad@uic.edu.
• 2University of California, San Francisco, CA, USA.
• 3Leonard Schanfield Research Institute, Chicago, IL, USA. 

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Housing Outcomes & Predictors of Success: The Role of Hospitalization in Street Outreach

SUMMARY:

What is known on the subject? 

• Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. 

What this paper adds to existing knowledge? 

• Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. 

What are the implications for practice? 

• Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals.

ABSTRACT:

Introduction 
Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. 

The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. 

Method
A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. 

Results 
Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization. It was significantly diminished by psychosis and prior homelessness >36 months . Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized. 

Discussion 
Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. 

Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.

Purchase full article at:   http://goo.gl/bXs23W

By:  Lettner BH1, Doan RJ2, Miettinen AW3.

• 1Department of Nursing, University of Toronto, Toronto.
• 2Department of Psychiatry, University of Toronto, Toronto.
• 3Department of Economics, University of Toronto, Toronto. 
• J Psychiatr Ment Health Nurs. 2016 Mar;23(2):98-107. doi: 10.1111/jpm.12287.

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Nature & Determinants of Suicidal Ideation among U.S. Veterans: Results from the National Health & Resilience in Veterans Study

BACKGROUND:

Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.

METHOD:

Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.

RESULTS:

The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). 

Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). 

Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively.

LIMITATIONS:

Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time.

CONCLUSIONS:

These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.

Purchase full article at:   http://goo.gl/u4D8Z6

By:  Smith NB1, Mota N2, Tsai J3, Monteith L4, Harpaz-Rotem I5, Southwick SM2, Pietrzak RH2.

• 1U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. Electronic address: Noelle.smith2@va.gov.
• 2U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
• 3Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness, Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA.
• 4Denver VA Medical Center, Rocky Mountain MIRECC, Denver, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
• 5U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA. 
• J Affect Disord. 2016 Mar 2;197:66-73. doi: 10.1016/j.jad.2016.02.069.

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Color It Real: A Program to Increase Condom Use and Reduce Substance Abuse and Perceived Stress

Few interventions have targeted perceived stress as a co-occurring construct central to substance use and subsequent HIV/AIDS risk reduction among African American urban young adults. 

The Color It Real Program was a seven session, weekly administered age-specific and culturally-tailored intervention designed to provide substance abuse and HIV education and reduce perceived stress among African Americans ages 18 to 24 in Atlanta, GA. Effectiveness was assessed through a quasi-experimental study design that consisted of intervention (n = 122) and comparison (n = 70) groups completing a pre- and post-intervention survey. 

A series of Analysis of Variance (ANOVA) tests were used to assess pre- to post-intervention changes between study groups. For intervention participants, perceived stress levels were significantly reduced by the end of the intervention (t(70) = 2.38, p = 0.020), condom use at last sexual encounter significantly increased (F = 4.43, p = 0.0360), intervention participants were significantly less likely to drink five or more alcoholic drinks in one sitting (F = 5.10, p = 0.0245), and to use clean needles when injecting the drug (F = 36.99, p = 0.0001). 

This study is among the first of its kind to incorporate stress management as an integral approach to HIV/SA prevention. The program has implications for the design of other community-based, holistic approaches to addressing substance use and risky behaviors for young adults.

Below:  Perceived Stress Scale Composite Score for Intervention and Comparison Group

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By:  Tiffany Zellner,1,* Jennie Trotter,2 Shelia Lenoir,2 Kelvin Walston,2 L’dia Men-Na’a,2 Tabia Henry-Akintobi,1 and Assia Miller3

¹Department of Community Health and Preventive Medicine, Morehouse School of Medicine Prevention Research Center, 720 Westview Drive SW, Atlanta, GA 30310, USA; Email: ude.msm@ibotnikat

²Wholistic Stress Control Institute, Incorporated, 2545 Benjamin E Mays Drive, Atlanta, GA 30311, USA; Email: moc.1citsilohw@tj (J.T.); Email:moc.1citsilohw@lks (S.L.); Email: moc.liamtoh@notslawnivlek (K.W.); Email: moc.loa@aannemaidl (L.M.-N.)

³McKing Consulting Corporation, 2900 Chamblee Tucker Road, Building 10, Suite 100, Atlanta, GA 30341, USA; Email: ude.msm@rellima

^*Correspondence: Email: ude.msm@renllezt; Tel.: +1-404-756-8833; Fax: +1-404-752-1707

Int J Environ Res Public Health. 2016 Jan; 13(1): 51. Published online 2015 Dec 22. doi:  10.3390/ijerph13010051

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Prevalence of Substance Use & Abuse in Late Childhood & Early Adolescence: What Are the Implications?

The aim of the present study was to assess the prevalence by gender of substance use and misuse in late childhood and early adolescence.

