1
|
Guo H, Wang J, Wang S, Zhou J, Wang X. Analysis of factors influencing substance use craving among Chinese substance users. Front Psychiatry 2022; 13:1070215. [PMID: 36506438 PMCID: PMC9731095 DOI: 10.3389/fpsyt.2022.1070215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substance use has been a serious public safety issue. It not only affects the users' physical and mental health but is also detrimental to social stability. To improve our understanding of this issue, the present study looked to examine the factors influencing substance use craving and develop interventions to reduce craving and relapse among substance users. MATERIALS AND METHODS A total of 502 substance users were included in this study. Socio-demographic characteristics and substance use-related characteristics were recorded using self-developed forms. With regard to psychological traits, we used the self-esteem scale, the experience of shame scale, and the revised Cheek and Buss shyness scale to assess the self-esteem, shame, and shyness of substance users, respectively. The degree of substance use craving of substance users was assessed using the visual analog scale (VAS). Data were analyzed using independent samples T-test, Pearson correlation analysis, and multiple linear regression analysis, as appropriate. RESULTS The majority of the substance users were unmarried, employed, and with lower education levels. For substance use-related characteristics, the age of first use was 27.52 ± 8.30 years and the duration of substance use was 12.29 ± 7.72 years. The scores of their self-esteem, shame, and shyness were 25.65 ± 3.19, 57.26 ± 7.82, and 37.8 ± 7.13, respectively. All substance users rated the intensity of their substance use cravings using the VAS, which showed that the mean score was 2.83 ± 1.87. Multiple linear regression analysis showed that substance use craving was positively associated with the frequency of substance use (β = 0.186, P < 0.001), times of substance rehabilitation (β = 0.128, P = 0.003), shyness (β = 0.211, P < 0.001), and shame (β = 0.091, P = 0.033), and negatively associated with self-esteem (β = -0.117, P = 0.008). CONCLUSION Factors and psychological traits related to substance use are important to account for substance use craving and relapse. Thus, our findings are helpful for a better understanding of the extent of substance use cravings among users and the selection of appropriate interventions to control the craving and relapse.
Collapse
Affiliation(s)
- Huijuan Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jizhi Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Siyuan Wang
- Pingtang Compulsory Isolation Detoxification Institute in Hunan Province, Changsha, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
2
|
Liu Y, Guo X, Yang B. Age at onset of drug use and aggressive behavior: The role of internal and environmental factors. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
3
|
A qualitative study to understand drivers of psychoactive substance use among Nepalese youth. PLoS One 2021; 16:e0259021. [PMID: 34739508 PMCID: PMC8570474 DOI: 10.1371/journal.pone.0259021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background Psychoactive substance use among youth is an emerging public health issue in Nepal. This exploratory study aimed to better understand the drivers of psychoactive substance use among Nepalese youth in Rupandehi district of Nepal. Materials and methods This study used a qualitative approach for data collection. Both in-depth interviews (IDI, seven participants) and focus group discussions (FGD, 13 participants) were conducted among study participants who self-reported as psychoactive substance users or had history of psychoactive substance use. Participants for IDI were aged between 11 and 24 years and between 18 and 35 years old for FGDs. Semi-structured interview guides were prepared separately for IDIs and FDGs. Interviews were conducted in Nepali language and were audio recorded, which were there transcribed and translated into English for coding and analyses. In addition, interviews notes were taken by two research assistants. An inductive thematic analysis was used to analyze the data. Results This study identified a range of drivers of psychoactive substances use among Nepalese youths. Themes included (i) socio-cultural factors, (ii) individual factors, (iii) academic environment, (iv) physical environment and the (v) influence of media. The socio-cultural factors were categorized into sub-themes of family relationships, ethnic identity and psychoactive substance use and lack of social acceptance. Individual factors included peer pressure, stress relief and coping with financial challenges. Accessibility and availability of psychoactive substances in the surrounding environment and lack of monitoring and reinforcement of rules/ law and regulations were other drivers to psychoactive substance use among this Nepalese youth cohort. Conclusion Our study identified several important drivers of psychoactive substance use among youth in the Rupandehi district of Nepal. Future works are anticipated to further explore youth initiation and use of psychoactive substances and support the design of interventions that address these risk factors to reduce and prevent subsequent harms.
