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Stanikzai MH, Wahidi MW. Bio-Psycho-Social Profile of People with Substance Use Disorders Treated in Locally Assigned Treatment Facilities in Kandahar, Afghanistan. Subst Abuse Rehabil 2023; 14:89-98. [PMID: 37576434 PMCID: PMC10417592 DOI: 10.2147/sar.s412821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
Background Substance use and its associated bio-psycho-social problems are public health concerns with harmful individual and social consequences. Objective This study assessed the bio-psycho-social profile of people with substance use disorders (SUD) treated at locally assigned treatment facilities in Kandahar, Afghanistan. Methods We conducted this facility-based cross-sectional study among 621 substance users receiving care at three locally assigned treatment facilities in November-December 2022. We performed multiple linear regression to determine factors associated with psychological symptoms. Results The mean age of the participants was 34.41 (± 10.10 SD) years. The majority of our subjects (81.2%) perceived their physical health as very good or fair. More than two-thirds (73.4%) rated their social support as high. Of all participants, 541 (87.1%) had symptoms of depression, 569 (91.6%) of anxiety, and 442 (71.2%) of stress. The prevalence of severe depression, anxiety, and stress was 34.8%, 65.8%, and 27.3%, respectively. The multiple linear regression showed that several attributes of people with substance use disorders [ie, having a low level of education (β=0.12, p=<0.001), being unemployed (β=0.31, p=<0.001), having a low level of social support (β=-0.35, p=<0.001), had a pre-existing medical condition (β=-0.28, p=<0.001), and having lived abroad in the past ten years (β=0.10, p=0.001)] were significantly associated with higher DASS-21 total scores. Conclusion This study highlights the importance of providing bio-psycho-social support programs and implementing therapeutic interventions to help people with substance use disorders, particularly those who are most susceptible to higher levels of bio-psycho-social problems.
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Affiliation(s)
| | - Mohammad Wahid Wahidi
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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Müller CP, Schumann G, Rehm J, Kornhuber J, Lenz B. Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment. Mol Psychiatry 2023; 28:2683-2696. [PMID: 37117460 PMCID: PMC10615763 DOI: 10.1038/s41380-023-02074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023]
Abstract
Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.
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Affiliation(s)
- Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Gunter Schumann
- The Centre for Population Neuroscience and Stratified Medicine (PONS), ISTBI, Fudan University, Shanghai, China
- PONS Centre, Charite Mental Health, Department of Psychiatry and Psychotherapie, CCM, Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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Alawa J, Muhammad M, Kazemitabar M, Bromberg DJ, Garcia D, Khoshnood K, Ghandour L. Medication for opioid use disorder in the Arab World: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103617. [PMID: 35182841 PMCID: PMC9851143 DOI: 10.1016/j.drugpo.2022.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World. METHODS Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy. CONCLUSION Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World.
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Affiliation(s)
- Jude Alawa
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Muzzammil Muhammad
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Maryam Kazemitabar
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Daniel J Bromberg
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danilo Garcia
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Box 100, 405 30 Gothenburg, Gothenburg, Sweden; Department of Behavioral Sciences and Learning, Linköping University, SE 581 83, Linköping, Sweden
| | - Kaveh Khoshnood
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Van Dyck Building, PO Box 11-0236, Riad El-Solh Beirut, 1107 2020, Lebanon.
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Clark AE, Goodwin SR, Marks RM, Belcher AM, Heinlein E, Bennett ME, Roche DJO. A Narrative Literature Review of the Epidemiology, Etiology, and Treatment of Co-Occurring Panic Disorder and Opioid Use Disorder. J Dual Diagn 2021; 17:313-332. [PMID: 34582313 PMCID: PMC9487392 DOI: 10.1080/15504263.2021.1965407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Panic disorder is a debilitating psychiatric disorder that often co-occurs with substance use disorders. Given the current opioid epidemic, the high reported rates of comorbid panic disorder and opioid use disorder are particularly concerning. In this narrative review, we describe the literature on panic disorder and opioid use disorder co-occurrence. METHODS 86 studies, 26 reviews, 2 commentaries, and 5 guidelines pertaining to opioid use disorder, panic disorder, and their comorbidity were identified using all EBSCO databases, PubMed, and Google Scholar. RESULTS First, we review epidemiological literature on the prevalence of the comorbid condition above and beyond each disorder on its own. Additionally, we discuss the challenges that complicate the differential diagnosis of panic disorder and opioid use disorder and contribute to difficulties establishing rates of comorbidity. Second, we review three theoretical models that have been proposed to explain high rates of co-occurring panic disorder and opioid use disorder: the precipitation hypothesis, the self-medication hypothesis, and the shared vulnerability hypothesis. Third, we outline how co-occurring panic and opioid use disorder may impact treatment for each condition. CONCLUSION Based on findings in the field, we provide recommendations for future research as well as treatment considerations for co-occurring panic and opioid use disorders.