A survey was conducted in 2013–2014 at primary and secondary schools of Padova, Veneto region, North-East Italy, on a sample of 171 pupils in 5th grade and 1325 in 6th to 8th grade.

…Among the 8th graders, more than one in three males and one in four females had experimented with smoking, and more than half the boys and nearly half the girls had experience of alcohol. In this same age group, almost two in three males and one in three females had used energy drinks, and nearly 5% of the boys had experience of marijuana and/or stimulant drugs. In addition, almost one in four of the male students in 8th grade had experimented with three of these substances.

The middle school years should be identified as the first period at risk concerning the use of these drugs. Prevention programs should begin in early adolescence, focusing on delaying the use or abuse of any of the “gateway drugs.”

Our findings indicate that smoking and both alcohol and energy drink consumption increment steadily with age in early adolescence – from 5th grade onwards – in both males and females, albeit with some gender-related differences, while 8th grade is the age showing a rising curve in the use of marijuana and stimulant drugs, especially in males.

In particular, our study showed that the number of adolescents who were smoking at least once a month increased steeply in 8th grade, although there were still few who smoked daily. These figures are consistent with the findings reported by the HBSC in Padua (Mirandola et al., 2010). In this age group, even smoking experimentally coincides with a significant 16-fold increase in the risk of becoming a smoker in adulthood by comparison with not smoking at all (Chassin et al., 1990).The wish to “experiment” typical of adolescent age encourages some teenagers to try cigarettes too, but for children who have already tried one or two cigarettes, the odds of them acquiring the habit is four times higher than for those who have never smoked. Once people have acquired the habit, it is difficult to stop and smoking is likely to be a long-term addiction (McNeill et al., 1989). These data confirm the importance of primary prevention programs directed at children and early adolescents to avoid them ever smoking at all, and prevention efforts focusing on younger children should be designed to discourage any experimentation, even just a puff. Starting prevention programs at high school is too late. In fact, HBSC data confirm that 19% of 15-year-old students in Italy smoke at least once a week (Cavallo et al., 2013), while in the USA the figure is 8.5% (Currie et al., 2012).

Judging from our study, in 8th grade almost one in three boys and one in five girls drink alcohol at least once a month, and 6.2% of males and 1.1% of females are at least weekly alcohol drinkers. These findings are comparable with the data for Italy emerging from the HBSC survey 2010, which indicated that 20.7% of 13-year-olds drink alcohol at least monthly (Cavallo et al., 2013). These figures indicate high alcohol drinking rates among younger adolescents and confirm that in Italy their contact with alcoholic beverages is extremely early and frequent.

The use of alcohol at an early age is associated with future alcohol-related problems (Kokotailo, 2010). Data from the National Longitudinal Alcohol Epidemiologic Study (Grant and Dawson, 1997) substantiated the conviction that the prevalence of lifetime alcohol dependence and alcohol abuse show a striking decrease with increasing age at onset of use. For people aged 12 years or younger at the time of their first use, the prevalence of lifetime alcohol dependence was 40.6%, whereas it was 16.6% for those who began to drink at 18 years old, and 10.6% for those who started at 21 years of age. Similarly, the prevalence of lifetime alcohol abuse was 8.3% for those who started drinking at 12 years or younger, 7.8% for those who started at 18 years old, and 4.8% for those who started at 21. The early onset of alcohol intake has been linked to familial and peer factors and the perception of the alcohol's dangerousness. Indeed, research show that parents' drinking, proactive parenting, peer influences, and perceptions of the harm drinking causes, all measured in late childhood, will affect the age of alcohol initiation, and this in turn affects the risk of alcohol misuse in late adolescence (Hawkins et al., 1997). Moreover, early alcohol initiation has also been associated with greater sexual risk-taking (unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy) (Stueve and O'Donnell, 2005), academic problems, other substance use, and delinquent behavior in mid- to late adolescence (Ellickson et al., 2003).

Below:  Prevalence distributions of lifetime substance use in different school grades by gender in Padova, Veneto region, North-East Italy, in 2013–2014

Below:  Prevalence distributions of number of different substances tried at least once in a lifetime (tobacco, alcohol, energy drinks, marijuana, stimulant drugs) in different school grades by gender in Padova, Veneto region, North-East Italy, in 2013-2014.

