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Vogel M, Choi F, Westenberg JN, Cabanis M, Nikoo N, Nikoo M, Hwang SW, Somers J, Schütz CG, Krausz M. Chronic Pain among Individuals Experiencing Homelessness and Its Interdependence with Opioid and Other Substance Use and Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010005. [PMID: 35010263 PMCID: PMC8751035 DOI: 10.3390/ijerph19010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 05/14/2023]
Abstract
Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use and chronic pain parameters were assessed with the Maudsley Addiction Profile and purpose-designed short instruments. The sample comprised 828 participants. Mean age was 42.4 years and 54% reported chronic pain. In bivariate analysis, chronic pain was significantly associated with use of opioids and stimulants, daily substance use, polysubstance use and injecting as route of administration. In multivariate analysis, only daily substance use (OR: 1.46, 95% CI: 1.02-2.09) and injecting (OR: 1.81, 95% CI: 1.08-3.05) remained as significant associated factors, whereas neither use of opioids nor use of stimulants specifically were significantly associated with chronic pain. Among participants with chronic pain, daily substance users (50% vs. 22%, p < 0.001) and injectors (66% vs. 24%, p < 0.001) were more likely to use non-prescribed medication for pain. Participants with daily substance use were less likely to receive professional treatment (52% vs. 64%, p = 0.017) and prescribed pain medication (42% vs. 54%, p = 0.023). Our findings suggest an association of chronic pain with patterns related to severity of substance use rather than to specific substance use in homeless persons with mental illness. Interventions aiming at prevention and treatment of chronic pain in this population should consider severity of substance use and associated risk behavior over use of specific substances.
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Affiliation(s)
- Marc Vogel
- Psychiatric Services Thurgovia, Division of Substance Use Disorders, 8596 Münsterlingen, Switzerland
- Center for Addiction Disorder, University of Basel Psychiatric Clinics, 4002 Basel, Switzerland
- Correspondence: ; Tel.: +41-71-686-41-41
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Maurice Cabanis
- Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Nooshin Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
| | - Julian Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V5A 1S6, Canada;
| | - Christian G. Schütz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, BC V6Z IY6, Canada
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Agency, Vancouver, BC V5Z 4H4, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, BC V6Z IY6, Canada
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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Yaghubi M, Abdekhoda M, Khani S. Effectiveness of Religious-Spiritual Group Therapy on Spiritual Health and Quality of Life in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 11:156-164. [PMID: 31839913 PMCID: PMC6904977 DOI: 10.22122/ahj.v11i3.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Spirituality is one of the most important factors that can contribute to the recovery of substance use disorder (SUD). The objective of this study is to evaluate the efficacy of the religious-spiritual group therapy on the spiritual health and the quality of life in methadone-treated patients. Methods This study was carried out in Qom City, Iran, in 2018. 72 methadone-treated patients were randomly selected and assigned in two groups: the experimental group (which received religious-spiritual therapy) and control group (which received no treatment). At the beginning of the study (pre-test), eight weeks after the start of the study (post-test), and three months after the start of the study (follow-up test), all participants completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Spiritual Well-Being Scale (SWBS). Participants in the experimental group received 8 sessions (90 minutes for each session) of spiritual and religious training, while the control group received no religious-spiritual intervention; it just was trained with general information on addiction. Data were analyzed using SPSS software and descriptive and inferential statistics methods. Findings The results of repeated measures analysis of variance (ANOVA) showed that there was no significant difference between the intervention and control groups in the pretest, but religious-spiritual training significantly increased spiritual health and the patients' quality of life (P < 0.001). Conclusion Religious-spiritual education can improve the quality of life and spiritual well-being in methadone-treated patients. The findings suggest that religious -spiritual education can be considered as an inexpensive, accessible, useful, and effective treatment for SUD treatment.