Collapse
|
4
|
Randall-Kosich O, Whitaker DJ, Guastaferro WP, Rivers D. Predicting drug court graduation: Examining the role of individual and programmatic characteristics. J Subst Abuse Treat 2021; 135:108654. [PMID: 34742608 DOI: 10.1016/j.jsat.2021.108654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/07/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although existing research suggests drug courts reduce recidivism and substance use, a large portion of drug court participants do not graduate. According to a conceptual framework, severity of need and program intensity may help to explain variation in drug court effectiveness. Understanding variation in drug court graduation can help to identify high risk participants and effective programmatic elements. METHODS Our sample included 247 drug court participants from an adult felony-level drug court located in a large metropolitan area of the southeastern United States that either graduated (n = 113) or were terminated (n = 134) from the program. We used participant and program characteristics from drug court program records to predict drug court graduation. RESULTS In bivariate analyses, several participant and program characteristics were significantly associated with drug court graduation. In the final multivariate model, only one participant-level characteristic was significantly related to graduation: emotional/personal risk and needs (aOR: 0.56, 95% CI: 0.33, 0.93). Alternatively, three program characteristics remained statistically significant predictors of drug court graduation in the final multivariate model. Receiving more individual counseling sessions was positively associated with drug court graduation (aOR: 1.27, 95% CI: 1.14, 1.41), while jail and monetary fine sanctions were negatively associated with drug court graduation (aOR jail: 0.45, 95% CI: 0.30, 0.68; aOR fine: 0.28, 95% CI: 0.10, 0.78). CONCLUSIONS Our findings suggest that drug court programs may benefit by tailoring services for individuals with high emotional/personal risk and participants who receive certain types of sanctions. More rigorous research should explore the causal relationship between individual counseling and drug court graduation to determine if wide-scale programmatic changes are warranted.
Collapse
Affiliation(s)
- Olivia Randall-Kosich
- School of Public Health, Georgia State University, Atlanta, GA, United States of America.
| | - Daniel J Whitaker
- School of Public Health, Georgia State University, Atlanta, GA, United States of America.
| | - Wendy P Guastaferro
- School of Criminology & Criminal Justice, Florida Atlantic University, Boca Raton, FL, United States of America.
| | - Danielle Rivers
- School of Public Health, Georgia State University, Atlanta, GA, United States of America.
| |
Collapse
|
5
|
Gao L, Roy Robertson J, Bird SM. Scotland's 2009-2015 methadone-prescription cohort: Quintiles for daily dose of prescribed methadone and risk of methadone-specific death. Br J Clin Pharmacol 2021; 87:652-673. [PMID: 32530053 PMCID: PMC7612180 DOI: 10.1111/bcp.14432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS As methadone clients age, their drug-related death (DRD) risks increase, more than doubling at 45+ years for methadone-specific DRDs. METHODS Using Community Health Index (CHI) numbers, mortality to 31 December 2015 was ascertained for 36 347 methadone-prescription clients in Scotland during 2009-2015. Cohort entry, quantity of prescribed methadone and daily dose (actual or recovered by effective, simple rules) were defined by clients' first CHI-identified methadone prescription after 30 June 2009 and used in proportional hazards analysis. As custodian of death records, National Records of Scotland identified non-DRDs from DRDs. Methadone-specific DRD means methadone was implicated but neither heroin nor buprenorphine. RESULTS The cohort's 192 928 person-years included 1857 non-DRDs and 1323 DRDs (42%), 546 of which were methadone specific. Actual/recovered daily dose was available for 26 533 (73%) clients who experienced 420 methadone-specific DRDs. Top quintile for daily dose at first CHI-identified methadone prescription was >90 mg. Age 45+ years at cohort-entry (hazard ratio vs 25-34 years: 3.1, 95% confidence interval: 2.4-4.2), top quintile for baseline daily dose of prescribed methadone (vs 50-70 mg: 1.9, 1.1-3.1) and being female (1.3, 1.0-1.6) significantly increased clients' risk of methadone-specific DRD. CONCLUSION Extra care is needed when methadone daily dose exceeds 90 mg. Females' higher risk for methadone-specific DRD is new and needs validation. Further analyses of prescribed daily dose linked to mortality for large cohorts of methadone clients are needed internationally, together with greater pharmacodynamic and pharmacokinetic understanding of methadone by age and sex. Balancing age-related risks is challenging for prescribers who manage chronic opiate dependency against additional uncertainty about the nature, strength and pharmacological characteristics of drugs from illegal markets.
