Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis

Although rare, drug abuse problems present a complex set of physical and psychosocial issues that complicate cancer treatment and pain/ symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction. As a result, they often struggle in their attempts to effectively treat patients who are or have been substance abusers, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In the first installment of a two-part series, the authors explore the epidemiology of substance abuse. An examination of the distinctions between abuse and dependence leads to definitions of these terms appropriate for the oncology setting. Guidelines for assessing aberrant drug-taking behavior are also offered. Part 2, which will appear in the next issue of ONCOLOGY, will discuss the clinical management of cancer patients with a history of substance abuse.     

Conflicts and issues in the treatment of child sexual abuse.

Although the very nature of child sexual abuse (CSA) cases necessitates the interface of three very different systems—judicial, social service, and mental health systems—the disparities in methods, goals, and perspectives of these systems often places them in direct conflict. Moreover, the lack of consensus within the mental health professions regarding the conceptualization and treatment of CSA cases combines with the tensions between these systems to raise a host of unique and highly problematic practical dilemmas. This article reviews some of these issues with the goal of highlighting the conflicts they reflect in the hope of raising professional awareness and engendering debate, which may lead to resolution or at least consensus within the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse among Native-American youth.

Substance use and abuse poses serious risks for American-Indian youth, their families, and their communities. This article briefly reviews the relevant social epidemiological data followed by a discussion of culturally relevant etiological factors. Current strategies for identification of youth at high risk for substance use are highlighted, concentrating primarily on the theoretical and methodological aspects appropriate for this population. In this context, data from recent work are reported. Given the nascent state of culturally appropriate prevention technology, issues of sensitive technology transfer and stereotyping are discussed in the context of current research. Study results from this sample, although dramatic, should not be overgeneralized to all American-Indian youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse: infant and childhood outcomes

IOL implantation in childhood is still controversial. INTENTION: The purpose of this retrospective study was to evaluate functional results and complications in children after IOL implantation. METHODS AND RESULTS: Posterior chamber IOLs were implanted in 52 eyes of 45 children. Cataract extraction was necessary because of traumatic, congenital/developmental and secondary lens opacities. Nine IOLs were implanted in children between the ages of 1.9 and 4 years, 17 IOLs from 4 to 8 years and 26 IOLs in patients 8 to 14.3 years old. In 38 of the 52 eyes (73%) vision improved after the surgery. Fifty-four percent had an acuity of at least 0.5. The functional results of children more than 8 years old were superior to those of younger patients. Children with traumatic cataracts had better visual acuities than those with other types of cataract. Except for secondary capsular opacities (75%) that could not be prevented by performing a primary posterior capsulotomy or capsulectomy and iris capture (31%), postoperative complications were rare. CONCLUSION: Favorable functional results can be achieved by IOL implantation in children with cataracts. Many patients require secondary surgical procedures because of capsular opacities and iris capture.     

Substance abuse assessment and treatment: The current training and practice of APA Division 22 members.

Objective: To determine the preparedness of rehabilitation psychologists to work with people with disabilities with primary or secondary substance-related problems by examining their education, training, and current practice. Design: Mail survey. Participants: 76 (47 men, 29 women) Division 22 members of the American Psychological Association. Results: Although 79% of respondents reported treating individuals with alcohol and other drug issues, over half rated their training in substance abuse treatment as inadequate. Referring to self-help groups and instilling cognitive-behavioral coping skills were common treatments. Participants reported a lack of preparation in substance abuse training in their graduate program coursework, practicum, and internship. Conclusion: Continuing education and changes to curriculum requirements, with linkage to existing certification bodies, should be considered to close the gap between training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse treatment for pregnant women: a window of opportunity?

Determination of the crystal structure of the human TBP-associated factor (hTAF(II))28/hTAF(II)18 heterodimer shows that these TAF(II)s form a novel histone-like pair in the TFIID complex. The histone folds in hTAF(II)28 and hTAF(II)18 were not predicted from their primary sequence, indicating that these TAF(II)s define a novel family of atypical histone fold sequences. The TAF(II)18 and TAF(II)28 histone fold motifs are also present in the N- and C-terminal regions of the SPT3 proteins, suggesting that the histone fold in SPT3 may be reconstituted by intramolecular rather than classical intermolecular interactions. The existence of additional histone-like pairs in both the TFIID and SAGA complexes shows that the histone fold is a more commonly used motif for mediating TAF-TAF interactions than previously believed.     

Substance use and abuse among children and teenagers.

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse research not yet done: Some guesses and preferences.