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Affiliation(s)
- Mehdi Yaghubi
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Samira Khani
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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Bogdanowicz KM, Stewart R, Broadbent M, Hatch SL, Hotopf M, Strang J, Hayes RD. Double trouble: Psychiatric comorbidity and opioid addiction-all-cause and cause-specific mortality. Drug Alcohol Depend 2015; 148:85-92. [PMID: 25578253 DOI: 10.1016/j.drugalcdep.2014.12.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/29/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Opioid misusers have recognized high mortality but the influence of psychiatric comorbidity in excess cause-specific mortality is unclear. METHODS Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Standard mortality ratios were calculated to compare mortality risk with the general population. Cox and competing risk regression models were used to investigate the effect of psychiatric comorbidity and psychological health on all-cause and cause-specific mortality (respectively) in OUD patients. RESULTS Of 4837 OUD patients, 176 had died. Mortality rates were substantially higher than the general population (SMR 4.23; 95%CI 3.63-4.90). Among those with OUD, comorbid personality disorder (PD) and comorbid alcohol use disorder (AUD) was associated with increased all-cause mortality in all models, including the fully adjusted model, controlling for socio-demographic factors, severity of drug use, risk behaviours and physical health (HR2.15, 95%CI 1.17-3.95; HR2.28, 95%CI 1.54-3.36). AUD was associated with increased risk of fatal overdose (HR2.57, 95%CI 1.26-5.26) and hepatic-related deaths (HR7.26, 95%CI 2.79-18.86). Individuals with OUD and comorbid PD had almost four times greater risk of liver related deaths compared to those without PD (HR3.76, 95%CI 1.21-11.74). Comorbid severe mental illness and poor psychological health were not associated with increased mortality. CONCLUSIONS This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify individuals at substantially elevated mortality risk to enable a more personalized approach to their medical care.
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Affiliation(s)
| | - Robert Stewart
- King's College London, Institute of Psychiatry, London SE5 8AF, UK
| | | | - Stephani L Hatch
- King's College London, Institute of Psychiatry, London SE5 8AF, UK
| | - Matthew Hotopf
- King's College London, Institute of Psychiatry, London SE5 8AF, UK
| | - John Strang
- King's College London, Institute of Psychiatry, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Richard D Hayes
- King's College London, Institute of Psychiatry, London SE5 8AF, UK.
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Fatséas M, Denis C, Lavie E, Auriacombe M. Relationship between anxiety disorders and opiate dependence--a systematic review of the literature: implications for diagnosis and treatment. J Subst Abuse Treat 2010; 38:220-30. [PMID: 20116963 DOI: 10.1016/j.jsat.2009.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 12/15/2009] [Accepted: 12/31/2009] [Indexed: 10/19/2022]
Abstract
Our objective was to evaluate the prevalence and temporal sequence of co-occurrence of anxiety disorders with opiate dependence in order to better define the relationship between these two disorders and to improve diagnosis and treatment. The search used Medline and Toxibase up to January 1, 2009, and was based on a systematic review method. Eighteen studies were found. Prevalence of anxiety disorders assessed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria was high in opiate-dependent treated persons (lifetime prevalence ranged from 26% to 35%). Among anxiety disorders, phobic disorders have been shown to often precede the onset of opiate dependence. The identification of substance-induced versus independent anxiety disorder has important treatment implication. The monitoring of anxiety symptoms after several weeks of abstinence may allow physicians to determine the relationship between dependence and anxiety and make a reliable diagnosis of any initial anxious disorder. Specific management of anxiety disorder may then be used.
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Affiliation(s)
- Melina Fatséas
- Laboratoire de Psychiatrie and EA 4139, Université Victor Segalen Bordeaux 2, INSERM-IFR-99, Bordeaux, France (EU)
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Rhodes T, Lilly R, Fernández C, Giorgino E, Kemmesis UE, Ossebaard HC, Lalam N, Faasen I, Spannow KE. Risk factors associated with drug use: the importance of ‘risk environment’. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000077733] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Astals M, Domingo-Salvany A, Buenaventura CC, Tato J, Vazquez JM, Martín-Santos R, Torrens M. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst Use Misuse 2008; 43:612-32. [PMID: 18393080 DOI: 10.1080/10826080701204813] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 189 opioid-dependent subjects on methadone maintenance treatment in Barcelona (Spain), we assessed the prevalence of co-occurrence substance use and non-substance-use disorders (dual diagnosis) by the Psychiatric Research Interview for Substance and Mental Disorders [PRISM], and the impact on quality of life (HRQoL) by the SF-12 (PCS-12 and MCS-12 scales). Rates of substance and non-substance-use diagnoses were 59% and 32%, respectively. Mean scores for PCS-12 and MCS-12 were 44.1+/-10.1 and 39.9+/-11.7, without differences by presence or absence of dual diagnosis. Heroin users on methadone treatment showed a high prevalence of dual diagnosis and a very impaired HRQoL.
