Recent sex trade and injection drug use among pregnant opiate and cocaine dependent women in treatment: The significance of psychiatric comorbidity

OBJECTIVES: This study examined whether opioid and cocaine dependent pregnant women with psychiatric comorbidity were at elevated risk for infectious disease by virtue of recent sex trade and injection drug use that overlapped with pregnancy. We hypothesized that opioid and cocaine dependent women with psychiatric comorbidity would have greater odds for engaging in recent sex trade and injection drug use. METHODS: Eighty-one, HIV-seronegative pregnant women (59.3% African-American, 37% white, and 3.7% other) who were enrolled in drug treatment in Baltimore, Maryland were recruited into an HIV prevention intervention study, provided informed consent, and attended an in-person, baseline assessment administered by trained clinicians. Assessments included the The Structured Clinical Interview for DSM-IV-TR Axis I Disorders, the HIV Risk Behavior Interview, and a demographic questionnaire. The majority of women had lifetime histories of opioid and/or cocaine dependence (93.8%) and those with an additional lifetime non-substance-related Axis I disorder comprised the psychiatric comorbidity group. RESULTS: Thirty-percent reported recent sex trade and/or injection drug use that overlapped with pregnancy. While psychiatric comorbidity was associated with 6 times the odds of opioid and cocaine dependent pregnant women having recently traded sex it was not associated with recent injection drug use. CONCLUSIONS: Findings underscore the need to (1) treat comorbid psychiatric disorders among pregnant women in treatment for cocaine and opioid dependence and (2) integrate HIV prevention interventions into drug dependence treatment for pregnant women, particularly those with psychiatric comorbidity given their elevated risk for infectious disease.

Childhood Abuse History and Substance Use Among Men and Women Receiving Detoxification Services

According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.

Clients with substance abuse and mental health concerns: a guide for conducting intake interviews

Although comorbidity (co-occurrence of a psychiatric and substance use disorder) is a common phenomenon at both mental health and substance abuse treatment agencies, rarely do such agencies thoroughly assess for both types of diagnoses during their standard intake interview. This article describes the development of an intake form designed to guide a comprehensive assessment of both mental health and substance abuse concerns. The form guides intake interviewers toward documenting administrative and demographic information, substance use and mental health concerns, and variables needed for compliance with grant funding sources. Use of the protocol and provide a clinical foundation for treatment planning and continuity of care for clients, while also providing error-free agency data that can be used for administrative, program planning, outcome assessment, and research purposes.

Rates and sequelae of the coexistence of substance use and other psychiatric disorders

OBJECTIVES

Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals.

METHODS

A retrospective population based study was performed on the entire population of psychiatric patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated.

RESULTS

The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990's. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients.

CONCLUSIONS

1.) Individual patient level--Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level--Educators must better prepare providers to deal with this challenging clientele.

The relationship of childhood abuse history and substance use in an Alaska sample

This study confirms a strong link between childhood abuse history and substance misuse based upon data obtained from an ethnically diverse (largely Alaska Native) sample of 192 pregnant women in substance misuse treatment in the mid-1990s. Nearly three-quarters of the women reported childhood victimization. Compared to women with no abuse history, abused women were significantly younger at the age of onset of substance misuse, used substances more frequently, had experienced more blackouts, had more family members with substance-misuse concerns, were more likely to have been raped, revealed more psychological problems, and had less formal education. Risk patterns differed slightly for women with physical versus sexual abuse histories, with the experience of physical violence having a stronger relationship with adulthood problem behaviors than the experience of sexual molestation. Overall, findings suggest an interactive cycle of violence and substance misuse that begins very early in childhood, especially for women who were physically abused, and continues in adulthood, though no cause-end-effect conclusions can be drawn. Treatment and prevention implications of these findings are discussed.