Collapse
Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Sheila M. Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Edinburgh Centre for Medical Informatics, Edinburgh, UK
| |
Collapse
|
6
|
The contribution of methamphetamine use to crime: Evidence from Australian longitudinal data. Drug Alcohol Depend 2020; 216:108262. [PMID: 32916517 DOI: 10.1016/j.drugalcdep.2020.108262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND To quantify the extent to which methamphetamine use is associated with increases in crime net of any premorbid risk of criminality among people who use the drug. METHODS Four one-month data panels from 469 participants dependent on methamphetamine were drawn from the MATES cohort (N = 501). Odds ratios for within-person effects were extracted from a random intercept logistic regression model for crime during periods of methamphetamine use compared to no use. Effects were adjusted for time-varying measures of age, other substance use, and socio-economic disadvantage (income, unemployment and unstable accommodation). Involvement in crime (property crime, drug dealing, fraud, violent crime) and days of methamphetamine in the past month were assessed using the Opiate Treatment Index. RESULTS Crime was more likely during months when participants used methamphetamine compared to when they did not (OR 13.2 95% CI 8.5-20.6; AOR 4.7 95% CI 2.8-8.0), this reflecting more property crime (OR 10.6 95% CI 6.3-18.0; AOR 5.5 95% CI 2.8-10.8), violent crime (OR 8.2 95% CI 4.2-15.9; AOR 3.4 95% CI 1.5-8.0), fraud (OR 3.4, 95% CI 2.0-5.8; AOR 1.7 95% CI 0.8-3.3) and dealing drugs (OR 18.2 95% CI 10.2-32.5; AOR 5.9 95% CI 3.0-11.9), although the adjusted relationship for fraud was not significant. Effects were dose related. CONCLUSIONS The use of methamphetamine was associated with significant increases in crime beyond premorbid risk for criminality. Crime is a likely social consequence of methamphetamine use and efforts are needed to reduce this impact.
Collapse
|
7
|
Gender Differences in Clinical and Sociodemographic Patterns of Substance Use Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
8
|
Doyle MF, Guthrie J, Butler T, Shakeshaft A, Conigrave K, Williams M. Onset and trajectory of alcohol and other drug use among Aboriginal men entering a prison treatment program: A qualitative study. Drug Alcohol Rev 2020; 39:704-712. [PMID: 32743856 DOI: 10.1111/dar.13123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander people are vastly over-represented in Australian prisons. Many people in prison attribute in some way their offences to alcohol and/or other drug (AOD) use. This paper aims to understand AOD use before first and between terms in prison, among a group of Aboriginal men enrolled in a prison-based AOD treatment program. It examines opportunities for prevention or treatment that might interrupt the cycle of alcohol consumption, offending and imprisonment. METHODS A thematic analysis of in-depth interviews with 14 Aboriginal men in an urban prison. RESULTS Participants had low levels of formal education, none having completed high school and had spent limited or no time in the workforce. All 14 spoke of being negatively affected by AOD use within their families. First alcohol and cannabis use were around age 12-14 years, first amphetamines and/or heroin use was around age 15. As adults, they had unstable accommodation and when released from prison returned to the same situation they had been in previously. Most believed they would not have offended and subsequently imprisoned if they did not have a substance use disorder. DISCUSSION AND CONCLUSION Without further support post-prison, the men in this study are likely to return to the same situation and continue their AOD use. Further efforts are needed to support families with substance use disorders and to give young Aboriginal and Torres Strait Islander people better education and training opportunities.
