Psychiatric and alcohol disorders as risk factors for drug abuse. A case-control study among adults in Rio de Janeiro, Brazil

Relationships among mental health status, social context, and demographic characteristics in Taiwanese aboriginal adolescents: a structural equation model

The purposes of this study were to examine the relationships among mental health status, demographic characteristics, and social contexts, including family conflict and support, connectedness to school, and affiliation with peers who exhibit delinquent behavior and who use substances, among Taiwanese aboriginal adolescents. A total of 251 aboriginal junior high school students in an isolated mountainous area of southern Taiwan were recruited, and the relationships among mental health status, demographic characteristics, and social contexts among them were examined using a structural equation model (SEM). The SEM revealed that family conflict and support had direct influences on mental health status and connectedness to school. Family conflict had a direct relationship with affiliation with peers who use substances, and family conflict and support were both indirectly linked with affiliation with peers who exhibit delinquent behavior and who used substances; these were mediated by a poor mental health status. Female and older age were directly linked with a poor mental health status and were indirectly linked with a greater number of peers who exhibit delinquent behavior and who use substances via the poor mental health status. Disruptive parenting was directly linked with affiliation with peers who use substances. The authors suggest that those who devise strategies to improve aboriginal adolescents' mental health and discourage substance use should take these relationships among mental health, demographic characteristics, and social contexts into account.

Correlates of methamphetamine use for Taiwanese adolescents

The aim of the present study was to assess the associations between methamphetamine (MAP) use and psychiatric comorbidity, individual attitudes and personal knowledge of MAP use, family characteristics and peer factors in Taiwanese adolescents via a case-control study. Two hundred adolescent MAP users and 400 adolescent non-users were recruited. Their psychiatric comorbidity, attitudes and knowledge toward MAP use, family characteristics and peer interactions were assessed systematically. The associations between MAP use and those factors were examined by univariate and multivariate analysis. In conditional logistic regression analysis, comorbid conduct disorder, attitude favorable to MAP use and poor knowledge of MAP use, disrupted parenting, lower caregiver education level, having friends using or providing MAP and actively interacting with peers were associated significantly with MAP use. Adolescent MAP use was correlated with multiple factors that lie within individuals and the interaction with their family and peers. Correlates of MAP use identified in the present study may be helpful for the design and implementation of preventive intervention.

Diet influences cocaine withdrawal behaviors in the forced swimming test

The effects of drugs of abuse might depend on several environmental factors, among them the individual's feeding habits. It was our objective to study the influence of the diet on cocaine acute behavioral effects and during the first 5 days of withdrawal after prolonged treatment. Rats were fed a balanced diet, high-protein diet, high-carbohydrate diet or high-fat diet from weaning to adulthood. Adult rats were injected with 15 mg/kg cocaine 24, 5 and 1 h before the forced swimming retest or the drug was administered daily during 15 days and the animals were evaluated in the forced swimming test on five daily occasions after drug withdrawal. Diets alone did not induce significant behavioral differences in locomotion, immobility, swimming, climbing or head shakes. Acute cocaine reduced immobility during the forced swimming test and increased locomotion demonstrating a nonspecific antiimmobility effect related to hyperactivity. Acute cocaine reduced head shakes of rats fed high-protein and high-carbohydrate diets. After cocaine withdrawal, head shakes were decreased for rats fed any of the diets and rats were more immobile if fed a high-fat diet and were less immobile if fed a high-protein or high-carbohydrate diet. In conclusion, differences in the amounts of macronutrients in the diet may cause different behavioral outcomes after acute cocaine and during cocaine withdrawal.

