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)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cannabis use, abuse, and dependence in a population-based sample of female twins

OBJECTIVE: The rate of cannabis use by women has been increasing in recent decades. This study examined the etiology of cannabis use and abuse among women and the possible role of genetic risk factors. METHOD: Unselected individual twins (N=1,934) from female-female pairs ascertained through a population-based registry, including both members of 485 monozygotic pairs and of 335 dizygotic pairs, were interviewed by telephone to assess lifetime cannabis use, heavy use, abuse, and dependence as defined by DSM-IV criteria. Biometric model fitting was performed with the Mx computer package. RESULTS: The prevalences of lifetime cannabis use, heavy use, abuse, and dependence were 47.9%, 6.7%, 7.2%, and 2.2%, respectively. Model fitting suggested that twins' resemblance for liability to cannabis use was due to both genetic and familial-environmental factors, while twins' resemblance for heavy cannabis use and abuse and symptoms of dependence resulted solely from genetic factors, with heritabilities ranging from 62% to 79%. The frequency of adolescent social contact between co-twins, which was greater among monozygotic than among dizygotic twins, predicted the twins' resemblance in cannabis use. However, further analyses suggested that the heritability of cannabis use was at most modestly inflated by such social factors. CONCLUSIONS: In women, genetic risk factors have a moderate impact on the probability of ever using cannabis and a strong impact on the liability to heavy use, abuse, and, probably, dependence. By contrast, the family and social environment substantially influences risk of ever using cannabis but plays little role in the probability of developing heavy cannabis use or abuse.     

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.     

Substance dependence. Information, diagnosis and therapy--encouragement for pragmatic treatment

According to the author's experience with addiction diseases, questions of etiology, diagnostics, and therapy are reviewed. Starting with basic terms: such as the addicted human and his background, the drugs and the disease, chosen facts are combined with the author's individual experiences and theories for pragmatic actions are derived.     

An epidemiological survey on use and abuse of antianxiety drugs among Beijing residents

OBJECTIVE: To investigate the current trend of use and abuse of antianxiety drugs in Beijing residents in 4 urban and 2 rural areas. METHODS: A cluster sampling household survey of 6567 subjects out of 3000 families was made by 6 local grass roots mental health centers collaboratively. Screened with designed questionnaire, the positive addicted subjects were examined with present state examination (PSE), eysenck personality questionnaire (EPQ) and social disability screening schedule (SDSS) to detect their psychosocial status. RESULTS: Benzodiazepine (BZD) has been widely prescribed and the rate of usage for 1 year is 61.82/1000, whereas the rate of dependence is 16.29/1000, constituting 1/4 of long-term users. This study also indicates that Valium is a most preferred drug among all available BZD used by the majority of addicted subjects. CONCLUSIONS: It is concluded that the reported dependence is not epidemic but iatrogenic in nature attributable to persistent misuse of BZD. It is stressed that guideline of rational clinical application of BZD should be laid down so as to markedly reduce further possible misuse and abuse of the drugs of this kind.     

The use of anatomical dolls to assess child sexual abuse: A critical review.

Reviews the empirical literature to investigate the following 2 aspects of the controversial use of anatomical dolls to assess for child sexual abuse: (1) Are anatomical dolls valid tools to assess child sexual abuse? (2) What progress has been made toward the development of an anatomical doll interview that is objective and standardized? 16 empirical studies were located which have assessed children's reactions to anatomical dolls. Criteria used to evaluate the studies are listed. In regard to validity, the empirical data suggest that children who have been referred for sexual abuse respond differently to anatomical dolls than nonabused children. Furthermore, considerable progress has been made toward the development of an objective assessment protocol and reliable scoring criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse training in APA-accredited doctoral programs in clinical psychology: A survey.

A survey addressing training provided in the area of substance abuse was mailed to all 160 doctoral clinical psychology programs provisionally and fully accredited by the American Psychological Association (APA). A total of 95 replies were received (59%). This study was conducted to ascertain whether levels of doctoral training in this area have changed appreciably since comparable surveys by J. A. Selin and S. Svanum (1981) and B. Lubin et al (1986). Because of the considerable increase in number of APA-accredited PsyD programs since the previous 2 surveys, it was also possible to compare relative levels of training in substance abuse in PhD, PsyD, and combined PhD/PsyD programs. Survey results did not suggest that substance abuse training either has changed markedly over time or differs substantially across types of degree programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hiring, training, and retaining the hard-core unemployed: A selected review.

Reviews studies concerning the hiring, training, and retaining of the hard-core unemployed. Evidence indicates that the characteristics of the hard-core unemployed (e.g., age, sex, and marital status) and the characteristics of the supervisory and counseling roles and their occupants are related to turnover. Although training does not seem to affect the propensity to terminate, it does have both functional and dysfunctional effects on work attitudes. Job structure, pay level, and other organizational variables are related to turnover. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

Evaluated the relationship between substance use; depression and disability acceptance; and 2 preventable medical complications, pressure ulcers and urinary tract infections (UTIs), following spinal cord injury (SCI). 103 SCI patients (aged 16–63 yrs) undergoing inpatient rehabilitation, were recruited for interviews after 2-, 6-, and 18-mo of admission. 80 Ss completed all 3 evaluations, of which, 71 were followed up for 30 mo. Information was obtained on substance use, severity of drinking problems, depression intensity, and psychological aspects of post-injury adaptation. An increased risk of pressure ulcers 30 mo after injury, was associated with use of psychotropic medications, and abstinence from alcohol, with a history of drinking problems. UTIs were related to illicit substance use. Impairment characteristics were important predictors initially after injury, while abstinence with a history of drinking problems predicted ulcers later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

