Prevalence of substance use disorders among veterans and comparable nonveterans from the National Survey on Drug Use and Health.

The Department of Veterans Affairs (VA) operates over 200 substance abuse treatment programs. Historically, planning for these services has not been informed by population-level prevalence data. Accordingly, the authors analyzed the National Survey on Drug Use and Health data from 2000 to 2003 to estimate substance use and substance use disorder prevalence among all veterans. The authors present the data in comparison to comparable nonveterans. Data show notable rates of substance use among veterans; 22.6% and 4.4% of veterans reported binge drinking and any illicit drug use in the past month, respectively. In addition, prevalence varied by geographic location. Monitoring substance use prevalence is needed to ensure the VA and other substance use providers can plan appropriate substance use disorder services for current and future enrollees, including veterans of the current military operations in Iraq and Afghanistan. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The substance use system: social and neighborhood environments associated with substance use and misuse

Substance use theory and practice have traditionally focused on individuals who misuse substances or who are at risk for substance misuse, but this emphasis is shifting. The present study views both substance use and misuse systematically, assessing the relationships between the physical and social environments and substance use and misuse in dynamic interplay. This substance use system was examined through a survey of approximately 10,000 persons, aged 22-44, from primarily inner-city neighborhoods in the United States. Individual indicators such as race, sex, age, socioeconomic status, education, and religious service attendance relate to both the physical and interpersonal environments, even when each is controlled for the others. Qualities of both environments are strongly associated with substance dependency, even after individual indicators are controlled. These findings suggest the difficulty of bringing about change in drug and alcohol use without fundamental change in the environments where use takes place.     

Pathological gambling and substance misuse: a review of the literature

This paper reviews research conducted on the link between pathological gambling and substance misuse. We first examine the phenomenon of "pathological gambling," including similarities between pathological gambling and substance misuse, instruments used to measure pathological gambling, and the prevalence of pathological gambling in the United States and internationally. We then examine research on substance misuse among pathological gamblers, pathological gambling among substance misusers, and the treatment of the pathological gambler-substance misuser. We conclude with a discussion of future research needs.     

Substance use and multiculturalism

This paper reviews intercultural variability of substance use behaviors, including availability of international statistics on consumption of alcohol and other drugs, as well as the use of drugs available locally only. Within a conceptual framework of intercultural relations, it considers the history of transcultural spread of substance use behaviors and possible reactions to the introduction of new drugs within a culture or jurisdiction, including illustrations of the "law of alien poisons." Although intercultural views of substance use have generally concentrated on majority groups' views of substance use in minority groups, minority and non-Western views of substance use need to be considered in the context of increasing international and intercultural communications that increase the rate at which substance use behaviors spread. Both Western and non-Western experiences with substance use and misuse must be taken into account so that better interventions can be developed to deal with addictions and other substance-related problems.     

Managing anxiety and depression in alcohol and drug dependence

Previous research has highlighted the high prevalence (30-60%) of comorbid anxiety and mood disorders in clients with substance misuse disorders and, equivalently, a third of those with affective disorder report a history of substance use disorder (Kessler et al., 1994; Regier et al., 1990; Robins & Regier, 1991). This article reviews the management of such cases and identifies key issues in the assessment process, as well as potential avenues for treatment. Other articles have highlighted the increased service utilisation and the cost of care and treatment of comorbidity. This article will primarily focus on the management of individual cases and will briefly refer to issues of service organisation. Although antidepressant or anxiolytic pharmacotherapy may have a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of side-effects or adverse reactions in individuals who continue to engage in substance misuse or who have medical complications associated with drug or alcohol dependency. Effective psychosocial approaches largely focus on brief, empirically tested manualised therapies such as cognitive therapy (Carroll, 1998a). However, modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients exhibiting comorbidity. The data available demonstrate some evidence for the benefits of structured psychological approaches, but more sophisticated randomized controlled trials are required to evaluate the efficacy of both psychological and pharmacological approaches.     

Shared Predictors of Youthful Gambling, Substance Use, and Delinquency.

Given that gambling, alcohol misuse, other drug use, and delinquency are correlated, it is hypothesized that these problem behaviors have shared antecedents. Measures from 3 explanatory domains--sociodemographic factors (age, race, and socioeconomic status), individual factors (impulsivity and moral disengagement), and socialization factors (parental monitoring and peer delinquency)--were tested for links to problem behaviors in 2 longitudinal samples of adolescents. Black youth had lower levels of problem behaviors than Whites. Impulsivity was a significant predictor of alcohol misuse for females and delinquency for males. Moral disengagement predicted gambling for males. Parental monitoring showed a significant inverse relationship to alcohol misuse and other substance use for males. Peer delinquency showed numerous prospective paths to youth problem behaviors for both genders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbid substance use disorder: prevalence, patterns of use, and course

Research on the prevalence, patterns, and course of substance use disorders in severe mental illness gives key insights into the complex interaction of substance use and mental disorder. Understanding the literature on comorbidity has implications for the design of clinical services and for the direction of future research in the field.     