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Affiliation(s)
- Mònica Astals
- Department of Psychiatry and Drug Abuse and Psychiatric Research Group, Hospital del Mar (IAPS) and Institut Municipal d'Investigació Mèdica (IMIM), and Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
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Karow A, Verthein U, Krausz M, Schafer I. Association of personality disorders, family conflicts and treatment with quality of life in opiate addiction. Eur Addict Res 2008; 14:38-46. [PMID: 18182771 DOI: 10.1159/000110409] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The purpose of this study was to investigate the association of the current status and longitudinal changes in different clinical and social variables with quality of life (QOL) in opiate addiction. Our hypotheses were that drug use, comorbid personality disorders and social problems are associated with worse QOL. METHODS 107 participants with long-term opiate addiction were included and interviewed at entry with the Europ-ASI and the PDQ-R. QOL (SF-36) and changes in different domains of the Europ-ASI were assessed after 2 years. RESULTS Personality disorders, interpersonal conflicts with the family or partner and ongoing need for somatic and psychiatric treatment were significantly associated with worse subjective QOL, whereas changes in drug and alcohol use, the economic situation, legal problems and social problems with persons outside of the family showed no relevant association with QOL. CONCLUSION Our results provide support for an emphasis in treatment on helping clients to reduce intra- and interpersonal conflicts according to comorbid conditions and among family members and partnerships. In addition, the present data provide further support for the advantages of extended interventions in long-term opiate addiction.
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Affiliation(s)
- A Karow
- Department of Psychiatry und Psychotherapy, University Hospital Hamburg Eppendorf, Hamburg, Germany.
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Westermeyer J. Comorbid schizophrenia and substance abuse: a review of epidemiology and course. Am J Addict 2007; 15:345-55. [PMID: 16966190 DOI: 10.1080/10550490600860114] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Over the last dozen years, our knowledge regarding comorbid schizophrenia (SCZ) and substance use disorder (SUD) has evolved in several ways. First, the rate of lifetime comorbid SCZ-SUD appears to have increased another 20-30%, so now about 70-80% of persons with SCZ have lifetime SUD. Second, early remission of SUD has become commonplace among patients with SCZ, perhaps outnumbering the number of SCZ-only patients as well as those with active SCZ-SUD. Third, sustained SUD remission is well demonstrated, though the rates may yet be low. Fourth, research on comorbid SCZ-SUD is filling out our knowledge in many areas, including the characteristics of SCZ patients at risk for SUD, reasons SCZ patients seek out substances, effects of various substances on SCZ course and symptoms, and obstacles to SUD recovery in people with SCZ. The influence of SUD treatment and self-help on epidemiology and course has not been adequately evaluated. Primary prevention and early treatment of SUD in SCZ patients are still relatively neglected, though they offer our greatest hope for enhancing the lives of people with SCZ and improving the cost efficacy of care.
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Affiliation(s)
- Joseph Westermeyer
- Department of Psychiatry, Minneapolis VAMC, Minneapolis, Minnesota 55417, USA.
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Nocon A, Bergé D, Astals M, Martín-Santos R, Torrens M. Dual diagnosis in an inpatient drug-abuse detoxification unit. Eur Addict Res 2007; 13:192-200. [PMID: 17851240 DOI: 10.1159/000104881] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In Spain, detoxification in general hospitals plays an important role in the medical care of patients. We aim to provide clinicians with information on the prevalence and correlates of psychiatric co-morbidity in drug abusers in detoxification. A sample of 115 substance-abuse inpatients (mean age 31.9 +/- 6.4 years) in a Detoxification Unit of a general university hospital was studied using the Spanish version of the PRISM. Most of the patients had multiple dependence diagnoses and co-morbid axis I or axis II psychiatric disorders. Patients with dual diagnosis showed lower psychosocial functioning than patients without co-morbidity and more dependence diagnoses due to cannabis and sedatives. A total of 80% of the patients successfully completed the detoxification process. The present results enhance the value of detoxification in a general hospital as a first step of the overall treatment strategy.