Collapse
Affiliation(s)
- Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jill Guthrie
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Tony Butler
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Katherine Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Megan Williams
- National Centre for Cultural Competence and Sydney Institute of Criminology, The University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Gisev N, Bharat C, Larney S, Dobbins T, Weatherburn D, Hickman M, Farrell M, Degenhardt L. The effect of entry and retention in opioid agonist treatment on contact with the criminal justice system among opioid-dependent people: a retrospective cohort study. Lancet Public Health 2019; 4:e334-e342. [PMID: 31201133 PMCID: PMC6673674 DOI: 10.1016/s2468-2667(19)30060-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence on the effectiveness of opioid agonist treatment (OAT) in reducing crime is mixed. We aimed to assess the effect of OAT on crime in terms of delaying time to first charge and reducing overall charge rates, as well as the relationship between OAT retention and overall charge rates. METHODS We did a retrospective cohort study of opioid-dependent people who entered OAT for the first time between Jan 1, 2004, and Dec 30, 2010, in New South Wales (NSW), Australia. We used three linked NSW and national administrative datasets. Data on OAT were obtained from the Pharmaceutical Drugs of Addiction System, data on charges were obtained from the Reoffending Database, and data on mortality were obtained from the National Death Index. The cohort was followed up until Dec 31, 2011. Time-dependent OAT exposure was modelled using Cox proportional hazards models (time to first charge) and Andersen-Gill intensity models (total charge-days). Retention in OAT was modelled using two features of treatment engagement, number of OAT episodes and proportion of follow-up time in OAT (presented in quartile groupings: lowest, low-mid, low-high, highest) using zero-inflated negative binomial regression (total charges). All models were adjusted for sociodemographic, criminographic, and treatment-related variables. FINDINGS 10 744 new OAT entrants were included in the study. 5751 (53·5%) people were charged with an offence. In adjusted analyses, OAT was associated with an initial benefit in delaying the time to first charge (hazard ratio 0·43, 95% CI 0·33-0·55) and reducing total charge-days (0·39, 95% CI 0·30-0·52); however, these protective effects reduced over time. Total charge rates were higher as the number of OAT episodes increased (incident rate ratio [IRR] 1·13, 95% CI 1·11-1·15), and when relatively lower proportions of time were spent in OAT (IRR among the lowest three quartiles ranged from 1·11 [95% CI 1·02-1·21] to 1·22 [95% CI 1·12-1·33]). INTERPRETATION OAT was associated with a reduction in overall charge rates and was more protective as treatment engagement increased. Maximising treatment retention is crucial to achieving long-term health and social benefits of OAT. FUNDING Australian National Health and Medical Research Council, Australian Institute of Criminology, National Institute on Drug Abuse, Australian Government Department of Health, UNSW Sydney.
Collapse
Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Don Weatherburn
- New South Wales Bureau of Crime Statistics and Research, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australi
| |
Collapse
|
10
|
Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Seddon T, Millar T. Effect of initiating drug treatment on the risk of drug-related poisoning death and acquisitive crime among offending heroin users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 51:42-51. [PMID: 29156402 PMCID: PMC5788328 DOI: 10.1016/j.drugpo.2017.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/17/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND A recent Cochrane review of randomised trials identified a lack of evidence for interventions provided to drug-using offenders. We use routine data to address whether contact with treatment services reduces heroin users' likelihood of a future acquisitive offence or drug-related poisoning (DRP) death. METHODS Heroin-users were identified from probation assessments and linked to drug-treatment, mortality and offending records. The study cohort was selected to ensure that the subject was not: in prison, in treatment or had recently left treatment. Subjects were classed as initiators if they attended a triage appointment within two weeks of their assessment; non-initiators otherwise. Initiator and non-initiators were compared over a maximum of one year, with respect to their risk of recorded acquisitive offence or DRP-death. Balance was sought using propensity score matching and missing data were accounted for using multiple imputation. RESULTS Nine percent of assessments identified for analysis were classed as initiators. Accounting for observed confounding and missing data, there was a reduction in DRPs associated with initiator assessments, however there was uncertainty around this estimate such that a null-effect could not be ruled out (HR: 0.42, 95% CI 0.17-1.04). There was no evidence of a decrease in the recidivism risk, in fact the analysis showed a small increase (HR: 1.10, 95% CI 1.02-1.18). CONCLUSION For heroin-using offenders, initial contact with treatment services does not appear to reduce the likelihood of a future acquisitive offence.