The impact of childhood abuse on treatment outcomes of substance users.

The impact of childhood emotional, physical, and sexual abuse on treatment outcomes for substance users is not well understood. This study assessed the prevalence and impact of these kinds of maltreatment among a sample of American Indian, Mexican American, and Anglo American female and male substance users in residential treatment programs. Compared to men, women in all ethnic groups reported more abuse. Compared to a no-abuse group, respondents who reported abuse had lower self-esteem scores and higher depression scores at treatment entry and lower self-esteem scores at treatment completion. Although childhood abuse was not related to treatment outcome, gender and ethnicity were. Treatment implications for providers of drug abuse services and services to victims of violence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug and alcohol problems among individuals with severe mental illness in south London

BACKGROUND: High rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such as schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. These 'dual diagnosis' patients have mainly been investigated in the USA, and there has been very little research in Europe, where patterns of substance abuse may be different. METHOD: All patients with psychotic illnesses who had any contact with the mental health services in a geographically defined sector in South London over a specified period were studied. Individuals with problems related to alcohol or drugs were identified using standardised interviews with subjects and their keyworkers. Data on psychiatric service use during the previous 2 years were also obtained. RESULTS: One hundred and seventy-one subjects with psychotic illnesses were interviewed (response rate: 78.4%). The one-year prevalence rate for any substance problem was 36.3% (95% CI = 29.1-43.5), for alcohol problems it was 31.6% (95% CI = 24.6-38.5), and for drug problems 15.8% (95% CI = 10.3-21.3). Young male subjects were at higher risk of having substance problems. Patients with substance problems had spent almost twice as many days in hospital as those without such problems over the previous two years (difference = 26.3 days, 95% CI = 3.8-48.7). CONCLUSIONS: The prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.     

Mindfulness meditation and substance use in an incarcerated population.

Despite the availability of various substance abuse treatments, alcohol and drug misuse and related negative consequences remain prevalent. Vipassana meditation (VM), a Buddhist mindfulness-based practice, provides an alternative for individuals who do not wish to attend or have not succeeded with traditional addiction treatments. In this study, the authors evaluated the effectiveness of a VM course on substance use and psychosocial outcomes in an incarcerated population. Results indicate that after release from jail, participants in the VM course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. The utility of mindfulness-based treatments for substance use is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of studies of heavy users of psychiatric services

OBJECTIVES: This paper reviews studies of patients who are heavy users of psychiatric services and identifies areas in which further research and evaluation are indicated. METHODS: Extensive searches were conducted of the English language psychiatric and psychological literature before 1994. Important references from initially identified studies were followed up. More than 200 articles were reviewed, 72 of which are described in this review. The 72 papers were selected because they dealt with three questions: What is heavy service use? What patient characteristics contribute to it? What service delivery characteristics contribute to it? RESULTS AND CONCLUSIONS: Criteria for identifying and defining heavy users of psychiatric services vary among studies. Few studies of heavy service users have attempted to examine use of all psychiatric services, both inpatient and community based. In most studies, 10 to 30 percent of patients are identified as heavy users, those who utilize between 50 and 80 percent of service resources. This group consists of a constantly changing cohort of patients who generally have psychotic illnesses as well as comorbid personality disorders and high levels of drug and alcohol misuse. Few studies have examined social issues such as isolation, homelessness, and social support, although these factors appear to contribute significantly to heavy service use. Few attempts have been made to define heavy-user groups in fiscal terms. More research on heavy users of psychiatric services is clearly needed to improve providers' ability to plan appropriately targeted mental health services for this disabled group of patients who use expensive resources.     

Measure of religious background and behavior for use in behavior change research.

Consideration of religiosity as a factor in behavior change research requires a reliable measure of religious behavior. Such a measure may be particularly helpful in research on substance misuse given the negative association between religiosity and substance use and the role of religiosity and spirituality often reported in the process of recovery from substance use disorders. In this regard, this article describes the development and evaluation of the Religious Background and Behavior (RBB) questionnaire as a brief measure of religious practices. The results suggest the RBB is made up of two factors, labeled God Consciousness and Formal Practices , and that the RBB possesses excellent test-retest reliability and satisfactory internal consistency. It is concluded that the RBB can serve as a reliable instrument for assessing religious behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the differential effectiveness of a life skills program (IPSY) on alcohol use trajectories in early adolescence.

