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Suchanecka A, Boroń A, Chmielowiec K, Strońska-Pluta A, Masiak J, Lachowicz M, Chmielowiec J, Janiszewska-Olszowska J, Grzywacz A. The HINT1 Gene rs2526303 Polymorphism and Its Association with Personality Traits in Cigarette Smokers. Int J Mol Sci 2024; 25:1218. [PMID: 38279213 PMCID: PMC10816865 DOI: 10.3390/ijms25021218] [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: 12/12/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
The development of a substance use disorder (SUD) is a multifaceted process influenced by both genetic and environmental factors. Recent research has suggested the potential involvement of the HINT1 gene in various aspects of plasticity, mood regulation, anxiety-like behaviour, and stress-coping mechanisms. Moreover, personality traits are also recognised to be instrumental in developing substance dependency. Given these considerations, our study investigated the associations among cigarette smoking, personality traits, and the rs2526303 polymorphism. Additionally, we investigated the interactions between personality traits and rs2526303 in the HINT1 gene. The study group comprised 531 volunteers: 375 cigarette users (mean age = 29.42 ± 10.72; F = 49%, M = 51%) and 156 never-smokers (mean age = 26.93 ± 10.09; F = 79%, M = 21%). Genotyping was conducted using the real-time PCR method, and the NEO Five-Factor Personality Inventory and State-Trait Anxiety Inventory were administered. There were no statistically significant differences in the frequency of rs2526303 genotypes and alleles in the cigarette user group compared to the control group. Compared to the control group, the cigarette users obtained higher scores in the assessment of the NEO-FFI Extraversion scale and lower results for the NEO-FFI Openness, Agreeableness, and Conscientiousness scales. Additionally, there was a statistically significant effect of rs2526303 genotype interaction and cigarette-using status on the conscientiousness scale. These outcomes collectively suggest a notable association between cigarette smoking and specific dimensions of personality, particularly highlighting differences in extraversion, openness, agreeableness, and conscientiousness. Furthermore, the detected interaction effect involving rs2526303 concerning conscientiousness signifies a complex interplay between genetic factors and smoking behaviour.
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Affiliation(s)
- Aleksandra Suchanecka
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (A.S.); (A.S.-P.)
| | - Agnieszka Boroń
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 St., 70-111 Szczecin, Poland;
| | - Krzysztof Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (K.C.); (J.C.)
| | - Aleksandra Strońska-Pluta
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (A.S.); (A.S.-P.)
| | - Jolanta Masiak
- Second Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, 1 Głuska St., 20-059 Lublin, Poland;
| | - Milena Lachowicz
- Department of Psychology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Jolanta Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (K.C.); (J.C.)
| | | | - Anna Grzywacz
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (A.S.); (A.S.-P.)
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Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ. Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023:15248380231205821. [PMID: 37920999 DOI: 10.1177/15248380231205821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.
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Villalba K, Domenico LH, Cook RL, O’Connor J, Michael-Samaroo K, Espejo MJDP, Martin P, Dévieux JG. Emotion regulation and cognitive function as mediating factors for the association between lifetime abuse and risky behaviors in women of color. PLoS One 2023; 18:e0279325. [PMID: 37903096 PMCID: PMC10615312 DOI: 10.1371/journal.pone.0279325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The relationship between lifetime abuse (i.e., childhood abuse, intimate partner violence) and risky behaviors is well established. One proposed mechanism is poor emotion regulation and executive functioning, as a potential mechanism that may explain the relationship between lifetime abuse and risky behaviors. However, research on executive functioning and emotion regulation as mediators of this relationship has been limited. In the present study, we examined this association. We hypothesized that lifetime abuse would be significantly associated with executive function and emotion regulation which in turn would be associated with greater alcohol use and risky sex. METHODS This cross-sectional study included 150 women with a history of lifetime abuse who were assessed for hazardous alcohol use using the AUDIT Score; emotion regulation was measured using the Difficulties with Emotion Regulation Scale (DERS); risky sex was measured using the question: "in the last 90 days, how many people did you have anal or vaginal sex without using a condom? Executive function was assessed using the NIH Toolbox. RESULTS The mediation model followed the self-regulation theory, which proposes executive function as the higher-order cognitive process. Results showed that executive function deficit and poor emotion regulation significantly mediated the relationship between lifetime abuse and hazardous alcohol use (indirect effect = .097, SE .031, 95% CI = .035 to .158). CONCLUSION Our findings suggest a higher-order cognitive process with executive function promoting emotion regulation as a potential mechanism for alcohol problems in women of color who experienced lifetime abuse.
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Affiliation(s)
- Karina Villalba
- College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Lisa H. Domenico
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Julia O’Connor
- School of Social Work, University of Central Florida, Orlando, Florida, United States of America
| | | | | | - Pilar Martin
- College of Nursing and Public Health, Adelphi University, Garden City, New York, United States of America
| | - Jessy G. Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, United States of America
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Andersen SL, Fishbein DH. Commentary: Improving the Effectiveness and Utility of the Helping to End Addiction Long-Term (HEAL) Prevention Cooperative: A Full Translational Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:111-118. [PMID: 36580206 PMCID: PMC9797884 DOI: 10.1007/s11121-022-01477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
The Helping to End Addiction Long-term (HEAL) Prevention Collaborative (HPC) is designed to expedite the development of programs aimed at preventing opioid misuse and opioid use disorder (OUD) in older adolescents and young adults (ages 16-30). Funded by the National Institutes of Health Office of the Director (ODP-NIH), the HPC includes ten outcome studies that focus on distinct interventions to determine their effectiveness and real-world applicability. Also included is a coordinating center at RTI International that supports the individual projects. This commentary highlights the scientific and practical significance of this cooperative and its promise for facilitating the production and implementation of successful interventions. Attributes such as novel program designs, advanced methodologies, addressing unique characteristics of diverse populations, and real-time analysis of data and costs make this cooperative highly innovative. We note, however, that papers in this Supplemental Issue did not specifically address the persistent need to obtain stronger effect sizes than those achieved to date. Existing data captured earlier in development (< 16 years of age) are uncovering interactive neurocognitive and social-contextual mechanisms underlying the phenomena we wish to prevent. HPC projects could be guided by this information to incorporate developmentally appropriate measures of mechanisms shown previously to be influential in targeted outcomes and determine how they are impacted by specific components of their interventions. This mechanistic information can provide a roadmap for constructing interventions that are more precision-based and, thus, more likely to yield greater benefits for a larger number of recipients. Furthermore, an understanding of underlying mechanism(s) promises to shed light on the sources of heterogeneity in outcomes for further intervention refinement. It is quite possible, if not probable, that meaningful measures of underlying processes will reveal subtypes-some with very high effect sizes and others that are much lower-directly enabling program refinements to more directly target mechanisms that portend and explain less favorable outcomes. Described herein is a full-spectrum translational approach which promises to significantly boost effect sizes, a key objective that should be reached prior to scaling.
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Affiliation(s)
- Susan L Andersen
- Harvard Medical School, Boston, MA, 02478, USA
- The National Prevention Science Coalition to Improve Lives, Oakland, CA, 94609, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina, 105 Smith Level Road, Chapel Hill, NC, 27599, USA.
- Human Development and Family Studies, The Pennsylvania State University, State College, PA, 16802, USA.
- The National Prevention Science Coalition to Improve Lives, Oakland, CA, 94609, USA.
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Walter ZC, Carlyle M, Kerswell N, Mefodeva V, Nixon RDV, Cobham VE, Hides L. Study protocol: implementing and evaluating a trauma-informed model of care in residential youth treatment for substance use disorders. Front Psychiatry 2023; 14:1169794. [PMID: 37840800 PMCID: PMC10572352 DOI: 10.3389/fpsyt.2023.1169794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Comorbidity between Substance Use Disorders and trauma/post-traumatic stress disorder (PTSD) is common, particularly within residential treatment services. Comorbidity is associated with poorer treatment retention and treatment outcomes. Integrated treatment approaches are increasingly recommended but are still under examined in residential treatment services. This study will implement and evaluate a novel model of trauma-informed care (TIC) in a youth (18-35 years) residential substance use treatment service. Methods and analysis A single-armed, phase 1 implementation trial will be conducted in one residential treatment service. The model, co-developed with staff, incorporates: (i) workforce development in TIC through staff training and clinical supervision; adaptions to the service (ii) policies, procedures, and physical settings and (iii) treatment program adaptions (in delivery style and content) to be more trauma-informed; (iv) client screening and feedback for trauma and PTSD at service entry; and (v) the provision of support, referral and/or trauma-focused therapy to those with PTSD. Service outcomes will include adherence to the TIC model and client treatment completion. Client substance use and mental health measures will be collected at service entry, and 1-, 3-, 6- and 12-months follow up. Staff outcomes, including workplace satisfaction, burnout, and fatigue, as well as perceptions and confidence in delivering TIC will be collected at baseline, and at 3-, 6-, 12- and 18-months following training in the model. The sustainability of the delivery of the TIC model of care will be evaluated for 12 months using service and staff outcomes. Ethics and dissemination The study has received ethical approval by the University of Queensland (Approval number: 2020000949). The results will be disseminated through publication in a peer-reviewed scientific journal, presentations at scientific conferences, and distributed via a report and presentations to the partner organization.Clinical trial registration: ACTRN12621000492853.