Below:  Prevalence distributions of ongoing substance use in different school grades by gender in Padova, Veneto region, North-East Italy, in 2013–2014

Full article at:   http://goo.gl/Z7p7qj

By:  Luigi Gallimberti,^a Alessandra Buja,^b,⁎ Sonia Chindamo,^a Camilla Lion,^c Alberto Terraneo,^a Elena Marini,^a Luis Javier Gomez Perez,^b and Vincenzo Baldo^d

^aNovella Fronda Foundation, Foundation for Studies and Applied Clinical Research in the Field of Addiction Medicine, Padua, Italy

^bDepartment of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Padua, Via Loredan 18, 35128 Padova, Italy

^c2nd School of Hygiene and Preventive Medicine Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, 35128 Padova, Italy

^dDepartment of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padua, Via Loredan 18, 35128 Padova Italy

Luigi Gallimberti: ti.itrebmillagoiduts@itrebmillag.igiul; Alessandra Buja: ti.dpinu@ajub.ardnassela; Sonia Chindamo: moc.liamg@omadnihc.ainos;Camilla Lion: ti.dpinu.itneduts@noil.allimac; Alberto Terraneo: ti.itrebmillagoiduts@oiduts; Elena Marini: moc.duolci@iniram.anele; Luis Javier Gomez Perez: ti.dpinu@zerepzemog.reivajsiul; Vincenzo Baldo: ti.dpinu@odlab.oznecniv

^⁎Corresponding author at: Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Via Loredan 18, 35128 Padova, Italy.Department of Molecular MedicineLaboratory of Public Health and Population StudiesInstitute of HygieneUniversity of PadovaVia Loredan 18Padova35128Italy ; Email: ti.dpinu@ajub.ardnassela

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Participants' Perception of a Unique Community of Practice for Substance Abuse Education in the Caribbean

BACKGROUND:

Substance abuse is a significant public health challenge in the Caribbean. It is important that health and allied professionals be adequately trained in this field. The Caribbean Institute on Alcoholism and other Drug Problems (CARIAD) was established to provide new knowledge, and share successful best practices in substance abuse in the Caribbean. CARIAD brings together diverse participants from throughout the region in a structured community of practice, and emphasizes local knowledge formation. This paper evaluates the acceptability and perceived impact of CARIAD to/o;n participants.

METHODS:

Authors analyzed anonymous written evaluations of 458 CARIAD participants completed immediately after the programme in 2003-2;012. Questionnaires collected quantitative data on the acceptability of the programme in meeting the learning needs of participants. Perception of programme acceptability and impact on the participant were also obtained from descriptive content analysis of qualitative data obtained through open-ended questions. A 2013 on-line follow up survey collected data about the utilization and dissemination of knowledge acquired at CARIAD from 141 graduates of the same period. Data analysis employed basic descriptive statistics and qualitative content analysis.

RESULTS:

Participant evaluation immediately following CARIAD showed a high level of satisfaction with the organization, structure, content and usefulness of the programme. Participants valued the programme's cultural relevance and the opportunity for networking and collaboration. They expressed a collective solidarity, and empowerment to address substance abuse problems. Participants reported that CARIAD had impacted positively on their professional practice, and facilitated knowledge transfer to colleagues and communities.

CONCLUSION:

CARIAD is perceived as an effective community of practice, producing a network of graduates who use the acquired knowledge, skills, and motivation to lead in the field of substance abuse in the Caribbean. This process of learning can be recommended to countries where research is not prioritized and evidence-driven interventions are not always available.

Purchase full article at:  http://goo.gl/maIcux

By:   Reid SD1, Downes E2, Khenti A2.

• 1 The University of the West Indies , St. Augustine , Trinidad.
• 2 Centre for Addiction and Mental Health , Toronto , Canada.

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Predictors of Depression Recovery in HIV-Infected Individuals Managed Through Measurement-Based Care in Infectious Disease Clinics

BACKGROUND:

Treatment of comorbid chronic disease, such as depression, in people living with HIV/AIDS (PLWHA) increasingly falls to HIV treatment providers. Guidance in who will best respond to depression treatment and which patient-centered symptoms are best to target is limited.

METHODS:

Bivariable analyses were used to calculate hazard ratios for associations between baseline demographic, mental health-related, and HIV-related factors on time to first depression remission among PLWHA enrolled in a randomized trial of measurement-based antidepressant management. Time-updated factors also were analyzed at time of antidepressant (AD) initiation/adjustment and 8 weeks post AD initiation/adjustment.

RESULTS:

Baseline comorbid depression and anxiety; comorbid depression, anxiety and substance abuse; and generalized anxiety disorder predicted a slower time to first remission. Being on ART but non-adherent, having panic disorder, having a history of a major depressive episode, or having been in HIV care for >10 years prior to study initiation predicted a faster time to first remission. Sleep difficulty or fatigue at the time of AD initiation/adjustment predicted a slower time to remission. In non-remitters at 8 weeks post AD initiation/adjustment, sleep difficulty, anxiety, and fatigue each predicted a slower time to remission.

LIMITATIONS:

Remission was determined by PHQ-9 scores, not diagnostic criteria. The results may apply only to depression recovery in this particular model of treatment. We conducted only exploratory analyses to determine magnitude of effects.