Objective: This study investigated whether a universal school-based life skills program—IPSY (Information + Psychosocial Competence = Protection)—against substance misuse exerted the same effectiveness for young adolescents (10.5–13 years) from distinct alcohol use trajectories characterized by late childhood risk factors (temperament, self-worth, social problems with peers). Method: Analyses were based on a German sample of school students (N = 1,484). A longitudinal quasi-experimental design (intervention/control) with schoolwise assignment to the respective groups was used. Data were gathered via self-report questionnaire. Two-part growth mixture modeling was applied. Results: Two prototypical trajectory classes of early alcohol use were found: a problematic group with a sharp increase in prevalence and quantity of consumed alcohol (19.7%) and a normative group with a moderate increase in both outcomes (80.3%). The problematic trajectory class was associated with several risk factors. IPSY decreased the likelihood of membership in the problematic group. Furthermore, IPSY buffered the increase in prevalence and quantity for the normative group, whereas it had no effects on these indicators for the problematic group. Concerning quantity of alcohol use, the effect size in terms of a difference in estimated means between intervention and control group at the last measurement point in the normative group was d = 0.33 (95% CI [0.21, 0.44]). Conclusions: Study findings indicate the usefulness of IPSY for reducing alcohol use especially in normative developing adolescents. However, the minority of adolescents consistently pursuing a problematic developmental pathway of alcohol use seem to be in need of earlier, more tailored treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexual trauma and substance misuse: a pilot study

This research investigates the type of and extent to which additional problematic experiences and behaviors are associated with a history of both substance misuse and childhood sexual abuse. In a recent study of women undergraduate students, 30 years and older, 15 disclosed a history of problematic alcohol and/or drug use. Of these, 10 had experienced sexual trauma as children; five had not. This report compares these two subsamples with respect to problematic experiences and behavior. Implications for counseling and research are discussed.     

Perspective on the integration of substance user needs assessment and treatment planning

In the 1970s and 1980s, several techniques for assessing the needs for substance user treatment were developed. Generally these techniques relied upon the data developed from large-scale data-gathering systems, originally designed to assess the capacity of the substance user treatment system nationwide. The need assessment techniques generally require making estimates of the prevalence of substance use disorders in the population and then applying them to the national utilitization experience. As first attempts often do, these approaches tended to simplify complex problems and tended to rely too heavily on the only available data. The result was that they tended to reify current practice rather than to define best practice. In the 1990s, new challenges face those attempting to assess needs for substance user services. As a result of the last decade's emphasis on cost containment, new concepts have challenged traditional views of needs assessment. This paper will discuss those new concepts and their impact on the needs assessment endeavor. In particular, the impact of the concept of medical necessity will be examined.     

Pre- and Postinjury Substance Misuse Among Veterans With Spinal Cord Injury.

Objective: To identify rates of substance misuse with onset before and after spinal cord injury (SCI) and to investigate whether patients with a history of substance misuse are more likely to report being intoxicated at the time of injury. Participants: One hundred twenty-four veterans with traumatic SCIs. Measures: Alcohol and nonalcohol psychoactive substance use disorder (PSUD) sections of the Structured Clinical Interview for DSM-III-R. Results: Forty (32%) had a lifetime PSUD. Of those, 55% recalled the onset of their PSUD occurring preinjury, 27.5% recalled the onset occurring postinjury, and 17.5% could not recall their age at onset. Compared with participants who reported postinjury onset of PSUD, those with reported preinjury onset were more likely to report intoxication at time of injury. No significant relation was found between intoxication at injury and presence of a lifetime PSUD. Conclusion: Intoxication at injury does not necessarily substantiate the existence of an underlying substance misuse problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Restructuring public mental health and substance abuse service systems

The authors originally circulated the concepts in this proposal during May 1995. The purpose was to support an open, public dialogue regarding the restructuring of the mental health and substance abuse services in Illinois in anticipation of Medicaid funding changes. Restructuring mental health and substance abuse service systems should follow certain key principles. These principles are applicable to other states, particularly those large in territory and population. The authors propose the temporary use of multiple managed care companies serving as administrative services only (ASO) organizations, each of whom would have responsibility for a given geographic portion of a state. The role of the ASOs would be to organize providers into networks on a regional basis and transfer managed care expertise in financing and clinical management to the relevant state departments and provider groups. Changes in the service delivery system would be phased in over time with reorganization of key components of the system during each phase. Where the provision of mental health, substance abuse, and social services is split among multiple state agencies, these agencies would be merged to achieve unified funding and administrative efficiency. Patients and advocacy organizations would play a key role in overseeing and shaping system restructuring at all levels, including a governmental board reporting to the governor, overseeing ASO organizations' operations and assuring quality and access at the provider level. The authors propose funding of public behavioral health services through use of a tiered, integrated funding model.     

Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)