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Affiliation(s)
- Ashton E Clark
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Shelby R Goodwin
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | | | | | - Emily Heinlein
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA.,Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
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Raffi ER, Gray J, Conteh N, Kane M, Cohen LS, Schiff DM. Low barrier perinatal psychiatric care for patients with substance use disorder: meeting patients across the perinatal continuum where they are. Int Rev Psychiatry 2021; 33:543-552. [PMID: 34406106 DOI: 10.1080/09540261.2021.1898351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pregnant and postpartum patients with substance use disorders (SUD) often have other co-occurring mental health disorders. Complications of substance use and mental health conditions, such as overdose and suicide, are a significant contributor to maternal morbidity and mortality. For individuals dually diagnosed with SUD and other mental health disorders, the perinatal period can be both a motivating and a vulnerable period for care. Barriers to optimal care include, but are not limited to, lack of screening, lack of referrals for care, a limited number of psychiatric providers available to care for pregnant patients, and stigma around mental health and addiction care in pregnancy. In this review, we discuss approaches to low-barrier perinatal psychiatric care for women with SUD to promote engagement in care. We review (1) appropriate psychiatric assessment and diagnostic work-up; (2) treatment planning incorporating shared-decision making, non-punitive and culturally sensitive patient-centred care, and principles of harm reduction with a focus on psychopharmacology, and (3) the benefits of an integrated and collaborative multidisciplinary care model for this subpopulation of vulnerable patients.
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Affiliation(s)
- Edwin R Raffi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gray
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Nkechi Conteh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha Kane
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee S Cohen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Davida M Schiff
- MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
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7
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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8
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Stokes PRA, Kalk NJ, Young AH. Bipolar disorder and addictions: the elephant in the room. Br J Psychiatry 2017; 211:132-134. [PMID: 28864753 DOI: 10.1192/bjp.bp.116.193912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/23/2022]
Abstract
Addictions are highly prevalent in bipolar disorder and greatly affect clinical outcomes. In this editorial, we review the evidence that addictions are a key challenge in bipolar disorder, examine putative neurobiological mechanisms, and reflect on the limited clinical trial evidence base with suggestions for treatment strategies and further developments.
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Affiliation(s)
- Paul R A Stokes
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola J Kalk
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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9
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Campbell ANC, Montgomery L, Sanchez K, Pavlicova M, Hu M, Newville H, Weaver L, Nunes EV. Racial/ethnic subgroup differences in outcomes and acceptability of an Internet-delivered intervention for substance use disorders. J Ethn Subst Abuse 2017; 16:460-478. [PMID: 28368740 DOI: 10.1080/15332640.2017.1300550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Therapeutic Education System (TES), an Internet version of the Community Reinforcement Approach plus prize-based motivational incentives, is one of few empirically supported technology-based interventions. To date, however, there has not been a study exploring differences in substance use outcomes or acceptability of TES among racial/ethnic subgroups. This study uses data from a multisite (N = 10) effectiveness study of TES to explore whether race/ethnicity subgroups (White [n = 267], Black/African American [n = 112], and Hispanic/Latino [n = 55])moderate the effect of TES. Generalized linear mixed models were used to test whether abstinence, retention, social functioning, coping, craving, or acceptability differed by racial/ethnic subgroup. Findings demonstrated that race/ethnicity did not moderate the effect of TES versus TAU on abstinence, retention, social functioning, or craving. A three-way interaction (treatment, race/ethnicity, and abstinence status at study entry) showed that TES was associated with greater coping scores among nonabstinent White participants (p = .008) and among abstinent Black participants (p < .001). Acceptability of the TES intervention, although high overall, was significantly different by race/ethnicity subgroup with White participants reporting lower acceptability of TES compared to Black (p = .006) and Hispanic/Latino (p = .008) participants. TES appears to be a good candidate treatment among a diverse population of treatment-seeking individuals with substance use disorders.