Collapse
Affiliation(s)
- Matthias Pierce
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Sheila M Bird
- MRC Biostatistics Unit at University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
| | - John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Graham Dunn
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Tim Millar
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| |
Collapse
|
11
|
Pierce M, Hayhurst K, Bird SM, Hickman M, Seddon T, Dunn G, Millar T. Insights into the link between drug use and criminality: Lifetime offending of criminally-active opiate users. Drug Alcohol Depend 2017; 179:309-316. [PMID: 28837946 PMCID: PMC5608072 DOI: 10.1016/j.drugalcdep.2017.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND We test whether the offending trajectory of those who test positive for opiates is greater than test-negative controls and whether the relationship is constant both prior to, and post, opiate initiation. We consider whether these relationships differ according to gender and offence type. METHODS The study provides an analysis of historical offending records in adults linked to test results for opiate and cocaine metabolites. Those testing positive for opiates were linked to treatment records to retrieve data on age of opiate initiation. Rate ratios (RR) were calculated to compare opiate positive testers to opiate and cocaine negative controls, separately by gender and adjusting for age and birth cohort. Age of opiate initiation was included in a second model as a time-dependent variable. Within-subject clustering was accounted for using generalised estimating equations. RESULTS Opiate-positive cases had higher rates of offending than test-negative controls, both prior to, and post, opiate initiation. Initiation of opiate use increased the RR by 16% for males but doubled it for females. The RR increase in non-serious acquisitive crime was greater than that seen in serious crime. For males only, opiate initiation narrowed the difference in violent offending rate between cases and controls. A larger offending increase was associated with opiate initiation in female, compared to male, users. CONCLUSIONS For most crime categories, the difference between groups is exacerbated by opiate initiation. The findings indicate that opiate prevention initiatives might be effective in reducing offending, particularly among females.
Collapse
Affiliation(s)
- Matthias Pierce
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
| | - Karen Hayhurst
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
| | - Sheila M. Bird
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Toby Seddon
- School of Law, University of Manchester, 4.46A Williamson Building, Oxford Road, M13 9PL, UK.
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Jean McFarlane Building (First Floor), Oxford Road, M13 9PL, UK.
| | - Tim Millar
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Stimulant use disorders are significant contributors to the global burden of disease, with a growing impact on women. Psychosocial interventions are the gold standard for treating this condition, but several barriers may prevent women from accessing appropriate treatment. Therefore, we systematically reviewed the most recent findings about psychosocial interventions for stimulant use disorders, focussing on results relevant to women. RECENT FINDINGS Twenty-two eligible studies were identified. Psychosocial interventions in stimulant use disorders were examined in 17 recent studies, but no analyses for sex-related differences were performed. These aspects were investigated in further five studies, either through secondary analyses on the female subgroup or specifically examining a female-only sample. Contingency management, either alone or in combination with other interventions, provided the most positive results on several outcome measures. Only one pilot study showed good potential for an alternative approach of systemic family therapy, warranting further research in this direction. SUMMARY Research in stimulant use disorders shows an increasing interest in exploring interventions capable of addressing sex-specific issues. Combined therapy including contingency management and other treatments appears the most promising option, but larger secondary studies are needed to rank the efficacy of different psychosocial interventions while considering their feasibility and acceptability in specific subpopulations, including women.
Collapse
|
13
|
Pierce M, Dunn G, Millar T. Confounding in longitudinal studies in addiction treatment research. ADDICTION RESEARCH & THEORY 2017; 25:236-242. [PMID: 28392755 PMCID: PMC5360166 DOI: 10.1080/16066359.2016.1247812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 06/07/2023]
Abstract
Background: The effectiveness of treatment for people with substance use disorders is usually examined using longitudinal cohorts. In these studies, treatment is often considered as a time-varying exposure. The aim of this commentary is to examine confounding in this context, when the confounding variable is time-invariant and when it is time-varying. Method: Types of confounding are described with examples and illustrated using path diagrams. Simulations are used to demonstrate the direction of confounding bias and the extent that it is accounted for using standard regression adjustment techniques. Results: When the confounding variable is time invariant or time varying and not influenced by prior treatment, then standard adjustment techniques are adequate to control for confounding bias, provided that in the latter scenario the time-varying form of the variable is used. When the confounder is time varying and affected by prior treatment status (i.e. it is a mediator of treatment), then standard methods of adjustment result in inconsistency. Conclusions: In longitudinal cohorts where treatment exposure is time varying, confounding is an issue which should be considered, even if treatment exposure is initially randomized. In these studies, standard methods of adjustment may result be inadequate, even when all confounders have been identified. This occurs when the confounder is also a mediator of treatment. This is a likely scenario in many studies in addiction.