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Affiliation(s)
- Zoe C. Walter
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Molly Carlyle
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Nick Kerswell
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Valeriya Mefodeva
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Reg D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Vanessa E. Cobham
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Children’s Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
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Lee HY, Song J, Choi EY. Childhood abuse and opioid prescription use in adulthood: Differences between non-Hispanic Whites and non-Hispanic Blacks in the United States. PLoS One 2023; 18:e0291752. [PMID: 37733706 PMCID: PMC10513245 DOI: 10.1371/journal.pone.0291752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Despite the rapid rise in opioid prescription medication usage, little research has examined the role of early life adversity, such as childhood abuse, particularly in the context of race, in opioid prescription usage in adulthood. Guided by the life course perspective, the current study investigates whether experiencing childhood abuse increases the risk of opioid prescription use in adulthood and whether this association varies by race. Data were sourced from the second wave of the Midlife in the United States (MIDUS) study (2004-2005). The analytic sample consisted of two groups: non-Hispanic Whites (n = 714) and non-Hispanic Blacks (n = 151). Opioid prescription use was identified from the participants' medication list using the MULTUM Lexicon Drug Database Classification System. Three types of childhood abuse-emotional, physical, and sexual-were assessed via summary scales derived from the Childhood Trauma Questionnaire. The results indicate a significant interaction between childhood physical abuse and race. Among non-Hispanic Whites, higher exposure to physical abuse during childhood was associated with greater odds of opioid prescription use in adulthood, even after adjusting for chronic pain, physical and mental health, and sociodemographic characteristics. However, the association between childhood physical abuse and opioid prescription use in adulthood was non-significant among non-Hispanic Black individuals. These findings underscore the long-term adverse health effects of physical abuse in childhood, particularly for non-Hispanic Whites, and suggest support for developing and implementing tailored intervention strategies.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States of America
| | - Jieun Song
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Eun Young Choi
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States of America
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Winiker AK, Heidari O, Pollock S, Sodder S, Tobin K. Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder. Subst Use Misuse 2023; 58:1651-1659. [PMID: 37495397 PMCID: PMC10758239 DOI: 10.1080/10826084.2023.2238301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers' perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Omeid Heidari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sarah Pollock
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Shereen Sodder
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Compton MT, Zern A, Langlois S, Ashekun O. Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings. Community Ment Health J 2023; 59:363-369. [PMID: 35976478 DOI: 10.1007/s10597-022-01014-9] [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: 01/27/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023]
Abstract
Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, 722 W. 168th Street, Room R249, 10032, New York, NY, USA. .,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Belfrage A, Mjølhus Njå AL, Lunde S, Årstad J, Fodstad EC, Lid TG, Erga AH. Traumatic experiences and PTSD symptoms in substance use disorder: A comparison of recovered versus current users. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:61-75. [PMID: 36793481 PMCID: PMC9893129 DOI: 10.1177/14550725221122222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The aim of this study was to investigate the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD) in treatment-seeking individuals with ongoing substance use disorder (SUD) compared to individuals who have recovered from SUD. Methods: Patients with SUD recruited from the STAYER study (N = 114) underwent an examination of alcohol and drug use, childhood trauma, negative life events and PTSD symptomatology. In this study, only participants with 12-month concurrent polysubstance use was included. Using historical data from the STAYER study, alcohol and drug trajectories were dichotomised as (1) current SUD (current SUD) or (2) recovered from substance use disorder (recovered SUD). Crosstabs and chi-tests were used to measure differences between groups. Results: Childhood maltreatment, traumatic experiences later in life and symptoms of concurrent PTSD were highly prevalent in the study population. We found no significant difference between the current and recovered SUD groups. Recovered women reported a lower prevalence of physical neglect (p = 0.031), but a higher prevalence of multiple lifetime traumas (p = 0.019) compared to women with current SUD. Both women with current SUD and recovered women reported a significantly higher prevalence of sexual aggression than men (p < 0.001 and p < 0.001, respectively). In addition, men who have recovered from SUD reported a lower prevalence of PTSD symptoms over cut-off 38 (p = 0.017), of re-experiencing (p = 0.036) and of avoidance (p = 0.015), compared to recovered women. Conclusion: Reported trauma did not differ between persons with current SUD and those who had recovered from SUD. Gender differences discovered in this study indicate the importance of developing individualised and gender-specific treatment models for comorbid PTSD/SUD.
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Affiliation(s)
- Anna Belfrage
- Anna Belfrage, Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
| | | | | | | | - Elise Constance Fodstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; and Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Torgeir Gilje Lid
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; and Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Aleksander Hagen Erga
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; and Department of Biological and Medical Psychology, University of Bergen, Norway
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Fodstad EC, Ushakova A, Pallesen S, Hagen E, Erga AH, Erevik EK. Personality and substance use disorder: Characteristics as measured by NEO-personality inventory–revised. Front Psychol 2022; 13:982763. [PMID: 36420387 PMCID: PMC9676467 DOI: 10.3389/fpsyg.2022.982763] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
The present study investigates the personality characteristics of a cohort of patients with Substance Use Disorders. The included participants (n = 123) were recruited from specialized treatment for addictions in Norway. The personality scores in the current sample were compared to the Norwegian norm sample with t-tests. Age and gender differences in personality scores were assessed by bivariate correlation analyses and t-tests, respectively. The sample had higher scores on Neuroticism and lower scores on Conscientiousness, Agreeableness, Extraversion, and Openness compared to the norm sample (p < 0.01). The effect sizes of the differences between the current sample and the Norwegian norm sample were large for Neuroticism and Conscientiousness. Older participants scored higher on Agreeableness and its facets A1: Trust and A2: Straightforwardness and lower on the facet E5: Excitement-Seeking (p < 0.01). No significant (p < 0.01) gender differences in NEO-PI-R scores were found. In conclusion, the current results support previous findings regarding personality traits associated with SUD. The clinical relevance of the findings is discussed.
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Affiliation(s)
- Elise Constance Fodstad
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
- *Correspondence: Elise Constance Fodstad,
| | - Anastasia Ushakova
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Egon Hagen
- Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
| | - Aleksander Hagen Erga
- Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Eilin Kristine Erevik
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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Dunn KE, Turner GM, Oswald LM. Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety. J Addict Med 2022; 16:709-715. [PMID: 35914024 PMCID: PMC10834051 DOI: 10.1097/adm.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adverse childhood experiences, or early life trauma (ELT), may be a potential risk factor for opioid use disorders (OUDs) that could be further influenced by depression, anxiety, and stress. The prevalence and strength of these associations are largely unknown. METHODS This study examined the association between current OUD severity and lifetime history of ELT, and the degree to which current depression, anxiety, and stress influenced this association, in persons (n = 310) with at least 1 lifetime exposure to opioids using an online survey. RESULTS Ninety-three percent of respondents experienced at least 1 trauma in their lifetime, and 65% met the criteria for OUD. Early life trauma was largely unassociated with demographics but demonstrated an almost "dose-dependent" association among all forms of ELT (total, general, physical, emotional, sexual), whereby more ELT was associated with more severe current OUD. A multivariate mediation model found perceived stress to be a robust mediator of this association. Current psychiatric functioning did not significantly moderate the relationship between ELT and OUD, suggesting that ELT may impact OUD severity at varying levels of psychiatric functioning. CONCLUSIONS These data support existing evidence that greater ELT may influence adult OUD severity and identify perceived stress as a potential mechanistic contributor to this association. Results are preliminary in nature but support continued research into mechanisms underlying the association between ELT and OUD, particularly conformational changes in the stress system resultant from ELT, and interventions to mitigate the impact of ELT on OUD development and/or develop trauma-informed OUD treatment approaches.
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Affiliation(s)
- Kelly E Dunn
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (KED, GMT); and Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD (LMO)
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12
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Kors S, Kurdziel-Adams G, Towers C, Fortner K, Macfie J. Sexual Abuse as a Risk Factor for Opioid Misuse in Pregnancy. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:538-549. [PMID: 35395922 DOI: 10.1080/10538712.2022.2056104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to identify a potential relationship between childhood sexual abuse and opioid misuse in pregnancy and to illustrate the need for better integration and collaboration between the medical and psychological disciplines to combat the opioid crisis. We sampled 93 pregnant women at a high-risk pregnancy clinic within a university medical center who were in their second trimester or beyond. Fifty-five women were considered high-risk due to opioid misuse and 38 women were considered high-risk due to medical reasons other than drug use. Our findings reveal both presence of and severity of sexual abuse were significantly associated with opioid misuse in pregnancy, while physical abuse, emotional abuse, and neglect were not. While childhood sexual abuse is a significant risk factor for opioid misuse in pregnancy, most doctors do not feel comfortable asking about trauma history. A public health approach to opioid misuse in pregnancy must consider how "diseases of despair" disproportionately impact women with limited access to adequate psychological and medical care. A preventative model of care, which targets screenings for ACEs in primary care and gynecological visits may help decrease the impact of sexual abuse.