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Affiliation(s)
- Aimee N C Campbell
- a Columbia University Medical Center , New York , New York.,b New York State Psychiatric Institute , New York , New York
| | - L Montgomery
- c Mental Health and Substance Abuse Counseling Program , University of Cincinnati, School of Human Services , Cincinnati , Ohio
| | - Katherine Sanchez
- d School of Social Work , University of Texas at Arlington , Arlington , Texas
| | - M Pavlicova
- e Columbia University, Mailman School of Public Health , New York , New York
| | - M Hu
- a Columbia University Medical Center , New York , New York
| | - H Newville
- f University of Washington , Seattle , Washington
| | - L Weaver
- g Icahn School of Medicine at Mount Sinai , New York , New York
| | - E V Nunes
- a Columbia University Medical Center , New York , New York
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10
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Kim EJ, Kim Y, Seo WS, Lee SH, Park EJ, Bae SM, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (I) - Clinical Presentation and Comorbidity -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Eun Jin Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yunsin Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Wan Seok Seo
- Department of Psychiatry, Yeungnam University School of Medicine, Daegu, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eun Jin Park
- Department of Psychiatry, Inje University School of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Seung-Min Bae
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Lee S, Choi JW, Kim KM, Kim JW, Kim S, Kang T, Kim JI, Lee YS, Kim B, Han DH, Cheong JH, Lee SI, Hyun GJ, Kim BN. The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center. Soa Chongsonyon Chongsin Uihak 2016. [DOI: 10.5765/jkacap.2016.27.4.236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sumin Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Choi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Min Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sooyeon Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Johanna Inhyang Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Gi Jung Hyun
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Behavioral impulsivity mediates the relationship between decreased frontal gray matter volume and harmful alcohol drinking: A voxel-based morphometry study. J Psychiatr Res 2016; 83:16-23. [PMID: 27529648 DOI: 10.1016/j.jpsychires.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022]
Abstract
Alcohol use disorder (AUD) with harmful drinking patterns is on the one hand characterized by impulsive behavior and is on the other hand known to involve structural brain alterations with lower gray matter volume (GMV), especially in the prefrontal cortex (PFC). So far it is unclear whether frontal brain volumes are associated to harmful alcohol drinking and impulsivity, while controlling simultaneously for a wide array of important confounding factors, which are related to alcohol consumption. We used voxel-based morphometry in 99 adults ranging within a continuum of normal to harmful drinking behavior and alcohol dependence, measured by the 'Alcohol Use Disorders Identification Test', to examine whether the severity of harmful drinking is correlated with structural markers, in particular in the PFC and whether such markers are linked to self-reported impulsivity. We included alcohol and nicotine lifetime exposure, age, education, and BMI as covariates to control that GMV decreases were not related to those factors. Harmful drinking was associated with lower GMV in the right frontal pole, left inferior frontal gyrus, and bilateral inferior parietal lobe. GMV loss in the PFC regions was correlated with increased impulsivity. Follow-up mediation analyses showed that the relationship between GMV in the frontal pole and harmful drinking was mediated by impulsivity. Our findings show that PFC reductions are associated with harmful drinking and impulsivity. Our data suggest that reduced frontal pole GM, independent of a number of alcohol drinking associated covariates, e.g. lifetime alcohol consumption, is related to impaired top-down control of alcohol drinking behavior.
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Pastor V, Antonelli MC, Pallarés ME. Unravelling the Link Between Prenatal Stress, Dopamine and Substance Use Disorder. Neurotox Res 2016; 31:169-186. [DOI: 10.1007/s12640-016-9674-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 12/21/2022]
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Abstract
BACKGROUND Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. OBJECTIVES In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. METHODS Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. RESULTS Synthesis led to the development of two themes; "substance use mediates acceptance and social inclusion" and "substance use provides perceived opportunities for control and power." CONCLUSIONS/IMPORTANCE The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.