A case-control study on alcohol and psychiatric disorders as risk factors for drug abuse pattern

We evaluated alcohol and psychiatric disorders as risk factors for the pattern of drug abuse/dependence in a matched case-control study (370 adults). Cases (drug abusers) and controls were selected in the community using the snowball technique and matched by sex, age, and friendship. Information was gathered using the "Composite International Diagnostic Interview" (CIDI). Three patterns of drug abuse/dependence were evaluated: any drug abuse/dependence, only cannabis, and cocaine and other drugs. Logistic conditional regression showed that alcohol dependence was strongly associated with pattern of drug abuse/dependence. Thus, compared to the "no drug abuse group", the odds ratio for association with diagnosis of abuse/dependence on cocaine and other drugs was 10.2 (95% CI: 4.9-21.2), whereas for abuse/dependence on cannabis only, the odds ratio was 1.0. For affective disorders, the odds ratio was 2.0 (95% CI: 1.10-3.64) for the group that received a diagnosis of abuse/dependence on cocaine and other drugs, whereas no association was found for those with abuse/dependence on cannabis only. In conclusion, there is not a homogeneous group of "drug users", and the role of risk factors depends on the drug use pattern.

Does multisite sampling improve patient heterogeneity in drug misuse research?

The aim of this study was to investigate whether multisite sampling increased heterogeneity among a sample of cocaine users from São Paulo, Brazil. Six hundred and fourteen cocaine users were interviewed at 23 fixed sites plus an out-of-treatment sample. The sites were then regrouped into six main types: university outpatient clinics, public outpatient clinics, public inpatient units, private inpatient units, HIV services and non-treatment. Marked differences were found between users recruited at these sites, especially in relation to age, gender, employment status, criminal history, history of prostitution, previous drug misuse treatment, duration of cocaine use and lifetime use of intravenous cocaine. These results suggest that multisite sampling is a valid method for increasing patient heterogeneity, but whether it improves representativeness and thus the generalisability of drug misuse research is debatable.

High dose cocaine use in São Paulo: a comparison of treatment and community samples

This cross-sectional study investigates patterns of drug use and associated problems among 332 cocaine users from treatment and community samples in São Paulo, Brazil. Data were collected using a structured questionnaire and the Severity of Dependence Scale (SDS). The majority were regular users of high doses of smoked cocaine. After controlling for severity of cocaine use, users in the community were found to be more involved in illegal activities, more likely to report adverse effects of cocaine, to be involved in prostitution, and to have lived on the streets. Better methods are required to provide interventions to tackle the problems and risk behaviors of these cocaine users.

[Mental disorders as risk factors for the development of cocaine abuse/dependence: case-control study]

OBJECTIVE

To evaluate the role of psychiatric disorders and alcohol dependence as possible risk factors for cocaine abuse/dependence.

METHODS

The case-control study used the "snowball" technique in order to select untreated cocaine users (cases) and to match sex, age and friendship. Information was gathered using the Composite International Diagnostic Interview (CIDI), and computer diagnosis were generated according to the DSM-III-R criteria. The analysis was performed through the logistic conditional regression.

RESULTS

The study included 208 subjects. The main results showed that having a history of alcohol dependence was independently associated with an increased risk of cocaine abuse/dependence (OR=15,1; 95% CI 3,8-60, 2); no other psychiatric disorder was significantly associated with an increase in this risk after the multivariate analysis. An increased risk of cocaine abuse/dependence was also found for those who related suicide thoughts (OR=3,1; 95% CI 0,91-10,8), suggesting an association between more severe manifestations of depression and cocaine abuse.

CONCLUSIONS

These findings suggest that programs directed towards the treatment and prevention of cocaine abuse must be prepared to address issues related to comorbidity of drug abuse with alcohol and other psychiatric disorders

Individual risk factors for adolescent substance use

Identification of risk factors that influence initiation and escalation of drug use in the adolescent population is the approach which has gained currency. The wide array of risk factors involved can be condensed into three main domains: constitutional predisposition, environmental factors (family and peers) and life events. This has been complemented by a surging interest in protective factors. Recent research evidence has been helpful in defining the direction and strategy of prevention efforts. A definite trend has emerged in that family influences are being increasingly targeted. The rationale for this shift seems to come from the observation that home environment, family relationships and parenting styles are almost always involved as risk factors, mediators or as protective factors.

Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity

Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.