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Affiliation(s)
- Stephanie Kors
- Cambridge Health Alliance, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Craig Towers
- University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kimberly Fortner
- University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Jenny Macfie
- University of Tennessee, Knoxville, Tennessee, USA
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13
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Moore SK, Okst K, Smith L, Fatkin T, Creedon T, Fredericksen AK, Gawande R, Schuman-Olivier Z. "Today I Can Look in the Mirror and Like Myself": Effects of a Trauma-Informed Mindful Recovery Program on Self-Compassion. Front Psychol 2022; 13:780383. [PMID: 35719537 PMCID: PMC9201725 DOI: 10.3389/fpsyg.2022.780383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/19/2022] [Indexed: 01/28/2023] Open
Abstract
Background Opioid-related deaths continue to rise. Psychological trauma is commonly comorbid with Opioid Use Disorder (OUD). Adverse childhood experiences can disrupt the development of emotion regulation, increasing risk of substance use. Self-compassion may reduce OUD risk and outcomes by facilitating emotion regulation, decreasing the toxicity of shame, and reducing internalized stigma that can hinder recovery. Mindfulness practice enhances self-compassion. Methods This study is part of a pilot (N = 18) of the Mindful Recovery OUD Care Continuum (M-ROCC) during buprenorphine office-based opioid treatment (OBOT). The present study was conducted to gain a deeper understanding of the intervention’s effects on self-compassion development, and to explore differential changes in self-compassion during the intervention among participants with varying intensity of trauma exposure measured by high levels of childhood adversity (defined by 4+ adverse childhood experiences (ACEs) at baseline). We conducted secondary analyses of a subset of qualitative interview data (N = 11 unique participants) collected for the pilot study (weeks 4 and 24, 14 total interviews) to elaborate upon changes in Self-Compassion Scale (SCS-SF) scores. Results In the primary pilot study, participants’ mean SCS-SF scores shifted significantly from baseline to week 24, β = 0.22, p = 0.028. This change is elaborated upon through interviews. Despite pervasive challenges to becoming more self-compassionate (e.g., trauma histories and substance use), participants reported increased compassionate self-responding and decreased uncompassionate self-responding. Mindfulness training was identified as the primary mechanism underlying the shift. Kindness to self and others and—to a lesser extent an increased sense of common humanity—were also identified as key to overall self-compassion. Compared to those in the lower ACEs group, participants in the higher ACEs group tended to have lower baseline self-compassion scores (d = 1.09, p = 0.055). Conclusion M-ROCC may increase self-compassion among patients with OUD during OBOT by increasing compassionate, and decreasing uncompassionate, self-responding. Patients with OUD with greater childhood adversity tended to have lower levels of self-compassion, which improved with M-ROCC. Future trials with larger samples are needed to confirm these potential outcomes, mechanisms, and differential impacts between ACEs subgroups.
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Affiliation(s)
- Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Kayley Okst
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Lydia Smith
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Thomas Fatkin
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Timothy Creedon
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - A Kiera Fredericksen
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Richa Gawande
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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14
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Wu S, Lindstrom Johnson S, Wolfersteig W, Diaz MJ, Aguilar-Amaya M. The power of local research to inform adverse childhood experiences in substance use prevention in adolescents and adults. BMC Public Health 2022; 22:1197. [PMID: 35705922 PMCID: PMC9199124 DOI: 10.1186/s12889-022-13503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background The impact of adverse childhood experiences on substance use has been well reported, however, less well documented is looking at the comparison of youth and adult substance use and their respective adverse childhood experiences. This study leveraged local data sources to support prevention efforts inside a state-level working group and examined research questions that explored the relationship between reported adverse childhood experiences and substance use for youth and adult samples at the state level. Methods This study conducted a series of logistic regression models (95% CI) between substance use outcomes with different age group populations to investigate the relationship between adverse childhood experiences and substance use for each group. Adverse childhood experiences scores and substance use were examined using two Arizona datasets: 1) Arizona Youth Survey (n = 42,009) and 2) the Behavioral Risk Factor Surveillance System (n = 5328). Results The results of youth and adult datasets were consistent: users with adverse childhood experiences scores of 4 to 6 had a positive association with more substance use. When the variables were examined, showing the entire sample of youth and adult groups compared to those subgroups with a score of zero, a score of 1 to 3, and a score of 4 to 6, the overall pattern was the same; the more frequent use of substances was directly associated to the group with higher scores. Additionally, findings support increased attention on prevention and intervention efforts with higher reports of adverse childhood experiences as well as substance use. Conclusions These findings demonstrate how local research can help prioritize prevention resources and increase the value of data-based decision-making. Policy-makers and providers can examine youth and adult data to compare priorities and assess for planning purposes. Specifically, it is possible to replicate known research findings, identify the most impacted subpopulations, and forecast the community’s future needs.
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Affiliation(s)
- Shiyou Wu
- School of Social Work, Arizona State University, Phoenix, USA
| | | | - Wendy Wolfersteig
- School of Social Work, Arizona State University, Phoenix, USA. .,Southwest Interdisciplinary Research Center, Arizona State University, 400 E. Van Buren, Suite 800, Phoenix, AZ, 85004, USA.
| | - Marisol Juarez Diaz
- Southwest Interdisciplinary Research Center, Arizona State University, 400 E. Van Buren, Suite 800, Phoenix, AZ, 85004, USA
| | - Maria Aguilar-Amaya
- Southwest Interdisciplinary Research Center, Arizona State University, 400 E. Van Buren, Suite 800, Phoenix, AZ, 85004, USA
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15
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van Draanen J, Aneshensel CS. Parental and own substance use disorder: The intersection of gender and early adversity. Drug Alcohol Depend 2022; 234:109393. [PMID: 35338899 PMCID: PMC9018609 DOI: 10.1016/j.drugalcdep.2022.109393] [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: 06/15/2021] [Revised: 12/16/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children who are exposed to parental substance use disorder (SUD) have a higher risk of SUD themselves. This study examines the extent to which the association between parental and own SUD is conditional upon childhood trauma, socioeconomic status, and gender. METHODS This study uses data from the Nashville Stress and Health Study with 1234 respondents ages 25-65 collected from 2011 to 2014, weighted be representative of the general population. The association between parental SUD and own SUD was estimated using Cox Proportional Hazard Models, controlling for covariates, and testing for interactions. RESULTS Other things being equal, the risk of own SUD is more strongly associated with parental SUD in households with childhood traumas among men, but not women. Childhood trauma is not associated with own SUD in the absence of parental SUD among men. For men with parental SUD exposure, just one traumatic event is associated with a 38% increased risk of own SUD (HR=1.382, SE=.201, p < 0.05). For men, living with grandparents is associated with added SUD risk (HR=1.476, SE=.228, p < 0.05). For women, childhood trauma is not associated with own SUD, but parental SUD (HR=1.556, SE=.238, p < 0.01), and early onset mood or anxiety disorder (HR=1.682, SE=.316, p < 0.01) are. For both genders, those who are African American have lower risk of SUD than those who are White (HR=0.774, SE=.109, p < 0.05 for women; HR=0.672, SE=.079, p < 0.01 for men). CONCLUSIONS Parental SUD is associated with a substantial increase in risk for own SUD, and this association differs by gender and early trauma.
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Affiliation(s)
- Jenna van Draanen
- Department of Community Health Sciences, University of California, Los Angeles, 650 Charles E Young Drive S, Los Angeles, CA 90095, USA.
| | - Carol S. Aneshensel
- Department of Community Health Sciences, University of California, Los Angeles, 650 Charles E Young Drive S, Los Angeles, California, USA, 90095
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16
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Langlois S, Zern A, Kelley ME, Compton MT. Adversity in childhood/adolescence and premorbid tobacco, alcohol, and cannabis use among first-episode psychosis patients. Early Interv Psychiatry 2021; 15:1335-1342. [PMID: 33289325 DOI: 10.1111/eip.13086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/14/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022]
Abstract
AIM Premorbid substance use is widely recognized as a crucial factor in early psychosis. We explored the effects of childhood/adolescent adversity on premorbid tobacco, alcohol, and cannabis use. We hypothesized that adversity in childhood would be associated with an increased likelihood of use, and amount of intake, of tobacco, alcohol, and cannabis. We analysed which domains of adversity have the greatest impact. METHODS First-episode psychosis patients were enrolled from six inpatient psychiatric units in Atlanta, Georgia and Washington, D.C. Premorbid substance use was thoroughly measured, and childhood/adolescent adversity was rated using 14 scales/subscales. Factor analysis was used to reduce these scales/subscales to the three domains of adversity (termed Violence and Environmental Adversity, Interpersonal Abuse, and Neglect and Lack of Connectedness). Regression analyses determined associations between adversity domains and premorbid substance use. RESULTS Our sample (n = 247) primarily consisted of African Americans (86.2%) and males (74.5%). Violence and Environmental Adversity was significantly associated with five of six substance use variables and marginally associated with the sixth. Interpersonal Abuse was unassociated with substance use, and Neglect and Lack of Connectedness was associated only with a lower likelihood cannabis use. When Violence and Environmental Adversity results were stratified by gender, effects on tobacco use and amount of tobacco use were stronger among females. CONCLUSIONS Childhood/adolescent trauma and adversity have meaningful associations with premorbid substance use in first-episode psychosis patients. First-episode psychosis and clinical high-risk treatment settings may benefit from expanding the assessment of childhood/adolescent adversity to include factors pertaining to violence exposure and adversities beyond abuse and neglect.