Collapse
Affiliation(s)
- Matthias Pierce
- Centre for Biostatistics, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUK
| | - Graham Dunn
- Centre for Biostatistics, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUK
| | - Tim Millar
- National Drug Evidence Centre, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUK
| |
Collapse
|
14
|
Hayhurst KP, Pierce M, Hickman M, Seddon T, Dunn G, Keane J, Millar T. Pathways through opiate use and offending: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 39:1-13. [PMID: 27770693 PMCID: PMC5234472 DOI: 10.1016/j.drugpo.2016.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/07/2016] [Accepted: 08/29/2016] [Indexed: 11/02/2022]
Abstract
BACKGROUND Although evidence points to a strong link between illicit drug use and crime, robust evidence for temporal order in the relationship is scant. We carried out a systematic review to assess the evidence for pathways through opiate/crack cocaine use and offending to determine temporal order. METHODS A systematic review sourced five databases, three online sources, bibliographies and citation mapping. Inclusion criteria were: focus on opiate/crack use, and offending; pre-drug use information; longitudinal design; corroborative official crime records. Rate ratios (RR) of post-drug use initiation to pre-drug use initiation were pooled using random effects meta-analysis. RESULTS 20 studies were included; UK (9) and US (11). All were of opiate use. Mean age at (recorded) offending onset (16.7yrs) preceded mean age at opiate-use onset (19.6yrs). Substantial heterogeneity (over 80%: unexplained by meta-regression) meant that RRs were not pooled. The RR for total (recorded) offending ranged from 0.71 to 25.7 (10 studies; 22 subsamples: positive association, 4: equivocal, 1: negative association). Positive associations were observed in 14/15 independent samples; unlikely to be a chance finding (sign test p=0.001). Individual offence types were examined: theft (RR 0.63-8.3, 13 subsamples: positive, 9: equivocal, 1 negative); burglary (RR 0.74-50.0, 9 subsamples: positive, 13: equivocal); violence (RR 0.39-16.0, 6 subsamples: positive, 15: equivocal); and robbery (RR 0.50-5.0, 5 subsamples: positive, 15: equivocal). CONCLUSIONS Available evidence suggests that onset-opiate use accelerates already-existing offending, particularly for theft. However, evidence is out of date, with studies characterised by heterogeneity and failure to use a matched non-opiate-user comparison group to better-establish whether onset-opiate use is associated with additional crime.
Collapse
Affiliation(s)
- Karen P Hayhurst
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester M13 9PL, UK.
| | - Matthias Pierce
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester M13 9PL, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Evaluation, School of Social and Community Medicine, The University of Bristol, Bristol BS8 2PS, UK
| | - Toby Seddon
- School of Law, The University of Manchester, Manchester M13 9PL, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK
| | - John Keane
- School of Computer Science and Manchester Institute of Biotechnology, The University of Manchester, Manchester M13 9PL, UK
| | - Tim Millar
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
15
|
Gao L, Dimitropoulou P, Robertson JR, McTaggart S, Bennie M, Bird SM. Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013. Drug Alcohol Depend 2016; 167:214-23. [PMID: 27593969 PMCID: PMC5047032 DOI: 10.1016/j.drugalcdep.2016.08.627] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 01/31/2023]
Abstract
AIM To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients. DESIGN Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013. SETTING Scotland's Prescribing Information System and National Records of Scotland. MEASUREMENTS Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression. FINDINGS Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5). CONCLUSION Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.
Collapse
Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, Cambridge CB2 0SR, United Kingdom
| | | | - J Roy Robertson
- Usher Institute of Population Health Sciences and Informatics, Edinburgh University, EDINBURGH EH16 4UX, United Kingdom
| | - Stuart McTaggart
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, United Kingdom
| | - Marion Bennie
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, United Kingdom; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
| | - Sheila M Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, United Kingdom; Department of Mathematics and Statistics, Strathclyde University, Glasgow G1 1XH, United Kingdom.
| |
Collapse
|