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Affiliation(s)
- Agnes Nocon
- Department of Psychiatry, Hospital del Mar, Barcelona, Spain
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Landheim AS, Bakken K, Vaglum P. Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry 2006; 6:44. [PMID: 17054775 PMCID: PMC1626456 DOI: 10.1186/1471-244x-6-44] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 10/20/2006] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Most help-seeking substance abusers have comorbid psychiatric disorders. The importance of such disorders for the long-term course of substance abuse is, however, still unclear. The aim of this paper is to describe six-year outcomes regarding death and relapse among alcoholics and poly-substance abusers and to analyse the predictive value of lifetime psychiatric disorders on relapse. METHODS A consecutive sample of substance-dependent patients who received treatment in two counties in Norway (n = 287) was followed up after approximately six years. Information on socio-demographics, Axis I (CIDI) and II disorders (MCMI-II) and mental distress (HSCL-25) was gathered at baseline. At follow-up, detailed information regarding socio-demographics, use of substances (AUDIT and DUDIT) and mental distress (HSCL-25) was recorded (response rate: 63%). RESULTS At six-year follow-up, 11% had died, most often male alcoholics (18%). Among the surviving patients, 70% had drug or alcohol related problems the year prior to follow-up. These patients were, classified as "relapsers". There were no significant differences in the relapse rate between women and men and among poly-substance abusers and alcoholics. The relapsers had an earlier onset of a substance use disorder, and more frequently major depression and agoraphobia. Multivariate analysis indicated that both psychiatric disorders (major depression) and substance use factors (early onset of a substance use disorder) were independent predictors of relapse. CONCLUSION For reducing the risk of long-term relapse, assessment and treatment of major depression (and agoraphobia) are important. In addition, we are in need of a comprehensive treatment and rehabilitation program that also focuses on the addictive behaviour.
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Affiliation(s)
- Anne Signe Landheim
- Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway
| | - Kjell Bakken
- Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
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Fischer B, Cruz MF, Rehm J. Illicit opioid use and its key characteristics: a select overview and evidence from a Canadian multisite cohort of illicit opioid users (OPICAN). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:624-34. [PMID: 17052030 DOI: 10.1177/070674370605101002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). METHOD We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n=679) was collected in 2002. RESULTS Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in CONCLUSIONS Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.
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Affiliation(s)
- Benedikt Fischer
- Public Health and Policy Unit, Centre for Addictions Research of British Columbia, Victoria.
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Rodríguez-Llera MC, Domingo-Salvany A, Brugal MT, Silva TC, Sánchez-Niubó A, Torrens M. Psychiatric comorbidity in young heroin users. Drug Alcohol Depend 2006; 84:48-55. [PMID: 16388919 DOI: 10.1016/j.drugalcdep.2005.11.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 11/28/2005] [Accepted: 11/30/2005] [Indexed: 11/25/2022]
Abstract
In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.
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Affiliation(s)
- M C Rodríguez-Llera
- Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain
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Bäwert A, Fischer G. Addiction – who is not affected? Wien Med Wochenschr 2005; 155:549-61. [PMID: 16425010 DOI: 10.1007/s10354-005-0232-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2004] [Accepted: 10/11/2005] [Indexed: 10/25/2022]
Abstract
Addiction and addiction-related behaviour increased during the past decades. Several substances with psychoactive attributes, like opioids, cocaine or alcohol, can lead to dependence with physical and/or mental symptoms. In addition to substance-related addiction, non-substance-related dependence requires special attention. Increasing numbers of workaholics and patients suffering from internet-addiction, gambling or eating-disorders can be observed. To meet international treatment standards for addiction, diversification of therapy is necessary and, additionally, gender-related aspects in development and treatment of dependence and addiction-related behaviour are essential for state-of-the-art therapy of this patient population.