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Affiliation(s)
| | - Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
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17
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Prevalence of Adverse Childhood Experiences of Parenting Women in Drug Treatment for Opioid Use Disorder. Community Ment Health J 2021; 57:872-879. [PMID: 32556861 DOI: 10.1007/s10597-020-00661-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Descriptive adverse childhood experience (ACE) prevalence data on parenting women seeking treatment for opioid use disorder (OUD) is limited, despite this group being one of the fastest growing sub-populations of the opioid epidemic. The aim of this study was to: (1) determine prevalence of ACEs) in a population of parenting women in treatment for OUD, (2) characterize ACEs, and (3) compare study ACE data to Pennsylvania Behavioral Risk Factor Surveillance System (PA BRFSS) to normalize study results. Between 2014 and 2018, ACEs were collected from parenting women (N = 152) enrolled in treatment for OUDs. Results showed on average women were 30.3 years of age (SD 4.6, range 22-41 years) non-Hispanic (87.0%), white (74.0%), and held a high school education or less (76.0%). The mean total ACE score was 4.3 (SD 2.3; range 0-8). Most women reported 4 ≥ ACEs (65.0%), while only 5.0% reported 0 ACEs. The current sample had higher mean ACE score (4.3 PSMDT vs. 1.4 PA BRFSS Data) than PA BRFSS Data. The burden of ACEs in parenting women in treatment for OUD is significant. Understanding the trauma parenting women in drug treatment have experienced, may support efforts to reduce stigma of this population. Public health intervention and policy work that is trauma proactive is needed to address this growing epidemic.
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18
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Johnson ME, Zaidi F. Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children. ADDICTION RESEARCH & THEORY 2021; 29:479-489. [PMID: 35035335 PMCID: PMC8758115 DOI: 10.1080/16066359.2021.1891414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 06/14/2023]
Abstract
AIM Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. METHODS A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. RESULTS Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. CONCLUSION Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.
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Affiliation(s)
- Micah E. Johnson
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Farwah Zaidi
- The Study of Teen Opioid Misuse and Prevention Laboratory, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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19
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Rogers AH, Zvolensky MJ, Ditre JW, Buckner JD, Asmundson GJG. Association of opioid misuse with anxiety and depression: A systematic review of the literature. Clin Psychol Rev 2021; 84:101978. [PMID: 33515811 DOI: 10.1016/j.cpr.2021.101978] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/14/2022]
Abstract
The opioid epidemic is a public health problem associated with a host of negative outcomes. Although clinicians recognize covariation between opioid misuse with anxiety and depressive symptoms and disorders, research on this topic has only recently accumulated. Progress in this domain is impeded by the lack of systematic and integrative research to better understand and treat these co-occurring problems. This paper represents the first attempt to systematically review the empirical literature examining relations between opioid use and misuse, and anxiety and depression. In the first section, we define key terms and describe the article selection strategy. In the second section, we review the prevalence of anxiety and depressive symptoms among individuals who use and misuse prescription and illicit opioids. In the third section, we review the magnitude of associations between anxiety and depressive symptoms and disorders with opioid misuse, as well as highlight studies examining the longitudinal and temporal sequence of the relations between these variables. In the fourth section, we focus on experimental therapeutics, reviewing what is known about individual difference and transdiagnostic vulnerability factors for anxiety and depression that might contribute to opioid misuse and its symptoms. Finally, we discuss current knowledge gaps and present a heuristic model to guide future research.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; HEALTH Institute, University of Houston, Houston, TX, United States.
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
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20
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Santo T, Campbell G, Gisev N, Tran LT, Colledge S, Di Tanna GL, Degenhardt L. Prevalence of childhood maltreatment among people with opioid use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 219:108459. [PMID: 33401031 PMCID: PMC7855829 DOI: 10.1016/j.drugalcdep.2020.108459] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Experience of childhood maltreatment (CM) is a risk factor for opioid use disorder (OUD). CM is also associated with comorbid mental disorders and poor treatment outcomes among people with OUD. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of CM among people with OUD. METHODS We searched MEDLINE, EMBASE, and PsycINFO to identify observational studies that evaluated CM among people with OUD from January 1990 to June 2020. Prevalence of each CM type, sample characteristics, and methodological factors were extracted from each eligible study. Random-effects meta-analyses were used to pool prevalence estimates. Stratified meta-analyses were used to assess heterogeneity. RESULTS Of the 6,438 publications identified, 113 studies reported quantitative CM data among people with OUD and 62 studies (k = 62; N = 21,871) were included in primary analyses. Among people with OUD, the estimated prevalence of sexual abuse was 41% (95% CI 36-47%; k = 38) among women and 16% (95% CI 12-20%; k = 25) among men. Among all people with OUD, prevalence estimates were 38% (95% CI 33-44%; k = 48) for physical abuse, 43% (95% CI 38-49%; k = 31) for emotional abuse, 38% (95% CI 30-46%; k = 17) for physical neglect, and 42% (95% CI 32-51%; k = 17) for emotional neglect. Sex, history of injecting drug use, recruitment methods, and method of assessing CM were associated with substantial heterogeneity. CONCLUSIONS People with OUD frequently report the experience of CM, supporting the need for trauma-informed interventions among this population. Future research should consider the impact of CM on OUD presentations and when assessment is appropriate, use of validated instruments.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia; School of Health and Sports Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, 4556, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW, 2042, Australia; Faculty of Medicine, UNSW Sydney, Wallace Wurth Building, 18 High Street, Kensington, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
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Austin AE, Short NA. Sexual Violence, Mental Health, and Prescription Opioid Use and Misuse. Am J Prev Med 2020; 59:818-827. [PMID: 33220753 DOI: 10.1016/j.amepre.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous research indicates that sexual violence is associated with prescription opioid use and misuse. However, this literature is limited by a lack of sex-specific analyses, an inability to establish temporality between experiences of sexual violence and prescription opioid outcomes, and little understanding of mechanisms underlying these associations. METHODS Data from Waves IV (2008) and V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (N=10,685) were analyzed in March 2020. The association of sexual violence with past 30-day prescription opioid use and misuse among women and men and mediation by depression and anxiety diagnoses were examined using generalized structural equation modeling. Temporality was established using self-reported age at the first experience of sexual violence and age at first depression and anxiety diagnoses. RESULTS Sexual violence was associated with an increased likelihood of prescription opioid use and misuse among women (OR=1.68, 95% CI=1.19, 2.39 for use; OR=1.18, 95% CI=0.95, 1.55 for misuse) and men (OR=2.37, 95% CI=1.37, 4.12 for use; OR=1.71, 95% CI=1.06, 2.75 for misuse). Among women, depression (p=0.0420) and anxiety (p=0.0450) diagnoses mediated the association with prescription opioid use, and anxiety diagnosis (p=0.0210) mediated the association with prescription opioid misuse. Among men, anxiety diagnosis (p=0.038) mediated the association with prescription opioid use, and depression diagnosis (p=0.0390) mediated the association with prescription opioid misuse. CONCLUSIONS Secondary prevention efforts focused on evidence-based, trauma-informed behavioral health treatment among survivors of sexual violence may prevent prescription opioid use and misuse as strategies for coping with the psychological impact of these traumatic experiences.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Nicole A Short
- Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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22
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Winstanley EL, Mahoney JJ, Lander LR, Berry JH, Marshalek P, Zheng W, Haut MW. Something to despair: Gender differences in adverse childhood experiences among rural patients. J Subst Abuse Treat 2020; 116:108056. [PMID: 32741501 DOI: 10.1016/j.jsat.2020.108056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 01/27/2023]
Abstract
Existing research has demonstrated that patients in treatment for an opioid use disorder (OUD) have high rates of adverse childhood experiences (ACE) compared to community-based samples. While research has documented important gender differences in ACEs in patients with OUD receiving treatment in urban areas, research has not shown whether these findings would generalize to rural and Appalachian areas, which are known to have lower ACE scores. We conducted a secondary analysis of existing clinical data, utilizing intake assessment data from a rural Appalachian outpatient buprenorphine program. We restricted the sample to patients with an OUD who presented for treatment between June 2018 and June 2019 (n = 173). The clinical intake assessment included a modified 17-item ACE instrument that patients self-administered. More than half (54.3%) of patients reported having experienced 4+ categories of adverse childhood experiences. On average, females endorsed 4.5 categories of adverse experiences, whereas males endorsed 3.3 (p < 0.00); female patients were significantly more likely to have experienced sexual abuse (42.4% versus 10.6%, p < 0.00). Alarmingly, 25.9% of females and 8.2% of males reported being forced to have sex before age 18. Disproportionately high rates of childhood adversities, particularly among females, may partially explain despair in rural Appalachian areas. OUD treatment programs should conduct clinical assessments of trauma and integrate trauma-informed care into drug treatment, especially for female patients residing in rural Appalachia.
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Affiliation(s)
- Erin L Winstanley
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - James J Mahoney
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Laura R Lander
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Wanhong Zheng
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Marc W Haut
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States; West Virginia University, School of Medicine, Department of Neurology, United States; West Virginia University, School of Medicine, Department of Radiology, United States
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Merrick MT, Ford DC, Haegerich TM, Simon T. Adverse Childhood Experiences Increase Risk for Prescription Opioid Misuse. J Prim Prev 2020; 41:139-152. [PMID: 31989435 PMCID: PMC10976456 DOI: 10.1007/s10935-020-00578-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The United States is in the midst of an opioid overdose epidemic, with a significant portion of the burden associated with prescription opioids. In response, the CDC released a Guideline for Prescribing Opioids for Chronic Pain, which promotes access to treatment for opioid use disorder. Decades of research have linked childhood adversity to negative health and risk behavior outcomes, including substance misuse. Our present study builds upon this work to examine the relationship between adverse childhood experiences (ACEs) and prescription opioid misuse. We compiled data from the Behavioral Risk Factor Surveillance System implemented by Montana and Florida in 2010 and 2011, respectively. Logistic regressions (run in 2017) tested the associations between ACEs and subsequent prescription pain medicine/opioid misuse outcomes in adulthood. ACEs were prevalent, with 62.7% of respondents in Montana and 50% in Florida reporting at least one ACE. The presence of ACEs was positively associated with prescription opioid misuse across both samples. Respondents reporting three or more ACEs had increased odds of taking opioids more than prescribed, without a prescription, and for the feeling they cause. Our results support a strong link between ACEs and prescription opioid misuse. Opportunities to prevent opioid misuse start with assuring safe, stable, nurturing relationships and environments in childhood and across the lifespan to prevent ACEs from occurring, and intervening appropriately when they do occur. Substance use prevention programs for adolescents, appropriate pain management and opioid prescribing protocols, and treatments for opioid use disorder can address ACEs by enhancing treatment safety and effectiveness and can reduce the intergenerational continuity of early adversity.