Predicts that there may be a focus in the 1990s toward studies that describe the dynamics of substance abuse in the natural environments in which it occurs to (1) address the relapse problem, (2) examine long-term treatment outcome, and (3) explore natural recovery. Matching patient characteristics to different treatments may also occur. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variation in access to outpatient substance abuse treatment: organizational factors and conceptual issues

We propose to use a general mixing distribution in modeling the heterogeneity of the fecundability of couples. We introduce a sequence of parameters called canonical moments, which is in one to one correspondence with the moments, to characterize the mixing distribution. By using the bootstrap method, we can estimate the standard errors of our estimates. Our method modifies the usual moment estimates so that the resulting mixing distribution is always supported on [0, 1]. Moreover, the downward bias of the moment estimate of the number of support points would be reduced. Our approach can be used for censored data. The application of our technique in finding the sterile subpopulation is also discussed. The theory is illustrated with several data examples and simulations.     

Process and outcome research in the treatment of adult victims of childhood sexual abuse: Methodological issues.

Distinguishes between process and outcome research, describes areas within process and outcome research that would be applicable to studying adult survivors of sexual abuse, and identifies methodological issues in these research areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbians and cancer support: clinical issues for cancer patients

Unidirectional, ouabain-insensitive K+ influx rose steeply with warming at temperatures above 37 degreesC in guinea pig erythrocytes incubated in isotonic medium. The only component of ouabain-insensitive K+ influx to show the same steep rise was K-Cl cotransport (Q10 of 10 between 37 and 41 degrees C); Na-K-Cl cotransport remained constant or declined and residual K+ influx in hypertonic medium with ouabain and bumetanide rose only gradually. Similar results were obtained for unidirectional K+ efflux. Thermal activation of K-Cl cotransport-mediated K+ influx was fully dependent on the presence of chloride in the medium; none occurred with nitrate replacing chloride. The increase of K+ influx through K-Cl cotransport from 37 to 41 degrees C was blocked by calyculin A, a phosphatase inhibitor. The Q10 of K-Cl cotransport fully activated by hydroxylamine and hypotonicity was about 2. The time course of K+ entry showed an immediate transition to a higher rate when cells were instantly warmed from 37 to 41 degrees C, but there was a 7-min time lag in returning to a lower rate when cells were cooled from 41 to 37 degrees C. These results indicate that the steepness of the response of K-Cl cotransport to mild warming is due to altered regulation of the transporter. Total unidirectional K+ influx was equal to total unidirectional K+ efflux at 37-45 degrees C, but K+ influx exceeded K+ efflux at 41 degrees C when K-Cl cotransport was inhibited by calyculin or prevented by hypertonic incubation. The net loss of K+ that results from the thermal activation of isosomotic K-Cl cotransport reported here would offset a tendency for cell swelling that could arise with warming through an imbalance of pump and leak for Na+ or for K+.     

Substance abuse and bipolar affective disorder

This interview study was conducted to explore the onset, course, and features of bipolar affective disorder complicated by substance abuse. Forty-four patients with a diagnosis of bipolar affective disorder were interviewed using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scale for Depression, Young Mania Rating Scale, and a questionnaire concerning psychiatric history. Current substance users averaged twice as many hospitalizations for mood problems. The age of onset of mood problems for substance users was significantly earlier than that of the nonusers (p < or = .05). Substance users were four times as likely to have other comorbid axis I disorders (p < or = .05) and twice as likely to have dysphoric mania at time of interview. This preliminary study suggests that individuals with bipolar affective disorder complicated by substance abuse may have more hospitalizations, a higher incidence of dysphoric mania, earlier onset of mood problems, and more comorbid axis I disorders.     

Substance abuse and the emergency room: programmatic implications

A literature review (1984 to 1995) was conducted to identify cost effective policy implications regarding substance use in the emergency room (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonly marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and further assessment provided only when high risk factors have been identified. These include: males, younger patients, metropolitan centres, after midnight and on weekends, injury from violence, accidents including MVAs, high acuity and psychiatric morbidity. Further, this screening should be complimented by an intervention, referral and treatment resource for those in need.     

Substance use and abuse among patients with comorbid dysthymia and substance disorder

This study determines the substance use and abuse patterns among patients with comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as compared with patients with SRD only. Differences in use and abuse patterns could be useful for (a) understanding motivations for use, such as self-treatment, and (b) assisting clinicians to identify cases of dysthymia among SRD patients. Retrospective and current data were obtained regarding history of substance use and current SRD diagnoses. Two university medical centers with alcohol-drug programs located within departments of psychiatry were the settings. A total of 642 patients was assessed. of whom 39 had SRD-dysthymia and 308 had SRD only. Data on past usc were collected by a research associate using a questionnaire. Current SRD and dysthymia diagnoses were made by psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD only did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter "use careers" of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis abuse/dependence. This study indicated that patients with dysthymia and SRD have exposure to most substances of abuse that is comparable to patients with SRD only. However, they selectively use certain substances less often than patients with SRD only. Early use of caffeine may reflect self-treatment for depressive symptoms among patients with SRD-dysthymia.