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MESH Headings
- Behavior, Addictive/complications
- Behavior, Addictive/diagnosis
- Behavior, Addictive/psychology
- Behavior, Addictive/therapy
- Disruptive, Impulse Control, and Conduct Disorders/complications
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/psychology
- Disruptive, Impulse Control, and Conduct Disorders/therapy
- Humans
- Mental Disorders/complications
- Mental Disorders/diagnosis
- Mental Disorders/psychology
- Mental Disorders/therapy
- Practice Guidelines as Topic
- Practice Patterns, Physicians'/trends
- Psychotherapy/methods
- Psychotherapy/trends
- Substance-Related Disorders/complications
- Substance-Related Disorders/diagnosis
- Substance-Related Disorders/psychology
- Substance-Related Disorders/therapy
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Affiliation(s)
- Andjela Bäwert
- Universitätsklinik für Psychiatrie, Medizinische Universität Wien, Wien, Austria.
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Modestin J, Matutat B, Würmle O. Two types of classification for male opioid dependence: identification of an opioid addict with depressive features. Eur Arch Psychiatry Clin Neurosci 2005; 255:419-27. [PMID: 15868066 DOI: 10.1007/s00406-005-0592-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 03/01/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There are similarities between alcoholics and opioid addicts and an overlap between both diagnostic groups. We tested the hypothesis that the type I and II classification, well established in male alcoholism, could also be relevant in a population of male opioid addicts. METHODS A sample of 100 hospitalized adult opioid dependent men were studied with the help of an extended semi-structured clinical interview, considering four classification criteria sets devised by Cloninger et al. (1981, 1982), von Knorring et al. (1985, 1987), Buydens-Branchey et al. (1989) and Babor et al. (1992). RESULTS The two types of classification could be confirmed with all four criteria sets. In at least three of four analyses, 52 patients were allocated to the same larger cluster C1, and 25 patients to a smaller cluster C2. These two groups were compared with each other with the help of the stepwise discriminant analysis. Seven variables were identified which excellently discriminate between the groups: The C2 patient is younger, has a history of therapy because of depression and a history of severe suicide attempts, also abuses benzodiazepines and becomes violent while intoxicated. His father suffers from alcoholism and received treatment because of depression. The C1 patient lacks these characteristics. CONCLUSIONS The hypothesis was confirmed, showing that the two types of classification for male opioid addicts is feasible. A depressive type of male opioid dependent patient was identified. Early identification of patients of this type is clinically important.
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Affiliation(s)
- J Modestin
- University of Zurich, Department of Psychiatry, Burghölzli Hospital, Lenggstrasse 31, 8029, Zurich, Switzerland.
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Encrenaz G, Rondeau V, Messiah A, Auriacombe M. Examining the influence of drop-outs in a follow-up of maintained opiate users. Drug Alcohol Depend 2005; 79:303-10. [PMID: 16102374 DOI: 10.1016/j.drugalcdep.2005.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 01/21/2005] [Accepted: 01/25/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In most longitudinal studies of problem opiate users, drop-outs are frequent, but not taken into account. However, missing data can induce important bias in parameters estimates. OBJECTIVE The aim of this study was to examine the influence of drop-outs in the statistical analysis of a follow-up of opiate users in maintenance treatment. METHODS Participants were 519 patients who had sought maintenance treatment between 1994 and 2001. Drug use was studied using the drug composite score of the Addiction Severity Index. A classical data analysis (linear mixed effects model for repeated measurements) was compared with a selection model, which consists, in this case, of a joint modelling of the score and of the drop-out probability in order to reduce bias induced by drop-outs. RESULTS At 18 months, 38% of the patients were available for evaluation. Drop-outs were associated with low drug use and were informative. Each model showed that the score decreased over time and that it was associated with psychiatric problems. Unlike the classical method, the joint model showed no significant association between the score and age or treatment setting. CONCLUSIONS These results show the importance of accounting for informative drop-outs in data analysis before drawing conclusions from such studies.
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Affiliation(s)
- G Encrenaz
- Laboratoire de Psychiatrie and Jeune Equipe 2358, Bordeaux, France.