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Affiliation(s)
- Emma Chorlton
- a Division of Health Research, Lancaster University , Lancaster , United Kingdom
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Lanza HI, Grella CE, Chung PJ. Adolescent obesity and future substance use: Incorporating the psychosocial context. J Adolesc 2015; 45:20-30. [PMID: 26349450 DOI: 10.1016/j.adolescence.2015.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 01/08/2023]
Abstract
A growing body of work has shown that obese adolescents are at risk of engaging in problematic substance use, but mixed findings highlight the complexity of the relationship. Incorporating the psychosocial context into this research may inform past discrepancies. The current study assessed whether obese adolescents had a higher likelihood of experiencing a psychosocial context that predicted problematic substance use in young adulthood. Latent class analysis on 10,637 adolescents from The National Longitudinal Study of Adolescent to Adult Health (Add Health) identified four psychosocial classes in adolescence: Adjusted, Deviant Peer/Victimization, Moderate Depression, and Maladjusted. Obese adolescents were more likely to belong to the Maladjusted class, characterized by higher levels of depression and deviant peer affiliation. Those in the Maladjusted class had the second highest levels of cigarette smoking and marijuana use in young adulthood. Obese adolescents' psychosocial context should be considered in future research linking obesity and substance use.
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Affiliation(s)
- H Isabella Lanza
- California State University, Long Beach, Department of Human Development, 1250 Bellflower Blvd., Long Beach, CA 90804, USA; University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Christine E Grella
- University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Paul J Chung
- University of California, Los Angeles, Department of Pediatrics, 10833 LeConte Ave., Los Angeles, CA 90095, USA.
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Young S, Sedgwick O. Attention deficit hyperactivity disorder and substance misuse: an evaluation of causal hypotheses and treatment considerations. Expert Rev Neurother 2015; 15:1005-14. [DOI: 10.1586/14737175.2015.1059756] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Daff E, Thomas SDM. Bipolar disorder and criminal offending: a data linkage study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1985-91. [PMID: 24791923 DOI: 10.1007/s00127-014-0882-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The current study explored criminal offending among people diagnosed with bipolar disorder with and without comorbid substance use and compared this with a community sample with no history of bipolar disorder. METHODS A case-linkage design was used to compare patterns of officially recorded criminal offending between 1,076 people with bipolar disorder drawn from a state-wide psychiatric case register with a community comparison group. RESULTS Those with bipolar disorder were significantly more likely than community members to be charged with, convicted of, and be found guilty of, violent, non-violent and intermediate level criminal offences. Those with a comorbid substance use disorder were two times more likely than those without a substance use disorder to offend; both groups had a significantly higher chance of offending than the community sample. Females with bipolar disorder were significantly more likely to have been convicted of violent offences, irrespective of substance use. Significant interactions were found between bipolar disorder and substance use for males and females with respect to violent offending and for males with respect to non-violent offending. CONCLUSIONS There is a statistically significant association between bipolar disorder and the likelihood of having a criminal history. Co-occurring substance use differentially impacts on the likelihood of criminal offending for males and females.
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Affiliation(s)
- Elizabeth Daff
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
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18
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The impact of substance abuse on the severity of manic relapse in bipolar disorder. MIDDLE EAST CURRENT PSYCHIATRY 2014. [DOI: 10.1097/01.xme.0000452970.82711.b8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lanza HI, Grella CE, Chung PJ. Does adolescent weight status predict problematic substance use patterns? Am J Health Behav 2014; 38:708-16. [PMID: 24933140 DOI: 10.5993/ajhb.38.5.8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To identify underlying patterns of cigarette smoking, alcohol use, and marijuana use in young adulthood, and ascertain whether adolescent overweight or obesity status predicts problematic substance use patterns. METHODS The study included 15,119 participants from the National Longitudinal Study of Adolescent Health (Add Health) at Wave 1 (11-19 years) and Wave 3 (18-26 years). Latent class analysis was conducted. RESULTS Participants were classified into a Low Substance Use (35%), Regular Smokers (12%), High-risk Alcohol use (33%), or High Substance Use (20%) class. Overweight/obese adolescents had a greater likelihood of belonging to the Regular Smokers class. CONCLUSIONS Overweight/obese adolescents are at higher risk of engaging in regular cigarette smoking without problematic alcohol or marijuana use.
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Affiliation(s)
- H Isabella Lanza
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
| | - Christine E Grella
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Paul J Chung
- Department of Pediatrics, University of California, Los Angeles, USA
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Sanchez K, Walker R, Campbell ANC, Greer TL, Hu MC, Grannemann BD, Nunes EV, Trivedi MH. Depressive Symptoms and Associated Clinical Characteristics in Outpatients Seeking Community-Based Treatment for Alcohol and Drug Problems. Subst Abus 2014; 36:297-303. [PMID: 25084694 DOI: 10.1080/08897077.2014.937845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. METHODS Baseline data from a randomized clinical effectiveness trial of a computer-assisted, Web-delivered psychosocial intervention were analyzed. Participants (N = 507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. RESULTS One fifth (21%; n = 106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and posttraumatic stress disorder (PTSD; 42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (P = .001), greater impairment in social adjustment (P < .001), and poorer health status (P < .001), but not to days of drug use in the last 90 days (P = .14). CONCLUSIONS Depression is a clinically significant problem among substance abusers, and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes, and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment.