CONCLUSIONS:

Baseline comorbid anxiety with or without substance abuse predicts slower time to depression remission among PLWHA treated in HIV clinics. Targeting anxiety or fatigue at the time of AD initiation/adjustment or sleep difficulty, anxiety, and fatigue at 8 weeks post AD initiation/adjustment could shorten time to depression remission in this model.

Purchase full article at:   http://goo.gl/T7NBmH

By:   Sowa NA1, Bengtson A2, Gaynes BN3, Pence BW2.

• 1Department of Psychiatry, University of North Carolina School of Medicine (http://www.med.unc.edu/psych), Chapel Hill, NC, USA. Electronic address: nathaniel_sowa@med.unc.edu.
• 2Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA.
• 3Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
• J Affect Disord. 2015 Dec 22;192:153-161. doi: 10.1016/j.jad.2015.12.031. 

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Chasing the Bean: Prescription Drug Smoking among Socially Active Youth

PURPOSE:

Alternative consumption practices of prescription drug misuse have been less well monitored than general prevalence. We describe prescription drug smoking among socially active youth and highlight correlates of this practice. We also examine its association with drug problems, drug dependence, and mental health.

METHODS:

We surveyed 404 young adults recruited from nightlife venues in New York via time-space sampling. We use linear and logistic regression models to examine the probability of smoking prescription drugs and its association with drug problems, dependence, and mental health. Qualitative findings supplement the survey data.

RESULTS:

Males have higher odds than females (odds ratio [OR] = 3.4), and heterosexuals have higher odds than sexual minority youth (OR = 2.3) of smoking prescription drugs. Those involved in electronic dance music nightlife have higher odds (OR = 2.1) than those who do not participate in that scene, whereas those in college bar scenes have lower odds (OR = .4) of having smoked prescription drugs. Prescription drug smokers report more drug problems (β = .322) and greater symptoms of dependence net (β = .298) of the frequency of misuse and other characteristics. Prescription drug smokers do not report greater mental health problems. Qualitative interview data support these survey findings.

CONCLUSIONS:

Prescription drug smoking is a significant drug trend among socially active youth. It is associated with drug problems and symptoms of dependence net of frequency of misuse. Prevention and intervention efforts for youth who misuse prescription drugs should address the issue of prescription drug smoking, and this may be an area for clinicians to address with their adolescent patients.

...In terms of escalation to smoking prescription drugs, our results demonstrate that this mode of administration was more likely among males. Although studies have suggested that the lifetime prevalence of illicit drug use is converging between males and females [30], studies have shown that males often use a wider range of drugs [31] and have heavier patterns of substance use [32]. These findings on escalation to smoking pills cohere with this broader literature. Recent pain killer misusers also reported higher odds of smoking prescription pills.

In terms of subcultural participation, those involved in EDM scenes were much more likely to report smoking pills. This may relate to the misuse of prescription drugs to moderate the effects of “club drugs” popular in such scenes [33]. Further examinations of the role of prescription drug smoking in polydrug combinations are necessary. By contrast, those involved in the college bar scene were less likely to have smoked prescription drugs. This is somewhat surprising given that studies have regularly highlighted the high prevalence of prescription drug misuse among college students [4]; yet, college students may misuse prescription drugs primarily for functional reasons and thus may be less inclined to smoke pills.

Regarding consequences, we found no effect for smoking prescription drugs on mental health outcomes, but strong effects for the CIDI and SIP-AD measures of problem drug use. Thus, our findings provide further support to previous research identifying that transitions to non-oral modes of consumption (mostly sniffing) increase prescription drug abuse related problems [15]. Attesting to the strength of the effect, we observed increased symptoms of dependence associated with smoking prescription drugs even net of the effect of frequency of prescription drug misuse. Thus, smoking is associated with higher dependence and problems above and beyond greater recent misuse. Although the effect of frequency of misuse on drug problems is perhaps unsurprising, the effect of smoking provides clinicians and practitioners with another indicator of increased likelihood of dependence and problems associated with prescription drug misuse... 

Full article at:  http://goo.gl/4zM2dE

By:   Kelly BC¹, Vuolo M², Pawson M³, Wells BE⁴, Parsons JT⁴.

¹Department of Sociology, Purdue University (https://www.cla.purdue.edu/sociology/), West Lafayette, Indiana; Center for HIV Educational Studies & Training, New York, New York. Electronic address: bckelly@purdue.edu.

²Department of Sociology, Purdue University, West Lafayette, Indiana.

³Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York.

⁴Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York; Department of Psychology, Hunter College, City University of New York, New York, New York.

J Adolesc Health. 2015 Jun;56(6):632-8. doi: 10.1016/j.jadohealth.2015.02.008.

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