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Fischer B, Rehm J, Brissette S, Brochu S, Bruneau J, El-Guebaly N, Noël L, Tyndall M, Wild C, Mun P, Baliunas D. Illicit opioid use in Canada: comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study). J Urban Health 2005; 82:250-66. [PMID: 15872194 PMCID: PMC3456573 DOI: 10.1093/jurban/jti049] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Most of the estimated 125,000 injection drug users (IDUs) in Canada use illicit opioids and are outside treatment (i.e., methadone maintenance treatment). Empirical data suggest that illicit opioid users outside treatment are characterized by various health and social problem characteristics, including polydrug use, physical and mental morbidity, social marginalization, and crime. Although required for evidence-based programming, systematic information on this specific substance-user population is sparse in Canada to date. This article presents and compares key characteristics of population of illicit opioid users outside treatment in five cities across Canada (OPICAN cohort). Overall, the majority of OPICAN participants regularly used both a variety of illicit opioids and cocaine or crack, reported physical and mental health (e.g., mood disorder) problems, lacked permanent housing, were involved in crime, and had their "ideal" treatment not available to them. However, key local sample differences were shown, including patterns of heroin versus prescription opioid use and levels of additional cocaine versus crack use as well as indicators of social marginalization. Illicit opioid user population across Canada differ on key social, health, and drug use indicators that are crucial for interventions and are often demonstrated between larger and smaller city sites. Differentiated interventions are required.
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Affiliation(s)
- Benedikt Fischer
- University of Toronto and Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Levin FR, Hennessy G. Bipolar disorder and substance abuse. Biol Psychiatry 2004; 56:738-48. [PMID: 15556118 DOI: 10.1016/j.biopsych.2004.05.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Revised: 04/27/2004] [Accepted: 05/12/2004] [Indexed: 11/18/2022]
Abstract
Substance use disorders are overrepresented in individuals with bipolar and bipolar spectrum disorders. Although awareness of this phenomenon has increased over the past 20 years, few empirically based treatment strategies have been developed for this challenging patient population. This review examines the relationship between bipolar and substance use disorders and treatment options that have been studied in this patient population. First, we examine the high prevalence rates of substance use disorders in individuals diagnosed with bipolar disorder, the common problems associated with establishing a bipolar disorder diagnosis in individuals who abuse substances, the possible explanations for the frequent coexistence of bipolar and substance use disorders, and the negative effect of substance abuse on the course of and treatment outcomes for bipolar disorder. The review then focuses on treatment approaches for this patient population, including integrated group therapy for co-occurring bipolar and substance use disorders and pharmacotherapies that target both disorders. Finally, we present suggestions for medications that might be tested for their efficacy in treating both disorders in specific subgroups of patients with bipolar and substance use disorders.
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Affiliation(s)
- Frances R Levin
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York 10032, USA.
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Abstract
The purpose of this article is to provide a review of the prevalence, assessment, and treatment of common psychiatric disorders found among patients with opioid dependence. Dependence on opioids can include both persons who are physically dependent on opioids and persons who fulfill the criteria for a syndrome of opioid dependence, such as that found in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). The latter grouping of persons typically abuse illicit opioids, and prevalence of comorbid conditions and approaches in diagnosis and treatment have been studied in these patients. High rates of other psychiatric disorders--both other substance-use disorders as well as non-substance-use psychiatric disorders--have been reported. The most common non-substance-use psychiatric disorders are depressive, anxiety, and personality disorders. When evaluating and planning treatment of opioid-dependent patients with concurrent psychiatric symptoms, it is important to determine if such symptoms are independent of the substance use or substance induced. In the former case, treatment should follow routine clinical practice, whereas in the latter case, treatment stability in substance use should be the first therapeutic step. The presence of a pain condition can further complicate assessment and treatment, as either pain itself or treatments used for pain may produce symptoms that overlap with psychiatric disorders.
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Affiliation(s)
- Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
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Hättenschwiler J, Rüesch P, Modestin J. Comparison of four groups of substance-abusing in-patients with different psychiatric comorbidity. Acta Psychiatr Scand 2001; 104:59-65. [PMID: 11437752 DOI: 10.1034/j.1600-0447.2001.00053.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in-patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder. METHOD Apart from sociodemographic, therapy-related variables and a detailed survey of their substance use, all subjects were assessed with BPRS and SCL-90-R. RESULTS No differences were found in the patients' demography, psychosocial adjustment and substance consumption career. Significant differences were found in regard to some therapy variables reflecting adherence to treatment and global outcome and to the level of psychopathology. CONCLUSION Both substance use and comorbid psychiatric disorder have a variable impact on distinct areas of patients' general condition and functioning. The group with comorbid affective disorder appeared to be the most difficult to treat and the therapeutic approach to this disorder deserves reconsideration.
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