This study examined relationships between medical complications resulting in hospital stays and alcohol and illicit substance use in 71 persons with recent spinal cord injury (SCI). At 5 intervals after injury, medical records were reviewed for pressure ulcers and urinary tract infections (UTIs). Abstainers with histories of drinking problems before SCI were at greater risk for UTIs from 7 to 12 months after injury and for longer hospital stays. Former drinkers may not have implemented the self-care skills that were a focus during inpatient rehabilitation. Preinjury illicit substance abuse was related to an increased risk of pressure ulcers 30 months after SCL Clinical implications are clear: Psychologists should inquire about substance use patterns, monitor psychological well-being, and explore the ways in which self-care habits are related to substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review.

A review of theories to predict the mental health effects of child sexual abuse suggests that existing models have not adequately defined stress and coping constructs and have not specified how those variables might interact with other environmental factors. This article outlines a transactional model that conceptualizes sexual abuse as a stressor consisting of a series of abuse events, abuse-related events, and disclosure-related events that each tend to increase risk for maladaptive outcomes. The model also proposes that cognitive appraisals and coping responses mediate the effects of these events, that developmental and environmental factors may moderate relationships between sexual abuse stressors and victim responses, and that victims' initial responses may effect subsequent levels of abuse-related stress. Empirical studies relevant to the major components of this model are reviewed, and the implications of these findings for future research are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use disorders. Difficulties in diagnoses

Patients attempt, consciously or unconsciously, to minimize or disguise their substance use, in part to preserve shreds of self-respect, avoid guilt and shame, and avoid the real or imagined criticism of others. It is ironic that substance users not only use the substance to gain access to pleasant events or escape or avoid unpleasant events, but also to deny, minimize, or disguise that very use for the same reasons.     

Contemporary issues in counseling psychology: A selected review.

As a psychology specialty, counseling psychology has confronted and dealt with many issues since its inception. Currently, a number of highly challenging issues continue to confront counseling psychology. In this article I provide a selected review of contemporary issues affecting counseling psychology. In my review I supplement previous issue publications by drawing on recent developments emerging in counseling psychology over the past several years. The three areas reviewed are (a) changing work settings and work roles, (b) identity issues, and (c) educational and training issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse problems, psychiatric severity, and HIV risk in Millon Clinical Multiaxial Inventory-II personality subgroups.

This study identified clinically meaningful psychopathology subgroups of drug-dependent male veterans based on cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records completed shortly after inpatient admission. A high pathology cluster subgroup was defined by clinically significant elevations on multiple personality disorder and symptom scales. An antisocial cluster subgroup was identified by a highly significant mean elevation on the Antisocial scale and secondary clinical elevations on the Aggressive and Narcissistic scales. Finally, a subclinical cluster subgroup was defined by the absence of clinically significant elevations on any MCMI-II scales. In comparison with members of the other two groups, members of the high pathology subgroup exhibited more substance abuse and psychiatric problems and less favorable attitudes relevant to HIV-AIDS risk reduction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using epidemiological data to guide clinical practice: review of studies on cardiovascular disease and use of combined oral contraceptives

OBJECTIVE: To explore the usefulness of epidemiological data to guide clinical practice by seeking an answer to the question "What is the risk of cardiovascular disease among users of currently available, low dose, combined oral contraceptives who are aged less than 35 years, do not smoke, and do not have a medical condition known to increase the risk of vascular disease?" DESIGN: Review of all relevant published studies identified from the library of references held by Royal College of General Practitioners' Manchester Research Unit, checking of reference lists of identified studies, and Medline search. MAIN OUTCOME MEASURES: Identification of methodologically sound studies able to address the specific clinical question. RESULTS: Our literature search identified 74 papers about the relation between current use of combined oral contraceptives and cardiovascular disease: 23 papers reporting risk of venous thromboembolism, 22 on ischaemic stroke, 13 on haemorrhagic stroke or subarachnoid haemorrhage, 13 on all stroke, and 33 on myocardial infarction. Only five papers provided information that directly addressed our clinical question; all related to the risk of venous thromboembolism. Fourteen of the discarded papers probably had the potential to answer our clinical question. CONCLUSIONS: Much of the epidemiological data about the risk of cardiovascular disease in users of combined oral contraceptives is not useful to clinicians. Some of the discarded data could be made more useful to clinicians by reanalysis. This situation is unlikely to be unique to use of contraceptives.     

Buprenorphine treatment of opioid dependence: A review.

Buprenorphine, a partial mu-agonist opioid, is a promising pharmacotherapy for the treatment of opioid dependence. One hundred and eight papers are organized according to 3 components essential to buprenorphine's use as a pharmacotherapy for opioid dependence: inducting patients onto buprenorphine, maintaining patients on buprenorphine, and discontinuing patients from buprenorphine treatment. The research suggests that inducting patients onto buprenorphine should lead to limited discomfort if appropriate procedures are followed. As a maintenance treatment, buprenorphine is as efficacious as methadone, blocks the effects of exogenously administered opioids, promotes treatment compliance, and, importantly, can support an alternate day dosing regimen by doubling the daily dose. Discontinuing buprenorphine treatment appears to result in a mild-to-moderate opioid withdrawal syndrome that is less severe than that observed with full-efficacy agonists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)