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Affiliation(s)
- Melissa T Merrick
- Division of Violence Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, NE (F64), Atlanta, GA, 30341-3724, USA.
| | - Derek C Ford
- Division of Violence Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, NE (F64), Atlanta, GA, 30341-3724, USA
| | - Tamara M Haegerich
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, NE (F62), Atlanta, GA, 30341-3724, USA
| | - Thomas Simon
- Division of Violence Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, NE (F64), Atlanta, GA, 30341-3724, USA
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Zvolensky MJ, Rogers AH, Shepherd JM, Vujanovic AA, Bakhshaie J. Anxiety sensitivity and opioid misuse and dependence among trauma-exposed adults with chronic pain. J Behav Med 2020; 43:174-184. [PMID: 32072365 DOI: 10.1007/s10865-020-00142-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
It is unclear if anxiety sensitivity may serve as mechanism underlying the relation between posttraumatic stress symptom severity and opioid misuse and dependence among trauma-exposed persons with chronic pain. Therefore, the current study evaluated the explanatory role of anxiety sensitivity in the relations between posttraumatic stress symptom severity and opioid misuse and dependence. Participants included 294 trauma-exposed adults with chronic pain (71.4% female, Mage = 37.79 years, SD = 10.85, Mpain rating = 7.32/10) that reported current moderate to severe chronic pain and prescription opioid use. Participants were recruited via an online national survey in the United States of America. There were statistically significant indirect effects of posttraumatic stress symptom severity via anxiety sensitivity in relation to opioid misuse and dependence. The indirect effects of the reverse models for opioid misuse and dependence also were significant and suggest the potential for bi-directional relations; however, the magnitude of the effect was smaller in the tests of specificity than in the original models. The present findings provide initial empirical evidence that greater posttraumatic stress symptom severity is related to anxiety sensitivity, which in turn, is associated with increased opioid misuse and dependence among trauma-exposed individuals with chronic pain.
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Affiliation(s)
- Michael J Zvolensky
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA.
- Department of Behavioral Sciences, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Andrew H Rogers
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Justin M Shepherd
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Anka A Vujanovic
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Jafar Bakhshaie
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
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Carlyle M, Rowley M, Stevens T, Karl A, Morgan CJA. Impaired empathy and increased anger following social exclusion in non-intoxicated opioid users. Psychopharmacology (Berl) 2020; 237:419-430. [PMID: 31686176 PMCID: PMC7018792 DOI: 10.1007/s00213-019-05378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE Social functioning is modulated by the endogenous opioid system. In opioid use disorder, social functioning appears disrupted, but little research has delineated the nature of these deficits and their relationship to acute opioid use. OBJECTIVES The current study aimed to assess both emotional and cognitive empathy, along with subjective and physiological responses to social exclusion in opioid users who were either acutely intoxicated or non-intoxicated from using opioids. METHODS Individuals on an opioid substitution medication (OSM) were divided into 'intoxicated users' (had taken their OSM the same day as testing, n = 20) and 'non-intoxicated users' (had taken their OSM > 12 h ago, n = 20) and compared with opioid-naïve controls (n = 24). Empathy was assessed using the multifaceted empathy test and self-report questionnaire. Participants also underwent a period of social exclusion (Cyberball Game) and completed measures of mood and physiological responses (salivary cortisol and heart rate). RESULTS Non-intoxicated users had significantly lower emotional empathy (the ability to experience others' emotions), as well as greater anger after social exclusion when compared with the intoxicated users and controls. Anger did not change with social exclusion in the intoxicated user group and cortisol levels were lower overall. CONCLUSIONS Reduced ability to spontaneously share the emotions of others was reported in non-intoxicated users, particularly regarding positive emotions. There was some support for the idea of hyperalgesia to social pain, but this was restricted to an enhanced anger response in non-intoxicated users. Equivalent rates of empathy between the intoxicated users and controls could indicate some remediating effects of acute opioids.
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Affiliation(s)
- Molly Carlyle
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
| | - Megan Rowley
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Tobias Stevens
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Anke Karl
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Celia J A Morgan
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
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Carlyle M, Rockliff H, Edwards R, Ene C, Karl A, Marsh B, Hartley L, Morgan CJ. Investigating the Feasibility of Brief Compassion Focused Therapy in Individuals in Treatment for Opioid Use Disorder. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819836726. [PMID: 31043786 PMCID: PMC6446438 DOI: 10.1177/1178221819836726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
Opioid use disorder (OUD) is reaching epidemic proportions worldwide, and is notoriously difficult to treat. Compassion focused therapy (CFT) has emerged as therapeutic tool for treating individuals exhibiting high levels of self-criticism and low self-esteem, both of which are common in OUD. Until now, however, there had been no research investigating this therapy in patients with OUD. Before running a premature clinical trial, it is important to fully assess the feasibility and acceptability of this treatment in this group of individuals. We aimed to assess the feasibility of CFT treatment in individuals with OUD in a short group intervention, which was co-created by the research team, service users and a local drugs service. The intervention involved three 2-hour sessions held over 3 weeks, where participants engaged in compassion-orientated psychoeducation and self-compassionate exercises. Individuals were randomly assigned to either the CFT group (n = 15), the active control (relaxation) group (n = 12) or the waitlist control group (n = 11). Of 103 individuals approached, 45% attended a baseline visit suggesting the treatment was acceptable to this group. A relatively low attrition rate across the 3 groups was found for CFT (21.1%), with no difference in drop-out between the groups. Qualitative analysis of interviews with participants identified a desire for more sessions. Compassion focused therapy was thus feasible and well-tolerated in those with OUD, and a further trial to evaluate any clinical differences may be warranted.
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Affiliation(s)
- Molly Carlyle
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK
| | - Helen Rockliff
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK
| | | | - Crina Ene
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK
| | - Anke Karl
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK
| | - Beth Marsh
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK.,Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Celia Ja Morgan
- Psychopharmacology and Addiction Research Centre (PARC), College of Life and Environmental Science, University of Exeter, Exeter, UK
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Crutchfield DA, Güss CD. Achievement Linked to Recovery from Addiction: Discussing Education, Vocation, and Non-Addict Identity. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1544058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel Alan Crutchfield
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
| | - C. Dominik Güss
- Department of Psychology, University of North Florida, Jacksonville, Florida, USA
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Ağaçhanlı R, Alnıak İ, Evren C. Sexual Dysfunctions are Predicted by Childhood Sexual Abuse in Women with Opioid Use Disorder. Subst Use Misuse 2018; 53:2184-2189. [PMID: 29671681 DOI: 10.1080/10826084.2018.1461228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Studies on sexual functioning of populations with substance use disorders (SUDs) are mostly conducted with male substance users. We have very limited information about the sexuality and related factors in women with opioid use disorder (OUD). OBJECTIVES We aimed to evaluate the relationship between childhood traumatic experiences (CTEs) and sexual dysfunctions (SDs) of women with OUD and to compare it with a sample of women who do not have SUD. METHODS Participants included 51 outpatient women with OUD who were on opioid maintenance treatment (OMT) with Buprenorphine/Naloxone and 48 women without SUD. Participants were evaluated by a semi-structured sociodemographic form, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS In women with OUD; CTQ-28, BDI, STAI, and GRISS scores were significantly higher. In the partial correlation analysis, sexual abuse was found to be significantly correlated with nonsensuality, avoidance and total GRISS score. In stepwise regression model, sexual abuse was found to predict SDs together with depression. CONCLUSIONS CTE, SD, depression, and anxiety rates were higher in the women with OUD. Especially childhood sexual abuse was associated with SDs in this group. Sexual abuse was predicting SDs together with depression. Further investigation of different characteristics of women with SUD may give an opportunity to clinicians to have a better understanding for adaptable treatment strategies.
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Affiliation(s)
- Ruken Ağaçhanlı
- a Department of Psychiatry , Ardahan State Hospital , Sugoze , Ardahan , Turkey
| | - İzgi Alnıak
- b Department of Alcohol and Drug Addiction Research, Treatment and Education Center (AMATEM), Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry , Neurology and Neurosurgery , Zuhuratbaba , Istanbul , Turkey
| | - Cuneyt Evren
- b Department of Alcohol and Drug Addiction Research, Treatment and Education Center (AMATEM), Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry , Neurology and Neurosurgery , Zuhuratbaba , Istanbul , Turkey
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Worley MJ, Isgro M, Heffner JL, Lee SY, Daniel BE, Anthenelli RM. Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial. Addict Behav 2018; 84:263-270. [PMID: 29763835 DOI: 10.1016/j.addbeh.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation. METHODS The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up. RESULTS Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day. CONCLUSIONS Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.