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Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
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21
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Khazaal Y, Gex-Fabry M, Nallet A, Weber B, Favre S, Voide R, Zullino D, Aubry JM. Affective temperaments in alcohol and opiate addictions. Psychiatr Q 2013; 84:429-38. [PMID: 23456370 DOI: 10.1007/s11126-013-9257-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.05-1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95% CI 1.36-7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95% CI 0.42-0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.
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Affiliation(s)
- Yasser Khazaal
- Division of Substance Abuse, Geneva University Hospitals, Grand pré, 70 C, 1206, Geneva, Switzerland,
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Perugi G, Ceraudo G, Vannucchi G, Rizzato S, Toni C, Dell'Osso L. Attention deficit/hyperactivity disorder symptoms in Italian bipolar adult patients: a preliminary report. J Affect Disord 2013; 149:430-4. [PMID: 23267727 DOI: 10.1016/j.jad.2012.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/11/2012] [Accepted: 12/11/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND It has been recently suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. With the aim to assess the impact of ADHD symptoms, we investigated the prevalence, epidemiological and clinical features associated with such a comorbidity in a sample of adult BD patients. METHODS A total of 96 outpatients (aged 18-65 years) with BD were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for systematic collection of familial, demographic, anamnestic and clinical informations and exploration of DSM-IV-TR diagnostic criteria for mood, anxiety, eating, impulse control and alcohol and substance use disorders. The DCTC also includes the Clinical Global Impression Bipolar scale (CGI-BP), the Global Assessment of Functioning scale (GAF) and the Sheehan Disability Scale (SDS). RESULTS In our sample, 19 (19.8%) out of 96 BD patients fulfilled ASRS criteria for current and lifetime (onset before 7 years of age) ADHD symptoms (ADHD+). Compared to BD probands without ADHD symptoms (ADHD-), ADHD+ patients showed higher rates of current mixed episode, and lower rates of mania. ADHD+ resulted in more severe mean scores on the CGI-BP mixed, depressive and global subscales. None of the ADHD+ patients were in remission of BD at the time of the evaluation, versus 24 (31.2%) of the ADHD- group. ADHD+ patients also reported higher rate of lifetime comorbidity with Substance Use Disorder (SUD) and Alcohol Abuse in comparison to ADHD- patients. In particular the different rate in substance abuse was related to cocaine and poly-drug abuse. The two groups did not report significant differences in functioning and social adjustment with the exception of familial adjustment that was more compromised in ADHD+ than in ADHD- patients. LIMITATIONS Retrospective design and limited sample size. CONCLUSIONS In ADHD+ patients, BD is associated with higher rate of mixed states, more severe psychopathology and more impaired familial functioning as well as higher rates of comorbid substance, alcohol and poly-drug abuse compared to BD patients without adult ADHD. Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD. Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD.
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Affiliation(s)
- G Perugi
- Department of Psychiatry, University of Pisa, Italy.
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Do patients with bipolar disorder drink alcohol for different reasons when depressed, manic or euthymic? J Affect Disord 2012; 136:926-32. [PMID: 21967890 DOI: 10.1016/j.jad.2011.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Many studies report high prevalence rates for co-morbid alcohol problems in bipolar disorder (BP). Some hypothesize that individuals use alcohol to self-medicate, but few studies examine the range of possible reasons and none explicitly explores the role of mood state. We examined drinking motives in BP depression, (hypo)mania and euthymia according to Cooper's cognitive motivational model of alcohol use (Cooper, 1994). METHODS Twenty-seven participants with BP were interviewed using the Drinking Motives Questionnaire. A calendar-based measure of alcohol use--the FORM90--was used to aid recall of drink-related behaviours and estimate alcohol intake. Each participant reported drinking motives and alcohol consumption for 30 consecutive days of euthymia, plus one past depressive and one past (hypo)manic episode. RESULTS Estimated alcohol intake was higher when depressed or (hypo)manic compared with euthymia. Drinking motives varied between mood states. Negative internal coping motives were specifically related to depression, whilst positive internal and external motives were more specifically related to (hypo)mania. During euthymia, the patients' motives did not differ from norms. CONCLUSIONS This is the first clinical study utilising a clearly defined cognitive motivational model demonstrating that the reasons to drink alcohol in patients with BP are mood-dependent. Interventions aimed at modifying problematic drinking behaviours in this population must take into account both individual and mood state variations in reasons for alcohol consumption. Self-medication or inadequate coping is not sufficient to generally explain alcohol intake across mood states and individuals.