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Affiliation(s)
- Matthew J Worley
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States.
| | - Melodie Isgro
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., M3-B232, PO Box 19024, Seattle, WA 98109, United States
| | - Soo Yong Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Belinda E Daniel
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States
| | - Robert M Anthenelli
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
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Lei Y, Xi C, Li P, Luo M, Wang W, Pan S, Gao X, Xu Y, Huang G, Deng X, Guo L, Lu C. Association between childhood maltreatment and non-medical prescription opioid use among Chinese senior high school students: The moderating role of gender. J Affect Disord 2018; 235:421-427. [PMID: 29677607 DOI: 10.1016/j.jad.2018.04.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/16/2018] [Accepted: 04/07/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-medical prescription opioid use (NMPOU) and childhood maltreatment are currently serious problems among adolescents worldwide, and childhood maltreatment may be associated with the increased rates of NMPOU. This study examined the specific associations between particular types of childhood maltreatment and lifetime NMPOU and assessed whether gender has a moderating effect on these associations. METHODS A 3-stage, stratified cluster, randomized sampling method was used to collect data from 11,194 high school students in Chongqing. RESULT The prevalence of the lifetime NMPOU among senior high school students in Chongqing was 7.7%. Physical abuse (AOR = 1.11, 95% CI = 1.07-1.14), emotional abuse (AOR = 1.05, 95% CI = 1.03-1.08), sexual abuse (AOR = 1.04, 95% CI = 1.01-1.07), physical neglect (AOR = 1.06, 95% CI = 1.04-1.09), and emotional neglect (AOR = 1.03, 95% CI = 1.02-1.04) were all positively associated with lifetime NMPOU. The moderating effects of gender on emotional abuse (P = 0.004) and sexual abuse (P = 0.019) were statistically significant in the adjusted model of lifetime NMPOU. According to the stratification analyses in which the male and female students were analyzed separately, female students who previously experienced emotional/sexual abuse had a higher prevalence of lifetime NMPOU. LIMITATIONS The study sample only contained school students and cross-sectional design limited our ability to make causal inferences. CONCLUSION Childhood maltreatment was positively associated with lifetime NMPOU, and gender had a moderating effect on the associations between childhood maltreatment and lifetime NMPOU. Early identification of and intervention for childhood maltreatment victims, particularly female victims, may help reduce the lifetime risk of NMPOU.
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Affiliation(s)
- Yiling Lei
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chuhao Xi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pengsheng Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Min Luo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Siyuan Pan
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xue Gao
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Yan Xu
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Guoliang Huang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Xueqing Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Holloway JL, Pulido ML. Sexual Abuse Prevention Concept Knowledge: Low Income Children Are Learning but Still Lagging. JOURNAL OF CHILD SEXUAL ABUSE 2018; 27:642-662. [PMID: 30071184 PMCID: PMC6328251 DOI: 10.1080/10538712.2018.1496506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
School-based child sexual abuse (CSA) prevention programs have proliferated since beginning over 30 years ago. Research on program effectiveness has emphasized summative outcomes while under-reporting implementation and process fidelity, limiting reliable comparisons across programs and populations. External validity is further limited by racially and economically homogenous samples, or a failure to report such demographics. This article presents data from a CSA prevention program delivered to 2nd and 3rd grade public school children. A formative concept and item level analysis on the Children's Knowledge of Abuse Questionnaire at baseline and four week follow-up, as well as fidelity and implementation data, are reported. Results show that children learn and retain certain concepts, but vary widely in knowledge across items. This sample of low-income, minority children also show lower baseline and "learned" abuse prevention knowledge compared to published norms, which is not attributed to implementation variability. These data give critical insight into workshop effectiveness that is masked in summative reporting, yet essential to adapting and strengthening school-based CSA programs. Knowing the long-term consequences of adverse childhood experiences and disparate health outcomes linked to race and socioeconomic status, it is imperative to adequately assess CSA prevention program impact across diverse populations.
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Affiliation(s)
- Jacqueline L Holloway
- a The New York Society for the Prevention of Cruelty to Children , New York , NY , USA
| | - Mary L Pulido
- a The New York Society for the Prevention of Cruelty to Children , New York , NY , USA
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Kaag AM, Reneman L, Homberg J, van den Brink W, van Wingen GA. Enhanced Amygdala-Striatal Functional Connectivity during the Processing of Cocaine Cues in Male Cocaine Users with a History of Childhood Trauma. Front Psychiatry 2018; 9:70. [PMID: 29593581 PMCID: PMC5857536 DOI: 10.3389/fpsyt.2018.00070] [Citation(s) in RCA: 12] [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: 10/04/2017] [Accepted: 02/21/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Childhood trauma is associated with increased levels of anxiety later in life, an increased risk for the development of substance use disorders, and neurodevelopmental abnormalities in the amygdala and frontostriatal circuitry. The aim of this study was to investigate the (neurobiological) link among childhood trauma, state anxiety, and amygdala-frontostriatal activity in response to cocaine cues in regular cocaine users. METHODS In this study, we included 59 non-treatment seeking regular cocaine users and 58 non-drug using controls. Blood oxygenation level-dependent responses were measured using functional magnetic resonance imaging while subjects performed a cue reactivity paradigm with cocaine and neutral cues. Psychophysiological interaction analyses were applied to assess functional connectivity between the amygdala and other regions in the brain. Self-report questionnaires were used to measure childhood trauma, state anxiety, drug use, drug use severity, and craving. RESULTS Neural activation was increased during the presentation of cocaine cues, in a widespread network including the frontostriatal circuit and amygdala in cocaine users but not in controls. Functional coupling between the amygdala and medial prefrontal cortex was reduced in response to cocaine cues, in both cocaine users and controls, which was further diminished with increasing state anxiety. Importantly, amygdala-striatal connectivity was positively associated with childhood trauma in regular cocaine users, while there was a negative association in controls. At the behavioral level, state anxiety was positively associated with cocaine use severity and craving related to negative reinforcement. CONCLUSION Childhood trauma is associated with enhanced amygdala-striatal connectivity during cocaine cue reactivity in regular cocaine users, which may contribute to increased habit behavior and poorer cognitive control. While we cannot draw conclusions on causality, this study provides novel information on how childhood trauma may contribute to the development and persistence of cocaine use disorder.
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Affiliation(s)
- Anne Marije Kaag
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
- Departement of Psychiatry, Academic Medical Centre, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Liesbeth Reneman
- Departement of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Judith Homberg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Medical Centre, Nijmegen, Netherlands
| | - Wim van den Brink
- Departement of Psychiatry, Academic Medical Centre, Amsterdam, Netherlands
| | - Guido A. van Wingen
- Departement of Psychiatry, Academic Medical Centre, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
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Association of childhood abuse and prescription opioid use in early adulthood. Addict Behav 2018; 76:265-269. [PMID: 28869906 DOI: 10.1016/j.addbeh.2017.08.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/14/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous research has examined the association of childhood abuse with opioid misuse and dependence in adulthood. However, little research has focused specifically on prescription opioids, and no studies have examined associations with prescription opioid use, a potential pathway to later opioid misuse and dependence. The aim of the present study was to examine the association of childhood emotional, physical, and sexual abuse with prescription opioid use in early adulthood. METHODS We used data from Waves I (12-18years) and IV (24-32years) of the National Longitudinal Study of Adolescent to Adult Health. At Wave IV, respondents reported experiences of childhood abuse occurring prior to age 18years and prescription opioid use in the last four weeks. We conducted multivariable logistic regression to examine associations of childhood abuse with recent prescription opioid use. RESULTS In multivariable models adjusted for respondent sex, race/ethnicity, age, and socioeconomic status, childhood emotional abuse (OR=1.57, 95% CI 1.29, 1.90), physical abuse (OR=1.46, 95% CI 1.14, 1.87), and any childhood abuse (OR=1.51, 95% CI 1.24, 1.82) were significantly associated with recent prescription opioid use. CONCLUSIONS Given continued increases in prescription opioid use and opioid-related morbidity and mortality in the U.S., understanding upstream social and environmental factors associated with prescription opioid use is important to strengthening and expanding current prevention and intervention strategies. Future research is needed to examine factors potentially mediating the association between childhood abuse and prescription opioid use in order to provide additional insights for prevention and intervention efforts.
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Stein MD, Conti MT, Kenney S, Anderson BJ, Flori JN, Risi MM, Bailey GL. Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug Alcohol Depend 2017; 179:325-329. [PMID: 28841495 PMCID: PMC5599365 DOI: 10.1016/j.drugalcdep.2017.07.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Adverse childhood experiences are associated with the development of substance use disorders. With opioid use disorder, a growing concern in the United States, we were interested in examining the relationship between adverse experiences and three landmarks of opioid use: age of opioid initiation, injection drug use, and lifetime overdose. METHODS Between May and December 2015, we interviewed consecutive persons seeking inpatient opioid detoxification. Participants were asked about age of opioid initiation, last month injection drug use, and lifetime history of overdose, and completed the ten-item Adverse Childhood Experience (ACE) questionnaire. RESULTS Participants (n=457) averaged 32.2 (±8.64) years of age, 71.3% were male, and 82.5% were non-Hispanic White. The mean score on the ACE scale was 3.64 (±2.75). Mean age at time of initiating opioid use was 21.7 (±7.1) years, 68.7% had injected drugs within the past month, and 39.0% had overdosed. After adjusting for age, gender, and ethnicity, the ACE score was inversely associated with age of initiating opioid use (b=-0.50, 95% CI -0.70; -0.29, p<.001), and positively associated with recent injection drug use (OR=1.11, 95% CI 1.02; 1.20, p=0.014) and the likelihood of experiencing an overdose (OR=1.10, 95% CI 1.02; 1.20, p=0.015) in a graded dose response manner. CONCLUSION Greater adverse childhood experiences are associated with three landmarks of opioid use risk. ACE screening may be useful in identifying high-risk subsets of opioid-using populations.