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Dell'osso L, Carmassi C, Stratta P, Massimetti G, Akiskal KK, Akiskal HS, Maremmani I, Rossi A. Gender Differences in the Relationship between Maladaptive Behaviors and Post-Traumatic Stress Disorder. A Study on 900 L' Aquila 2009 Earthquake Survivors. Front Psychiatry 2012; 3:111. [PMID: 23293608 PMCID: PMC3537190 DOI: 10.3389/fpsyt.2012.00111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 12/12/2012] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) represents one of the most frequently psychiatric sequelae to earthquake exposure. Increasing evidence suggests the onset of maladaptive behaviors among veterans and adolescents with PTSD, with specific gender differences emerging in the latter. Aims of the present study were to investigate the relationships between maladaptive behaviors and PTSD in earthquake survivors, besides the gender differences in the type and prevalence of maladaptive behaviors and their association with PTSD. METHODS 900 residents of the town of L'Aquila who experienced the earthquake of April 6th 2009 (Richter Magnitude 6.3) were assessed by means of the Trauma and Loss Spectrum-Self Report (TALS-SR). RESULTS Significantly higher maladaptive behavior prevalence rates were found among subjects with PTSD. A statistically significant association was found between male gender and the presence of at least one maladaptive behavior among PTSD survivors. Further, among survivors with PTSD significant correlations emerged between maladaptive coping and symptoms of re-experiencing, avoidance and numbing, and arousal in women, while only between maladaptive coping and avoidance and numbing in men. CONCLUSIONS Our results show high rates of maladaptive behaviors among earthquake survivors with PTSD suggesting a greater severity among men. Interestingly, post-traumatic stress symptomatology appears to be a better correlate of these behaviors among women than among men, suggesting the need for further studies based on a gender approach.
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Affiliation(s)
- Liliana Dell'osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa Pisa, Italy
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25
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McDonald JL, Meyer TD. Self-Report Reasons for Alcohol Use in Bipolar Disorders: Why Drink Despite the Potential Risks? Clin Psychol Psychother 2011; 18:418-25. [DOI: 10.1002/cpp.782] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schmidt S, Petermann F. Developmental psychopathology: Attention Deficit Hyperactivity Disorder (ADHD). BMC Psychiatry 2009; 9:58. [PMID: 19761584 PMCID: PMC2751746 DOI: 10.1186/1471-244x-9-58] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 09/17/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit/Hyperactivity Disorder (ADHD), formerly regarded as a typical childhood disorder, is now known as a developmental disorder persisting over the lifespan. Starting in preschool-age, symptoms vary depending on the age group affected. METHOD According to the variability of ADHD-symptoms and the heterogeneity of comorbid psychiatric disorders, a broad review of recent studies was performed. These findings were summarized in a developmental psychopathological model, documenting relevant facts on a timeline. RESULTS Based on a genetic disposition and a neuropsychological deregulation, there is evidence for factors which persist across the lifespan, change age-dependently, or show validity in a specific developmental phase. Qualitative changes can be found for children in preschool-age and adults. CONCLUSION These differences have implications for clinical practice as they can be used for prevention, diagnostic proceedings, and therapeutic intervention as well as for planning future studies. The present article is a translated and modified version of the German article "Entwicklungspsychopathologie der ADHS", published in Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 56, 2008, S. 265-274.
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Affiliation(s)
- Sören Schmidt
- Centre for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.
| | - Franz Petermann
- Centre for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
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Hofmann SG, Richey JA, Kashdan TB, McKnight PE. Anxiety disorders moderate the association between externalizing problems and substance use disorders: data from the National Comorbidity Survey-Revised. J Anxiety Disord 2009; 23:529-34. [PMID: 19059752 DOI: 10.1016/j.janxdis.2008.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 11/24/2022]
Abstract
Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, Boston, MA 02215, USA.