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Affiliation(s)
- Michael D. Stein
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Boston University School of Public Health, Boston, MA 02118
| | - Micah T. Conti
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Shannon Kenney
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906, USA; Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
| | | | - Jessica N. Flori
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Megan M. Risi
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Genie L. Bailey
- Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720,Warren Alpert Medical School of Brown University, Providence, RI, 02912
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Murphy KD, Lambert S, McCarthy S, Sahm LJ, Byrne S. “You Don’t Feel”: The Experience of Youth Benzodiazepine Misuse in Ireland. J Psychoactive Drugs 2017; 50:121-128. [DOI: 10.1080/02791072.2017.1371365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kevin D. Murphy
- Post-Doctoral Researcher, School of Pharmacy, University College Cork, Cork, Ireland
| | - Sharon Lambert
- Lecturer, School of Applied Psychology, University College Cork, Cork, Ireland
| | - Suzanne McCarthy
- Lecturer in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura J. Sahm
- Senior Lecturer in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
- Consultant Pharmacist, Mercy University Hospital, Cork, Ireland
| | - Stephen Byrne
- Chair in Clinical Pharmacy, School of Pharmacy, University College Cork, Cork, Ireland
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36
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Mirhashem R, Allen HC, Adams ZW, van Stolk-Cooke K, Legrand A, Price M. The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems. Addict Behav 2017; 69:98-103. [PMID: 28219827 PMCID: PMC5384831 DOI: 10.1016/j.addbeh.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/12/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Abstract
A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and trauma-related psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity-particularly urgency-and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multi-faceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP.
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Affiliation(s)
- Rebecca Mirhashem
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Holley C Allen
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, United States
| | - Katherine van Stolk-Cooke
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Alison Legrand
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States.
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Darke S, Torok M, Ross J. Developmental trajectories to heroin dependence: Theoretical and clinical issues. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2017. [DOI: 10.1111/jasp.12434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney New South Wales 2052 Australia
| | - Michelle Torok
- Black Dog Institute; University of New South Wales; Sydney New South Wales 2052 Australia
| | - Joanne Ross
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney New South Wales 2052 Australia
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Wiet S. Origins of Addiction Predictably Embedded in Childhood Trauma: A Neurobiological Review. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Susie Wiet
- General, Child and Adolescent Psychiatrist, Addiction Medicine, Holistic Treament for Psychiatry Trauma Addiction, University of Utah-Adjunct Volunteer Faculty, Salt Lake City, UT, USA
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Kumar N, Stowe ZN, Han X, Mancino MJ. Impact of early childhood trauma on retention and phase advancement in an outpatient buprenorphine treatment program. Am J Addict 2016; 25:542-8. [DOI: 10.1111/ajad.12437] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/14/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nihit Kumar
- Department of Psychiatry; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Zachary N. Stowe
- Departments of Psychiatry, Obstetrics and Gynecology, and Pediatrics; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Xiaotong Han
- Department of Psychiatry; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Michael J. Mancino
- Department of Psychiatry; University of Arkansas for Medical Sciences; Little Rock Arkansas
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40
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Davis JL, Davies S, Wright DC, Falsetti S, Roitzsch JC. Simultaneous Treatment of Substance Abuse and Post-Traumatic Stress Disorder. Clin Case Stud 2016. [DOI: 10.1177/1534650103259745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The type and timing of treatment for comorbid substance abuse and victimization has been debated in the past decade. Arguments have been made for simultaneous treatment and consecutive treatment of each difficulty. Current issues and a case study in which both problems are treated simultaneously are presented. The patient received inpatient detoxification, inpatient and outpatient group counseling following the 12-step program, and a cognitive-behavioral-oriented outpatient group in the substance treatment component. Multiple Channel Exposure Therapy (MCET), a 12-week manualized treatment developed to treat individuals suffering from both post-traumatic stress disorder and panic disorder, was implemented in the victimization component. At postassessment and at follow-up, the patient no longer met criteria for any pretreatment diagnoses, and her alcohol dependence was in remission. Clinical implications and recommendations for the treatment of substance abuse and victimization are discussed.
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Abstract
PURPOSE Opioid-dependent pregnant women are characterized by drug use during pregnancy and deficits in knowledge of newborn care and feeding, and of child development. We assessed parenting skills and concerns among pregnant women in buprenorphine treatment for prescription opioid dependence. STUDY DESIGN AND METHODS We interviewed 32 pregnant women who received buprenorphine treatment for prescription opioid dependence in a primary care setting and administered questionnaires, including the Adult-Adolescent Parenting Inventory version 2 (AAPI-2) and Childhood Experience of Care and Abuse Questionnaire. RESULTS AAPI-2 scores revealed medium risk of abuse for all five scales: inappropriate expectations of the child, low level of empathy, strong belief in corporal punishment, reversal of parent-child roles, and oppression of children's power and independence. Primary concerns of participants were neonatal abstinence syndrome (NAS) and their child's health. Pregnant women who received buprenorphine for treatment of prescription opioid dependence showed a lack of appropriate parenting skills, but did not express concern about their ability to parent. CLINICAL IMPLICATIONS Our findings suggest a need for nurses to assist prescription opioid-dependent pregnant women in acquiring additional parenting skills, to refer for educational parenting intervention, and to educate patients about NAS.
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Banducci AN, Hoffman E, Lejuez C, Koenen KC. The relationship between child abuse and negative outcomes among substance users: psychopathology, health, and comorbidities. Addict Behav 2014; 39:1522-7. [PMID: 24976457 DOI: 10.1016/j.addbeh.2014.05.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adults with substance use disorders (SUDs) report higher rates of child abuse than adults without SUDs. Prior work suggests that this abuse is associated with higher rates of psychosis, posttraumatic stress disorder, physical health problems, alcohol dependence, and cannabis dependence among substance users. Little is known about other problems associated with child abuse experienced by substance users. We hypothesized that among adults with SUDs, child abuse would be associated with elevated rates of all Diagnostic and Statistical Manual (DSM-IV-TR) psychiatric disorders, substance dependencies, and comorbidities assessed. METHOD We assessed 280 inpatients in substance use treatment with the Structured Clinical Interview for the DSM-IV-TR, the Diagnostic Instrument for Personality Disorders, and Childhood Trauma Questionnaire (CTQ). We used chi-square and regression analyses to establish whether rates of psychiatric disorders, substance dependencies, and comorbidities differed as a function of child abuse. RESULTS Consistent with our hypotheses, higher scores on the CTQ were associated with elevated rates of psychiatric disorders (mood disorders, anxiety disorders, psychotic symptoms, and personality disorders) and substance dependencies (alcohol dependence and cocaine dependence). Moreover, higher rates of all comorbidity patterns (e.g. comorbid alcohol dependence and anxiety) were observed among individuals who reported experiencing child abuse. Across all substance dependencies examined, individuals who had been abused had significantly higher rates of all psychiatric disorders assessed. CONCLUSIONS Individuals with substance use disorders who have been abused have particularly elevated rates of psychiatric and substance use disorders as a function of their abuse experiences. These findings have important treatment implications for individuals in residential substance use treatment settings.
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Giordano GN, Ohlsson H, Kendler KS, Sundquist K, Sundquist J. Unexpected adverse childhood experiences and subsequent drug use disorder: a Swedish population study (1995-2011). Addiction 2014; 109:1119-27. [PMID: 24612271 PMCID: PMC4048632 DOI: 10.1111/add.12537] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/19/2014] [Accepted: 02/28/2014] [Indexed: 12/14/2022]
Abstract
AIMS Exposure to extraordinary traumatic experience is one acknowledged risk factor for drug use. We aim to analyse the influence of potentially life-changing childhood stressors, experienced second-hand, on later drug use disorder in a national population of Swedish adolescent and young adults (aged 15-26 years). DESIGN We performed Cox proportional hazard regression analyses, complemented with co-relative pair comparisons. SETTING Sweden. PARTICIPANTS All individuals in the Swedish population born 1984-95, who were registered in Sweden at the end of the calendar year that they turned 14 years of age. Our follow-up time (mean 6.2 years; range 11 years) started at the year they turned 15 and continued to December 2011 (n = 1,409,218). MEASUREMENTS Our outcome variable was drug use disorder, identified from medical, legal and pharmacy registry records. Childhood stressors, as per DSM-IV stressor criteria, include death of an immediate family member and second-hand experience of diagnoses of malignant cancer, serious accidental injury and victim of assault. Other covariates include parental divorce, familial psychological wellbeing and familial drug and alcohol use disorders. FINDINGS After adjustment for all considered confounders, individuals exposed to childhood stressors 'parental death' or 'parental assault' had more than twice the risk of drug use disorder than those who were not [hazard ratio (HR) = 2.63 (2.23-3.09) and 2.39 (2.06-2.79), respectively]. CONCLUSIONS Children aged under 15 years who experience second-hand an extraordinary traumatic event (such as a parent or sibling being assaulted, diagnosed with cancer or dying) appear to have approximately twice the risk of developing a drug use disorder than those who do not.
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Affiliation(s)
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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44
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Banducci AN, Hoffman EM, Lejuez CW, Koenen KC. The impact of childhood abuse on inpatient substance users: specific links with risky sex, aggression, and emotion dysregulation. CHILD ABUSE & NEGLECT 2014; 38:928-38. [PMID: 24521524 PMCID: PMC4065225 DOI: 10.1016/j.chiabu.2013.12.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/06/2013] [Accepted: 12/26/2013] [Indexed: 05/15/2023]
Abstract
Adults with substance use disorders (SUDs) report a high prevalence of childhood abuse. Research in the general population suggests specific types of abuse lead to particular negative outcomes; it is not known whether this pattern holds for adults with SUDs. We hypothesized that specific types of abuse would be associated with particular behavioral and emotional outcomes among substance users. That is, childhood sexual abuse would be associated with risky sex behaviors, childhood physical abuse with aggression, and childhood emotional abuse with emotion dysregulation. 280 inpatients (M age=43.3; 69.7% male; 88.4% African American) in substance use treatment completed the Childhood Trauma Questionnaire (CTQ), HIV Risk-Taking Behavior Scale, Addiction Severity Index, Difficulties with Emotion Regulation Scale (DERS), Distress Tolerance Scale (DTS), and Affect Intensity and Dimensions of Affiliation Motivation (AIM). Consistent with our hypotheses, the CTQ sexual abuse subscale uniquely predicted exchanging sex for cocaine and heroin, number of arrests for prostitution, engaging in unprotected sex with a casual partner during the prior year, and experiencing low sexual arousal when sober. The physical abuse subscale uniquely predicted number of arrests for assault and weapons offenses. The emotional abuse subscale uniquely predicted the DERS total score, AIM score, and DTS score. Among substance users, different types of abuse are uniquely associated with specific negative effects. Assessment of specific abuse types among substance users may be informative in treatment planning and relapse prevention.
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Affiliation(s)
- Anne N Banducci
- Center for Addictions, Personality, and Emotion Research, University of Maryland College Park, Department of Psychology, 1147 Biology Psychology Building, College Park, MD 20742, USA.
| | - Elana M Hoffman
- Center for Addictions, Personality, and Emotion Research, University of Maryland College Park, Department of Psychology, 1147 Biology Psychology Building, College Park, MD 20742, USA
| | - C W Lejuez
- Center for Addictions, Personality, and Emotion Research, University of Maryland College Park, Department of Psychology, 1147 Biology Psychology Building, College Park, MD 20742, USA
| | - Karestan C Koenen
- Columbia University Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 720G, New York, NY 10032, USA
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Lijffijt M, Hu K, Swann AC. Stress modulates illness-course of substance use disorders: a translational review. Front Psychiatry 2014; 5:83. [PMID: 25101007 PMCID: PMC4101973 DOI: 10.3389/fpsyt.2014.00083] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
Childhood trauma and post-childhood chronic/repeated stress could increase the risk of a substance use disorder by affecting five stages of addiction illness-course: (a) initial experimentation with substances; (b) shifting from experimental to regular use; (c) escalation from regular use to abuse or dependence; (d) motivation to quit; and (e) risk of (re-)lapse. We reviewed the human literature on relationships between stress and addiction illness-course. We explored per illness-course stage: (i) whether childhood trauma and post-childhood chronic/repeated stress have comparable effects and (ii) whether effects cut across classes of substances of abuse. We further discuss potential underlying mechanisms by which stressors may affect illness-course stages for which we relied on evidence from studies in animals and humans. Stress and substances of abuse both activate stress and dopaminergic motivation systems, and childhood trauma and post-childhood stressful events are more chronic and occur more frequently in people who use substances. Stressors increase risk to initiate early use potentially by affecting trait-like factors of risk-taking, decision making, and behavioral control. Stressors also accelerate transition to regular use potentially due to prior effects of stress on sensitization of dopaminergic motivation systems, cross-sensitizing with substances of abuse, especially in people with high trait impulsivity who are more prone to sensitization. Finally, stressors increase risk for abuse and dependence, attenuate motivation to quit, and increase relapse risk potentially by intensified sensitization of motivational systems, by a shift from positive to negative reinforcement due to sensitization of the amygdala by corticotropin releasing factor, and by increased sensitization of noradrenergic systems. Stress generally affects addiction illness-course across stressor types and across classes of substances of abuse.
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Affiliation(s)
- Marijn Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX , USA
| | - Kesong Hu
- Human Neuroscience Institute, Department of Human Development, Cornell University , Ithaca, NY , USA
| | - Alan C Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX , USA ; Mental Health Care Line, Michael E. DeBakey VA Medical Center , Houston, TX , USA
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Fuller-Thomson E, Sawyer JL. Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys. Child Care Health Dev 2014; 40:124-33. [PMID: 23278274 DOI: 10.1111/cch.12024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. METHODS Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. RESULTS A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. CONCLUSIONS Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies.
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Affiliation(s)
- E Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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47
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Fowler JC, Allen JG, Oldham JM, Frueh BC. Exposure to interpersonal trauma, attachment insecurity, and depression severity. J Affect Disord 2013; 149:313-8. [PMID: 23507367 DOI: 10.1016/j.jad.2013.01.045] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Exposure to traumatic events is a nonspecific risk factor for psychiatric symptoms including depression. The trauma-depression link finds support in numerous studies; however, explanatory mechanisms linking past trauma to current depressive symptoms are poorly understood. This study examines the role that attachment insecurity plays in mediating the relationship between prior exposure to trauma and current expression of depression severity. METHODS Past trauma and attachment anxiety and avoidance were assessed at baseline in a large cohort (N=705) of adults admitted to a specialized adult psychiatric hospital with typical lengths of stay ranging from 6 to 8 weeks. Depression severity was assessed at day 14 of treatment using the Beck Depression Inventory-II. RESULTS Interpersonal trauma (e.g., assaults, abuse) was correlated with depression severity, whereas exposure to impersonal trauma (e.g., natural disasters, accidents) was not. Adult attachment partially mediated the relationship between past interpersonal trauma and depression severity at day 14 among psychiatric inpatients. LIMITATIONS Measure of trauma exposure did not systematically differentiate the age of exposure or relationship to the perpetrator. Individuals scoring high on the self-report attachment measure may be prone to over-report interpersonal traumas. CONCLUSIONS Treatment of depression in traumatized patients should include an assessment of attachment insecurity and may be fruitful target for intervention.
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48
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Darke S. Pathways to heroin dependence: time to re-appraise self-medication. Addiction 2013; 108:659-67. [PMID: 23075121 DOI: 10.1111/j.1360-0443.2012.04001.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 03/06/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
The self-medication hypothesis emphasizes the role of distressing affect as the primary motivator for the compulsive use that leads to substance dependence. The model also postulates that there will be psychopharmacological specificity between symptom presentation and the primary drug of dependence. In this review, the self-medication hypothesis is examined in relation to the development and chronicity of heroin dependence. It is argued that if self-medication has a role in engendering and extending substance dependence, it should be apparent in the use of a drug that carries such overwhelming personal risk. The psychopathology seen among adult users is certainly consistent with the model. More importantly, however, are the extraordinarily high levels of childhood trauma and psychopathology that occur typically well before the initiation of heroin use. In contrast, the postulate of drug specificity appears less supported by the polydrug use patterns typical of heroin users, and does not appear to be a necessary corollary of the model.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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Peles E, Potik D, Schreiber S, Bloch M, Adelson M. Psychiatric comorbidity of patients on methadone maintenance treatment with a history of sexual abuse. Eur Neuropsychopharmacol 2012; 22:883-91. [PMID: 22564825 DOI: 10.1016/j.euroneuro.2012.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to assess the prevalence of a history of sexual abuse and its relation to psychiatric comorbidity among former opiate addicts currently on methadone maintenance treatment (MMT). We evaluated the history of sexual abuse and current clinical obsessive compulsive disorder (OCD), dissociative identity disorder (DID), and complex posttraumatic distress disorder (cPTSD), and administered the Life Events Inventory Questionnaire among 125 MMT patients (76 females and 49 males). Eighty (64%) patients had experienced sexual abuse, 69 (55.2%) met the criteria for clinical OCD, 20 (16.0%) for cPTSD and 13 (10.4%) for DID. More females had clinical OCD than males (63.2% vs. 42.9%, respectively, p=0.03). Sexually abused patients had higher rates of clinical OCD than their non-abused counterparts (67.5% vs. 33.3%, respectively, p<0.0005) and a higher mean number of negative life events (8.0±2.0 vs. 7.1±1.8, p=0.01). Sexually abused patients showed a trend towards a higher Dissociative Experiences Scale score (17.6±10.1 vs. 14.6±8.1, p=0.08) and rate of DID (13.8% vs. 4.4%, p=0.1), but no significant difference in the rate of cPTSD (17.5% vs. 13.3%, p=0.6) compared to non-abused subjects. The 80 sexually abused patients were mostly female (85%), and 57.5% of them were abused by a family member. In summary, more sexually abused MMT patients were diagnosed with clinical OCD and fewer with cPTSD and DID. Those with cPTSD were characterized by more negative life events, higher dissociation scores, and assaults by a family member. We conclude that sexually abused MMT patients should be screened for clinical OCD.
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Affiliation(s)
- Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Afifi TO, Henriksen CA, Asmundson GJG, Sareen J. Childhood maltreatment and substance use disorders among men and women in a nationally representative sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:677-86. [PMID: 23149283 DOI: 10.1177/070674371205701105] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample. METHOD Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders. RESULTS All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect. CONCLUSIONS This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.
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Affiliation(s)
- Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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