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Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: a qualitative study. J Affect Disord 2009; 113:118-26. [PMID: 18571735 DOI: 10.1016/j.jad.2008.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 05/16/2008] [Accepted: 05/17/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few systematic studies have examined the reasons why patients with bipolar disorder and substance use disorders misuse alcohol and drugs of abuse. Such reasons may depend heavily on context so qualitative research methods that made no prior theoretical assumptions were employed. We explored the reasons patients give for misusing drugs and alcohol and how these relate to their illness course. METHOD Qualitative semi-structured interviews and thematic analysis with a purposive sample of 15 patients with bipolar disorder and a current or past history of drug or alcohol use disorders. RESULTS Patients based their patterns of and reasons for substance use on previous personal experiences rather than other sources of information. Reasons for substance use were idiosyncratic, and were both mood related and unrelated. Contextual factors such as mood, drug and social often modified the patient's personal experience of substance use. Five thematic categories emerged: experimenting in the early illness; living with serious mental illness; enjoying the effects of substances; feeling normal; and managing stress. LIMITATIONS The prevalence of these underlying themes was not established and the results may not apply to populations with different cultural norms. CONCLUSIONS Patterns of substance use and reasons for use are idiosyncratic to the individual and evolve through personal experience. Motivating the patient to change their substance use requires an understanding of their previous personal experience of substance use both in relation to the different phases of their bipolar disorder and their wider personal needs.
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Abstract
Galt die ADHS vor einigen Jahren noch als eine Erkrankung des Kindes- und Jugendalters, so versteht man heute darunter ein Störungsbild über die Lebensspanne. Mit Beginn im Vorschulalter divergieren die Symptome in Abhängigkeit des Alters. Daraus lässt sich ein Modell ableiten, welches diese Veränderungen (Komorbiditäten, Alltagsbeeinträchtigungen) auf der Zeitachse dokumentiert und mit den jeweils gültigen diagnostischen Kriterien in Verbindung bringt. Ausgehend von einer genetischen Prädisposition und einer neurobiologischen Dysregulation sind Faktoren festzustellen, die über die Lebensspanne andauern, sich altersspezifisch verändern oder nur für einen bestimmten Entwicklungsabschnitt gültig sind. Es wird deutlich, dass das Vorschulalter und der Übergang in das Erwachsenenalter die Phasen darstellen, in denen sich die meisten qualitativen Veränderungen feststellen lassen. Dies hat Implikationen für die klinische Praxis, indem diese Veränderungen zu Zwecken der Prävention, des diagnostischen Prozesses und der Therapieplanung herangezogen werden können und somit sowohl dem Anwender eine Hilfestellung bieten, aber auch als Ausgangspunkt für weitere Studien herangezogen werden können.
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Affiliation(s)
- Sören Schmidt
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
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McEvoy PM, Shand F. The effect of comorbid substance use disorders on treatment outcome for anxiety disorders. J Anxiety Disord 2008; 22:1087-98. [PMID: 18164585 DOI: 10.1016/j.janxdis.2007.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 11/12/2007] [Accepted: 11/15/2007] [Indexed: 11/27/2022]
Abstract
This study examined the impact of concurrent substance use disorders (SUDs) on outcomes for psychotherapy targeting anxiety disorders. Study 1 (N=484) sought to determine the prevalence of SUDs in a sample referred to a community anxiety disorders clinic, as well as the impact of comorbid SUDs on outcomes for a subsample (n=200) completing cognitive behavior therapy (CBT). Around one-quarter (22-29%) of patients with one or two anxiety disorders met criteria for at least one SUD, but this rate was substantially higher (46%) for patients with three anxiety disorders. Concurrent SUDs were associated with higher levels of anxiety but not depression or stress, compared to those without a SUD. However, concurrent SUDs did not moderate treatment outcomes. Study 2 (N=103) focused on the impact of alcohol use on diagnosis-specific symptom measures and generic measures of distress and disability, following a course of CBT for panic disorder or social phobia. Pre-treatment alcohol use did not predict changes in panic symptoms, performance anxiety, distress, or disability, but it did predict changes in social interaction anxiety. Problem drinking per se did not have any predictive utility in terms of treatment outcome. These findings suggest that clinicians treating patients for a primary anxiety disorder and concurrent SUD can be relatively optimistic about treatment outcomes.
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Affiliation(s)
- Peter M McEvoy
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry at St Vincent's Hospital, University of New South Wales, Darlinghurst, Sydney, NSW, Australia.
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